The AMA has a blog (no comments allowed, yet), and a VISION for Health Reform. It all sounds so wonderful and idyllic. Some of us bought into this mindset decades ago with good intentions, only to be used, abused, and betrayed by many who we thought were on the same road to provide care to our patients. The AMA still has good intentions, but it may be warped into positions which are not intended by the membership, (and non-membership). These physicians have little to say in the organization, if they continue voting with their feet.
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Tuesday, September 1, 2009
Friday, August 28, 2009
Travel Subsidy on the Health Train Express
The real 'deal'
The American Medical Association came out in favor of the House Democratic health care bill when the House Democratic leadership promised the doctors $230 billion in new spending to cancel out any future Medicare physician cuts (which are scheduled under an existing law called the Medicare Sustainable Growth Rate Formula). As a result, the doctors don’t have to give up anything under the health bills, and would actually pick up $230 billion under the House bill over 10 years.
Hundreds of 'sound bytes' and snippetes of highly charged statements are read daily by patients, providers and decision makers. Unfortunately for the uninformed (and even the informed) ferreting out the 'truth' is very difficult.
Both Republicans and Democrats seek the position to regain p ower, or retain power. One has to take with a grain of salt, analysis from either side of the aisle.
It's up to we the people to analyze and make your own decision regarding health issues, and be certain your opinion reaches your representatives. Avoid being a leftist or a right winger.
Perhaps we should not make any decision this year in the midst of economic upheaval from which we have not yet recovered.
Bailing out banks, financial institutions, automobile industry have left us all a bit depleted and in no position to make such a critical decision.
Professionals cast a jaundiced eye upon statistics and projections of healthcare financing. In reality it is difficult to imagine health care costs in 2016, while dealing at the present moment with a diffiicult system that is challenging to navigate for providers and patients alike.
I like to compare health reform to the end goal of orbiting a satellite. The most effective means of accomplishing this task is by 'staging' a rocket with three booster segments.
It would be almost impossible to accomplish this task with a 'one stage rocket'. This is also true of health reform.
One Small Step
Gravity acts to keep objects on earth and our present health system also retards change with inertia.
Here is some of the last weeks analysis.
WSJ's blog on health and the business of health.
Claims that health reform will be disastrous for businesses and government are wrong, writes Gary Locke, the U.S. secretary of commerce in an op-ed in the WSJ. Making his case for reform, Locke says that climbing health care costs already cost American businesses jobs and revenue, as well as entrepreneurship, and that isn’t sustainable. “In the short term, health-care costs pose a major problem for companies and their employees,” writes Locke. “In the medium and long-term, these costs pose serious challenges to our economy.”
Fixing Health Care will be good for the Economy
Wednesday, August 26, 2009
A Missing Passenger of the Health Train
Edward (Ted) Kennedy, D, Mass, departed from the Health Train yesterday. A significant voice in health affairs has left the stage. Not much more can be said by me when others have so elequantly described his life, and times. Health Train Express offers condolences to his family and constituents.
A moment of silence.....
Ramblings on the Health Train
My day here at the government run undisclosed location started off with my morning read of health related blogs, pundits, and rumor mongers.
Buckeye Surgeon from Ohio presents a personal interview with two of his medical school chums, one in private practice and the other who is employed by the Cleveland Clinic. Rather than trusting media sources and medical management statistics, Buckeye decided to do his highly statistically significant study with a cohort of two…..My take on the interview is that some doctors like to work in a group practice, while others are individualists, and like to work alone or in a smaller controllable environment, where you have a choice of wallpaper color, who you hire and fire, and are accountable for just about all you need to practice medicine, and all that you perform. That is what is so unique and vibrant about our health care system….choices for physicians and patients.
Over at MedPolitics , and RealClear Politics The discussion turns to the uninsured.
Here is the “scoop” from t he CATO Institute regarding the uninsured, and who they really are.
Monday, August 24, 2009
Lieberman--A Voice in the Wildness
One of the Senate's most powerful Democrats, Joseph Lieberman said Sunday that President Obama should take an "incremental" approach to fixing health care and argued that the country should postpone adding nearly 50 million new patients to the government system until after the recession is over.
"We morally, every one of us, would like to cover every American with health insurance," Sen. Joseph Lieberman of Connecticut, told CNN's John King on the "State of the Union" program.
