If you want healthcare reform all it would take is getting her testimony on tv. Obama could help with this. He could get the time. We could help too.
But anyone who see's this woman's testimony will feel it and they'll be outraged.
What Obama needs to do now is kill this idea that granny is going to be euthanized so some floozy can get an abortion and do so in a way that guarantees it,explains exactly what the consultations are and then hit them with the testimony video.
I know this is not much of a diary and more of a suggestion but I really have a strong feeling when I read or listen to her tell her tale.
A woman who could no longer live with herself.
Detailing the dirty deeds they do everyday.
Dr. Peeno delivered an oral statement along with written testimony for a Congressional hearing on "Contract Issues and Quality Standards for Managed Care." Her testimony was heard on May 30, 1996 by the Subcommittee on Health and Environment of the House of Representative's Committee on Commerce. Her entire testimony can be found at the National Coalition of Mental Health Professionals and Consumers."
My name is Linda Peeno, and although the witness list does not reflect this, I am a physician. I am a former medical director and medical reviewer. I did the job that was referred to repeatedly in the first panel as a physician manager for three health care organizations. I currently, though, primarily work in medical and health care ethics.
I am here primarily today to make a public confession. In the spring of 1987, as a physician, I denied a man a necessary operation that would have saved his life and thus caused his death.
No person and no group has held me accountable for this because, in fact, what I did was I saved the company a half a million dollars for this.
And furthermore, this particular act secured my reputation as a good medical director, and it ensured my advancement in the health care industry&emdash;in little more than a year, I went from making a few hundred dollars per week to an annual six-figure income.
In all my work, I had one primary duty and that was to use my medical expertise for the financial benefit of the organization for which I worked and according to the managed care industry... [In the managed care industry] it is not an ethical issue to sacrifice a human being for a savings, no matter how that savings occurs. And I was repeatedly told that I was not denying care. I was simply denying payment.
I am not an ethicist whose primary background has come from the books. For me, the ethical issues were born in the trenches and pit of the pain that I have come to realize that I cause. And if I am an expert here today, it is because I know how managed care maims and kills patients.
So I am here to tell you about the dirty work of managed care and this is the kind of straight talk that I wish Ms. Ignagni [President and CEO of the American Association of Health Plans] could hear now.
Now, let me explain to you the ways that I was a good medical director. I was regularly consulted by marketing on ways to change expensive benefits or change the language to give me loopholes to make denials when requests came.
For example in one plan, we were able to structure our investigational language exclusion so that I was often able to use it to deny almost anything that was expensive, and particularly out-of-network requests.
I turned preexisting exclusions into a game as I tried to connect almost any prior medical complaint or visit as a reason to deny payment.
There are many more thing that I could tell you about, but, ultimately I was only as good&emdash;and I put that in quotation marks&emdash;as the doctors in my network, for it was their numbers that I needed to prove that I was doing my job.
That meant that I did whatever it took to control them: intimidation, hassling, humiliation, I have done it all. I have used inadequate and inaccurate data to create reports to get doctors to make their numbers better, in other words, decrease their usage.
I have used "economic credentialling" to select the best inexpensive physicians and rarely correlated these with quality factors.
I have helped design contract provisions to ensure our payment and monitoring schemes got the results we wanted at the plan, and I have threatened deselection to numerous physicians who were especially difficult or costly.
However, there is one last activity that I think deserves a special place in this list. This is what I call the "smart bomb" of cost containment and that is medical necessity denials.
Let me take you to the heart of managed care.
Even if a plan denies using all the other things that I could list, it is impossible for them to deny their use of this practice because it is vital to managed care; that is making medical decisions about access, availability, and use.
And even when medical criteria is used, it is rarely developed in nay kind of standard traditional clinical processes. It is rarely standardized across the field. The criteria is rarely available for prior review by physicians or the members of the plan. So, even if a a plan has a clear benefit package and has all the perks, like free eye exams or free screening tests for cancer, other marketing ploys, the member's physician will never be the final authority on what his or her patient will get.
This might go unnoticed for simple needs, like a regular office visit or a bout of the flu, but I can tell you that when something unexpected or expensive happens, it is like a bucolic pasture turned battlefield. The land mines will start exploding everywhere.
And somewhere in every coverage booklet for every managed care plan is a claim that establishes the plan as the final authority for medical necessity. What that means is that there is some physician at some plan doing what I did.
That person rarely is continuing a clinical practice. They are sitting behind a desk making decisions about a patient they will never see or touch, completely removed from the consequence of their decisions. They are getting paid by someone to make decisions for the benefit of the plan and not for the benefit of the members.
I would like to conclude by saying, what kind of system have we created when a physician can receive a lucrative income for adding to the suffering of patients? I became a physician to care for, not bring harm to my patients, and I am haunted by the thousands of pieces of paper on which I have written that deadly word, "denial." Thank you.