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ObamaCare: The Terrifying Consequences To Healthcare
Canada Free Press
Tom Deweese
2/18/2014
Excerpt:
As the ObamaCare debate rages, we hear much about insurance companies, costs and people’s ability to pay. We hear the policy defended as proponents tell us it will provide healthcare to those who never had it. Of course, these proponents never seem to explain how those who couldn’t afford healthcare when it was a choice can now afford an even more expensive cost now that government mandates it.
However, these debates about the pros and cons of ObamaCare basically focus on money. What about the real issue – healthcare? What will ObamaCare do to our medical system? How will it affect the quality of our care? How will it affect doctor’s decisions as they attempt to take care of our health needs? And, ultimately, in a system controlled by government bureaucrats and government-written manuals – who will really be making the decisions that determine our quality of life? These are the real questions that need to be the center of the debate. And the answers are terrifying.
I recently received a report from an Oncologist, Dr John Conroy, who is fighting the desperate battle to treat cancer. All of those concerned Americans who wear their pink ribbons and dash for miles in their stop-cancer marathons should take a long hard look at what Dr. Conroy reports to be the future of all American medicine. They may want to start running straight at Congress to save their own lives.
Obviously, Oncology is a very detailed science, difficult for the layman to understand. That’s why American healthcare has always promoted specialists. Let’s begin with a patient who has discovered a lump on her breast. She takes a mammogram, undergoes a biopsy and is found to have adenocarcinoma. She is seen by an Oncologist and certain questions need to be addressed.
As Dr. Conroy explains the process, first, doctors must determine the “Stage” or extent of the disease. The most common system for determining classification of malignant tumors and the extent of a person’s cancer is called the TNM system. “T” measures the size of the tumor and if it’s invaded nearby tissue. “N” determines regional lymph nodes that are involved. “M” measures the distance the cancer has spread from one part of the body to another. These measurements are critical in determining how sick the patient may be.
In fact, there are four stages, classified under the TNM system, with multiple possible results determined by a large variable of TNM data. With an adenocarcinoma cell type under the microscope, there are about 40 pathological (histology) types which could lead to as many as 36,000 possible variable combinations of the cancer. The grade or aggressiveness of the cancer is 10 grades. So, 10?36,000 = 360,000 possibilities. Next, hormone sensitive status = 8 possibilities. So, 360,000 x 8 = 2,880,000 and menopausal status = 5,760,000 possible computer input combinations. These are the possible combinations on just one page of data in staging. So the computer system has to evaluate these combinations.
Whew! That’s a lot of data to determine how sick a patient may be, with what kind of cancer, at what stage. It’s all necessary data to determine the most effective course for treatment. Again, that’s why we have specialists who focus entirely on certain diseases and other maladies that affect our bodies. No one individual could possibly be knowledgeable in all aspects of the human body.
But now, with the growing control by government over health care decisions, things are changing. Over the past several years, a growing number of bureaucrats from insurance companies have been armed with manuals, guidebooks and calculators to step in to the decision making process to decide what treatment procedures are allowed. And it’s going to get far worse under ObamaCare, as a new layer of government bureaucrats is added to affect what doctors can do to save your life.
As Dr. Conroy explains, to look into the body and make a determination on where to start planning treatment, he uses x-rays and cat- scans (c-ts). “I generally cat-scan head to toe and look for metastasis and get a baseline.” However, such decisions for care by the doctors are now being decided by others. Says Dr. Conroy, “In the past, it was ok (to X-Ray and CT), not now. Over the last few years all the X-rays have to be approved, so there are companies now that have algorithms to evaluate your request (for a cat-scan or X- ray).” He explains that these companies, which work in partnership with hospitals and insurance companies, “process thousands of requests a day. “ They decide who gets to use the machines for what purposes. “So,” he explains, “if there’s no headache, then there is no cat-scan of the brain. If a normal chest x- ray is taken, then no cat-scan of the chest.”
Here’s where these rules and regulations start to really get scary. If he, as the doctor, wants to challenge the decision by the company as to whether he can get both a cat-scan and X-Ray, he will call them to do so. “I have to discuss this with the ‘medical director’ who will say yes — if I use certain ‘key’ words” Or the medical director will say “no,” the procedure does not fit the guidelines. Without having the medical background of the doctor or all of the data he has been trained to read, the company medical director can make the call – all based on a manual written to one size fits all!
Meanwhile, the doctor is responsible for the health of his patient, tasked with the job of making the right decision as he is forced to move forward blindly. He’s unable to get the complete information he needs to make an educated evaluation, because a bureaucrat rejected his request for the proper testing. Yet, if the doctor makes the wrong decision and the patient suffers or dies, he is liable for legal action by the patient’s family. He has no legal protection if he missed a lesion in the brain. Says Dr. Conroy, “I am liable, let alone the damage to patient.”
How “Red Tape” Strangles Treatment
The most important detail to expose here is that, while the doctor has had years of training and experience in the field – the medical director does not have to be qualified.
