AAPS: PHOENIX VA.

New Obamacare Endgame: the VA for All May 26, 2014 By Richard Amerling, M.D. author Physicians' Declaration of Independence Scandal at the Phoenix Veterans Administration lifted the curtain of secrecy on the VA’s secret waiting lists. The VA lies while patients die. This is by no means a new phenomenon. The nation’s single-payer system for veterans has long been greatly overloaded. Congress tried to fix it in 1996 by passing a law requiring that any veteran needing care had to be seen within 30 days. The VA is supposed to have a wonderful electronic medical records system, and the EMR is supposed to be the magic formula for efficiency and quality. The VA gamed the electronic system to hide the waiting lists. Readers of the British press will be struck by the similarities between fudging waiting lists at VA hospitals and stacking patients in ambulances outside UK hospitals. Finding it impossible to comply with a National Health Service mandate that all patients admitted to an emergency room be seen within four hours, ho spitals kept patients waiting in ambulances outside the ER! Britain’s NHS and our VA system are both administratively top-heavy, command-and-control bureaucracies. All such systems tend to expand, along with their budgets, as administrators hire more and more people to do what they were supposed to be doing. There is no competition, and virtually no accountability. Every problem is always someone else’s responsibility. Mandates and quotas, rather than incentives, are used to motivate those in the trenches. Physicians working in the VA system, like the NHS, are mostly salaried employees. There are many fine doctors in both systems, but the incentives in place do not reward them for going the extra mile, seeing the additional patient, or doing another procedure if it means going past their shift. Inevitably, these systems create backlogs and lengthening queues for care. Americans need to take a close look at the VA—and not only because of their concern about poor treatment of our wounded warriors. It is the prototype for Obamacare. The intent behind Obamacare is to completely centralize control over health care, and thus turn American health care into one huge Veterans’ Administration. In 2011 I wrote that Obamacare was designed as Medicaid for all. Medicaid expansion is a key component of the law. If Congress wanted to expand coverage to the ten million or so individuals who fall through the cracks of the private/public health system, this could have been accomplished easily by offering them Medicaid or Medicare. These creaky systems could be made to work better simply by eliminating the price controls on physicians and allowing them to balance bill patients for the difference between payment and the cost of providing service. But expanding coverage was not the goal. The stated goal of government central planners, and of many medical elites, is to abolish traditional fee-for-service medicine. They wrongly blame FFS for out of control health care spending. This is absurd on its face. FFS medicine pre-dates the massive health spending inflation that was largely brought on by Medicare and Medicaid, and the domination by third-party payers. The lack of price transparency and the removal of most disincentives to utilization of health services are what led to the incredible over-spending on health care that we’ve seen since the ‘60s. FFS is the only way to insure the prompt delivery of needed care. But what central planners want is for all physicians to be salaried employees of either the government or of large hospital systems. Then planners could centrally control care through “payment-for-performance” algorithms built into electronic records. The promptness and quality of care will suffer. Obamacare is already becoming like the VA. A kidney transplant patient suddenly developed blurred vision. This alarming symptom could signal a brain tumor or other serious diagnosis. I would have arranged for an MRI to be done the same day. Her new Obamacare plan, however, offered a specialist appointment two weeks hence. The shameful backlog in our VA system could be remedied overnight by either giving veterans vouchers for care in the private, FFS system, or by building incentives into the VA payment structure. Ah, but this would require an acknowledgment that their top-down system has failed. Richard Amerling, MD is an Associate Professor of Clinical Medicine and a renowned academic nephrologist at the Beth Israel Medical Center in New York City. Dr. Amerling studied medicine at the Catholic University of Louvain in Belgium, graduating cum laude in 1981. He completed a medical residency at the New York Hospital Queens and a nephrology fellowship at the Hospital of the University of Pennsylvania. He has written and lectured extensively on health care issues and is President-elect of the Association of American Physicians and Surgeons. Dr. Amerling is the author of the Physicians' Declaration of Independence.

