Texas Medicine Letters: June 2010

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Letters - June 2010

Tex Med . 2010;106(6):7-8.

Haiti Photos Are Moving

I am deeply honored to be featured in your Portrait section. (See April 2010 Texas Medicine , page 72.)

Matt's (Austin photographer Matt Rainwaters) pictures are extremely moving, especially the one of Dr. Villarreal warming the dying baby with his body. (See "Helping Haiti, " pages 21-49.) Matt needs to be commended on his excellent professional work.

I was especially pleased with all the other groups and individuals from Texas who went. It shows what Texans are made of.

Also, thank you to the Texas Medicine  staff for producing a world-class publication!  

Miguel A. Cintron, MD , Harlingen

Credit Dr. Padilla

I just went through the "Helping Haiti" article in this month's magazine.

Having been a part of the Hope International mission to Fort Liberté, I was reminded of the time I spent serving those in need. Thanks for the memories. Kudos to Matt Rainwaters for his professionalism and great pictures. They truly tell the story much better than any words could.
The one person who is solely responsible for this mission is Juan Padilla, MD. Dr. Padilla truly went above and beyond what most of us did. He visited the island twice, each time for more than 10 days. He took time to personally collect donations from people on the streets of Brownsville. How do I know? I was standing next to him when this happened. 

Once again, great article. Thanks on behalf of all the doctors, nurses, and laypersons who participated in this.

Jose A. Bossolo, MD,  Brownsville

Don't Be Stupid

With reference to your article on accountable care organizations ("ACOs," February 2010 Texas Medicine , pages 20-25), insurance companies have long tried to shift risk to doctors, using various schemes and disguises. ACOs are another example of this deception.

Doctors who sign up for these programs are just stupid. It is that simple.

It is time to call a spade a spade and refuse to participate. Doctors at Baylor need to refuse and join another hospital, preferably a hospital run by the doctors themselves.

Zech Dameron III, MD,  Coppell

Don't Fall for ACOs

I write in response to the article "ACO's: Just Another New Dress on an Old Pig?" in the February 2010 issue.

The first sentence says it all: "Insurers and employers have tried HMOs, capitation, pay for performance, and bundled payments ..." Why have these entities been at the helm with such ideas? Not out of an overwhelming concern for the patient, but rather as an attempt to increase their own profit margins while shifting financial risk on the physician. Then politicians swoop in under the influence of these same interest groups with talk of "controlling cost and improving quality." The glaring contradiction is that it is not necessary to incentivize physicians to control costs and improve quality, as physicians are not the source of the cost and quality issues.

The same political entities that call for reform and put forward so-called "solutions" are the cause of their own problem. Patients do not decry the cost of a physician visit; they decry the cost of their insurance premiums. Patients do not fret over quality once they have access to a physician; they fret over quality when they are denied access because a third party is trying to bolster its profits at the patient's expense.

And isn't the mantra of "coordinating care" an organized way to proceed? Whenever you allow an outsider to come in to "coordinate," you will be left holding the proverbial short end of the stick, and your coordinator will have acquired the high ground.

The article ends with the ubiquitous cry that physicians must submit to changes to avoid being "faced with the prospect of a single-payer system." Our old friend, "the sky is falling" argument. It is amazing that shifting financial responsibility to physicians is portrayed as the solution, with no mention of reigning in profits of the insurance companies, pharmaceutical industry, and mega law firms.

Doctors must look past this masquerade to avoid falling victim. Physicians don't need to be organized by an outside force. Physicians don't need to bear the brunt of health care reform's costs. Washington and Brookings Institution: Look elsewhere if you want to see where cost control efforts should be centered. Physicians: Don't allow yourselves to become the next employee of corporate America.

R. Paul Gray,  medical student, Texas A&M College of Medicine

Don't Focus Fraud Probe on Physicians

I am an internist in a small town. Dr. Thomas Clark's letter in the February issue of Texas Medicine told about the frightening introduction of the "RACs" (recovery audit contractors). (See "Educate, Don't Punish," February 2010 Texas Medicine, page 8.)

This is another attempt by our government to save some money on its share of the bill for our nation's health care. However, not enough is being done to save money by investigating and prosecuting fraud by home health agencies that go into our patient's homes and start "therapy" without proper supervision by the patient's physician.

At least four of my elderly patients have told me that a "nurse" from a home health agency from a nearby large city came to their homes uninvited and "visited" them to start therapy. When I received the fax to approve therapy, I refused. In several cases, they told me that they had obtained prescriptions for the "therapy" from a physician who had never seen the patient. When I called the agency to try to get them to stop, the nurse accused me of not taking proper care of my patient. It was unlikely that their physical therapist was going to help anything.

I reported two of the cases to local law enforcement. Their plan was to report this to some higher authority. After about a year, the agency is still doing fraud.

Possibly, more funds could be saved by putting these agencies out of business than inflicting the RACs on physicians and hospitals. 

TMA should advocate stronger enforcement for this type of fraud.

Bobby W. Marek, MD , Brenham

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