Reader Comments

"Evidence-Based Medicine": Corporate Medicine’s Corrupted Instrument

"Janna" (2020-05-15)

 |  Post Reply

2) Specific challenges I encountered with my patient's RVOT VT ablation case had no bearing on Cigna's decision. 8) My patient will now has four months from the date of her final denial letter to ask for an state-directed independent external review of the Cigna's coverage decision via the Illinois Insurance Fairness Act as her only remaining avenue for recourse. In our subsequent discussion, it appeared the director felt the timeliness of their reviews was satisfactory, despite a timeline that stretched over fourteen months for this entire process. It is in the interest of insurers to make the payment denial/review process as difficult as possible for patients and providers. This gives the nurses a chance to mentor others and ensure patients receive proper care from newer nurses. Thanks to their growing avarice and their undisclosed political and health care policy activities, none of the leadership or board members of the ABIM found fault with the purchase of a $2.3 million condominium complete with a chauffeur-driven Mercedes S class town car in December 2007. (The condominium expenses totaled $850,340 from December 2007 through June 30, 2013 (FY 2008: $42,522, FY 2009: $164,460, FY 2010: 161,957, FY 2011: $165,982, FY 2012: $161,980, FY 2013: $153,439)).

But I am also not so naive to believe that certain members of ABIM worked in isolation from خرید کالای پزشکی other professional societies and organizations. I will say at the outset that I do not think that most of the physicians and staff who work at or for the ABIM are bad people. The number of people with MCI in the general over 65 non-demented population is not known but some believe it may be as high as 20 percent. Here I am, a non-anonymous board-certified cardiac electrophysiologist with over twenty years experience who was caught in a challenging case with my patient and am now being told by a pediatrician from an insurance company that there's no merit to my concerns about an unfair denial for coverage of the 3D mapping portion of my patient's claim. Surviving Postpartum Blues from Public Relations (PR) Mumpreneur Worries of work and the possible stress of coping with the new baby were found to be the suicide triggers of a mother and her baby who fell from their unit on the twelfth floor in Bukit Panjang, Singapore, late last year.

However, positive trends in health and wellness started showing up in trend reports as early as last year. More importantly, health care requires trust of all those who touch the field, especially when the care provided, no matter how seemingly far removed, impacts a patient's physical or socioeconomic well-being. Likewise, trust in communications that occur between physicians on a patient's behalf are equally important. But this fact is clear: until yesterday's explanation by Dr. Wachter, the ABIM has consistently and repeatedly denied the existence of their Foundation to the public, the Internal Revenue Service, and practicing physicians between 1989 and 1999 and by doing so, I believe the ABIM's actions in regard to board re-certification have been deceptive, discriminatory and have violated the integrity and trust of the public and our profession. Why does it matter whether physicians are safe placing their trust in the ABIM? Because if the ABIM physician credentialing standards are corrupt, then standards for quality metrics contained in modifications to Social Security Law 1848 made by the Affordable Care Act, hospital credentialing rules requiring Board re-certification by the ABIM, and insurance physician payment rules are also corrupt. Health care requires continuous quality improvement.

As health care dollars get tighter and medicine becomes increasingly codified, significant conflicts of interest will continue to rise for a fair and impartial review of payment denials. Factors that influence demand are hospital expansion and upgrading, Department of Health projects, and population growth. 3) Physician reviewers often do not hold expertise in the specialty areas they are asked to review. 4) If the insurance company claims to have an individual of the same specialty externally review a case, physician providers are not notified of the basis for the denial nor given the names of the reviewers, limiting one's ability to verify the reviewer's credentials or to understand the rationale for the denial. Of the external reviewers, the director claimed one was board-certified in internal medicine and interventional cardiology and the other external reviewer was board-certified in internal medicine, cardiology and cardiac electrophysiology. Integrity and trust in medicine are vital.

Has trust been eroded? 1) In Cigna's case, some insurance coverage decisions disregard current standards of care and up-to-date expert consensus statements in lieu of poorly-updated corporate medical coverage policies. The keypad is designed and backed by a sophisticated technology that adheres to universally accepted standards. As I reflect on this case, I used this sophisticated mapping technology because I felt I needed it to improve my patient's outcome and safety. Will I have to avoid the use of this technology knowing my patient may have to pay for it because a pediatrician or a general cardiologist who knows nothing about my field might not approve its use? The $58,000 increase in general and administrative expenses in 2019 was primarily due to the combination of a $29,000 increase in our clinical trial expenses and an $18,000 increase in licenses and permitting costs. What does their work demand? The only proof required is the educational qualification and proof of service or work performed.

Add comment