From iHealthBeat

 

A brief visit to an excellent source of Health News

Health Care Providers Identify Roadblocks to Meaningful Use

On Monday and Tuesday, more than a dozen physicians and representatives of hospitals discussed challenges associated with meeting requirements under the meaningful use program, AHA News reports.

Under the 2009 federal economic stimulus package, health care providers who demonstrate meaningful use of electronic health records can qualify for incentive payments through Medicare and Medicaid (AHA News, 1/11).

Attendees spoke during a two-day meeting of the Implementation work group of the Health IT Standards Committee. The speakers were advanced users of EHRs, according to Modern Healthcare (Conn, Modern Healthcare, 1/12).

Attendees' Concerns

Attendees said that many hospitals will face challenges complying with the incentive program's meaningful use requirements.

Joanne Sunquist -- CIO of Minneapolis-based Hennepin County Medical Center -- said developing reports to demonstrate meaningful use "has become an onerous, difficult and time-consuming process" ADD EXPENSIVE (mine)(Page, Becker's Hospital Review, 1/12). Sunquist added that health care organizations might encounter difficulty implementing quality reporting systems using vendor-provided workflow information (Goedert, Health Data Management, 1/12).

According to Charles Christian -- CIO of Good Samaritan Hospital in Indiana -- smaller facilities could experience difficulty implementing health IT because they might not have appropriate in-house staff and would have to rely on outside help.

Linda Reed -- vice president and CIO of Atlantic Health in New Jersey -- said that physicians need more guidance on implementing technology to support health information exchange (Monegain, Healthcare IT News, 1/12).

According to Lyle Berkowitz -- medical director of clinical information systems at Chicago-based Northwestern Memorial Physicians Group -- independent physician practices are at a disadvantage because they do not have access to resources compared with hospital-affiliated groups (Modern Healthcare, 1/12).

Meeting attendees called for HHS to provide more time before implementing the incentive program's Stage 2 requirements (AHA News, 1/11).

Read more: http://www.ihealthbeat.org/articles/2011/1/12/health-care-providers-identify-roadblocks-to-meaningful-use.aspx#ixzz1AsYTqTww

del.icio.us Tags: ihealthbeat,ehr costs,meaningful use,hhs,incentives

SCOTUS in Mayo Clinic v. IRS

 

Health Train is back on the track again.  In another round of health care complications where getting a medical education turns into a high priced legal venture for one of the largest most famous medical clinics in the world.  You can bet your bottom dollar this had much more to do with cash flow for Mayo than whether the relatively less well off junior MDs could escape Uncle Sam’s money sucking vacuum machine.  More about Complications here.

I found some commentary on the WSJ blog on Health

 

.

• workaholic wrote:

As interns in the 70’s, we worked 128 hour weeks and loved it. We are graying now and find the trainees to be eager but lazy, not committed to their patients, while very committed to their CPOEs, EHRs, and mobile devices, as the patient lies in pain and poop. We were paid a fixed amount per year, period, with weekends on and two weeks of vacation when someone else told us to take it.

There is a reason why the Hopkins is so great. I do not remember if they took out social security, I will check my stubs (I am a packrat) but if they did, I will seek a refund plus interest.

• Anonymous wrote:

Perhaps they can be employees for the purpose of IRS but not employees for the purpose of some different state laws. Part of the Supreme Court’s point is that it will defer to the reasoned and careful judgment of the agency (here, IRS) when there is not some compelling reason to reverse the position of the agency. This creates a public climate and legal climate where irrational decisions of agencies can be corrected, but, all the decisions of all government agencies are not constantly being revised over and over every time a judge somewhere entertains an alternative opinion. I agree with the IRS that the job has most of the characteristics of employment, not those of being “a student.”

• Academic wrote:

This has other potential negative consequences. If residents are considered employees than there are overtime rules, and limits on work hours that could be applied depending on the states laws. This could mean that in the future newer physicians will have less time spent in training. Not a pretty picture, especially for surgeons where hours, repetition and numbers of procedures makes a huge difference in ability to perform a task correctly.

 

SCOTUS blog goes into further analysis and arguments:

 

How can the Web be used for Health Health Habits.?

Now for the real bread and butter.  I just attended a webinar from Health 2.0 where participants are meeting t he Health 2.0 challenge thrown down by Matt Holt of the Health Care Blog.