HAMBURG-EPPENDORF University Hospital PRIVATE STEM CELL TRANSPLANT for Plasma Cell Ca.

GERMANY: HAMBURG-EPPENDORF Univ Hosp STEM CELL TRANSPLANT 1460 bed Univ.Hosp HAMBURG-EPPENDORF: Auto.Stem Cell Transplant approx. Euro 50,000.

WELCH ALLYN PANOPTIC ophthalmoscope Toronto WOMENS' COLLEGE HOSPITAL

Welch Allyn $600 PANOPTIC ophthalmoscope now provided in all exam units of Toronto WOMENS'COLLEGE HOSP. About 10y ago CPSO discipline committee, after Peer review by Kitchener Mall Ophthalmologist, did not know of its existence and had to be shown pictures. Shows danger to Ontario doctors' career if they use advanced techniques unknown to CPSO less than up-to-date committee members; filling gaps in their clinical practice with paid visits to Toronto from distant regions of the Province.

OMA retirement homes; part of End-of-Life planning

Last OMA Pres, a Hamilton-area GP wanted to focus on End-of-Life. The OMA Board has ignored for at least ten years the suggestion that the OMA has its own Retirement Homes. Similar to the 15,000 member ACTRA (Alliance of Canadian Cinema, Television and Radio artists)Lodge on the Esplanade; regular Friday evening performances are held at the LCBO licensed Green Room. A TV program showed Retirement Homes sponsored by various USA Universities. Various other Unions have retirement homes e.g. United Steelworkers. As a Charitable "Home for the Aged" 80% of the cost would be paid by the Provincial Govt. The first ACTRA PERFORMING ARTS LODGE, formed with the Screenwriters' Guild, opened in 1993 at 110 ESPLANADE, near the NOVOTEL CENTRAL TORONTO. The OMA has over 23,000 members whose income is not less than ACTRA members.

SUNLIFE extends CRITICAL ILLNESS INSURANCE to 75y.

SUNLIFE extends CRITICAL ILLNESS INSURANCE to 75y. $250,000 paid by cheque. Money can used at will by insured.

ORASURE TECHNOLOGIES Inc.Saliva test for HIV 1/2

Not sold in Canada. $40 a test WALGREEN pharmacies 1202 PINE AVE NIAGARA FALLS, NY 14301 716-2850286

HILTON HOTEL,Toronto May 11-12 Canadian Centre for Applied Research in Cancer Control (ARCC)

ARCC ffices BC Cancer Research Centre (BCCBC), Vancouver & Cancer Care Ontario (CCO),Toronto. Key speaker: NY Memorial Sloane-Kettering Cancer centre Director Health Policy Dr. Peter BACH MD, MAPP(MA in Public Policy). Increasing cost of medicine depends on HIGHER UTILIZATION (Q) and HIGHER PRICES(P) 260 attended. No rep from OMA Board or OMA Policy Staff Cancer drugs now authorized by committees at (CADTH) Ottawa-based "Canadian Agency for Drugs and Technologies in Health." In April 2014 took over pCODR "Pan-Canadian oncology drug review." (For those with private insurance or private means treatment at USA hospitals avoids CADTH delays.

UPPER CANADA COLLEGE (UCC) grads who become Medical Doctors.

UCC costs about $50,000/year after tax. There are many scholarships and bursaries for families who can not pay normal fees for bright boys. UCC publishes "OLD TIMES" (56 pp) which lists on 16 large pages what UCC grads are doing. 10 MDs are listed from 1962 to present. About 150 graduate yearly. SIX remained in Canada THREE practice in USA ONE in London,UK TWO GPs, One GP is also a financial planner ONE INTERNIST TWO NEUROLOGISTS ONE OBS/GYNAE ONE ORTHOPAEDIC SURGEON ONE OSTEOPATH (Private practice) ONE CLINICAL RESEARCH ONE UROLOGIST Few OHIP-paid Doctors could afford UCC fees without a family trust,private income or a wealthy wife. Most grads go into financially rewarding accountancy, banking, business, insurance, private equity and law. Medicine in Ontario does not reward creative thinking or experience. OHIP pays the same for a new grad and a MD with many practice years. Also the Left-wing Ont.College of Physicians & Surgeons (CPSO) is a danger to a career.