One of the Senate's most powerful Democrats said Sunday that President Obama should take an "incremental" approach to fixing health care and argued that the country should postpone adding nearly 50 million new patients to the government system until after the recession is over.
"We morally, every one of us, would like to cover every American with health insurance," Sen. Joseph Lieberman of Connecticut, told CNN's John King on the "State of the Union" program.
"I'm afraid we've got to think about putting a lot of that off until the economy's out of recession," he added.
"There's no reason we have to do it all now, but we do have to get started. And I think the place to start is health delivery reform and insurance market reforms."
Although we physicians recognize perhaps more than most that out health system is flawed, most know that this must be accomplished in small steps, focusing first on defects in our insurance system, which lead to the increasing numbers of insured, and increasing overhead to physicians and our society in general.
In the back of each our minds are the millions of uninsured who present in our offices, on an hourly basis, in the emergency department and public health clinics.
The term "The Public Option" thus far remains clouded in hyperbole, sounds good or bad, depending if your leaning is to the left, or to the right.
For many "The Public Option" remains a poorly disguised euphemism for Socialized Medicine.
Wednesday, August 19, 2009
Value, Security, Beauty and Elegance
Mark Smith, CEO California Health Care Foundation, (video link) spoke at the Microsoft Connected Health Conference meeting in June.
Comparisons between Richard Nixon’s Health Reform Proposals and Obama’s proposals..as described by Mark Smith, illuminate the similarities and differences. Read what a staunch conservative Republican proposed for a national health universal payor program.
Mark Smith and the things to get ‘right’
- Standards
- How will we wire doctors …nagging fear
- Attributes for providers:
- Simplicity, Adaptability, Functionality
- Attributes for “patients”
- Value (for the patient) solve the patients perceived needs.
- Security and privacy issues
- Beauty, elegance (something ‘they want’)
Dr Smith presented what doctors and patients would like from health IT developers.
K.I.S.S.
Health care financing in itself is a morass of complicated systems. Those who wish to make it as simple as possible, are mistakenly driven toward a universal payor model. What lurks behind the scene with that model is unknown and unintended levels of bureaucracy and the considerable expense of reorganization of the entire system.
It seems public opinion is focusing on these elements:
1. Eliminate cherry picking by private payers, elimination of exclusionary policies and waivers as well as predatory premiums.
2. A public option (which could be temporary) for lapses in employment, and/or insurability, or disability
3. Developing an actuarial insurance base that includes all citizens of the United States.
4. Elimination of free care for undocumented aliens.
5. Elimination of reimbursements based upon procedural coding.
6. Transparency and private oversight of government insurance plans and development of health IT.
7. Improve physician availablity for both primary care and specialty physicians by ''federalizing' medical licensure. Present state regulations amount to restraint of free trade. State licensing largely depends upon national testing standards.
K.I.S.S. Keep it Simple, Stupid !
Tuesday, August 18, 2009
The SERMO-AMA Disconnect
Kevin MD today makes some keen observations about the recent dissolution of the AMA – SERMO connection. The sad fact is the outcome weakens the credibility of both organizations. No one knows what the ‘pre-nuptial agreement’, nor what investment in hard cash we as physicians made in SERMO. It would be nice if there were some transparency, other t han the posturing of either side.
My view is that we as physicians were hurt by these events. Neither side seems to want to own accountability for the rupture in the partnership. My guess is that The American Medical Association reacted like a ‘hurt parent’ when confronted by SERMO with the ‘truth’. The AMA and it’s board obviously did not see the relationship as mutually beneficial. The American Medical Association seems to have treated SERMO as a mere ‘marketing opportunity” for the AMA. They never really saw this relationship as a true “partnership.” Partnerships require trust, and trust requires time and actions to prove it’s worth. The AMA lost the opportunity to hear from the disenchanted physicians who no longer belong to the AMA. Perhaps the AMA thinks that by withdrawing its support for SERMO, it will wither and die. SERMO will find a number of other suitors. Mere numbers do not make any organization strong. Many ordinary decision makers and the general public no longer see the AMA as representative of doctors, and the AMA now shares the stereotyping as just one more special interest lobbying group.
