The American Thoracic Society and its International conference continues to enlarge. Of 15,000 registrants, there were 12,000 professionals including 3,000 international physicians who made the trek to New Orleans this year. It was a pleasure to be sharing ideas with colleagues from three continents over breakfast and en route to conferences. Valentine Poppa, a member of SEDMS and of Sacramento Medicine editorial committee, was the chair of the session, “Pulmonary Manifestations of Immunoglobulin Deficiency” and presented a paper entitled “Pulmonary Manifestations of IgG, IgA and IgM Deficiency.” Congratulations, Val.
Arthur Gelb, MD, who once considered Sacramento as a possible practice location, gave a renegade session at an off-site hotel concerning lung reduction surgery. There were also a number of “legitimate” seminars and symposia on this subject. One Chief of Thoracic Surgery who gave a “Meet the Professor” session, pointed out that surgeons were using RBRVS codes for bullectomy or pleurodesis as the closest thing to “lung reduction surgery.” He said surgeons were upset that medicare recipients had a good deal with cheap charges. A medicare reviewer has advised the professor that using the wrong RBRVS code, even though the charge is less, is considered MEDICARE FRAUD… We, of course, understand medicare fraud in Sacramento since one of our members is sitting in jail for using what he thought was the closest RBRVS code for what he was doing.
The president’s lecture was given by Bernard Lo, MD, Professor of Medicine and Director of the Program in Medical Ethics at UCSF. He suggested that managed care is needed to control costs, because physicians aren’t doing it. HMOs cover 29% of all insured persons, PPOs (Preferred Provider Organization) 29%, POSs (Point of Service Plans) 14%, and FFS (Fee For Service) are at 29% and shrinking. He stated that HMOs are no longer growing as fast as expected. Dr Lo said that typical monthly premiums for a family of four at UCSF are $361, $388, $387, and $990, respectively. (The latter was called “the Mercedes” of the plans–does that make the cheap HMO the “Geo Metro” plan?) He mentioned that he had opted for the lowest plan, reducing his premium from $388 to $361, a $27 savings. Do you suppose he drives a GEO Metro or Mercedes? It always interests me to see if people are more particular about their mechanized fossil fuel burning vehicles than their own complex biochemical physiology. As physicians shouldn’t we challenge the public’s willingness to spend more on their cars than their bodies?
After enjoying Pete Fountain’s superb clarinet at his club inside the Riverside Hilton, our city tour guide in New Orleans said we should visit Bourbon Street one night, even if only for 10 minutes. “N’awlings”, as the natives say, is the birthplace of Dixieland Jazz. Al Hirt wasn’t playing the evening we walked through Bourbon Street, which is closed off to traffic at 8PM each night to allow people to wander from clubs on one side of the street to those on the other side. Stages of some of the clubs could be seen from the street, giving impetus to public nudity, and inviting orgies. The Doctors that stayed in the French Quarter complained that the noise was so loud until 2 AM that they couldn’t sleep. The commotion resumed at 5:30 AM when trucks came to wash down the streets. Many of the revelers emptied their bladders and stomachs all over the streets and sidewalks. No wonder the streets had to be hosed down every morning before the work day started. Humans must be the only mammals that mistreat their bodies in this fashion and call it fun.
We got home just in time to welcome friends from London who make an annual trek to our own Dixieland Jazz festival as well as festivals in Europe and Australia. We enjoyed discovering Bodo Bucar’s Green Town Jazz Band from Slovenia, Bob Pelland’s Grand Dominion Jazz Band from Vancouver, Nobby Baldwin’s Merseysippi Jazz Band from Liverpool, and Hamish McGregor’s Fat Sam Jazz Band from Scotland. Two weeks of contact with international friends who are willing to share their global point of view was truly engaging.