New Study Compares Tort Systems -- Reform Improves Health Care for Patients

A new study by the Pacific Research Institute, US Tort Liability Index: 2008 Report, measures the best and worst tort systems in America. In the report, the authors examine evidence provided by top economists and legal scholars on the benefits of tort reform in peoples' lives and conclude that, among other things, reform improves health care and health care access. The report also discusses the cost of defensive medicine - most of which is prompted by medical liability concerns - which has now reached the astounding total of $163 billion a year. This is the sum of the direct costs of defensive medicine, estimated to be $124 billion a year by PriceWaterhouse Coopers, and PRI's own estimate of the $39 billion indirect costs from lost productivity due to reduced access to health care attributable to defensive medicine. According to PRI, increased health-care costs brought on by defensive medicine have also added some 3.4 million Americans to the rolls of the uninsured.

I used to work in Indiana, which has one of the more doctor friendly malpractice systems. Potential lawsuits are brought before a panel for an opinion prior to a lawsuit being filed. Indiana also has a cap, or limit, on how much money a plaintiff can win for pain and suffering. All this led to low malpractice insurance costs. In New Jersey it is quite different.

Posted by Domenico Savatta, M.D. | Permalink | Comments (0) | TrackBacks (0) | | |

I have previously written about sexual function and how it changes after prostate cancer surgery.
As men are being diagnosed with prostate cancer at a younger age and at an earlier stage, the preservation of erectile function and the ability to maintain satisfactory erections has become more important. My partners and I offer a variety of options to assist in the recovery of erections including having a vacuum device specialist come in to the office once a month, teaching patients how to give penile injections and intra-urethral suppositories, and prescribing viagra, levitra, and cialis on a maintenance, preventative basis.

One of the most frustrating things is insurance companies not paying for maintenance medicines even though most urologists feel these medicines help erections return sooner and possibly more fully. There was an excellent review of the literature by Dr. McCullough of NYU that I read this weekend. He is one of the world's authorities on erectile dysfunction.

This is a great source of information for urologists who can receive 1.5 CME credits.

I will start giving this link out to patients with a letter to see if it helps get them at least partial payment from insurance companies.

I hope patients report any positive experiences with insurance companies paying for their PDE5 inhibitors after surgery.

I have been personally prescribing 1/2 of a pill of the maximum strength to be taken on Mon, Wed, and Friday evenings.

Posted by Domenico Savatta, M.D. | Permalink | Comments (0) | TrackBacks (0) | | |

I recently had an encounter with United Healthcare that initially resulted in a denial of a request to treat one of their patients with UPJ stenosis (partial obstruction of the drainage leading from the kidney to the bladder) with a robotic repair of the condition. The denial was initially based on the perception that such surgery was "experimental" and not a generally accepted form of treatment. After nearly two months of back and forth, I have approval to do the procedure and I believe I have convinced United Health to accept the procedure generally for all its subscribers. I have posted below several references to articles that I forwarded to the medical director in the course of our discussions. Most pyeloplasties are done in children and you can see that the articles reflect that, although my patient was an adult. Perhaps they will be of help to someone else in a similar situation.

Continue reading "Are da Vinci Pyeloplasties "Experimental"" »

Posted by Dale Russell M.D. | Permalink | Comments (1) | TrackBacks (0) | | |

When I first started this blog I tried to be fair about my views on different subjects, but also to be positive about them.

This is my first negative post and it has to do with the power of HMOs and their ability to prevent their patients from access to some technologies.

Patients every day ask me if their robotic prostatectomy for prostate cancer is covered by insurance and the answer is almost always yes.

Unfortunately this isn't the case throughout the country. A new patient of mine is flying across the country to have me perform his surgery. Half of the reason is because I am good at performing the surgery and have good results, but I am afraid to say the other half is because he can not have the surgery in California through his insurance plan.

Although there are many articles in the literature that support the use of robotics in urology, some insurance carriers still call it experimental and will not cover it.

The FDA approved robotic surgery with the daVinci robot for prostatectomy for prostate cancer in 2001.

My personal experience has consisted of over 200 open prostate cancer surgeries while in Indiana and New Jersey, as well as over 130 robotic prostatectomies in the last 17 months (my entire 9 man group has not performed an open one in the same time frame).

I can do the surgery well open or robotic, but feel the robotic is a far better procedure than open and will not perform an elective open prostatectomy for prostate cancer.

My reasoning as such:
With robotics, none of the 130 patients have been given blood and I haven't asked a patient to donate blood as we did with open since the 3rd operation.
The hospital stay has been cut to 24 hours for 93% of the patients, with only 1 patient in the last 100 going home after 2 days.
Most of my patients have resolution of their urinary function within 2 months and many are having erections in 2 months as well, which is much better than what I saw with open surgery.

To me this translates into a better operation.

It is unfortunate that patients that have insurance and think they are covered for all reasonable conditions are being denied in network coverage for their prostate cancer.

Posted by Domenico Savatta, M.D. | Permalink | Comments (16) | TrackBacks (0) | | |