Even as an early supporter of SERMO, and Dr. Palestrant’s meteoric rise in medical social networking, as well as major media, I feel somewhat chagrined, and can feel the angst of Dr. Palestrant….
I do not know the inner workings or the need for capital that SERMO required when the partnership was formed. The AMA is a much more mature and well structured organization, not dependent on the actions of one man. Dr. Palestrant seems to act alone, however I do know that I once served on an advisory council. I haven’t heard anything about that council for several years.
The fact that so few replied to the survey about the AMA is not surprising, given that most surveys have a very low yield . Also, given the fact that most doctors only occasionally sign into SERMO occasionally most missed the actual survey itself.
The fact is that doctors need the AMA, and also need organizations such as SERMO.
Other organizations have made the same observations
Saturday, August 15, 2009
Daniel Palestrant, MD
Dan Palestrant, CEO and founder of Sermo.com has made the rounds of three media giants CNN, MSNBC, & CNBC.
In a friendly face-off with the AMA and other organized medical groups, Dr. Palestrant ably demonstrates that the AMA does not accurately represent many physicians. Of the 800,000 physicians less than 250,00 are AMA members.
What is fascinating to me is that SERMO began only three years ago as a meeting place for grand rounds, and physician to physician interaction regarding interesting clinical cases and treatments. Members must be authenticated as duly licensed and credentialled MDs or DOs. Sermo's 110,000 members represent all specialties of medicine from family practice to all specialties.
Members communicate almost in real time posting in different categories of interest, ranging from business, politics, practice management to each specialty. SERMO also surveys it's membership regarding clinical issues and treatment. The high interest in health reform and AMA positions on health reform stimulated active discussions on the SERMO boards, and it became apparent that 90% of participants did not support AMA positions. Dr. Palestrant decided to provide a more formal poll of issues. In the limited time available for sound bytes he was unable to elaborate on all the other issues of concern to physicians.
Sermo has unexpectedly developed into a sounding board for previously alienated physicians, not it's original intent.
SERMO has only been in existence less than three years.
Not only will SERMO continue to play an important part in health reform discussions, but it will also have a moderating effect on the AMA from a formerly silent minority (majority) of physicians.
Hat's off to Daniel Palestrant MD another courageous physician and true visionary.
Thursday, August 13, 2009
Mr. President: 'Shut up!'
The above title is my own..GML
The $50,000 Gangrenous Foot
By Buckeye Surgeon
"This one just takes the cake. We're definitely going to need another Beer Summit after President Obama's latest gaffe:
"If a family care physician works with his or her patient to help them lose weight, modify diet, monitors whether they're taking their medications in a timely fashion, they might get reimbursed a pittance. But if that same diabetic ends up getting their foot amputated, that's 30,000, 40, $50,000 immediately the surgeon is reimbursed. But why not make sure that we're also reimbursing the care that prevents the amputation? Right? That will save us money."
The ignorant arrogance, it just oozes. Vascular surgeons are getting 50 grand to lop off legs? Interesting. I surely would have done a vascular fellowship if that were the case. Sounds like a gravy train. Sit around, wait for poorly remunerated, overworked primary care docs to neglect the diabetic care of their patients, and boom, one day six of them show up in the office with gangrenous feet. Jackpot!
Listen, amputation is the procedure of last resort. And generally patients don't get referred to vascular surgeons needing amputations. They get referred with rest pain or with ischemic/diabetic ulcers. And then it's a progression of intervention. Conservative care. Stenting. Fem-pop bypass. Revision bypass. Fem-distal bypass. And then, finally, when all else has failed, the patient may need an amputation. And this process is generally managed entirely by the vascular surgeon!
There are those who would say (my least favorite Obama phrase) that our President "simply misspoke". But in the context of his recent remarks on ENT docs whacking out tonsils for financial gain, I tend to think that we're starting to see a pattern. The American College of Surgeons does as well. Once again, we see the President attacking the fragmented physician faction, demonizing us as the primary source of our health care woes. And the way he opted to use leg amputation as an example; chosen randomly out of thin air or a deliberate ploy? There is no more gruesome procedure in surgery than an elective amputation. The imagery and connotation it evokes is powerfully negative--- rich proceduralists hacking off your leg for a cash bonanza. Again, this man does not speak flippantly or off the cuff. Everything is purposeful.
