And Here’s Something Else For You PCPs To Do

DrRich | December 6th, 2010 - 7:40 am

Podcast:

Thanks to Ms. Wood of the Occam Practice Management Blog for calling DrRich’s attention to an interesting article appearing recently in the Wall Street Journal Health Blog. This article describes the efforts of a non-profit organization called the Investor Protection Trust to (it appears) medicalize the problem of financial scams involving the elderly.

Specifically, under the auspices of the IPT, government securities regulators will be teaming up with physicians organizations (in particular, the American College of Physicians and the American Academy of Family Physicians), to train PCPs to recognize signs that their elderly patients are victims of financial fraud or exploitation. If such fraud is uncovered or suspected, the physician is to notify Adult Protective Services, an organization which (helpfully) is not subject to certain annoying confidentiality regulations. IPT estimates that screening for financial abuse can be accomplished by adequately-trained PCPs in only three short minutes.

The plan is to have PCPs take special training to help them recognize the signs of financial elder abuse. This training can be accomplished in only two hours, the IPT explains, and will be conducted “under the auspices of medical ethics continuing education.”

Long-time readers will know that DrRich is the President (and sole member) of Future Old Farts of America. (He retains this position despite the fact that his eligibility for FOFA is rapidly expiring, and, some have suggested, has already expired.) As President of FOFA, DrRich naturally deplores financial fraud perpetrated upon the elderly. Indeed, this is one of the chief reasons he opposes Obamacare.

So DrRich applauds this new effort to protect the fiscal wholeness of our beloved elderly. The plan is flawless, as it has something good in it for everyone – except, perhaps, the PCPs.

The IPT itself stands to gain much from this new program, since this organization is funded through fines collected from investment-fraud cases. Having American PCPs embark on a major, sustained, grass-roots effort to troll for such investment fraud (using screening criteria developed by the IPT itself) should greatly increase this organization’s revenue.

The major physicians organizations which represent PCPs – the ACP and the AAFP – also come out ahead by supporting this effort. They reap, of course, all the public relations benefits that always go along with new programs aimed at assisting our esteemed elderly population. But perhaps more importantly, their participation in this program helps them with the small “ethics problem” they have lately created for themselves.

As regular readers will know, the ACP and AAFP are major proponents – and indeed the authors – of the New Age medical ethics that was formally adopted by the medical profession in 2002. This new ethics, as DrRich has patiently explained, obligates physicians to strive to practice medicine for the benefit of the collective. Practically speaking, the “new ethics” creates the ethical foundation by which American physicians will practice medicine according to fiats handed down by government-controlled expert panels. That is, it excuses physicians from their now-obsolete obligation to always do what’s best for the individual patient, in favor of doing what’s best for society as a whole, as determined at a distance by the Central Authority.

All well and good. As DrRich has amply demonstrated, the ACP (at least) is quite satisfied with its new medical ethics, and sees no reason to reconsider. But still, this creates a problem for the ACP when it comes to “medical ethics continuing education.” Thoughtful physicians, when faced with indoctrination programs aimed at getting them to absorb the new medical ethics, often raise uncomfortable questions, questions which (as, again, DrRich has shown) even the chairperson of the ACPs’s ethics committee cannot effectively answer. Clearly then, having formally tossed real medical ethics aside has undoubtedly made these ethics sessions somewhat awkward for the instructors.

What better solution to this embarrassing problem than distraction? Simply turn these annoying continuing education sessions into something other than a discussion of medical ethics.  Turn it into, say, a two-hour session on recognizing financial fraud among the elderly. You’ve got to have something to talk about, after all – and defrauding the elderly is unethical, is it not?  It is not hard to understand why physicians organizations are so supportive of the IPT’s new effort.

But, of course, the very first among the beneficiaries of the medicalization of elder fraud is the government.

