Maintenance of Certification (#MOC):
When we (physicians) took our medical degrees, residency training, and commitment to lifelong learning & patient lives…and got duped into paying @ABMSCert millions of $$$ for the privilege (ahem, requirement) of taking time away from the… https://t.co/p3GapNdhkLtwitter.com/i/web/status/1…
Why does this matter?
1. It’s a financial racket, pure and simple. 87.9% of these boards’ revenue come from exam fees…exams which are functionally mandatory since insurances, hospitals and other employers of physicians require it to practice.
For those just now realizing insurers don’t care if you live or die—
🚨🚨🚨Insurers do not care if you live or die.
In fact, death is highly cost effective, especially if it is fast, and especially if you are chronically ill.
Up to 25% of all Medicare expenditures are spent on… twitter.com/i/web/status/1…
Talking a little more about medical loss ratio (MLR), the ACA actually required that insurers keep to at least a 80% MLR, though there are liberal rules on what can quality as “medical loss” (aka paying for healthcare) beyond just paying for healthcare.
We don’t have to do prior auth. Like ever. We just order what the patient needs, and the patient gets it done in the ED.
But here’s why we care about prior auth anyways:
B/c not a shift goes by where a patient doesn’t land in the… twitter.com/i/web/status/1…
Need your gallbladder taken out electively? Too late (waiting for auth), now you’re in the ED with cholecystitis.
Had a “nodule” seen on a CT, but couldn’t get a repeat scan authorized…ever? Now it’s metastatic and you’re in the ED for crippling pain.
💰Short-term $ goals of #PE drive the long-term nature of caring for lives. Nothing like devolving a 70-year patient life into a 5-7 year $ projection geared towards the next sell off…
💰Highly leveraged PE ➡️ desperate $$$ decisions(⬇️ staffing, ⬇️access clinics, ⬇️quality/ availability of supplies and treatments)
💰10x more likely for bankruptcy of the healthcare entity
So what are #PBMs? Chances are, if your meds suddenly got changed by your insurer, or you’ve been waiting weeks on #priorauth for a med you need, or you pay $$$$$ for a drug in the US that is cheap overseas, you’ve already experienced a #PBM and didn’t even know… twitter.com/i/web/status/1…
That’s b/c #PBMs aren’t meant to be known, they’re meant to be a middleman in healthcare cutting in an extra layer of profit for them and an extra cost to you…wonder why #prescriptiondrug pricing makes no sense compared to prices in other countries? This is why.
Mar 26, 2023 • 6 tweets • 7 min read
Can’t talk about #womenshealth w/o mentioning #maternal death -unfortunately on the rise in America...how does one of the richest countries have the highest rate of maternal & infant mortality?🧵npr.org/sections/healt…@acog@ACOGPregnancy
We have high c-sx rates, low prenatal care, high chronic disease rates in our mothers. Post-partum care is a single visit at 6 weeks. Working pregnant moms may opt to induce labor for the 'convenience' of optimizing their leave...
Mar 25, 2023 • 6 tweets • 4 min read
Incredible piece in @propublica on the dark underbelly of #healthcare#insurance — making profit margins off of denying claims (aka healthcare) to its members when they need it most propublica.org/article/cigna-…
If time is money, this is what @Cigna thinks the health of its members is worth: 1.2 seconds
Mar 25, 2023 • 7 tweets • 6 min read
#womenshealth is #disparate because medicine evolved in a patriarchal society. Male presentations of disease are “typical”, female ones are “atypical”. Society becoming more #gender#equal, doesn’t undo the historical bias of medicine we still rely our practice on - as a result,… twitter.com/i/web/status/1…
While #postpartum care is an obvious example. @American_Heart published that women don’t classically present with chest pain like men in heart attacks, but instead may have fatigue or insomnia. This can be easily written off by doctors as “stress” ahajournals.org/doi/full/10.11…
Mar 25, 2023 • 5 tweets • 3 min read
Great 🧵- my takeaway since having a 👶🏻myself: if a patient comes to the ER postpartum, DO NOT BLOW THEM OFF. The barrier to leave the house is so high, that if they put on pants to come to the ER, they NEED something. HELP.
Women’s symptoms are often seen as histrionic or atypical at baseline by a medical system grown in patriarchy. Postpartum is one of the most vulnerable times in a woman’s life, so if they seek help, do so, without judgement or barrier.