One of the solutions can be found at :  Healthy People .

Analysis for 2011

Pronouncements From on High

LOS ANGELES, CA -- (Marketwire) -- 01/11/11 -- The sluggish economy and the farthest-reaching health reform in more than 50 years will continue to ratchet up pressure on U.S. providers to reduce costs and improve quality, setting the stage for The Camden Group's annual Top 10 Trends in Healthcare in 2011. These pressures will trigger an avalanche of activity centered on accountable care organizations (ACOs), bundled payments, and patient-centered medical homes. At the same time, they will compel more physicians to seek employment with hospitals or large medical groups and spur more consolidation of hospitals and medical groups/independent practice

"2011 is the year when a growing number of providers move forward with new care delivery models and run into the very real challenges posed by overhauling traditional ways of treating patients. The fundamental question is whether providers can manage costs and improve quality while maintaining provider choice and open access," says Steven T. Valentine, president of The Camden Group. "As always, the devil is in the details."

Yes, indeed it is. (Health Train Express)

Further predictions:

The Camden Group    predicts the following Top 10 Trends will have major and continuing impact on the healthcare sector during 2011:

1. Insurance membership takes hit from slow recovery. Few unemployed will take advantage of COBRA while employees, faced with paying more of their health plan premium, will select high-deductible, low-premium PPO plans, hurting HMOs.

2. No easing on payment pressure. Although health plan payments will keep pace with inflation and operating cost increases, they will not make up for declining or stagnant Medicaid and Medicare payments.

3. Patients postpone care, hurting providers too. With high unemployment and underemployment and increased out-of-pocket costs, people will continue to put off treatment, keeping volumes at hospitals, ambulatory centers, and physician offices soft.

4. Cost is king. Soft volume, downward pressure on revenues, and deteriorating payer mix with increased bad debt will drive providers to seek more cost savings. However, unions, staffing ratios, and regulations will make cuts difficult. At the same time, health plans will begin to explore and increase the use of tiered networks and stratify payment to encourage use of lower-cost providers.

5. Capital remains elusive. As in 2010, most non-profit hospitals will find it difficult to access capital. Lenders are requiring an increase in days cash-on-hand, coverage ratio, stronger EBITDA, and smaller borrowings. Credit rating agencies want to see: 1) physician alignment strategy, 2)clinical integration and cost reduction action, 3) IT plan, and 4) plans to capture more market share.

6. Physicians make or break new care models. To improve outcomes and lower costs, hospitals and medical groups will focus on accountable care, bundled payments, patient-centered medical homes, and/or clinical integration. Reducing variation in care -- primarily by physicians -- will be central to any successful strategy. An effective bundled payment strategy, for example, requires specialists to address clinical resource consumption and supply cost and use while standardizing care protocols in conjunction with hospitalists and intensivists.

7. Construction focus is on fast returns. Construction projects will be scaled down, with a focus on regulatory compliance, enhancing throughput, improving care/outcomes, and if possible, capturing additional market share. Providers also will prioritize construction that generates superior returns, such as surgical services and imaging centers. Do not be surprised to see the growth of freestanding emergency departments to reduce the need for hospitals, increase access, and provide capacity for the newly insured.

8. IT becomes more pervasive -- or else. Information technology underpins providers' ability to shift to new care models, so IT moves to center stage with efforts to implement electronic medical records, (EMRs,) computerized physician order entry (CPOE), and health information exchanges (HIEs.) Provided, of course, medical facilities already have in place ePrescribing, PACS, and online results reporting and scheduling.

9. Let's make a deal. Mergers and acquisitions will be brisk as more hospitals and physician groups acknowledge they lack the resources to invest in information technology, facilities, and equipment for new delivery models or the leverage to negotiate effectively with health plans. Given their central role in new models, the value of primary care medical groups will increase. It is possible that health plans will enter the market to acquire these medical groups.

10. Market share, market share, market share. Hospitals and medical groups have underutilized assets and must get them busy. Providers also realize that more volume will generate incremental revenue and decrease per unit cost. Hospitals will hunt for new programs to fill empty or underperforming assets.

 

We also need to factor in the “Social Media Impact” on ACOs

Social Media goes to the E.R.

Pretty soon it will be all F.U.B.A.R.

del.icio.us Tags: aco,accountable care organization,market share,cost,underperforming assets

Stem Cell and Grievous Brain Trauma.

