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I don't think that by refusing to provide a service like free telemedicine as opposed to a patient presenting for care is going to have the dire consecuences you propose. 
But I also think that people have to have personal responsibility for their healthcare. They need "skin in the game"
Certainly making efforts to change behavior, alter diets, avoid risky behaviors like drinking to excess, use of illegal drugs for mind altering, If these are not done, why does anyone have moral obligation to help out when bad things happen as a result of the patient's poor choices and behaviors? Especially when so muc is spent and invested on making people aware of the consecuences of bad behaviors, and offer programs to help correct them, etc>Doing the right thing, also applies to the individual too.  SO is it a bad thing for an orthopedist to out a femur fracture up in traction inlieu of going to the operating room for a medullary rod for thos epatients who can't pay for the surgery? Outcome is the same.just it takes longer for the fracture to heal in traction then it does with a rod. What about CABG? SHould we be paying for CABG for smokers? What about type II diabetics who are not compliant?  Yep, I am a strong believer in personal repsonsibility. I am also in favor of providing care for the needy but believe that the more fortunate can get different, not necessarily better care. For me it's like owning a car. Some people can afford a Lambourghini, others only a HUgo. If the taxpayers are paying for the car, then the recipient should get a Hugo.     Marty
Martin Herman, M.D.

Pediatric Emergency Medicine 
Sacred Heart Children's Hospital
FSU @ Sacred Heart, Division of Pediatrics
5153 N. 9th Ave, 6th Floor Nemours Bldg
Pensacola, FL 32504
Ph: 850 416 7658(office)
Ph: 901 219 9202 ( cell)
Fx: 850 416 7677
Email: [log in to unmask]
 
CONFIDENTIALITY NOTICE: 
This email message and any accompanying data or files is confidential and may contain privileged information intended only for the named recipient(s). If you are not the intended recipient(s), you are hereby notified that the dissemination, distribution, and or copying of this message is strictly prohibited. If you receive this message in error, or are not the named recipient(s), please notify the sender at the email address above, delete this email from your computer, and destroy any copies in any form immediately. Receipt by anyone other than the named recipient(s) is not a waiver of any attorney-client, work product, or other applicable privilege.



 Date: Sat, 30 Jun 2012 17:07:21 -0400
Subject: Re: Technology!
From: [log in to unmask]
To: [log in to unmask]
CC: [log in to unmask]

And if denial of that service leads to death?  bodily harm?  or permanent disability?  Part of what defines us as a profession is that we have a duty to act, not for money, but because it's the moral and ethical thing to do.  I will leave this profession if that mindset prevails....sorry! 
Mike

On Sat, Jun 30, 2012 at 3:06 PM, Marty Herman <[log in to unmask]> wrote:

ANdrew, If a service is not covered then we shouldn't provide it. I would not complain that "you can bill all you want, it's still not going to get paid".  So if the law prevents a physician form billing for a service tha tis not covered, ie most government programs , then those patients just don't get offered the service. THose who decide to pay and are allowed to , would then abe able to get a service, otherwise denied to others. That is life..




Marty

Martin Herman, M.D.



Pediatric Emergency Medicine

Sacred Heart Children's Hospital

FSU @ Sacred Heart, Division of Pediatrics

5153 N. 9th Ave, 6th Floor Nemours Bldg

Pensacola, FL 32504

Ph: 850 416 7658(office)

Ph: 901 219 9202 ( cell)

Fx: 850 416 7677

Email: [log in to unmask]



CONFIDENTIALITY NOTICE:

This email message and any accompanying data or files is confidential and may contain privileged information intended only for the named recipient(s). If you are not the intended recipient(s), you are hereby notified that the dissemination, distribution, and or copying of this message is strictly prohibited. If you receive this message in error, or are not the named recipient(s), please notify the sender at the email address above, delete this email from your computer, and destroy any copies in any form immediately. Receipt by anyone other than the named recipient(s) is not a waiver of any attorney-client, work product, or other applicable privilege.








 > Date: Tue, 26 Jun 2012 17:45:43 -0400

> From: [log in to unmask]

> Subject: Re: Technology!

> To: [log in to unmask]

>

> You can BILL all you want, it is just that insurance, especially

> government "insurance" will not PAY.

>

> Andrew

>

> On Tue, Jun 26, 2012 at 5:08 PM, Dr. Adam Friedlander

> <[log in to unmask]> wrote:

> > Who's to say you can't bill for the interaction?  Psychiatrists, lawyers,

> > accountants...they all bill for phone interactions, and more and more

> > physicians across the country are doing the same - especially those

> > physicians with their nice little boutique practices that don't accept

> > insurance.  A general pediatrician should DEFINITELY bill for telemedicine,

> > which is what this is.

