7 ms·

The centerpiece case for the story is an odd one to support the assertion. The article vilifies the evil doctors who carelessly churn through disability claims

by jws 8y ago

The centerpiece case for the story is an odd one to support the assertion. The article vilifies the evil doctors who carelessly churn through disability claims, but it also notes that the doctor for the article's centerpiece was not provided any medical records indicating the patient's cancer was metastasized and inoperable. Absent that information, the determination may have been correct. The doctor made $420k/yr for full time work processing claims. That puts him somewhere between dermatologists and urologists for doctor compensation, which is on the higher end of specialists. Is that too much? I have no idea, it seems like the job requires a great deal of breadth.

jakobegger 8y ago
> the doctor was not provided... If someone makes 400000 USD a year, shouldn't we expect him to actually check if he has all the required documents before making a decision? Of course, then the doctor would need to actually review the case...
hangonhn 8y ago
"In Chrisman’s case, Thrush failed to obtain one critical piece of evidence: a discharge paper from a hospital that stated Chrisman’s cancer was inoperable and had metastasized. The prognosis clearly qualified him for disability, even under the complex rules set by the Social Security Administration. The mistake was discovered only after Chrisman hired a lawyer." Sounds like the doctor screwed up.
- jws 8y ago
  Sounds like the doctor screwed up. That probably turns on "failed to obtain". The state collects and dumps case files onto the contract doctors. Is it the doctor's responsibility to search all sources of records for ones which were omitted and might be pertinent? Do privacy rules even allow this? I assume there is some waiver signed by the applicant to allow the state to request medical records, but is that then granted to the contract doctors?
  - lazyasciiart 8y ago
    It wouldn't have to be provided to the contract doctors, you'd just need a process where the doctor says "this paperwork is missing a discharge document, without that I can't make a determination" and the state/patient can get it. (I'm not a doctor so I don't know if a discharge document is something you would expect to see in a medical history)
    - warkdarrior 8y ago
      How would the doctor know that a document is missing?
      - lazyasciiart 8y ago
        That was the caveat in parentheses.
        riahi 8y ago
        You would only know there was a discharge summary if there was a corresponding admission history and physical. If no indication of an admission to a hospital was made, then you have no reason to expect a discharge summary. However, I would imagine the radiology reports would have included the metastases...
    - arkades 8y ago
      You generally don’t get, or expect to get, every last file in a medical record. That said, a discharge summary is just that - a summary. For a cancer to be found inoperable, the record would usually include multiple imaging studies, pathology studies, reports analyzing the above, a specialist consult note, a primary internist note addressing the specialist consult note, etc. A lot would have to be missing for there to be no hint of this. Normal medical records tend to have a lot of redundance around cancer diagnosis and prognosis.
- hitekker 8y ago
  Not only did Thrush screw up, the article points out he was also a convicted felon. Given the preponderance of evidence marshaled by this article, you’d have to be ideologically blind to defend this systemic crime.
logfromblammo 8y ago
One problem is that physicians are being employed to make medical decisions affecting people who are not their patients. Another problem is that politics has demolished state welfare programs that would ordinarily serve to support those who cannot work, and the only reasonable alternative to those facing homelessness and starvation is to apply for federal benefits, of which the only benefit commonly available may be Social Security disability. The politicians have already decided the people in question do not matter, and they would like to kill them off as quickly and quietly as possible, preferably in such a way that blame is not attachable to them. They have been temporarily frustrated by the fact that their targets have found some other means to acquire the means to survive. The physician that denies the disability claim by default is thus serving a political interest, not a medical or humanitarian one. They are not being paid to advance the health interests of the community, but to protect the coffers of the states from those who may have a lawful claim on the money in them, in a manner that is technically conformant with the letter of the law. The people dying while their disability denials are reviewed? That stems directly from the same political assumptions that mandate work requirements for welfare recipients. "Why should we give them money, if they're just going to die soon anyway, and they will never be able to pay it back?" It's the same premise businesses use to fire workers that are temporarily unproductive. "If you aren't making me money continuously, and especially right now, I have no further interest in you, so get out." So if you have stage IV metastatic cancer, and are unable to walk, stand, or sit, and may have enough pain and/or pain-management medication to make concentration difficult, then I guess you had better make sure you fill out your complex bureaucratic forms correctly, as just one of the many things you have to juggle now in order to not die. You also have to trust that everyone else involved, none of whom have any direct stake in your outcome, will also fill out their forms correctly. You can temporarily alleviate the symptom, but you cannot cure the disease without addressing its root cause: people who lack empathy for the infirm and the insolvent have acquired a large amount of power over both the government bureaucracy and the healthcare business. Thus I suspect that the only phrase the review physician really needed to make a disability determination--"diagnosis: inoperable stage IV metastatic cancer"--was intentionally omitted from the review materials, because it was the only way to plausibly deny the application. A vital missing record can plausibly be explained as accidental, if you intentionally make the bureaucratic process onerous enough. Absent that vital datum, the whole dossier of review materials was absolutely useless. There is no point in employing an impartial administrative physician at all, if the medical record is incomplete. In that light, paying someone $0.5M every year for "garbage in, garbage out" processing is a lot more than the healthcare value provided to the patients. But paying someone $0.5M to paint a veneer of respectability, professional expertise, and due process over a system that would otherwise be paying out many millions in disability benefits is a lot less than the political value provided to the system. It's a lot cheaper to pay out $0.5M and let those sick people die, than to pay out those millions to keep them all alive just a little longer, at $800 apiece, every month until they kick off. So the corrupt physicians working admin jobs under contract to the state aren't really at fault. Vote for government representation that believes "provide for the general welfare" is more of a mandate than an introductory rationale. Pay more to buy products from companies whom you know to be honorable with respect to their treatment of their workers. Try to treat people that you encounter in your job like people, rather than tasks or obstacles. You can't meaningfully change the outcome until you change the culture that produced it.