 

First let’s go over to KevinMD where my post about Public Health, and MPH’s has been re-posted by Kevin Pho MD.  I had actually forgotten about this post and did not know which one Kevin had chosen.  As a PCP my  post must have tweaked his Kool-Aid dispenser.

 

Personally I prefer Gatorade or G2, the drink for 21st Century Health Care.

My post today is about Stem Cell Research and it’s potential for Translational application to severe head injuries such as the one sustained by Gabrielle Gifford, Congresswoman from Arizona.

My thoughts are an imaginary scenario of injecting central neuro-stem cells into the wound tract of the bullet’s pathway. There it would  become part of the healing process, integrating, transforming and establishing new connections to replace those destroyed by the injury.  If only life and medicine were ever that simple.

The only positive aspect of this horror would be to stimulate a young (or old) clinical and basic science team to embark on the animal, pharma, and microbiology study toward succeeding in that goal.

 

del.icio.us Tags: Gabrielle Gifford,Stem Cells,Kevin Pho,KevinMD,Public health,MPH

The Medical Blogosphere

 

KevinMD.com will be hosting Health Train Express tomorrow, Monday January 9th 2011 . You can look for it at KevinMD.com

Kudos  to Dr. Pho !  All good  things start and end in New Hampshire.

Kevin Pho. MD has been at this about the same amount of time that I have been at my blog space.  Judging from the number of ‘hits’ his site has daily compared to mine reveals how ignorant I have been in regarding to the new age of information exchange.

I seem to know what to do,  but just have not invested time, money or staff into doing it.  He has been published in many big-time media spaces, such as CNN, USA Today,

Kevin’s appearances include the CBS Evening News with Katie Couric, New England Cable News, and WNYC-New York Public Radio’s The Takeaway, and he has spoken at the New England Journal of Medicine, Blog World and New Media Expo, and at academic Grand Rounds nationwide.

As social media’s leading physician voice,KevinMD.com was voted 2008′s Best Medical Blog.Forbes.com calledKevinMD.com a “must-read health blog,” and CNN.commanded @KevinMD one of its five recommended Twitter health feeds.

The Wall Street Journal had this to  say about KevinMD, ““punchy, prolific blog that chronicles America’s often dysfunctional health care system through the prism of a primary care provider,” while others have noted that “a lively comment stream on one of Kevin’s posts provides more insight on the day-to-day realities of health care than any piece of journalism can ever hope to impart.”

Forbes.com hailed KevinMD.com as a “must-read blog,” and CNN.com named @KevinMD as one of its five recommended health care Twitter feeds.

Kevin Pho on the Medical Blogosphere

 

With over 40,000 RSS subscribers and 33,000 followers on Facebook and Twitter, KevinMD.com is among the web’s most influential and prominent health care platforms.

Dr Pho, when do you have time to make an appointment for me?

del.icio.us Tags: blogosphere,medical,kevinmd,medical bloggers,medical social media

Health Train Leaves the Station (again)

 

The Health Train Express is moving once again, leaving the not so grand central terminal. 

The 112th Congress, 1st session has commenced, with another full plate regarding unraveling Obama care The first day consisted mostly of procedural matters.

Early today Speaker John Boehner had this to say early this morning regarding Obama care in preparation for the upcoming debate on new legislation to repeal all or parts of Obama care.  The discussion and vote which were to have taken place this week is to be postponed due to a procedural delay designed by Democratic opponents of repeal.

Speaker John Boehner ®

 

Greg Scandlen posted his “Welcome Freshman'” lecture to the  neophytes, and newbies in congress about the disastrous Obama care law.

My comments are (Yogi Berra), “It isn't over until it’s over.) We physicians must continue our opposition to this law, but not the goal of expanding health care coverage to many more of our citizens, and improving outcomes, reducing cost by increasing efficiency and reducing mindless bureaucracy.

del.icio.us Tags: health reform,Boehner,112th congress,obamacare,greg scandlen

Repeal the Health Train Express

 

Michelle Malkin has an interesting proposal, about Health Reform  H.R. _________________

The House Republicans have announced their plans to put the Obama care repeal up for a vote during the week of January 10, 2011. This evening they posted the text of the proposed legislation to the GOP House Committee on Rules website.

WAIVER-MANIA continues:

Malkin has this to say about current activity to alter or repeal the current Obama care Law.