I eagerly await the Great One's clarification of any "misrepresentations".
Mr. Obama's speech writers and advisors on health care are more than misinformed. They ignore (?purposefully?) the real facts, substitute platitudes and offer politically correct lies to bolster their reform proposals. GML
Wednesday, August 12, 2009
The Great Medicare Debate Part I JFK-Annis 1962
1962 and 2009, what do they have in common? Let's watch and listen to this presentation by John F Kennedy at the 'birth of medicare'.
I was there as a pre-medical student....it seems we have not come very far since then. $12.00/month for medicare premium... Originally presented as a program that required proof of need. JFK used the argument that the government had the duty to promote the 'general welfare"....sounds good to me.
Tuesday, August 11, 2009
WAR GAMES
War Games?
An interesting article appeared in iHealthbeat during the past month. iHealthbeat is a part of the California Health Foundation www.chcf.org and also publishes on the internet at www.ihealthbeat.org
The article points out what ‘we’ are up against with the coming health care reform, and the massive infusion of capital into health IT.
Several clips from the article:
War Game Forecasts Future of Electronic Records
by Leonard M. Fuld and Kim Slocum
Dateline: April 3, New York, N.Y.: Microsoft makes a play for Allscripts, then failing that attempt, pursues Kaiser Permanente to create an exclusive EHR-PHR agreement with the pre-eminent managed care behemoth. Allscripts independently cuts a deal with a large health care company to expand its sales force to aggressively penetrate the 80%-plus physicians who currently do not use EHRs."
Almost none of this has happened yet -- except within the confines of a war game used to stress test company strategies in the rapidly changing electronic health records industry. This war game, "The Battle for Healthcare Information," took place this spring, employing savvy health care-experienced business school students from Columbia, Kellogg, MIT and Wharton business schools. They formed teams, representing a variety of EHR players: Allscripts, Kaiser Permanente, McKesson and Microsoft.
What is a war game? It's a disciplined series of exercises designed to stress test company strategy. It does so by introducing today's economic reality and constraints rolled together with fact-based background on all the players, mostly competitors
A key point when considering staging a war game or strategy game: Do your homework. You need to do research on each of the companies whose roles you will play or test during the exercise
Another important echo comes in the comments on blogs reporting on the game. Doctors, hospital administrators, software designers and a large mass of patients have reacted strongly. Many patients are nervous about privacy issues. Doctors both fear the administrative burden and the potential distancing from patients that this technology will bring. The technology community admits that existing systems will not stand yet cannot see who can break down these tech walls, preventing true universal adoption of EHRs and PHRs.
The article diverges into areas not germane to this post.
Much of what this article discusses in regard to Health IT also applies to health reform.
Do providers and hospitals need to play more ‘War Games”? Without this strategizing no one can tell or even prophecy about unintended consequences of health reform. Because each segment of the health care industry plays to it’s own unique players, health reform may not have it’s intended consequences.
Will the changes increase the number of primary care providers? Will the changes reduce over-utilization.
Will it equalize reimbursements between primary care providers and specialists? Will bureaucracy be reduced? How will insurance companies react to legislated and mandatory rules forbidding cherry picking, waivers and exclusions, and discriminatory premiums?
Health reform is a big ticket item, complicated and will have many repercussions.
It's important to get the political issues, assumptions and ghosts regarding the "fearsome" competitor on the table in advance.
The health care industry is a highly regulated segment of the economy and has demonstrated in the past it’s unique reaction to market pressures.
Undoubtedly this will also apply to healthcare, pharma, hospitals and payors. Universal payor at first glance would seem to eliminate the vagaries of the ‘marketplace”, however it is also problematic adjusting to short and long term changes.
Sunday, August 9, 2009
Which Health Plan is Better??
Those of you who have read my two previous posts realize how fortunate we are to have Dr.Tom Coburn as a U.S. Senator. He uniquely represents physicians (as advocates of the patient). and is highly articulate, and well informed. His comments on the previous posts were from the Health, Education, Labor, and Pensions Committe during their discussions on SR 325.
WHICH HEALTH CARE PLAN IS BETTER??
The Patients Choice Act S 1099 or:
The Democratic House Bill HR 3200
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