Reconciliation- Health Reform

Walt Whitman writing during the civil war penned this poem about irreconciliable differences, and how they can lead to destruction.  (This puts in proper perspective the current tone of health  politic)

Reconciliation

By Walt Whitman

1819-1892

---

Word over all, beautiful as the sky,
Beautiful that war and all its deeds of carnage must in time be
utterly lost,
That the hands of the sisters Death and Night incessantly softly
wash again, and ever again, this solid world;
For my enemy is dead, a man divine as myself is dead,
I look where he lies white-faced and still in the coffin--I draw near,
Bend down and touch lightly with my lips the white face in the coffin.

 

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Contact your Representatives

 

Keep an eye out for a link to Healthtrain's new audio blogcast, soon to be replaced with a video blogcast.

I hope you have all been busy writing to your representatives about your opinon on health reform.  Reading the media makes one question the accurateness of what is being reported.

The Secret Meetings

The Imperial Senate

Voting for Healthcare Reform before voting against it.

America's Health Future Act  Read this important document.

And after reading it see: 

Grassfire.org

 

There are several web sites to help you contact your senator and/or congressman, and others who are key players in health  reform.

Health 2.0 Conference ver 3.0

I wanted to take a brief moment before I dash off to Health 1.0. Today marks the beginning of Health 2.0 in San Francisco. For t hose you who don't know what this is I refer you to Health2.0

Some interesting observations by Matthew Holt of  The HealthCare Blog.

What is Health 1.0 ?  It's the mess you are going to face in your office today, doctor.  I don't have to elaborate on it here. I hope you have a good day.

Meanwhile on capitol hill, things seem to have quieted down. The polls show a definite shift toward the Obama Plan (whatever that is)....The devil is in the details.  With the  recent outcry in August,  hopefully our elected representatives are reading the bill and having attorneys interpret congressional legalese.  The federal register will never be the same.

WASHINGTON (AP) - The fever has broken. The patient is out of intensive care. But if you're President Barack Obamayou can't stop pacing the waiting room. Health care...

Thanks to all of you...to the Todd Rubins, Scott Barbours, and Hal Scherz.....who participated and led the Million Med March last week.  We haven't heard anything from the doctors at the White House Rose Garden Tea Party, as yet. 

As you may know these docs were all fervent supporters of Obama's campaign for President.  Not much dissent there, and a safe bet for no demonstrations on the White House lawn. This was a real dog and pony show and a definite chance to land an autograph photo for that office wall.

Rose Garden at the White House

It’s Monday morning at 1600 Pennsylvania Avenue (The White House). President Obama has invited physician leaders to attend a meeting today regarding healthcare reform.

So, what is the agenda? There may be a hint of what will take place in an article in Medpage Today, describing Mr. Obama’s vision for health reform in America.

Here are President  Obama's  takeaway points:

"I don't believe malpractice reform is a silver bullet, but I have talked to enough doctors to know that defensive medicine may be contributing to unnecessary costs. So I am proposing that we move forward on a range of ideas about how to put patient safety first and let doctors focus on practicing medicine. I know the Bush administration considered authorizing demonstration projects in individual states to test these issues. It's a good idea, and I'm directing my Secretary of Health and Human Services to move forward on this initiative today."

"The only thing this plan would eliminate [in Medicare] is the hundreds of billions of dollars in waste and fraud, as well as unwarranted subsidies in Medicare that go to insurance companies ..."

To date, the White House has detailed hundreds of billions of dollars in cuts to the Medicare program. First, the administration outlined $634 billion in savings, about half of which would come from cuts to Medicare and Medicaid. These include elimination of overpayment to Medicare Advantage plans.

And insurance companies will be required to cover, with no extra charge, routine checkups and preventive care, like mammograms and colonoscopies -- because there's no reason we shouldn't be catching diseases like breast cancer and colon cancer before they get worse. That makes sense, it saves money, and it saves lives

There are those who claim that our reform effort will insure illegal immigrants. This, too, is false. The reforms I'm proposing would not apply to those who are here illegally"

"Some of people's concerns have grown out of bogus claims spread by those whose only agenda is to kill reform at any cost. The best example is the claim ... that we plan to set up panels of bureaucrats with the power to kill off senior citizens. It is a lie, plain and simple."

I know I will sleep much better tonight after our physician leaders meet with President Obama, knowing that our healthcare reform has been solved…

Did the Whitehouse Cherry-Pick the physicians who were invited to the Rose Garden??

Physician's for Obama

All supporters of President Obama who campaigned for his election

WHO WERE THE GATE-CRASHERS?