Over the past two months, we’ve been tracking the burgeoning list of unions, companies, and insurers who have used an HHS escape hatch to avoid the costly, destructive consequences of Obama care for their members and employees (see here, here, here, and here). The list keeps growing. Jamie Dupree has the latest update on what I’ve been calling Waiver-mania! More unions and companies that employ low-wage workers have gotten their pass now. The official Obama care refugee list (here) is now at 222.

del.icio.us Tags: health reform repeal,obama,house republicans,michelle malkin,health train express

Non Compliant Physicians: Guilty Until Proven Innocent

 

Liberty Loves Justice

Richard Reece, MD in his blog, Medinnovation today discusses increasing regulatory action, “drastically increase physician legal compliance obligations and potential liability under federal fraud and abuse statutes and the suspension of the government’s need to prove “intent” will create a compliance environment many physicians will find problematic”.

Henry Faird, Computer Scientist , Dartmouth, NY Times January 1, 2011

“With every technology, there is a dark side. Sometimes you can predict it, but often you can’t.”

Many call this ‘the butterfly effect”or another interpretation, ‘remote causation’.

“It uses different techniques and approaches to bring physicians into compliance - whistleblowers to spot offenders, computer protocols to guide ordering behaviors, electronic federal audits to identify coding abuses, new regulations compelling compliance, and creation of new organizations – accountable care organizations – using capitated payments to end fee-for-service billing”,and by identifying those physicians who violate compliance rules, reformers hope to shed light on what they consider to be a dark side of medicine - physician ordering practices that enhance income for themselves and hospitals in which they practice.

 

As with any top-down, Washington-based government program to regulate private behavior, there are dark sides to what government is trying to do.

•  
  • In the first place, government compliance is by its very nature retrospective. Regulators are not present at the physician-patient encounter and have little idea of the circumstances, dynamics, or context of what occurred or what was ordered at the point of care.
  
• • Second, medical coding is so confounding, confusing, and byzantine that nobody – including government – understands its nuances and complexities. The reality is that about 20% of physicians under code while about 5% over code.
  
• • Third, much if not most of the $60 billion of fraud and abuse that occurs in Medicare, is carried out by non-physicians who steal patients’ Medicare identity cards, set up storefront Medicare and Medicaid mills, and bill for items such as wheelchairs and other equipment or devices.
  
• • Fourth, herding doctors into accountable care organizations and consolidating care in large medical institutions, which have the administrative skills only large organizations possess, will not necessarily lower costs. Costs are invariably higher for hospital charges for inpatients and outpatients, in part due to “facility fees,” than for those performed by physicians outside hospital walls or jurisdictions.
• Fifth, some 70% to 80% of care is delivered by independent private physicians on a fee-for-service basis, usually through existing, often very sophisticated billing systems.. Converting or modifying these systems or integrating them with electronic billing systems will be a herculean, long-term task, fraught with certification and standardization difficulties.
• • Sixth, there is a Big Brother aspect to all of this. Already computer controlled camera surveillance systems are being installed in hospital rooms. These systems come with ominous computer-generated voices that announce to doctors and nurses, “ You have not washed your hands.”

An entire new industry is spawning, with consulting specialists, compliance attorneys, and their legions of clerical assistants.

And finally Dr. Reece forecasts these ‘dark aspects’ of health reform,accountability, and non-compliance.

“I can foresee camera. face recognition, and computer surveillance systems in doctors’ offices. I pray this will not occur. These systems have the potential to destroy confidentiality, limit personal freedoms, and induce physicians paranoia. Privacy is central and essential to effective medical care. “

Crazy ideas,  I think not !  Who would have ever forecast the use of body scanners at airports, invasive monitoring of routine electronic communications, emails, data mining without consent or prior knowledge…who would have thought a President would bypass congressional consent for appointments (such as the head of CMS.), nor the congress sending sweeping health regulatory law , empowering the Secretary of HHS with total control over health care reform.without reading nor analyzing it’s ramifications not just for health care, but the overall secondary impact on the foundering U.S. economy.

Citizens should be outraged an should not be duped into  believing (Doctor) Sam will “care for them”. 

del.icio.us Tags: dark side,HHS,Congress,Health Reform,Don Berwick,compliance,health regulation,accountable care organization,fraud and abuse,medinnovation,health train express

Cleaning Health Train Express

 

 

At the end of the year it’s time to clean house. Yes, it is  a bit early for Spring Cleaning, but Health Train has been advised of  climate change and perhaps increased ambient temperatures, and perhaps an early spring so here goes. Costco is already stocking up for spring and spring break, and the Easter flowers, bunnies and water toys are displayed.