He’s an employee! Dr. Conroy provided a resulting horror story that is certain to be repeated over and over again once ObamaCare gets control of the medical system. He reported, “I had a young patient with Hodgkin’s disease and I needed a follow-up cat-scan of the chest. It was refused (by the company medical director). I challenged the decision (I challenge all of them) and called the company. The medical director was a retired General Practitioner, playing golf in Florida.” Says Dr. Conroy, “the review companies intentionally have out of state physicians as medical directors so they do not have a state license that can be challenged.”
Then there is the massive mountain of paperwork required for each patient and each procedure. The official guideline for treatment paths for patients with malignancy is called “Pathways,” found at www.nccn.com. There are over 30 medical issue paths to choose. A doctor needs to match a pathway with his data, as described above. As mentioned, that can be a huge number of possible combinations. The insurance companies are already restricting treatment options by forcing doctors to accept their approval for therapy, or they won’t pay for it.
Now, follow the bureaucratic ball created by this mass of rules. Explains Dr. Conroy, “We are still on the first visit by the patient, (or second visit if something was challenged). It now takes 45-60 minutes to register a new patient. I get an hour for the history, exam discussion of treatment plan and then we have to load everything into the computer and fill out the required forms. With each patient visit we review all the data for accuracy, and again report it.”
All this for one patient on the first visit. And with each visit it all has to be continually rechecked and reported. If the doctor makes an error on a Medicare bill submission, the fine is $5,000 PER LINE. A typical chemotherapy visit may have 20 or more lines of code per visit. Says Dr. Conroy, “one year we used 250 cc bags of IV fluids for chemotherapy. It was more than enough fluid for treatment, but Medicare retroactively decided not to pay for 250 cc bags so, we had to repay Medicare Reimbursement for all the 250cc bags for an entire YEAR! We then changed to 1000 cc bag, Charged more, threw out most of it but got paid.”
So, now the patient has had surgery, some radiation treatment, and chemotherapy and the cancer is in remission. All of those procedures would have had to go through the bureaucratic review process.
Are there “Death Panels” in ObamaCare?
Let’s say, after treatment, unfortunately, the patient goes into relapse- the cancer returns. In the past, the doctor would start again, repeat treatment and keep the patient alive over multiple cycles of chemotherapy. But things are changing.
Reports Dr. Conroy, “enter the ‘death panels.’ I actually read the ACA law. They are not death panels per say, but panels appointed by the President, NOT reporting to Congress, that establish the funding and treatment for patients.” Those on the appointed panels are not physicians .
........................................
View the complete article at:
http://canadafreepress.com/index.php/article/61259
Canada Free Press
Tom Deweese
2/18/2014
Excerpt:
As the ObamaCare debate rages, we hear much about insurance companies, costs and people’s ability to pay. We hear the policy defended as proponents tell us it will provide healthcare to those who never had it. Of course, these proponents never seem to explain how those who couldn’t afford healthcare when it was a choice can now afford an even more expensive cost now that government mandates it.
However, these debates about the pros and cons of ObamaCare basically focus on money. What about the real issue – healthcare? What will ObamaCare do to our medical system? How will it affect the quality of our care? How will it affect doctor’s decisions as they attempt to take care of our health needs? And, ultimately, in a system controlled by government bureaucrats and government-written manuals – who will really be making the decisions that determine our quality of life? These are the real questions that need to be the center of the debate. And the answers are terrifying.
I recently received a report from an Oncologist, Dr John Conroy, who is fighting the desperate battle to treat cancer. All of those concerned Americans who wear their pink ribbons and dash for miles in their stop-cancer marathons should take a long hard look at what Dr. Conroy reports to be the future of all American medicine. They may want to start running straight at Congress to save their own lives.
Obviously, Oncology is a very detailed science, difficult for the layman to understand. That’s why American healthcare has always promoted specialists. Let’s begin with a patient who has discovered a lump on her breast. She takes a mammogram, undergoes a biopsy and is found to have adenocarcinoma. She is seen by an Oncologist and certain questions need to be addressed.
As Dr. Conroy explains the process, first, doctors must determine the “Stage” or extent of the disease. The most common system for determining classification of malignant tumors and the extent of a person’s cancer is called the TNM system. “T” measures the size of the tumor and if it’s invaded nearby tissue. “N” determines regional lymph nodes that are involved. “M” measures the distance the cancer has spread from one part of the body to another. These measurements are critical in determining how sick the patient may be.
In fact, there are four stages, classified under the TNM system, with multiple possible results determined by a large variable of TNM data. With an adenocarcinoma cell type under the microscope, there are about 40 pathological (histology) types which could lead to as many as 36,000 possible variable combinations of the cancer. The grade or aggressiveness of the cancer is 10 grades. So, 10?36,000 = 360,000 possibilities. Next, hormone sensitive status = 8 possibilities. So, 360,000 x 8 = 2,880,000 and menopausal status = 5,760,000 possible computer input combinations. These are the possible combinations on just one page of data in staging. So the computer system has to evaluate these combinations.