Another not as well known meeting today is the 

NATIONAL PHYSICIAN'S ALLIANCE PROGRAM

National Grand Rounds on Health Care Reform
Monday, October 5, 2009 12:00 PM Eastern

The meeting was held today at Columbus Square at Union Station.

To see the meeting WEBINAR, click on WEBINAR.

The meeting was sponsored by the AMSA (American Medical Student Association, and the  National Physician's Allliance Program.

Panelists included:

 

Arthur Kellerman, MD,MPH Dean for Health Policy, Emory University.

Meena Seshamani, PhD, MD
Director of Policy Analysis,
Office of Health Reform,
Director of Health & Human Services

The takeaway from both of these meetings is that we have 'their ear'. 

Physician involvement is critical, and now more than ever before, we are being heard.....WE must continue to be involved on a daily basis as legislation is developed.

202-456-1414

"Some of you may recognized this telephone number", states Congressman Tom Price MD R-                         . "It' the White  House"

Here is what he is asking us to do:

1. CALL THE WHITE HOUSE ON MONDAY! The President is meeting with a hand
picked group of docs who agree with him. He needs to hear from doctors in
the community who disagree with him.  CALL ON MONDAY TO: 

202-456-1414

2. Encourage your Physician Colleagues to do the same. Forward this email to:
your medical associations, post the phone number of doctor dining room, bulletin boards and talk to your colleagues in the corridor.

3. ENCOURAGE YOUR PATIENTS TO CALL THE WHITE HOUSE TO SAY “NO TO MANDATES, RATIONING, and THE PUBLIC OPTION”.

 

Here is what POLITICO has to say

 

An interesting point of view.  Socialize Property Insurance, but not Health Insurance.

 

Matthew Holt of The Health Care Blog makes this point in a recent post.

Docs 4 Patient Care

The rest of the story.....October 1 has come and gone. The group had another successful day barnstorming the capitol building. Hal, Scott and Todd as well as many other members of Docs4Patient Care started  their own filibuster and nearly shut down several senator's and other congressional offices.  I spoke with Senator Joe Lieberman's office and they too were being 'lobbied' by our group as well as many other individual physicians.

The alliance of providers and patient advocacy is a powerful platform for patients and physicians.

Docs4PATIENTCARE.ORG 

The Accelerator, or What's new in HIT

Advancing consumer-centric
health care by driving integration
of technology and the consumer experience across a network of
new and established technology companies and health care
organizations.

Quite a mouthful, what is this all about?

Health 2.0 Accelerator

Big words, bigger hopes, or just more smoke and mirrors?

Perhaps fueled by Stimulus funds.....

Free HICO scores online !!

What do credit card blogs have to do with health insurance? Read on at  Credit card forum (the blog)

Perhaps one of the new regulations in health reform will be a HICO score that parallels your FICO score.  Or perhaps we need a 'truth in health insurance "  law that parallels the 'truth in lending " law.

Check your HICO score monthly , clean up your health  !

Sick people, need not apply!

Million Med March October 1, 2009

Docs 4

PATIENT CARE

Ok everyone, we are on the eve of our second big trip to Washington.

It will never be perfect, but as good as it was for everyone last time, I expect that this one will be even better, because we learned a lot from last time and we'll be a bit more organized, I hope.

Enclosed are suggested talking points. Remember, they are SUGGESTED talking points. You can add your own to the list if you think that there is something missing. Please don't ask us to redo this with your point that we left out. 20 doctors can come up with 21 different talking point lists. This list encompasses 95% of the things that we all seem to agree about.

We have some appointments set up. The Congressmen and Senators know about us and word has gotten around about the last trip and this one. The appointments are a bit more scarce this time as a result. Nonetheless, we will go to their offices and try to get in to see them or their chief of staff or their healthcare team.

I have a list of people coming who emailed me. I do not want to put people's names on a mass mailing to confirm that you are coming. So, I'm going to ask anyone coming to just shoot a 1 line email to me today to confirm that we have you on our list. The reason for this, is because we've divided the docs that we have into 4 lobbying groups and we want to make sure that we have you. If you would prefer to be on your own (not advised), then don't bother replying.

All docs will meet in the plaza in front of the Capitol steps at 9:00AM and we will break into groups. There is one exception, the organizers of the Million med March have a 9:00 meeting and I will send a separate email to them about meeting earlier.

We will meet with Congressmen and Senators until about 11:15 and then head over to John MArshall PArk for the Million Med Rally and March.

We will then meet with Congressmen again after the march.

