Saving Medicare?

I’ve been getting to the point lately that the system needs to undergo some catastrophic collapse before it will get better. As the [Happy Hospitalist][1] says: > Here’s my position. It’s time to let the cuts stand. Congress should not reverse the 10.6% cuts that began in July 1st 2008. And here’s why: The financial … Read more


Boy I’d really like to try some of this [QuickClot][1] stuff in the OR. I think it would be great to use for a planned second look. [1]:

Ambulance Chaser

_Yes Virginia, they really do exist._ So here’s the story. The family of a trauma victim, a motor vehicle collision, is met outside the ICU by a lawyer saying that the particular vehicle in which they were traveling has a defect and he and his firm would be happy to represent them. The family never … Read more

Never Events

In October, 2007 CMS (Medicare) proposed a list of eight _preventable_ conditions that result in a prolongation and increase in cost of care to the hospitalized patient. These are what CMS terms **_never events_**. CMS is trying to couch this in terms of _patient safety_ but if you look at the list, there are only … Read more

Immediate Breast Reconstruction and CMS

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 … Read more

Ivory Towers

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 … Read more