Government Targeting Doctors At Your Expense

 

As a surgeon, I often tell patients facing surgery to get a second opinion. Although I may be confident in my opinion, if I sense reluctance in the patient I will suggest they discuss their situation with another surgeon.

This process usually happens before surgery or other medical procedures. But now the government is using second opinions after treatment to accuse the doctor of fraud.

Kyle Clark and Andrew George are lawyers who are members of the Mid-Atlantic Innocence Project. Writing in The Wall Street Journal, they share the lurid details of government oversight gone astray.

Dr. Richard Paulus, a renowned cardiologist in eastern Kentucky, has been inserting stents into blocked coronary arteries to save lives for the last 21 years. Due to his stellar reputation, his volume of patients brought his name to the attention of government prosecutors looking for ways to prevent fraud. The large number of bills submitted by Dr. Paulus was the only reason he was investigated.

These federal prosecutors hired a pair of other doctors to review the past cases of Dr. Paulus to determine if they warranted insertion of stents. In some of these cases the doctors working for the government disagreed with Dr. Paulus as to the severity of arterial blockage. Paulus had estimated 60% blockage in some cases, while the other doctors’ estimation was 30% or less. The government then declared Dr. Paulus guilty of unnecessary procedures as part of a scheme to defraud Medicare, Medicaid or private insurance companies.

The basis for this conclusion was two previous federal appellate court rulings that cardiologists can’t reasonably disagree by more than 10% to 20% about arterial blockage. This is a legal standard, not a medical one. Doctors can certainly disagree widely about the degree of blockage.

Clark and George have found 93 examples in scientific journals in which two cardiologists disagreed on the severity of a blockage by more than 40%. Sometimes they even disagreed by 100%, meaning one thought the artery was wide open while the other thought it was entirely blocked!

The judge who presided over Dr. Paulus’ trial understood this better than the jury. Judge David L. Bunning overruled the jury when they brought a guilty verdict and granted an acquittal.

The federal prosecutors in the Paulus trial refused to accept Judge Bunning’s acquittal. They appealed to the Sixth U.S. Circuit Court of Appeals. The Appeals Court overturned Judge Bunning’s acquittal without disputing the 93 examples given by Clark and George to refute their opinion. Sentencing is scheduled for March, 2019.

This disturbing example of government oversight gone astray has frightening implications. When doctors can lose their freedom over a simple difference of opinion, we are all at risk for compromised healthcare. The next time a cardiologist considers inserting a life-sustaining stent in your artery, he or she may remember this case and pass on the chance. If you die from a heart attack soon thereafter, who will your family sue, the government or your doctor? The government is obviously more concerned about saving money than about saving your life.

 

Obesity – A Threat to National Security?

 

Is obesity a threat to our national security? That may seem farfetched but a closer look should give us all pause.

Dr. Bill Frist, a heart and lung transplant surgeon and the former U.S. Senate Majority Leader, says we have a serious problem. A recently published report called Unhealthy and Unprepared, was released by a group of 750 retired generals and admirals that call themselves Mission: Readiness. The report says 71% of young Americans are ineligible to serve in the military because of obesity.

Frist says this alarming finding, coupled with declining interest in military service, is making it difficult for our military to find suitable recruits to protect our country and our interests abroad. The Army reports it was unable to meet recruiting goals for this year as of September.

The implications of these findings threaten our national security and the future of our healthcare system. If not addressed soon, generations of children will grow up to have serious and potentially life-threatening health issues. This will have a profound effect upon our military and the cost of healthcare for these individuals.

Young people with obesity are more likely to experience diabetes, heart disease, fatty liver disease, and serious bone and joint issues in later life. Overweight adolescents have a 70% chance of being obese as adults.

Frist says there is a solution to this problem. Research shows that high-quality early childhood education and care programs can help teach children the importance of physical activity and nutrition. Programs that require children to be active at school and provide them with healthy meals can provide a foundation for health and well-being later in life.

