OK, first off this part of my practice is over and I’ve moved on. But let me relay a story of how CMS (that’s Medicare for the uninitiated) works. I was asked by one of my local _breast surgeons_ if I would see a patient for immediate breast reconstruction with implants. The patient was to…

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An _Ivory Tower_ is supposed to be the tertiary referral center where they know everything and can take care of all difficult patients. So why is it when I have a specific need for a higher level of care that one of my _local_ Level 1 trauma centers, University of California, San Diego, balked. I…

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