Ontario Progressive Conservative Medical Group: ANTIBIOTIC OVERPRESCRIBING.

Liberal Government has given Antibiotic prescribing authority to Nurses & Pharmacists. College of Physicians and Surgeons (CPSO) accepts complaints from ANYONE, ANYWHERE IN THE WORLD. Patients demand antibiotics;if refused will threaten a complaint to CPSO. This will lead to high cost to GP in time and money.$3,600 a day charge to doctor for every day of a Discipline Committee TRIBUNAL (not a Court). Some pharmacists offer FREE rent, supplies and staff to GPs. There is pressure to prescribe. Possible solution: In non-rural areas,Antibiotics prescribed only by a Salaried Hospital Physician Infection Specialist. Would also help Infection statistics.

"MM" Plasma cell cancer an "OCCUPATIONAL DISEASE".

Ontario adds multiple myeloma to list of job-related cancers for firefighters The Ontario government is extending health care protection for firefighters - all the way back to 1960. On April 30, Premier Kathleen Wynne announced the province will increase cancer coverage for firefighters by adding six cancers to the list of those presumed to be related to their jobs. "We want to ensure that firefighters can get the support that they need and the care they need," Wynne said at a news conference in a Toronto-area fire station. "Firefighters face incredible risks every day - not only in the blazes they battle, but in the smoke they breathe in and all that is in that smoke." Breast cancer, multiple myeloma and testicular cancer will be added to the list immediately. Prostate cancer, lung cancer and skin cancer will be phased in by 2017. The addition of all six will be retroactive to Jan. 1, 1960. Wynne said the changes will make it easier for firefighters to qualify for benefits under the Workplace Safety and Insurance Act. Cancers already on the list include brain, bladder and kidney cancer, non-Hodgkin's lymphoma and certain types of leukemia. Source: CBC News

