Texas Medicine Letters: December 2012

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Letters – December 2012

Tex Med. 2012;108(12):7-8.

Friends or Foes?  

If history teaches us anything, it is that yesterday's sworn enemy might be today's ally, and then tomorrow's enemy again – just look at the British and French. The insurance lobby was our joined-at-the-hip cohort during tort reform, but certainly not over prompt pay. Now is a good time to revisit the old joke that starts "I'm from the government, and I'm here to help."

Three recent publications illustrate the role of government in health care.

Wang et al recently reported that compliance with the Surgical Care Improvement Project was not necessarily in patients' best interest. Compliance with the infection measures was not associated with improved infection outcomes, and compliance with thromboembolism measures resulted in at least 50 percent higher infection rates.1  

The urologists have had experience similar to the orthopods. Catalona et al reported that the U.S. Preventive Services Task Force that issued a recommendation against prostate-specific antigen screening did not have a single urologist or cancer specialist on its panel.2  

As previously noted in this publication, the Federal Trade Commission is now lumbering into the fray on scope-of-practice issues, potentially emasculating the state licensing boards. (See "Doctors Targeted," August 2012 Texas Medicine, pages 18-23.)

It is in this context that we assess the increasing levels of coercion, monetary and otherwise, to shepherd physicians into accountable care organizations. Is this a gracious offer of a generous windfall, or is it the piece of bacon that entices the family beagle out the door and into the garage?

Now more than ever we need the Texas Medical Association and our other collective groups to help us decipher whether these enticements are the act of a friend or of a seductive enemy, or perhaps something more banal, like Owen Wilson's character in the movie The Big Bounce (2004). He explained himself thus: "Sure we're friends – it's just that we have the type of friendship that if you really need me, I'm not going to be there for you." 

Stephen L. Brotherton MD 
Fort Worth
TMA President-Elect


  1. Wang Z, Chen F, Ward M, Bhattacharyya T. Compliance with Surgical Care Improvement Project measures and hospital-associated infections following hip arthroplasty. J Bone Joint Surg Am. 2012;94:1359-1366.
  2. Catalona WJ, D'Amico AV, Fitzgibbons WF. What the U.S. Preventive Services Task Force missed in its prostate cancer screening recommendation. Ann Intern Med. 2012;157(2):137-138.

 Government's Ulterior Motive? 


Recent news items, apparently in support of the Justice Department's effort to reduce or eliminate fraud and abuse by physicians and hospitals and clinics, have caused me concern.  

Physicians and institutions understand that the most complicated and expensive patients are those covered by Medicaid and Medicare, and we have grown gradually to expect remuneration often less than the cost of care. We are painted with a broad brush as using illegal tactics and methods to overcharge for services and for services not performed. Is the government in a less than subtle way trying to get our biggest group of supporters, our patients, to distrust us? This observer thinks so.

We need to remind ourselves to be circumspect in our day-to-day patient care and billing. Electronic charting and billing add to the time we spend caring for patients with little benefit to us, but also a lot of risk that reviewing entities can more easily access our data. Don't forget what happens when the camel gets its nose under the edge of the tent.  

Peter Wiles, MD

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