The State of Tennessee has taken a step to do something about the problem. They passed the Tom Cronan Physical Education Act, which will require elementary schools to provide at least 60 minutes of physical education per week. Frist joined with organizations like the American Heart Association (AHA) and NashvilleHealth to support this legislation.

Personally, this sounds a bit like re-inventing the wheel. I can remember as a child during the Kennedy administration we were all required to do similar physical education for the same purpose. Last I checked our human bodies still need the same level of physical activity to maintain proper health and fitness. Makes you wonder why these national guidelines were forgotten. Frankly, only 60 minutes in a week seems insufficient.

The AHA fitness guidelines for adults are at least 150 minutes per week of moderate intensity aerobic exercise or 75 minutes of vigorous aerobic activity or a combination of both, preferably spread throughout the week.

The value of regular exercise can’t be over-emphasized. Good exercise habits must be developed in children – and maintained as adults. A recent period of low back pain reminded me of the importance of exercise even to aging bodies, as well. We never outgrow the need for exercise if we want to remain healthy and fit. It’s the right thing to do at any age.

Golf and Your Doctor

Golf is often associated with doctors. The doctor’s day off to play golf is a well-worn cliché about the profession. How much does this cliché reflect reality?

Someone has actually taken the time and expense to study this question! Although I was intrigued with reading the study, it may be the most useless expenditure of time on research I’ve ever read.

I confess that I’m a physician who loves to play golf. I even chose to move from my home state of Pennsylvania to Florida in part because it would afford me the opportunity to play golf year round. But I never thought I’d read a research study devoted to analyzing the golf habits and talents of physicians.

The study was recently published in The BMJ under the title: Golf Habits Among Physicians and Surgeons: Observational Cohort Study. The stated objectives of the study were: To examine golfing patterns among physicians, the proportion who regularly play golf, differences in golf practices across specialties, the specialties with the best golfers, and differences in golf practices among male and female physicians.

The study comprised 41,692 physicians who actively logged golf scores in the U.S.G.A. amateur golfer database. This is 4.1% of the total of 1,029,088 physicians in the U.S. Men comprised 89.5% of physician golfers and among all male physicians, 5.5% play golf. Only 1.3% of female physicians play golf.

The highest proportion of physician golfers were in orthopedic surgery (8.8%), urology (8.1%) and plastic surgery (7.5%). The lowest proportion of physician golfers were in internal medicine and infectious disease (<3.0%).

The best golfers were in thoracic surgery, vascular surgery, and orthopedic surgery. These physicians scored about 15% better than specialists in endocrinology, dermatology and oncology.

How often does your doctor actually play golf?

These results were surprising. The idea that most physicians have a regular day set aside to play golf was mostly shattered by this study. Male golfers played an average of 14.8 games in the first six months of 2018 and female golfers played an average of 12.8 games. This works out to about one game of golf every 12.5 days or about once every two weeks.

How do physicians compare as golfers to non-physician golfers?

Overall, physicians were at best average golfers. The mean handicap among physicians was 15.0, which is slightly worse than the performance of non-physician golfers according to the U.S.G.A.

What have we learned through this study that impacts patient care?

Nothing. The study researchers state, “The association between golfing and patient outcomes, costs of care, and physician well-being are unknown.” Nevertheless, they are undaunted in their pursuit of future related research. They conclude:

“The findings of this study suggest several areas where research is needed and where federal research support—perhaps through a dedicated agency of the National Institutes of Health—might be warranted. Is patient mortality associated with the amount of time a patient’s physician plays golf (either negatively, because physicians release stress on the golf course, or positively owing to decreased availability and time spent away from developing clinical skill)? Do costs of care increase and patient outcomes worsen in the days after a physician has had a bad round of golf?

I’m sure you’ll be anxious to hear the results of such future research, especially if it is funded with your federal tax dollars. 🙂