> >

> > As the dual trained (EM and Peds) guy in my practice, many peds cases are

> > funneled to me when I am working, and there a quite a few kiddos who could

> > have easily stayed home if mom had sent us a photo, or had a FaceTime

> > interaction.  Nobody should suggest, however, that the advice should be

> > free, or that there shouldn't be appropriate informed consent for

> > telemedicine interactions...

> >

> > Adam D. Friedlander, M.D.

> > Nothside-Forsyth Emergency Department

> > Northside Emergency Associates

> >

> >

> >

> > On Tue, Jun 26, 2012 at 4:55 PM, Darrell Looney <[log in to unmask]> wrote:

> >

> >> I think a lot of the hostility is coming from the fact that more and more

> >> of us recognize that patients are held to no standard and therefore do

> >> whatever they want, while we as medical professionals are constantly

> >> buffeted by winds of changing regulation. Whether from the tempest of Press

> >> Ganey or the throws of litigation, it's hard to place confidence on

> >> technology or thought processes which utilize diagnostic acumen of those

> >> who seek to hold everyone else responsible for any bad outcomes associated

> >> with its use.

> >>

> >> The technology in and of itself = good

> >>

> >> The technology in the hands of those using it with impunity = misuse,

> >> abuse, poor decision making and poor outcomes (in other words, bad)

> >>

> >> Amazing that such a potentially useful gadget could have such great social

> >> benefit in a place like the African outback, while representing significant

> >> liability here in the US.

> >>

> >> DLooneyMD

> >>

> >> *****************************************************

> >> Shape your musical landscape! Add some funky violin jazz to your vibe!

> >> Da Phatfunk Clique

> >> DPC on Jango!

> >> DPC on Myspace!

> >> DPC on Facebook!

> >>

> >>

> >> > Date: Tue, 26 Jun 2012 15:41:54 -0400

> >> > From: [log in to unmask]

> >> > Subject: Re: Technology!

> >> > To: [log in to unmask]

> >> >

> >> > Wow, lot of hostility to technology!!  It's simply a tool like a

> >> > stethoscope, US, an otoscope, and is only helpful when used right.  But

> >> it

> >> > can be very helpful: they are using cell phone, pictures and text

> >> messages

> >> > in parts of Africa to expand the MD/RN coverage it to areas that are hard

> >> > to reach but are covered by cell service.  From what I have heard, it is

> >> > very useful and may even save a few lives.  The same thought has been

> >> used

> >> > to radically change farming practices and banking in the Developing

> >> world.

> >> >

> >> > Perhaps, we should look at how we can work with technological advances

> >> like

> >> > this, and the others that are coming (know 3 people personally, who are

> >> > working on similar cell technology as in Africa to be used here in North

> >> > America), for every one's benefit?  Might make life better for all of

> >> > us....just a thought!

> >> > MIke Falk.

> >> >

> >> >

> >> > On Tue, Jun 26, 2012 at 10:45 AM, Marty Herman <[log in to unmask]>

> >> wrote:

> >> >

> >> > > I wouldn't use this to prescribe. Maybe the FDA should just make every

> >> > > drug over the counter. Then people could just self diagnose and treat.

> >> If

> >> > > they are right, great, terrific, they save money. Butif they screw up

> >> , and

> >> > > need a physician to straighten out their health, well my fee wold be

> >> very,

> >> > > very high..and cash only!

> >> > >

> >> > > Marty

> >> > > Martin Herman, M.D.

> >> > >

> >> > > Pediatric Emergency Medicine

> >> > > Sacred Heart Children's Hospital

> >> > > FSU @ Sacred Heart, Division of Pediatrics

> >> > > 5153 N. 9th Ave, 6th Floor Nemours Bldg

> >> > > Pensacola, FL 32504

> >> > > Ph: 850 416 7658(office)

> >> > > Ph: 901 219 9202 ( cell)

> >> > > Fx: 850 416 7677

> >> > > Email: [log in to unmask]

> >> > >

> >> > > CONFIDENTIALITY NOTICE:

> >> > > This email message and any accompanying data or files is confidential

> >> and

> >> > > may contain privileged information intended only for the named

> >> > > recipient(s). If you are not the intended recipient(s), you are hereby

> >> > > notified that the dissemination, distribution, and or copying of this

> >> > > message is strictly prohibited. If you receive this message in error,

> >> or

> >> > > are not the named recipient(s), please notify the sender at the email

> >> > > address above, delete this email from your computer, and destroy any

> >> copies

> >> > > in any form immediately. Receipt by anyone other than the named

> >> > > recipient(s) is not a waiver of any attorney-client, work product, or

> >> other

> >> > > applicable privilege.

