Letters | 9-21-14

Larger game afoot in medical profession and its delivery

West Hawaii Today’s reprint of the Pittsburgh Post-Gazette editorial on Sept. 9, “Medicine upside down: When hospital rates are charged in the doctor’s office,” was important. It is indeed reprehensible when medical practices use devious means to unfairly increase charges to their patients. The specific practice cited is only one of many such “games” that are played by medical billing systems to get more money from their patients.

However, there is a larger, even more reprehensible “game” going on in many of these cases. In the situation described in that editorial, that clinic may well have had a significantly higher cost to provide services than a clinic unattached to a hospital. Almost all hospitals in the United States pay the Joint Commission five and six figure amounts or more as they “invite” the Joint Commission to inspect them every few years. Everyone seems to agree that this is a good thing, even though this has become a big business unto itself with the Joint Commission charging additional amounts to hospitals to teach them how to pass their own exams. If a hospital directly owns or runs any outside clinics, they must pay the Joint Commission additionally to inspect that clinic as well as the hospital. This is a major expense for that clinic. Does it justify that surcharge for the 20 minute dermatologist’s office visit described in the editorial? I don’t know. Maybe.

The real problem as I see it is that medical expenses and medical insurance costs are too high, not because the doctors are paid too much (certainly not the doctors I know in Kona), but because the expenses of doing medical business is so outrageously high for those doctors. The insurance and billing expenses are huge rip-offs. The coding systems, for example, are designed to be complex and mysterious. This gives jobs to people who can manipulate the codes to their advantage — like the insurance companies who frequently “downcode” medical bills to pay out less to care providers or re-interpret codes to extract more money from patient co-pays. They nickel and dime the providers who are too busy to go after the small amounts lost on each bill — but the insurance companies reap millions of dollars in total from those little thefts, which helps to pay their chief executive officers. Then, the doctors’ offices employ their own coders to outfox the insurance companies’ coders. More expense.

And electronic medical records? Everyone agrees that EMR slows down medical care delivery and promotes inaccuracy. Instead of making the exchange of medical information between caregivers easier, its true purpose is to enable insurance companies to look more easily into patient medical records and figure out how they can better downcode doctor bills.

National studies report that many physicians now regret choosing their profession and would not recommend it to their children. I don’t feel that way and my friends here in Kona don’t feel that way either. But the depersonalization that now accompanies corporate medicine, largely secondary to the fantastic profits that can be derived from selling health care and health care insurance, are the real problems.

Barry Blum, M.D.

Orthopedic Surgeon

Alii Health Clinic

Talk about garbage doesn’t add up

Correct me if I am wrong, but didn’t we go through this exercise in 1999? Well this time it’s different. All the bidders are bidding waste-to-energy burners. Bobby Jean Leithead Todd told the vendors that the county would landfill the resulting ash. Is it a waste-to-energy incinerator? No, to the county administration and some of the council members it is a waste-reduction facility, see West Hawaii Today, Aug. 22.

Now let’s look at the details. West Hawaii Today then published an interesting article on Aug. 25, “No garbage shortage here.” The statistics provided by the article are presented here in a slightly “different” manner and do not seem to support the headline. Total garbage collected: 451 tons per day (263 tons at Puuanahulu and 188 tons in Hilo). Total garbage needed: 500 tons per day (300 tons for Hilo incinerator and 200 to meet the minimum daily requirement at Puuanahulu). But not to worry, the county intends to rely mostly on East Hawaii (188 tons) to justify its 300-ton plant requirement. Figures don’t lie but sometimes figuring goes awry.

How do we turn our 451-ton supply into our 500-ton need? Let’s start figuring. We haul 112 tons of trash from West Hawaii to Hilo, add it to the 188 tons of Hilo trash. We now have 300 tons of trash in Hilo to burn. According to the article, burning leaves 30 percent by weight in ash — or 90 tons of ash to be hauled back to the west side. That is a total trash at Puuanahulu of 241 tons (263 less 112 plus 90 equals 241). Again we meet our goals, or have we? We hauled 112 tons to Hilo and the 90 of that back to Kona, should that cost be considered? What happened to the 210 tons left in Hilo? No problem, that all went up in smoke; 210 tons of pollutants every day. But that is another story. I guess that’s our waste reduction.

Robert (Bob) Green

Waikoloa

Electrical work causes large jam

Recently, I experienced many miles of a huge, unbelievable traffic jam extending from Honalo to Honaunau. None of the local radio stations had news regarding this traffic.

After sitting for close to an hour, I arrived at the cause. It was Hawaii Electric Light Co. Their trucks blocked the road so only one car could pass. Four HELCO workers stood proudly, no police officers in sight. When I pulled over to complain and ask if they had any clue what kind if mess they had created the answer was “Hey lady … this all because of you. You are creating this mess and people like you who stop and complain.” Realizing that I was speaking to some very simple-minded people, I drove on in frustration.

It is my opinion HELCO has a monopoly over our power here on the island and that they are a greedy bunch. At a time when our power bills should be coming down, we see large hikes in the rates. When folks are struggling to make ends meet, we see a larger power bill each month. This company not only gets special privileges to be the only source of power here but they get to raise their rates any time they want. HELCO is not community minded. Its focus is on profits, not the island residents.

Now they apparently have permission to make huge traffic jams and are screwing up the highway as well. Maybe HELCO should try working the night shift and stop blocking our highways.

Susan Oliver

Ocean View

US government grant call a scam

I must be a really good citizen. I just got a phone call from the Federal Grant Agency telling me that I am being given a grant for $7,000. I was to receive the money because I pay my taxes and my bills on time, and don’t have a criminal record. They even gave me a confirmation number and the phone number for her supervisor to call a number with a 360 area code. All I had to do was to call that number and speak to her supervisor and they would arrange to send me my money.

I Googled the area code. Apparently the U.S. government has offices in Saskatchewan, Canada. I never knew that. The only thing worse than a scammer is a stupid scammer.

It is my understanding that the smarter scammers actually use a 202 area code, which is Washington, D.C.

Timothy Ewing

Kona