USA CDC: MERS-CoV

CDC HEALTH ADVISORY Distributed via the CDC Health Alert Network May 3, 2014, 16:30 ET (4:30 PM ET) CDCHAN-00361 Summary The first case of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection in the United States, identified in a traveler, was reported to CDC by the Indiana State Department of Health (ISDH) on May 1, 2014, and confirmed by CDC on May 2. The patient is in a hospital in Indiana after having flown from Saudi Arabia to Chicago via London. The purpose of this HAN is to alert clinicians, health officials, and others to increase their index of suspicion to consider MERS-CoV infection in travelers from the Arabian Peninsula and neighboring countries. Please disseminate this information to infectious disease specialists, intensive care physicians, primary care physicians, and infection preventionists, as well as to emergency departments and microbiology laboratories. Background The first known cases of MERS-CoV occurred in Jordan in April 2012. The virus is associated with respiratory illness and high death rates, although mild and asymptomatic infections have been reported too. All reported cases to date have been linked to six countries in the Arabian Peninsula: Saudi Arabia, Qatar, Jordan, the United Arab Emirates (UAE), Oman, and Kuwait. Cases in the United Kingdom, France, Italy, Greece, Tunisia, Egypt, and Malaysia have also been reported in persons who traveled from the Arabian Peninsula. In addition, there have been a small number of cases in persons who were in close contact with those infected travelers. Since mid-March 2014, there has been an increase in cases reported from Saudi Arabia and UAE. Public health investigations are ongoing to determine the reason for the increased cases. There is no vaccine yet available and no specific treatment recommended for the virus. In some cases, the virus has spread from infected people to others through close contact. However, there is currently no evidence of sustained spread of MERS-CoV in community settings. Additional information is available at (http://www.cdc.gov/coronavirus/mers/index.html). Recommendations Healthcare providers should be alert for and evaluate patients for MERS-CoV infection who 1) develop severe acute lower respiratory illness within 14 days after traveling from countries in or near the Arabian Peninsula, excluding those who only transited at airports in the region; or 2) are close contacts of a symptomatic recent traveler from this area who has fever and acute respiratory illness; or 3) are close contacts of a confirmed case. For these patients, testing for MERS-CoV and other respiratory pathogens can be done simultaneously. Positive results for another respiratory pathogen (e.g H1N1 Influenza) should not necessarily preclude testing for MERS-CoV because co-infection can occur. Clusters of patients with severe acute respiratory illness (e.g., fever and pneumonia requiring hospitalization) without recognized links to cases of MERS-CoV or to travelers from countries in or near the Arabian peninsula should be evaluated for common respiratory pathogens. If the illnesses remain unexplained, providers should consider testing for MERS-CoV, in consultation with state and local health departments. Healthcare professionals should immediately report to their state or local health department any person being evaluated for MERS-CoV infection as a patient under investigation (PUI). Additional information, including criteria for PUI are at http://www.cdc.gov/coronavirus/mers/interim-guidance.html. Healthcare providers should contact their state or local health department if they have any questions. Persons at highest risk of developing infection are those with close contact to a case, defined as any person who provided care for a patient, including a healthcare provider or family member not adhering to recommended infection control precautions (i.e., not wearing recommended personal protective equipment), or had similarly close physical contact; or any person who stayed at the same place (e.g. lived with, visited) as the patient while the patient was ill. Healthcare professionals should carefully monitor for the appearance of fever (T> 100F) or respiratory symptoms in any person who has had close contact with a confirmed case, probable case, or a PUI while the person was ill. If fever or respiratory symptoms develop within the first 14 days following the contact, the individual should be evaluated for MERS-CoV infection. Ill people who are being evaluated for MERS-CoV infection and do not require hospitalization for medical reasons may be cared for and isolated in their home. (Isolation is defined as the separation or restriction of activities of an ill person with a contagious disease from those who are well.). Providers should contact their state or local health department to determine whether home isolation, home quarantine or additional guidance is indicated since recommendations may be modified as more data becomes available. Additional information on home care and isolation guidance is available at http://www.cdc.gov/coronavirus/mers/hcp/home-care.html. Healthcare providers should adhere to recommended infection-control measures, including standard, contact, and airborne precautions, while managing symptomatic contacts and patients who are persons under investigation or who have probable or confirmed MERS-CoV infections. For CDC guidance on MERS-CoV infection control in healthcare settings, see Interim Infection Prevention and Control Recommendations for Hospitalized Patients with MERS-CoV at http://www.cdc.gov/coronavirus/mers/infection-prevention-control.html. For suspected MERS-CoV cases, healthcare providers should collect the following specimens for submission to CDC or the appropriate state public health laboratory: nasopharyngeal swab, oropharyngeal swab (which can be placed in the same tube of viral transport medium), sputum, serum, and stool/rectal swab. Recommended infection control precautions should be utilized when collecting specimens. Specimens can be sent using category B shipping containers. Providers should notify their state or local health departments if they suspect MERS-CoV infection in a person. State or local health departments should notify CDC if MERS-CoV infection in a person is suspected. Additional information is available at http://www.cdc.gov/coronavirus/mers/guidelines-clinical-specimens.html. Additional or modified recommendations may be forthcoming as the investigation proceeds. For More Information For more information, for consultation, or to report possible cases, please contact the CDC Emergency Operations Center at (770) 488-7100.

FREE EYE BOOK and VIDEO LECTURES Dr.Timothy .ROOT

http://www.ophthobook.com/chapters Dr T Root was a graphic designer.