Wednesday, October 31, 2007

Scenes from an Ultrasound: Part Deux

Ultrasound Tech: Wow… she’s big….

Us: Really? How big?

Ultrasound Tech: Well, the measurements put her at 3 lbs. 2 oz.

Us: Hmmm….

*cut to OB’s office*

OB: She’s a big baby!

Me: Yeah, the tech mentioned that.

OB: No, really- only about 15-20% of babies are that big!

Me: Well, that figures. Her Daddy was 10 lbs. 3 oz.

OB: (palpating my abdomen) Yep, she’s a big big girl.

Me: Terrific.

So the general consensus seems to be that Vivian is A) healthy and B) large. This suits me just fine. I’d much rather partake of an epidural and other God-given medical interventions to birth my behemoth child than to worry over a tee-niny baby in the NICU. But don’t think Mama won’t push for the induction if Baby Girl continues to plump up at this rate.
Here’s the Reader’s Digest report on the physical aspects of the pregnancy.
Large. So large.
Heartburn, reflux, repeat.
Can’t reach itchy ankles.
Four words: feet in my ribs.
But the hard part is that I’m now officially riding the “pregnancy emotional roller-coster” as my favorite POS book called it. I cry. A lot. And I’m so damn tired I can’t see straight. Which probably doesn’t help the crying. It’s a crappy gig, since I am not accustomed to being unable to control these things with an iron… um… tear duct.
Don’t get me wrong- I am well aware these are temporary conditions and I will gladly do this for ten more weeks to get a healthy happy baby. But only doing it for nine weeks wouldn’t suck. Just sayin’.

Monday, October 08, 2007

An Open Letter

To The Women of the 2nd Floor:

It is horrifically bad she-karma to allow a PREGNANT WOMAN, much less any other sister, to exit the ladies room with her dress rucked up in the backside of her panties.

You know who you are.

A curse upon you. May your maxi pad adhesive yank at your pubes.

The Waddling Woman in Green

Thursday, October 04, 2007

Household Budget: Mortgage, Groceries, Health Care Fraud...

Over at DC Metro Moms today, Lawyer Mama started a discussion about health care. She correctly points out that for the average working class family (even those of us with “good” insurance) a single major illness or accident could prove financially catastrophic. And while it’s easy to point the finger at employers for not providing better (or in some cases, any) coverage or taking on bigger a bigger share of the premiums, the reality is that their costs for employee health care are also a financial burden, particularly for small businesses. Like Lawyer Mama, I want to see the candidates go after this issue in earnest. Also like Lawyer Mama, I don’t pretend to have all the answers. But let me offer a modest proposal.

The major barrier to more comprehensive and far-reaching health care coverage we hear about is cost. Nobody wants to pay for the oft-cited "skyrocketing healthcare costs" whether that's private employers or the government through socialized medicine. The irony of this is that health plans/payers/government agencies are missing MAJOR opportunities to cut those costs (and thereby making coverage more affordable/available) through comprehensive anti-fraud programs.

I work for a company whose primary line of business is as a Program Safeguard Contractor, or PSC for the Centers for Medicare and Medicaid Services. Broken down into simplest terms, we detect, investigate, and hopefully try to prevent Medicare fraud and abuse. Truthfully, CMS is really the only bright spot, in that their anti-fraud endeavors through the PSCs have been amazingly effective. The one little company I work for (180 employees total) typically gives the government an 11/1 ROI. Yes, that's right- we return about $11 to the Medicare trust fund for every $1 they spend on our operations. Last year, we identified about $220 million in fraud and abuse just in Medicare claims alone. Bottom line is what we do WORKS. And works well.

But most private insurers don't have any kind of decent anti-fraud measures in place. In many states, they are required to have some specific controls, but nothing nearly so comprehensive as the Medicare PSCs. Most of them have an SIU (special investigations unit- Medicare Part D providers are required to have these) that responds to complaints of fraud, but do little or no proactive data analysis, much less trying to "connect the dots" so to speak and go after more than isolated incidents. Some have started buying into automated anti-fraud technology in the form of software (IBM is one of the major players). But without a more comprehensive program and personnel to pursue the leads, it's like turning your garden hose on a California wildfire. PSCs like our company combine data analysis with investigative services and medical review functions for a comprehensive product. Periodically-updated software that spits out reports to be analyzed by senior management with no fraud-detection experience? That's not a substitute for what we do.

There are a lot of reasons insurers don’t have better anti-fraud programs in place. Lots of payers don’t quite comprehend the worth of the investment. Some of them don’t want to risk alienating large providers with investigations. “Prompt payment” laws in most states limit the amount of time a company can spend researching claims before they’re paid. Anti-fraud detection isn’t a standard part of claims payment software or processes. Lots of reasons. But in my not-so-humble opinion, it often comes down to cost. Fraud investigation is, by the nature of the work, a slow process that doesn’t yield profits over night. Long-term savings and better health for American families take a back seat when the noisy voices of investors come calling.

The NHCAA has estimated that about 3% (about $39 billion in 2000) of what this country pays for healthcare is lost to blatant fraud, which doesn’t even account for erroneous payments and abuse. (Some of the other government agencies have put that estimate as high as 10%.) Can you imagine what recovering/preventing even a fraction of that would do for making healthcare more affordable for working class families and their employers? I would hope that the candidates would give some thought to doing a better job of mandating the level of fraud detection and prevention mechanisms that private health plans have in place. I think socialized or government-funded healthcare is a long way off in this country, but bringing down the costs of our current system would go a long way to make life a little easier for the average family.

Wednesday, October 03, 2007

Evil at home and abroad...

This makes me so sad. And so angry.
I mean… truly… what kind of evil has to be in someone’s heart to kill BUDDHIST MONKS protesting peacefully? Monks- a group of people who truly believe and live a doctrine of non-violence.
I imagine it’s the same kind of evil that prompts someone to shoot Amish schoolchildren. But that was just one man- we can comfort ourselves with that- just one man with a questionable grip on his own sanity.
This is a government. A GROUP of people who cannot possibly have any motive to shoot these monks who have taken to the street to protest for rights and liberties they believe to be in the best interest of others. No possible motive except for the hateful greedy desire to oppress and overpower.
I think to myself- shame on them. Shame on their cold hard evil hearts.
And then I think to myself about our government. And our leaders. Our wealthy, privileged nation…whose freely elected leader just vetoed an opportunity to provide healthcare to children. A nation that pays contractors who use violence to make money at the expense of vulnerable civilians in a war-torn country. A country whose leaders preach "family values", but will rip a family apart on technicalities created by their own muddy bureaucracies.
And I am ashamed.