I need your help - abuses in medical practice and insurance.

[mmglobal]

2 years ago, I was asked to represent the patient community at the Third International Conference on Ethical Issues in Biomedical Engineering. (website) I have been invited to return and again, represent the patient community in a panel discussion on "Marketing, Payment and Regulation of Biomedical Devices" at the Fourth Internation Conference on Ethical Issues in Biomedical Engineering. (website)

I'll be making a presentation and then participating in the panel discussion on marketing, reimbursement and regulation. I'd like my presentation to cover:

• A balanced view of positive and negative impact of new technologies on the spine patient community.
• Case examples of abuses by the system as related to introduction of new devices. (read more below)

Abuses by the system may include, but are not limited to:

• reimbursement issues
• reimbursement issues
• informed consent
• reimbursement issues
• Workmen's comp abuse
• reimbursement issues
• Clinical trial, oversight of unsuccessful patients
• Complication reporting - outcome database - can't we weed out the bad surgeons?
• Oh yes... did I say reimbursement issues.

I spoke to Dr. Subrata Saha this morning. This year well over a dozen countries will be represented and the conference is growing nicely. I really enjoyed the conference in 2005 and look forward to this one. Late April in New York should be nice... perhaps we can have a spiney gathering there... Sunday afternoon 4/22?

[mmglobal]

I forgot to post... the help I want from the patient community is... I want to connect with patients who've suffered the worst of the worst of abuse by the system. Have you been told that you have to stop meds and go to boot camp in spite of the fact that you've got hard clinical data demonstrating severe pathology? Have you been scheduled for appointment for appointment and then have them cancelled on short notice? Have you had your funds cut off from your disability insurance company and they confess to a clerical error but it still takes 8 months to get it turned back on and meanwhile you lose your house? Did WC cash you out and you found yourself, after a WC injury, unemployable, uninsurable, unable to get SSD and basically fallen through the cracks unable to get appropriate medical care and have no options?

Did you have your doctor tell you that you were going to be is first or second time using a brand new device, but it's no big deal; only to discover that it is a very big deal and for many reasons, your life may have been ruined for lack of informed consent?

I want to talk to these people! I go to surgeon's conferences and hear presentations about research on patient abuse. This research gives the WC, legal and insurance industry political cover to deny needed treatment to people who really need it. I'd like to demonstrate that even worse than the patient abuse is the abuse by the system.

If you know these folks... send them to me. you can send email to the info address on iSpine or GPN websites.

Thanks in advance for the help.

Mark

[Poncho]

Okay, - Lets see - to get the ball rolling here --- I can relate to this as a work comp patient. However, my injury and ADR surgery was prior to FDA approval of any of the ADR's.

In my case, I felt that work comp was in a rush to place me in what they call MMI (maximum medical improvement). Pushing to have a functional capacity exam performed to determine percentage of disability. The doc was trying to trick me into going through the functional capacity exam and have me sign the documents that I would agree that this was the percentage level of permanent disablity. - They did not inform me that going through this would cut off my work comp benefits at the time. Nor did they inform me that I qualified for lifetime benefits under work comp related to my back. Most of the jobs involved lifting - I was unable to lift anything over 10 pounds. - Also, they would not give me a copy of my pateint rights - so that I would know what I was or was not entitled to. I had to do all the research on my own in pain, drugged up - etc.

I found out through forums like this prior to going through the functional capacity exam that this was a "trap" that once going though and signing those documents - I would be forced to find a permanent job within 30 days I believe within the hospital I worked for or have my "employment relationship severed" with them. Needless, I refused this functional capacity exam and any paperwork that went with it. Fought like hell and won my case with HR regarding job placement and did end up with a desk job. But, like I mentioned had to fight like hell....Another nurse that was a cervie, went through a similar process as myself - but went through the functional capacity exam. She signed the papers as they pertain to the exam and was cut a check (measly check at that) and told her case was closed because she was at MMI and the check was her "compensation"...

I have to do some more thinking here - but it is at least a start.

Poncho

[Poncho]

As far as playing the system for reimbursement. One of the ADR docs in the US I consulted with said that because there was not an insurance code or ICD-9 code for ADR that he would code it as an "intra - dynamic spacer" - in an attempt to receive reimbursement that way.

As far as clinical trial "oversights" - It seemed that here in the US, my case kept getting pushed back further and further on the waiting list. Waited on the list for 1 1/2 years before just giving up and going to Europe.

I never took my name off their list - and they never called me to set up surgery even after 2 surgical consults and discogram plus MRI's and all of the diagnostics proving the pathology AND being told that I was a candidate. I think that was 4 years ago...Hummm.... ( I won't mention names online )

Another issue as far as reimbursement....those of us that do have the financial resources to pay out of pocket (some of selling homes, cars, taking out loans, or charging up credit cards & etc to get lives back)- There needs to be more transparency as far as the price / costs associated with going through such a procedure. Granted, any complications can set one back more $$$ - but if the surgical clinics in Europe can give some sort of ball park estimate - why can't we???

Still trying to brainstorm some thoughts here.

[sahuaro]

One of the many good points Poncho raises is that of "Independent" Medical Examiners--doctors who prostitute themselves and abuse their medical licenses as "consultants" for insurance companies and WC. And they are immune from review from the state Medical Board because "there is no patient/doctor relationship." I don't know if this falls in the purview of your presentation, Mark, but I sure can provide some first-hand information--just let me know.

[Poncho]

Excellent point Sahuaro,

I wonder if this is regulated by the states? I'm thinking work comp laws vary from state to state.