The hall of mirrors the American medical system has become is perhaps the most elaborate, contorted, and ultimately fraudulent scheme in the history of man. Continue reading The American Hall of Mirrors
Random thoughts on an overcast Friday morning with a special appearance by Dick Nixon to show in historical context that time has been kind to him Continue reading A Little Bit Of This, A Little Bit Of That
Gonna get a little personal on you today.
Last week my older son Brian had a corneal transplant. Without it he would have gone blind, which would be a rather inconvenient condition to have given that his chosen profession is photography. You can see some of his work by clicking here.
He lives with a condition called keratoconus which you are welcome to click the link and find out more about, but basically means his corneas never formed properly. It occurs in around one out of every 2,000 people and is the leading cause of corneal transplant.
This was the third attempt to have the transplant, the first two aborted because of, first, a problem with anesthesia and second a problem with the viability of the cornea to be transplanted. With transplants the phrase “good enough” is never good enough. If it’s the least bit hinky the surgeon says no go.
As well she should.
Fortunately the third time was the charm. As he is a single gentleman his mother (Cruella) and I took care of him for the first few days of his recovery. That consisted mostly of keeping lights in the house low or off, making sure he took his anti-rejection medication and providing as much TLC as he would allow us to give. Once assured he was capable of going it on his own we returned him to his own house where he continues to recover.
From this experience I find myself up on the soapbox preaching the good word of organ donation and why you, yes you, should be taking the easy steps to participate in the process.
To see how, click the link below
.A warning before we start. This is going to be a sports essay. If you are not into sports, hang on till the end, I promise I’ll bring this around to current affairs.
You may have heard the gnashing of teeth and grinding of axes over the non-induction of Barry Bonds and Roger Clemens to the baseball Hall of Fame. This was their tenth year of eligibility and I don’t have the time or desire to explain the ins and outs of HOF voting but suffice it to say the two most dominant players of their era were told by the voters “so sad, too bad, you juice you lose”.
The Baseball Writers Association of America (BBWAA) are the folks who vote for or against induction into the Hall. Enough of them have taken the stand that anyone who used performance enhancing drugs is a cheater and should thus be banned from induction. So far major names from the steroid era, Bonds, Clemens, Sosa, McGwire, A-Rod, et al have failed to win election and either have or will soon fall from the ballot without induction.
Except for the guys they really liked and who, in the voters minds, might have used PEDs, might not, we’re not sure so we’re gonna just take a pass and pass them into the Hall or in other words, give them a hall pass. Like the one player who did get elected this year, David Ortiz. He was only tangentially mentioned in the Mitchell Report, MLB’s investigation into PED use that was released in 2007.
There are two things I think that are important to remember about the Steroid Era ™. The first is that it indeed was an era. It lasted from the late 1980’s or thereabouts until 2003 or thereabouts. In 1991 Major League Baseball banned the use of any PEDs, but they had no testing for it until 2003. Think about that for a moment. For twelve years players could use PEDs pretty much without fear of retribution because without testing there was no way to prove players were using. It was during that period that the record for most home runs in a season was broken twice and the Mark McGwire vs. Sammy Sosa “Long Gone Summer” took place.
While I think it’s absurd to think every major leaguer was using, I don’t think it’s absurd to think most major leaguers were using. In fact I think there were so many who were using that the level playing field moralists are always arguing steroids upended was actually level. If enough players were using then they were all back on even ground. Should they have been using? It’s easy now to say they shouldn’t have, but back in an age when there was no mechanism to see who was and who wasn’t, the pressure to use must have been acute. I’m not talking about pressure from teammates alone. I think the pressure to use came in subtle forms from managers, coaches, and even owners.
“Gee, we’re really looking for a shortstop who can give us 25-30 dingers a year and you’re only popping 10-15. What do you think you can do to get those numbers up? If you can’t, we’re gonna have to look elsewhere and we don’t want to do that since we’re gonna offer you a new multi-year, multi-million dollar contract”.
Money talks, the “pure” ballplayer walks on four pitches to first, down the foul line, and out the bullpen gate.
Bottom of the ninth, two outs, bases loaded, click below for more
So a couple of weeks ago the wife (Cruella) went to the doctor for her annual “well woman checkup”. If you are a woman you know what that means. If you are a man, ask a woman, and it would be best to ask a woman who understands your tolerance for the realities of the female anatomy, to explain it to you.
Cruella checked out just fine as she knew she would. She went out and had lunch with her friends, then tootled on home and thought nothing more of it. The next week an envelope arrived from Palo Alto Medical Foundation, the medical corporation that her doctor works for. In it was a bill for the “well woman checkup” to the tune of $493. Well that’s a surprise since our Blue Cross insurance should have covered the entire amount charged for the check up.
Here’s an important thing to know about my wife. Years ago she had a thought to get into a new line of work and decided medical billing would be an interesting application of her skills. Thus she took courses and bought text books on how to “code” as they say in the biz. Code refers to the various permutations of numbers and letters that are used to define the procedure a patient comes in for (in this case a well woman checkup) and the diagnosis the doctor comes up with (she’s fine, come back in a year). Those codes are the basis on which the doctor or the corporation he works for charge your insurance company and you. Suffice it to say that even though she never actually entered that field, the information never left her head. And the textbooks became fixtures in our bookcase.
It turns out that we got this bill because instead of the visit being coded as a well woman checkup, it was coded as a well woman checkup WITH a diagnosis that something was wrong. Z01.411 versus Z01.419. I am not making these code numbers up. Getting on the phone she called the doctor’s office and was told, no we in the office coded it properly, you’ll need to call the corporate billing department to see if they changed anything.
Ah yes, welcome to the third circle of hell. When you go to the doctor at Palo Alto Med, which by the way is actually owned by a larger corporation called Sutter Health, the doctor’s office is responsible to code the reason for and result of the visit. That information is sent on to the actual Sutter Health billing department, ostensibly to double check it was billed properly, before it is sent on to your health insurance company so they can pay the bill. In order to make sure the code is correct, or perhaps to justify their code, the doctor also sends on their notes from the visit.
Oh you thought your medical records were private. How quaint.
So now Millie in billing gets to read all the doctor’s notes on your visit and can decide, nope, we gotta change this code or add in another code here because in the notes there is a mention of maybe possibly kinda sorta if I squint real hard there might be a potential problem. Thus Z01.411 becomes Z01.419. Then she ships it all off to Blue Cross happy in the knowledge she has served her corporate masters well. She kicks back, puts her feet up on the desk, takes a long sip from her martini glass and pulls out a Kool Menthol to celebrate her achievement. That’s assuming she redid the coding in an honest attempt to be as correct as possible.
Thing is, Sutter Health is actually kinda known for not being the most reputable when it comes to doing honest coding. To the tune of a $90 million dollar fine by the federal government.
Does that have you intrigued? Click the link below to continue on