The weather forecast looks good for Thursday- high of 70, and clear.

REMEMBER THAT EVERYONE SHOULD COME WEARING SCRUBS AND WHITE COATS. THIS IS FOR REAL!!. It makes for an impressive show, and that is why we are all taking the time off from our lives to come to Washington. I'm looking forward to seeing all of you there.

Hal

Hal Scherz MD

President, Docs 4 Patient Care

www.docs4patientcare.org

Letter to Congressmen and Senators:

TALKING POINTS FOR CONGRESSIONAL LOBBYING

1. There is no need to rush a bill through just to satisfy a political promise. Healthcare reform needs to be thought out and done carefully. There is only one chance to do this correctly.

2. The problem with healthcare isn’t the care. It is the best care in the world. The quality of US healthcare and the outcomes are being unfairly attacked so that the system can be changed.

3. There are solutions that have been offered to address problems in a targeted fashion that Congress and the White House are not listening to.

4. Access to health insurance is a problem for 15-20 million US citizens. This can be addressed immediately with insurance vouchers and tax credits utilizing the current private insurers.

5. Cost of healthcare insurance is high and needs to come down. This can be done by promoting competition. First by repealing the antitrust exemption that insurance companies operate under (McCarron- Fergusson Act) and by relaxing restrictions on internet sales of healthcare insurance across state lines.

6. Eliminate pre-existing conditions by expanding risk pools and establishing high risk pools.

7. Allow people to purchase their own insurance and receive the same tax breaks as employers. This will uncouple insurance from the workplace and make it portable.

8. Push for Health Savings Accounts to make people better consumers of healthcare resources, which would drive costs down. Other ways to drive costs down would be to have doctors and hospitals post fees so that patients could shop. Eliminate antitrust regulations, Stark regulations, and many other government regulations on doctors which actually drive healthcare costs up.

9. Medical Liability Reform- specialty boards to decide on the merits of cases before they go to trial. Caps on awards, loser pays for frivolous lawsuits.

10. No government run or sponsored health insurance program (public option, coops, insurance exchange, triggers, mandates)

11. No government oversight board determining medical decisions

12. The AMA does not represent the majority of practicing US doctors- only 17% belong to the AMA and most of these are retired, practice academic medicine, are in administration, or are residents and students

13. Our #1 priority is the health and well being of our patients- your constituents (when talking to elected officials)

Million Med March

 

 Put this on your schedule:  October 1, 2009 in Washington, D.C.

An Interview with Hal Scherz, MD a Pediatric Urologist. Hal Scherz practices in Atlanta, Georgia..

Hal has taken the bold step of forming a grass roots organization to link individual physicians and groups with patient advocacy groups to visit congressional representatives (U.S. Sentate, and House of Representatives) during the Health Reform debate and afterward.

The organization is ‘DOCS4PATIENTCARE.ORG ‘. The organization also goes by the same name.

Health Train: Hal, tell me about docs4patientcare .

Dr. Scherz: I decided to form a group that would go to Washington DC for the   "White Coats to Congress Rally "   during the initial march in early September 2009. It was an amazing experience to see so many physicians motivated and willing to take a day from their busy schedule to attend the event.

Health Train: What did you experience at the ‘march’?

Dr Scherz: Several things,

1. We individual physicians have gained an audible voice in the debate and decision making process.

2. Physicians are now willing to participate in grassroots activities outside the cloak of organized medicine.

3. Many physicians do not feel that the AMA or other specialty organizations represent them adequately.

4. The power of individuals is greater than the power collectively of our organizations.

5. Patient advocacy groups and individuals have a greater effect when united in this common goal of insuring that the doctor patient relationship is maintained and strengthened.

6. The people we met in D.C were not political activists, nor radicals. They are ordinary Americans with a passionate message about health reform and the dangers of governmental control and/or intervention in the health process.

Health Train: Where do you go from here?

Dr Scherz:

Our most immediate goal is to gather another group to travel to Washington DC for the ‘Million Med March”. On October 10, 2009.

Health Train: What groups are you affiliated with?

None. We are independent and have no political allegiances or agenda other than making the individual physician’s voices heard.

Health Train: Where are your Chapters?

Dr Scherz: Atlanta, Chicago, Dallas, Indiana, Phoenix, Baltimore, New York

Health Train: How do I join?, Is this a PAC?

Dr Scherz: No, it is not a PAC. You can go to our website: www.docs4patientcare.org to register. We are not a PAC. We merely encourage individuals and empower their activities.

Health Train: When is the next “Event”?