Most directly, anything that helps to keep the estates of the (pleasantly) befuddled elderly intact, until they pass on to their more permanent rewards, will increase revenues to the state and federal governments through inheritance taxes.*

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*DrRich leaves it to the reader to decide whether the benefits to the overall economy are greater if the accumulated wealth of the elderly is passed on to the government, or to perpetrators of fraud. Which entity – government or crooks – is more likely to make use of that money in a truly stimulatory fashion? It boils down to the old argument between Keynes and Hayak, of course. In the interest of both brevity and civility, DrRich declines to take up this argument at the present moment. Still and all, it is indeed a point for consideration.
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But the government – and any healthcare payer – benefits immediately from this new program, even before the elderly person dies.

A major strategy in cutting the cost of healthcare – THE major strategy – must always be directed toward controlling the behavior of PCPs. This strategy, for instance, fully explains the massive tangle of uninterpretable rules and regulations which the PCP must painstakingly navigate today, the violation of any one of which is now a federal crime punishable by massive fines and imprisonment. Another tactic for controlling the PCP’s behavior is to severely constrain their face-time with patients, and to tightly regulate what must occur during these now-brief doctor-patient encounters.

Accordingly, during the 7.5 minutes allotted for each patient visit, the PCP must complete a 10-to-15-point checklist of required activities that fall under the rubric of “Pay for Performance.” Such checklists are designed, among other things, to keep the PCP and patient from straying off to address medical questions which do not appear on approved lists, and which might lead to unfortunate medical expenditures.

From the government’s standpoint, adding yet another obligation to the PCP’s critical checklist – an obligation which is so obviously beneficial to our elderly citizens, and which after all takes only three minutes to complete (leaving a full 4.5 minutes for actual medical issues) – is a very useful thing. And furthermore, it is the right thing. Anyone objecting to PCPs being directed to screen for financial abuse in their elderly patients immediately reveals themselves to be completely heartless and unfeeling and, likely, a Republican.

The PCPs, of course, are the only losers here. They are being asked to add yet another impossible task to their already-impossible list of jobs. Furthermore, as we have seen, once some outside body declares that it is the PCPs job to accomplish some impossible new task (such as assuring that all of their patients actually quit smoking), then our friends in the legal profession can immediately begin suing PCPs who fail to accomplish it.

So now the adult children of neglected elderly parents, finding that their inheritance has been frittered away because someone talked Pap-Pap into having a new roof installed on his house every year, will have somewhere to go to recover their damages.

If, as has been DrRich’s contention, the ultimate goal is to render primary care medicine so very odious, demeaning, exasperating and dangerous as to become a completely untenable proposition for any self-respecting American physician, so that by default the role of PCP will have to be filled with lower-level professionals who presumably will be more accepting of central directives, happier with checklists, and more comfortable with time-clocks than most doctors ever could be, then this new initiative is more than just a good idea. It is truly inspired.

12 Responses to “And Here’s Something Else For You PCPs To Do”

  1. An MD says:

    Besides the fact that I agree that the purpose of all this is to distract from real medical care, isn’t it time instead to establish a primary care lawyer and primary care financial advisor. Isn’t it time the govt. asserted it’s ability to do those things better than the private sector as well ???

  2. DrPoor says:

    In addition, according to the Alzheimer’s Association and thanks to the Patient Protection and Affordable Care Act, cognitive assessments are to become a “mandatory” part of annual wellness visits for Medicare patients starting in January 2011. What other unfunded mandates will they put on us?

  3. Hal Dall, MD says:

    Doctors, er excuse me, PCPs need to do EVERYTHING POSSIBLE for each and every patient as long as they do not treat anything. And are not paid for it.

  4. GingerR says:

    Interesting post.

    My father recently passed away from Alzheimer’s after a decline. At one point one of his several doctors mentioned to my mother that they should be on guard against financial ripoffs.

    They had engaged the services of an reputable estate manager at his first diagnosis, and financial ripoffs weren’t really a worry of mine. My mother, whose marbles are in pretty good shape for someone in her 70s, took this advice as good reason to liberate my father from bank cards and dolled out spending money to him so that any money goofs would be limited by whatever cash he was carrying around.