> >> > >

> >> > >

> >> > >

> >> > >  > Date: Mon, 25 Jun 2012 23:13:27 -0500

> >> > > > From: [log in to unmask]

> >> > > > Subject: Re: Technology!

> >> > > > To: [log in to unmask]

> >> > > >

> >> > > > Very cool device.

> >> > > >

> >> > > > The manufacturer claims it could reduce the cost of healthcare by

> >> > > reducing office visits. So your doctor sees you over the Iphone but

> >> > > insurance won't pay for a phone encounter. All the liability, no

> >> payment.

> >> > > Maybe the patient could send the image to the nurse call line from

> >> their

> >> > > insurance provider who might not even be in the USA and get a

> >> prescription

> >> > > sent from Mexico.

> >> > > >

> >> > > >

> >> > > >

> >> > > > Jason Foland, MD

> >> > > > Clinical Associate Professor of Pediatrics

> >> > > > Florida State University COM

> >> > > > Medical Director, Pediatric Respiratory Therapy

> >> > > > Pediatric Critical Care Physician

> >> > > > Sacred Heart Children's Hospital

> >> > > > Pensacola, Florida

> >> > > >

> >> > > > Sent from my iPad

> >> > > >

> >> > > > On Jun 25, 2012, at 8:21 AM, "Radhika Vijayan" <[log in to unmask]>

> >> wrote:

> >> > > >

> >> > > > > Have any of you heard of this new device aparently being tested in

> >> Bay

> >> > > area.

> >> > > > >

> >> > >

> >> http://www.technologyreview.com/news/428197/parents-could-skip-the-doctors-office-with-this/


> >> > > > >

> >> > > > > One of my collegues came across this article.

> >> > > > > Sounds like a new wave in health care

> >> > > > > Radhika Vijayan

> >> > > > > HackensackUMC

> >> > > > >

> >> > > > >

> >> > > > >

> >> > > > >

> >> > > > >

> >> > > > >

> >> > > > >

> >> > > > >

> >> > > > >

> >> > > > > Build yourself a Temple of Peace, which no man can take away, no

> >> power

> >> > > can

> >> > > > > destroy, With a life of Harmony, find your joy in Yourself, exactly

> >> > > where you

> >> > > > > are now.

> >> > > > > Swami Chinmayananda

> >> > > > >

> >> > > > > For more information, send mail to [log in to unmask]

> >> > > the message: info PED-EM-L

> >> > > > > The URL for the PED-EM-L Web Page is:

> >> > > > >                 http://listserv.brown.edu/ped-em-l.html

> >> > > >

> >> > > > For more information, send mail to [log in to unmask] with

> >> the

> >> > > message: info PED-EM-L

> >> > > > The URL for the PED-EM-L Web Page is:

> >> > > >                  http://listserv.brown.edu/ped-em-l.html

> >> > >

> >> > > For more information, send mail to [log in to unmask] with

> >> the

> >> > > message: info PED-EM-L

> >> > > The URL for the PED-EM-L Web Page is:

> >> > >                 http://listserv.brown.edu/ped-em-l.html

> >> > >

> >> >

> >> > For more information, send mail to [log in to unmask] with the

> >> message: info PED-EM-L

> >> > The URL for the PED-EM-L Web Page is:

> >> >                  http://listserv.brown.edu/ped-em-l.html

> >>

> >> For more information, send mail to [log in to unmask] with the

> >> message: info PED-EM-L

> >> The URL for the PED-EM-L Web Page is:

> >>                 http://listserv.brown.edu/ped-em-l.html

> >>

> >

> > For more information, send mail to [log in to unmask] with the message: info PED-EM-L

> > The URL for the PED-EM-L Web Page is:

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>

> For more information, send mail to [log in to unmask] with the message: info PED-EM-L

> The URL for the PED-EM-L Web Page is:

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For more information, send mail to [log in to unmask] with the message: info PED-EM-L

The URL for the PED-EM-L Web Page is:

                 http://listserv.brown.edu/ped-em-l.html


 		 	   		  
For more information, send mail to [log in to unmask] with the message: info PED-EM-L
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