Health Train reviewed the blog friend list and found only three blogs that have been dormant for more than six months.  Frankly I was surprise to see the longevity of health blogs. 

Observation #1

There appears to be two classes of health blogs:

1. Those dedicated to  patient information, case studies, educational information and anecdotal stories. Some are very sad, some are inspiring, and some despair at the follow of some humans who are resistant to being helped in their suffering.

2. Those dedicated to political issues, rants, raves, frustration at the realities of medical practice today. A great deal is published by ‘medical experts’ without clinical experience but ‘grounded’ with MBAs, MPHs, and those on ‘committees, or national foundations.  Some of these ‘experts’ have considerable power and authority to make decisions that effect our patients.

3.Blogs related to health information technology and the ‘build out’ of the medical digital world.

In addition to blogs, there are other more structured forums:

Medpedia, which aggregate a large number of health blogs.

SERMO, a physician only blog limited to licenses MDs. This blog has specialty sections, and sections devoted to political commentary, practice management. The site is supported by Pharma and mined for physician comment about treatments. No patient information is disclosed.

Large media publication blogs (columns, such as WSJ, NY Times, LA Times and newspapers from cities around the United States.

Community Groups dedicate to specific disease entities

The Health Well,  an aggregation of many health blogs, and journal references

Futurists weight in with prognostication seeing into the future with what seems to be unwarranted certainty at the outcome of health reform.

 

Here’s Johnny. You make up the answer and question.  The best answer about health reform, (post in comments) will receive an iPad. The deadline for entering is January 31, 2010

del.icio.us Tags: free iPad,Carnac,Health Blogs,forums

Blogger Takes Leave

I have been told the most boring thing in the world is a blogger who writes about blogging.

Actually blogging is all about people, and yesterday I was a bit saddened to hear that one of my best blogging friends is taking a break from blogging.

 

Unplugging

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I have made a very big decision: I am going to unplug myself from the internet world for a while.  That means that I am hanging up my blogging for now.

Distractible MD(Rob Lambert MD) has been around since the dawn of the age of blogging….at a time when blogging was not user friendly at all. Even the cloud blog publishers were arcane and byzantine

After five years or so of blogging one makes some close friends, not at all unlike having a pen pal when I was knee-high to  a grasshopper. (not sure if that is a relevant metaphor for Gen X,Y,Z or iGadgets.)

Bloggers tend to develop a circle of friends.   Our circle has been broken. 

Hope he will be back soon.  Have a good rest. Hope you don’t have carpal tunnel syndrome. 

Recharge   your batteries, guys like you always come back !

 

GML

del.icio.us Tags: Musings of a Distractible MD,Doc Rob,Health blogs

Tiny Bubbles

 

Best of the WSJ Health Blog for 2010

By Katherine Hobson

Tonight the Health Blog will close the book on 2010 as we head out for the long holiday weekend. Not, however, before highlighting a few of our favorite posts from the more than 1,100 that ran this year. Our thoroughly subjective list includes posts notable for their subject matter, news value or just because we liked them a lot. In no particular order:

Cavs Have a Word for LeBron James: Narcissistic Jilted Cleveland Cavaliers majority owner Dan Gilbert put King James on the couch in July and came up with this diagnosis, but the sports psychologist we consulted disagreed. As things stand today, LeBron can certainly be described as “winning”; his new team, the Miami Heat, is 25-9.

Here’s What Primary Care Doctors Do All Day A study by a Philadelphia internist lays bare the paperwork involved in running a small practice. One stat: the number of phone calls a physician made each day was higher than the number of patient visits.

For Dendreon, It’s 500 Prescriptions for Provenge and Counting No one’s neutral on the Yankees, and no one’s neutral on Dendreon. This year the company won FDA approval for its prostate-cancer treatment Provenge, and in this August post we polished our math skills and calculated how many patients had completed treatment in the second quarter.

Prevention Task Force Cancels November Meeting; Would Have Included Prostate Screening Vote The U.S. Preventive Services Task Force rescheduled this meeting, originally set for Election Day, for March 2011; one staffer later quit, saying “politics trumped science.”