    While googling some drug that had been prescribed for my father she came upon an ad for white teeth, which she clicked. She ordered whatever it was they were selling, and got herself involved in a credit card scam that eventually required a lot of letter writing and the issuance of new credit cards.

    I feel like one obligatory mention of watching out for financial abuse is warranted, but since you can’t count on people thinking the advice applies to them it’s probably better to stick to whatever ailment has brought the person into the office.

    • DrRich says:

      GingerR,

      I agree with you.

      Perhaps we can mandate that financial advisors must complete a medical “review of systems” for their clients with each visit, since doctors won’t have the time to do it anymore.

      Rich

  5. Thank you, Dr. Rich, for your excellent post supporting this effort to keep our seniors safe. I believe that this clearly points out the need to upgrade electronic medical records (the implementation of which shall be mandatory as called for in the 2009 stimulus law) to include the collection and storage of the patient’s financial information. According to the government, independent think tanks and the Health Information Management Systems Society, the use of EMRs makes it much faster and more efficient to record and recall information gathered in the clinic. It therefore follows that PCPs will have more than ample time to perform a financial “review of systems” as a part of the patient’s current social history at the time of each visit. This should include the amount, type, distribution and location of the patient’s financial assets. Standardized guidelines of financial health can then be used to determine whether this distribution raises any financial red flags with respect to possible fraud. When the patient presents for subsequent visits the process should be repeated. Any substantial change in the type, amount or distribution of assets can then be processed by the EMR, and changes that exceed those recommended by the Medical Financial Guidelines (MFG) should be reported by the PCP to the Investor Protection Trust (IPT) within 24 hours. All of this can be implemented through a convenient system of checkboxes and electronic reminders that the PCP must complete before, during or after each visit. These safeguards should immediately be made part of the Federal Meaningful Use requirements. While the process may take more than 3 minutes per visit and the purchase and maintenance cost of the EMR financial alert package will probably cost the physician around $5,000 per year, the net savings to seniors, IPT and state and federal governments will more than make up for the cost. Physicians will be compensated by the pride they feel having helped so many people and institutions, and contributing to reduction of the federal budget deficit.

    It’s all so simple, really.

    • DrRich says:

      Doug,

      The beauty of your suggestion is that, given that the government already has full access to our electronic medical records (and therefore, so do the people who run sites like WikiLeaks), the notion of also supplying the government with the complete records of our financial assets will seem, by comparison, a mere triviality. It is plain that no reasonable person could object to this idea.

      Rich

  6. About 30 years ago, one of my patients expressed concern that her husband, also a patient, was being bilked by the owner of the board and care home where both of them lived. They were apparently pretty well off and the board and care was what we would now call “assisted living.” I was concerned that it might be happening but both were in their 80s and it could also be a delusion of the wife. I contacted an acquaintance who did asset management for many residents of Leisure World, a retirement community close by. I arranged for him to interview the wife while the husband was in my examining room and the care taker was waiting outside. He concluded that there was no problem and it was all done without alarming the husband and caretaker.

    About ten years later, the asset manager was arrested for swindling clients out of their estates.

    Quis custodiet ipsos custodes?

    • DrRich says:

      Michael,

      You certainly made every attempt to help your patients. I would simply point out that physicians could make that same effort today, without compromising on the medical care they were able to provide, if they ran direct-pay practices instead of working for the government.

      Rich

  7. Steve RPAC says:

    I’m with you up until the point you made your comment about “with lower-level professionals who presumably will be more accepting of central directives…” But maybe I can forgive it if you somehow put a disclaimer up that all your comments have been completely reviewed by the Politically Correct Subcommittee of the Collective. My goodness I LOVE that term and it so much better describe what’s been happening than simply turning medicine into a business.

    • DrRich says:

      Steve,

      I believe I am properly covered by my use of the word “presumably.” I have written in the past about how our central authorities might ultimately become disappointed with the malleability of nurse practitioners, doctor-nurses, clinical nurse specialists, and other non-physician PCPs.

      After all, the nursing profession (unlike the medical profession) has not formally changed its professional ethics to place the needs of the collective ahead of the needs of the individual patient.

      Rich

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