by jws 8y ago

jakobegger 8y ago

> the doctor was not provided... If someone makes 400000 USD a year, shouldn't we expect him to actually check if he has all the required documents before making a decision? Of course, then the doctor would need to actually review the case...

hangonhn 8y ago

"In Chrisman’s case, Thrush failed to obtain one critical piece of evidence: a discharge paper from a hospital that stated Chrisman’s cancer was inoperable and had metastasized. The prognosis clearly qualified him for disability, even under the complex rules set by the Social Security Administration. The mistake was discovered only after Chrisman hired a lawyer." Sounds like the doctor screwed up.

jws 8y ago
Sounds like the doctor screwed up. That probably turns on "failed to obtain". The state collects and dumps case files onto the contract doctors. Is it the doctor's responsibility to search all sources of records for ones which were omitted and might be pertinent? Do privacy rules even allow this? I assume there is some waiver signed by the applicant to allow the state to request medical records, but is that then granted to the contract doctors?
- lazyasciiart 8y ago
  It wouldn't have to be provided to the contract doctors, you'd just need a process where the doctor says "this paperwork is missing a discharge document, without that I can't make a determination" and the state/patient can get it. (I'm not a doctor so I don't know if a discharge document is something you would expect to see in a medical history)
  - warkdarrior 8y ago
    How would the doctor know that a document is missing?
    - lazyasciiart 8y ago
      That was the caveat in parentheses.
      - riahi 8y ago
        You would only know there was a discharge summary if there was a corresponding admission history and physical. If no indication of an admission to a hospital was made, then you have no reason to expect a discharge summary. However, I would imagine the radiology reports would have included the metastases...
  - arkades 8y ago
    You generally don’t get, or expect to get, every last file in a medical record. That said, a discharge summary is just that - a summary. For a cancer to be found inoperable, the record would usually include multiple imaging studies, pathology studies, reports analyzing the above, a specialist consult note, a primary internist note addressing the specialist consult note, etc. A lot would have to be missing for there to be no hint of this. Normal medical records tend to have a lot of redundance around cancer diagnosis and prognosis.
hitekker 8y ago
Not only did Thrush screw up, the article points out he was also a convicted felon. Given the preponderance of evidence marshaled by this article, you’d have to be ideologically blind to defend this systemic crime.

logfromblammo 8y ago

One problem is that physicians are being employed to make medical decisions affecting people who are not their patients. Another problem is that politics has demolished state welfare programs that would ordinarily serve to support those who cannot work, and the only reasonable alternative to those facing homelessness and starvation is to apply for federal benefits, of which the only benefit commonly available may be Social Security disability. The politicians have already decided the people in question do not matter, and they would like to kill them off as quickly and quietly as possible, preferably in such a way that blame is not attachable to them. They have been temporarily frustrated by the fact that their targets have found some other means to acquire the means to survive. The physician that denies the disability claim by default is thus serving a political interest, not a medical or humanitarian one. They are not being paid to advance the health interests of the community, but to protect the coffers of the states from those who may have a lawful claim on the money in them, in a manner that is technically conformant with the letter of the law. The people dying while their disability denials are reviewed? That stems directly from the same political assumptions that mandate work requirements for welfare recipients. "Why should we give them money, if they're just going to die soon anyway, and they will never be able to pay it back?" It's the same premise businesses use to fire workers that are temporarily unproductive. "If you aren't making me money continuously, and especially right now, I have no further interest in you, so get out." So if you have stage IV metastatic cancer, and are unable to walk, stand, or sit, and may have enough pain and/or pain-management medication to make concentration difficult, then I guess you had better make sure you fill out your complex bureaucratic forms correctly, as just one of the many things you have to juggle now in order to not die. You also have to trust that everyone else involved, none of whom have any direct stake in your outcome, will also fill out their forms correctly. You can temporarily alleviate the symptom, but you cannot cure the disease without addressing its root cause: people who lack empathy for the infirm and the insolvent have acquired a large amount of power over both the government bureaucracy and the healthcare business. Thus I suspect that the only phrase the review physician really needed to make a disability determination--"diagnosis: inoperable stage IV metastatic cancer"--was intentionally omitted from the review materials, because it was the only way to plausibly deny the application. A vital missing record can plausibly be explained as accidental, if you intentionally make the bureaucratic process onerous enough. Absent that vital datum, the whole dossier of review materials was absolutely useless. There is no point in employing an impartial administrative physician at all, if the medical record is incomplete. In that light, paying someone $0.5M every year for "garbage in, garbage out" processing is a lot more than the healthcare value provided to the patients. But paying someone $0.5M to paint a veneer of respectability, professional expertise, and due process over a system that would otherwise be paying out many millions in disability benefits is a lot less than the political value provided to the system. It's a lot cheaper to pay out $0.5M and let those sick people die, than to pay out those millions to keep them all alive just a little longer, at $800 apiece, every month until they kick off. So the corrupt physicians working admin jobs under contract to the state aren't really at fault. Vote for government representation that believes "provide for the general welfare" is more of a mandate than an introductory rationale. Pay more to buy products from companies whom you know to be honorable with respect to their treatment of their workers. Try to treat people that you encounter in your job like people, rather than tasks or obstacles. You can't meaningfully change the outcome until you change the culture that produced it.