Whew! That’s a lot of data to determine how sick a patient may be, with what kind of cancer, at what stage. It’s all necessary data to determine the most effective course for treatment. Again, that’s why we have specialists who focus entirely on certain diseases and other maladies that affect our bodies. No one individual could possibly be knowledgeable in all aspects of the human body.
But now, with the growing control by government over health care decisions, things are changing. Over the past several years, a growing number of bureaucrats from insurance companies have been armed with manuals, guidebooks and calculators to step in to the decision making process to decide what treatment procedures are allowed. And it’s going to get far worse under ObamaCare, as a new layer of government bureaucrats is added to affect what doctors can do to save your life.
As Dr. Conroy explains, to look into the body and make a determination on where to start planning treatment, he uses x-rays and cat- scans (c-ts). “I generally cat-scan head to toe and look for metastasis and get a baseline.” However, such decisions for care by the doctors are now being decided by others. Says Dr. Conroy, “In the past, it was ok (to X-Ray and CT), not now. Over the last few years all the X-rays have to be approved, so there are companies now that have algorithms to evaluate your request (for a cat-scan or X- ray).” He explains that these companies, which work in partnership with hospitals and insurance companies, “process thousands of requests a day. “ They decide who gets to use the machines for what purposes. “So,” he explains, “if there’s no headache, then there is no cat-scan of the brain. If a normal chest x- ray is taken, then no cat-scan of the chest.”
Here’s where these rules and regulations start to really get scary. If he, as the doctor, wants to challenge the decision by the company as to whether he can get both a cat-scan and X-Ray, he will call them to do so. “I have to discuss this with the ‘medical director’ who will say yes — if I use certain ‘key’ words” Or the medical director will say “no,” the procedure does not fit the guidelines. Without having the medical background of the doctor or all of the data he has been trained to read, the company medical director can make the call – all based on a manual written to one size fits all!
Meanwhile, the doctor is responsible for the health of his patient, tasked with the job of making the right decision as he is forced to move forward blindly. He’s unable to get the complete information he needs to make an educated evaluation, because a bureaucrat rejected his request for the proper testing. Yet, if the doctor makes the wrong decision and the patient suffers or dies, he is liable for legal action by the patient’s family. He has no legal protection if he missed a lesion in the brain. Says Dr. Conroy, “I am liable, let alone the damage to patient.”
How “Red Tape” Strangles Treatment
The most important detail to expose here is that, while the doctor has had years of training and experience in the field – the medical director does not have to be qualified.
He’s an employee! Dr. Conroy provided a resulting horror story that is certain to be repeated over and over again once ObamaCare gets control of the medical system. He reported, “I had a young patient with Hodgkin’s disease and I needed a follow-up cat-scan of the chest. It was refused (by the company medical director). I challenged the decision (I challenge all of them) and called the company. The medical director was a retired General Practitioner, playing golf in Florida.” Says Dr. Conroy, “the review companies intentionally have out of state physicians as medical directors so they do not have a state license that can be challenged.”
Then there is the massive mountain of paperwork required for each patient and each procedure. The official guideline for treatment paths for patients with malignancy is called “Pathways,” found at www.nccn.com. There are over 30 medical issue paths to choose. A doctor needs to match a pathway with his data, as described above. As mentioned, that can be a huge number of possible combinations. The insurance companies are already restricting treatment options by forcing doctors to accept their approval for therapy, or they won’t pay for it.
Now, follow the bureaucratic ball created by this mass of rules. Explains Dr. Conroy, “We are still on the first visit by the patient, (or second visit if something was challenged). It now takes 45-60 minutes to register a new patient. I get an hour for the history, exam discussion of treatment plan and then we have to load everything into the computer and fill out the required forms. With each patient visit we review all the data for accuracy, and again report it.”
All this for one patient on the first visit. And with each visit it all has to be continually rechecked and reported. If the doctor makes an error on a Medicare bill submission, the fine is $5,000 PER LINE. A typical chemotherapy visit may have 20 or more lines of code per visit. Says Dr. Conroy, “one year we used 250 cc bags of IV fluids for chemotherapy. It was more than enough fluid for treatment, but Medicare retroactively decided not to pay for 250 cc bags so, we had to repay Medicare Reimbursement for all the 250cc bags for an entire YEAR! We then changed to 1000 cc bag, Charged more, threw out most of it but got paid.”
So, now the patient has had surgery, some radiation treatment, and chemotherapy and the cancer is in remission. All of those procedures would have had to go through the bureaucratic review process.
Are there “Death Panels” in ObamaCare?
Let’s say, after treatment, unfortunately, the patient goes into relapse- the cancer returns. In the past, the doctor would start again, repeat treatment and keep the patient alive over multiple cycles of chemotherapy. But things are changing.
Reports Dr. Conroy, “enter the ‘death panels.’ I actually read the ACA law. They are not death panels per say, but panels appointed by the President, NOT reporting to Congress, that establish the funding and treatment for patients.” Those on the appointed panels are not physicians .
........................................
View the complete article at:
http://canadafreepress.com/index.php/article/61259