The next ‘Event”   The Million Med March"  will take place on October 10,2009 in Washington, DC. Details will be posted on the website, www.docs4patientcare.org

Health Train: Can I form my own chapter in my area?

Dr Scherz: Yes ,by all means, we are encouraging joining local chapters or forming your own chapter

Healht Train: Do you want to add anything else?

Dr. Scherz: We are an organization searching for passionate and articulate physicians to go to Washington D.C. and possibly have the opportunity to speak on a national forum regarding pending health reform legislation.

Health Train:   Thank you Dr Scherz....we'll see you in Washington on the  1st  of October.

For more information go to  www.docs4patientcare.org

He's Back

 

Most of us realize that our government in D.C. has been out of control for over a decade (perhaps much longer).

According to this interview with Pete Stark, Congressman from California it makes sense that the more debt the government has, the wealthier the country is.

 

  I am not certain of the rationale of this statement but perhaps it alludes to the ability of our government to borrow money reflects upon our income, ability and willingness to make payments on that debt.  In October 2008 we came to an abrupt ending to that rhetoric.  The past 12 months are a witness to the failure of that economic model .  We shall call that "Pete Stark Economics".  Perhaps in 30 years or so Mr. Stark will be the Nobel Prize winner in Economics.  However I am not holding my breath,

More 'free' Things..

Health IT continues to be in the limelight of health reform. And there is a great deal of scrambling to obtain a share of the stimulus IT funding passed by congress this year.

Two cardiologists from Johns Hopkins University , David Meyerson and Sammy Zakira elaborate in the Washington Post a typical frustrating encounter for the majority of physicians who are confronted by a seriously ill patient and an unobtainable coherent medical history. Both of these physicians attend patients at the VA Hospitals in Baltimore, MD.

They write, "Most currently available electronic medical record software is unwieldy and difficult to quickly access, and there is still no vehicle for the timely exchange of critical medical data between providers and facilities." The cardiologists note that the federal stimulus package included about $50 billion for health IT, but they argue that "it will be difficult and costly to construct new systems ensuring interoperability of all current hospital software."

This does not address the issues of outpatient clinical care, which have a far greater number of clinical encounters.

The VA system has been using VISTA as their EMR. They advocate for the adoption of the VA VISTA system as the backbone for EMR in the United States. They also suggest that any other EMRs be interoperable with the VA system. Both of these suggestions enjoy considerable merit for several reasons.

1. It is a proven stable platform

2. It has been used by many or most physicians during training.

3. It is ‘free’. This is not entirely accurate. The program itself is free of charge, but does require some expertise in tweaking it for the underlying operating system. The operating system is somewhat arcane and no longer in popular demand.

4. There is a pool of IT specialists familiar with the system that can be ‘tapped’ for implementing the system and training it’s users.

5. The suggestion that other systems be interoperable with VISTA is a good one. The standard is there….and it works! This eliminates the controversy about which standard will be adopted. There are several competing certification organizations in play at this time. This will cause delays and perhaps avoid further confusion should several different regional standards emerge.

6. VISTA is scalable.

7. The taxpayers have already invested considerable ‘billions of dollars’ in this system.

The negatives are:

1. VISTA is not well designed for independent practitioners, or small group practices.

2. It bears the perhaps unwarranted ‘stigma’ of being a government computer system, with real and/or imagined prejudices against such a system. Such as the Post Office.

3. It is an ‘older system’ designed more than 15 years ago, with multiple ‘patches’.

The Uninsured Patient

One of the greatest frustrations for any physician in the U.S. is the "uninsured patient".  Coming face to face with one of the 'forgotten' patients can ruin an entire day of work. Knowing how to help a patient and being totally powerless to do so ranks right up there with an announced audit from the IRS and/or a letter from a plaintiff's attorney that you are about to get your a-- sued.

In fact what has evolved in most practice offices is a highly refined  filtering mechanism to keep these patients away from you, the physician.  This vicious and exclusionary process developed without any forethought as a means to insure the financial survival of our present health system.  It flies in the face of what  physicians are really all about....caring for people.

In order to see a physician you must be a 'card carrying" patient or have a wad of cash (which is rapidly evolving into a wad of plastic bits and bytes, or a wheelbarrow)  At any rate the 'plastic card' now carries more power that one could have ever imagined.

At one time it did not matter, doctors and hospitals could and did give away millions of dollars of care because they  were compensated fairly and sufficiently.  Even if ph ysicians gave away their services (which is a small percentage of total health care costs) the patient could not access lab work, imaging services, nor have access to medications.