Medicare

  1. Who's paying your doctor?

    Everyone likes free stuff, and your doctor is no exception.

    But when those gifts come from a big drug company, they come with strings attached: prescribe our drugs... prescribe them more often... and prescribe them for more people.

    Soon, it's going to be easier than ever to figure out if your doc is on the wrong end of one of these arrangements -- because every drug company with even a single product covered by Medicare will have to report every last penny they give to doctors.

    Doesn't matter if it's a $50,000 speaking fee for being a "thought leader" or a $50 lunch for his office staff -- it has to be reported to the feds, who will then place it online for the world to see.

    This has been a long time coming, but your doctor probably can't figure out why. He thinks he can't be influenced -- that he might get a gift or cash from Big Pharma, but he can still think for himself.

    The track record says otherwise: Docs who get cash and prizes from drug companies are more likely to use that company's drugs and are even more likely to use them off-label for unapproved conditions.

    One Big Pharma rep told NPR in 2010 that he could pay a doctor $1,500 to deliver a short presentation prepared by the company -- and the following week that doctor will write up to $200,000 in new prescriptions for his company's drugs.

    That's one heck of a return on investment.

    So, starting later this month, you'll be able to search a federal database and see who's giving your doc what -- from those mutually lucrative speaking fees to a cheap lunch.

    Companies that fail to report payments and other gifts will be on the hook for fines of $10,000 per violation -- but with a cap of $1 million a year, that alone is probably not enough to get the industry's attention.

    After all, drug companies routinely pay hundreds of millions and even billions of dollars in fines. Next to that, a million bucks is a bargain -- the kind of spare change they might find in the CEO's sofa cushions.

    But the new law has some other penalties that could turn out to be a lot harsher than any dollar amount: A senior official -- the CEO, CFO or the chief compliance officer -- is going to be held responsible for the accuracy of each report.

    And if it's got a few missing pieces, he could face some consequences.

    Fines might not get their attention -- but that sure will.

  2. The problem that's seven times worse than reported

    To err is human... but to make a potentially deadly mistake and consider it just another normal day on the job, you'd have to work in a hospital.

    The newest numbers on medical mistakes are in, and they're uglier than ever: The Department of Heath and Human Services says six out of seven errors -- including potentially fatal blunders -- go unreported.

    Now, no one likes to admit to their mistakes... and in the past, doctors and nurses were no exception. They'd often fail to report their mistakes simply to cover their own butts.

    But DHS investigators say today's doctors, nurses and other hospital staffers are a different breed: They'll admit to those mistakes... if they could only figure out what constitutes a mistake!

    Believe or not, many don't realize when a patient has been hurt by botched medical care. And others make or encounter mistakes so often that they don't consider them mistakes anymore.

    It's just another day at the office.

    But recognizing those mistakes is supposed to be a key part of the Medicare process -- with hospitals that hope to cash Medicare checks required to report all patients who are harmed by their care.

    That includes patients hurt or killed by hospital-acquired infections, drug overdoses, wrong medications, bedsores, delirium from too many painkillers and more.

    To find out that doctors and nurses can fail to spot that six times out of seven is just astounding -- and that's not even the biggest problem here. The agency's inspectors also found that even when a mistake is recognized, it almost never leads to changes to prevent it from happening again.

    In the new study, independent doctors reviewed a small sample of patient records and found 293 who were harmed by their medical care -- with only 40 of those incidents reported to hospital management.

    Of those, only 28 -- less than 10 percent of the original total -- were investigated, and just five led to actual changes in either policy or practice.

    But that's just scratching the surface. All told, investigators say 130,000 Medicare patients are harmed by their care every single month -- some of them more than once.

    One recent study even found that 15,000 Medicare patients are killed by those medical mistakes every month.

    The sad reality is that if you're sick or injured, the hospital is turning into the last place you want to be.

  3. The great nursing home swindle

    It's the biggest scandal -- and the biggest swindle -- you've never heard of: Dementia patients are being shipped back and forth between nursing homes and hospitals in a calculated attempt to raise their cash value.

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