Thursday, January 29, 2009

Economics, job losses

Last week, I had the pleasure of watching the inauguration of our 44th president. I felt optimistic about our future, even though President Obama's speech was not full of the optimism he expressed during the campaign, rather full of realism. I know the economic disaster we have on our hands, as well as the diplomatic one, the wars we are fighting and some might say losing. Yet, I am basically a glass half-full kind of a person!

However, I am really starting to see the effects our economy. On the news this morning, there was more disturbing news about record job losses, record company closures, etc. In my community, there always seems to be a recession with few good-paying jobs, expensive gas and groceries, and a lot of elderly people with limited incomes. But now, we are seeing an influx of people from elsewhere in the country who have lost their jobs. They move here because housing is still inexpensive, and the weather is nice. I guess if you're going to be unemployed, at least it's nice to sit in the sunshine. But really, it's shocking to realize the numbers of people moving from industrial cities like Detroit, Minneapolis, Pittsburgh. The problem is that there are, like I said before, few good jobs.

I was speaking with a drug rep who survived large cuts at his company, only to be given a larger area of NM to cover. He is very grateful that he has a job, even if it means he doesn't see his family. I also now see several fathers in my clinic who are back home, having lost their jobs in the oil fields, suddenly becoming reacquainted with their wives and children, but jobless. I'm also seeing a rise in kids entering the military after high school because college is unaffordable.

It's just very different when you know people directly who are suffering from our economy, rather than only hearing about it on the news. I hope that our new president and congress can come together to create jobs, to improve education, and to improve our health care system. Sadly, I don't think there is a quick fix, even a great big economic stimulus package. I know that I'll just continue to take care of the families in the community; at least I can do that to a degree, whether they have health insurance or not!

Friday, January 16, 2009

Lab fees

As winter is progressing, I am getting busier, as are most pediatricians. It's amazing the difference between June and say, January or February, numbers. I appreciate my slower days in the summer, but I have to say that winter days in the office simply tend to fly by!

However, this winter is going to be a bit different. I've mentioned in a previous blog that our clinic now requires patients to pay for labs at the time they're done if they don't have any health insurance. This is awkward and annoying to me to have to explain that I want a particular test done, and, by the way, that will cost you ten bucks! I have the power to waive the fee if the family cannot pay, and I document exactly why the test is required. Yet, when I do this, there are many phone calls back and forth between our main office and my office to find out exactly why the fee was not paid. I could go on about this, but I've already complained about it in a previous blog.

Today, what brought this back to the forefront of my thoughts was that I had to ask a family to pay for a test, and I also happened to read another blog about lab fees:
I was shocked to see the prices he posted for labs. I had been told by the powers that be that we got a special rate for our labs and that we did not have to charge the administrative fees. So, just to show the stark differences, here is a list of some our fees, without the additional administrative fees: (admin charge is approx $10.)
  1. CBC (complete blood count with differential): $2.70
  2. BMP (basic metabolic panel): $2.70
  3. CMP (comprehensive metabolic panel with BMP): $2.76
  4. PSA (prostate specific antigen, a test for prostate cancer): $7.20
  5. TSH (thyroid stimulating hormone, a test for monitoring thyroid disease): $ 3.60
  6. Lipid panel: $2.58
  7. Urine culture: $6.00
The most expensive test on our basic listing is a hepatitis C RNA PCR for $181.20. Now, you can see an enormous difference in the costs I've listed versus those listed by the Country Doc. Why is there this difference? Admittedly, one needs to add $10 to the fees I've listed, and the rates I've listed have been negotiated for a large group of 8 health centers. In addition, the lab company is willing to accept some loss with uninsured patients, but this cost gets passed on to those with insurance. On a side note, it would be interesting to see what that particular lab charges insured patients for the same labs. But why is there so much difference between the two labs? Again, it brings to mind the problems we have with our health care system. Imagine saving $12 on each CBC that is drawn throughout the US - if 1/3 of the US population of ~305 million received one CBC per year, that would add up to 1.2 billion! I'm sure it's the same with the pharmaceutical companies and saving $12 per script written in the US would also add up.

I'm just hoping, come January 20, that the debate on healthcare will start up with actual results this time. I do know that SCHIP is already being re-addressed and will not be vetoed by the new president, so I have hope.

Monday, January 5, 2009

New Year's Resolutions/Wishes

Happy New Year to everyone!! Now that the holidays are over and school is back in session, my life is returning to it's usual busy wintertime schedule. It's also the time of year when people discuss their resolutions for the new year, and I see a lot more people walking on the track after work! I've often been tempted to ask if they are there to lose weight in the new year, but instead I just see how many days they seems that two weeks is about the maximum. All this aside, it's also a special January this year, as we will be inaugurating a new president in a few short weeks. I hope things will start to change quickly.

In light of the potential for change, I have come up with a list of my top 10 wishes for our health care system which I am hoping will be targeted for change early in this new administration. I know that some of these wishes are not free, and I don't know where the money will necessarily come from, but a wish is just that, a wish! I could also go on with many more wishes, but I think ten is a good start.

1. Renew and increase funding for SCHIP. Perhaps with more Democrats and more progressive Republicans in Congress, this will happen.

2. Increase reimbursement for pediatricians giving vaccines.

3. When considering universal health care, examine what other countries have done and perhaps create a system which combines the best from the different approaches being used world-wide. Having waited this long to do what most other first-world countries have already done, we might as well turn this to our advantage and learn from the mistakes of others.

4. We, as physicians, need to practice medicine responsibly. We need to accept that we are contributing to the skyrocketing costs of medical care in the US, and we need to do something about it.

5. Continue to encourage medical students to go into primary care with increased emphasis on programs that already exist, such as the National Health Service Corps. As costs for higher education continue to escalate and funding for student loans is cut, informing pre-med college students about the availability of scholarship programs may be more effective than in the past.

6. Continue to study pharmaceuticals specifically in the pediatric population.

7. Continue to promote the safety of vaccines. The American Academy of Pediatrics is working diligently on this effort.

8. Strive to continue research efforts with stem cells.

9. Provide adequate reimbursement for obesity counseling, nutrition education.

10. Let's get daily physical education back in schools!!