Caution: This Blog Post May Be Under Embargo The rules surrounding when the media can report on scientific papers are often convoluted, but rarely do they reach the extremes seen in this cancer-drug study saga involving Novartis and the annual American Society of Clinical Oncology meeting.

XMRV: Raising the Issue of Contamination This is just the latest thoroughly reported post Amy Dockser Marcus has written on the controversy surrounding the XMRV virus and its possible link to chronic fatigue syndrome. Click here to see all the Health Blog’s coverage on this topic from this year and earlier.

Tapeworms, Cow Gestation and Malpractice: Trolling the NEJM Archives After the venerable journal put its archives online, we took a spin through the articles published in the 1800s to learn about the hot medical issues du jour. (And for once, we knew we’d get no comments about the evils of electronic medical records!)

TEDMED: Soprano and Double-Lung Transplant Recipient Charity Tillemann-Dick Inspirational stories about patients and their physicians are everywhere in medicine, but this one — about a dangerously ill young soprano who refused to give up her singing and the doctor who told her “a happy patient is a healthy patient” — is one of our favorites. Happy new year, everyone.

 

FOX NEWS has their own list of the top health blogs

Of Course I have my own favorites

  It is almost time for Auld angzine, and some bubbly.

HAPPY NEW YEAR !!

The AMA is Lurking and Lurching

 

 

The American Medical Association checked in and made a comment about my last posting.  The Good news is that I know someone out there is reading my  stuff. My post was about commentary published on SERMO for their fifth anniversary in regard to the AMA and it’s relationship with physicians.  It has been disseminated by many that the AMA represents 33% or less of physicians.

You can  see the comments at my last post, or I will insert a few catchy PR mission statements  here. Actually the comments were made on Medpedia a blog aggregating service.

 

 

In all fairness I will publish the entire comment sent to me from the AMA.

“As the nation’s largest physician organization, the American Medical Association welcomes the diversity of physician opinions, but falsehoods and conspiracy theories do nothing to advance the common goals physicians share. The AMA’s support for the health reform law was based on it meeting a majority of strong principles, particularly expanding coverage to millions more Americans, that reflected policies established by medicine’s broadest forum of physicians with members from every state and specialty. The AMA has made expanding health coverage to all Americans a top priority and we made clear that this law, while historic, was a starting point and that Congress would still need to act on vital issues important to patients and physicians. Day in and day out, AMA is working hard to provide physicians with the advocacy and practical tools they need to care for patients and lead enhancements to our health system. In the past year alone, AMA has spurred improvements in the insurance industry’s chaotic payment system by exposing flaws and waste, helped physicians recoup millions in short-changed insurance payments, given physicians a powerful tool for negotiating fair contracts with insurers and held insurance companies accountable for questionable business practices.”

Perhaps we misjudge the AMA.

del.icio.us Tags: advocacy,AMA,Health Reform,insuance,contracts,health train express,medpedia,sermo

Are Doctors lurking, or lurching?

 

These are comments borrowed from SERMO (a physician only forum) and as they appeared in the Washington Times on December 27, 2010.

 

Doctors left in the lurch by own medical associations

 

 

      

 

By Dr. Douglas A. Perednia

The Washington Times

6:53 p.m., Monday, December 27, 2010

Here's a tip for those wanting to overhaul Obama care: Ask doctors how to make health care more efficient. They can tell you where to find hundreds of billions of dollars in cost savings. But don't imagine that you'll get any useful insights from the American Medical Association (AMA), the American College of Physicians (ACP), the American Academy of Family Physicians (AAFP) or most other big medical associations. Entrenched "professional" organizations like these are increasingly part of the problem.

These are depressing times for doctors in America. Real physician income is stuck in a decades-long decline. Adjusted for inflation, physician fees have fallen more than 25 percent since 1995. Indicators favorable to clinical practice are at or near record lows. The Physician Practice Environment Index for Massachusetts - the state model for Obama care - has declined in 16 of the past 18 years. Once-routine clinical tasks have become bureaucratic nightmares. The average physician now spends more than four hours each week on insurance and regulatory paperwork. Frustrated and tired, doctors are cutting hours and giving up independent practices to become hospital employees. Forty-six percent of U.S. physicians are over the age of 55. One-third are considering career change or retirement.

Obama care promises to make life even harder. The so-called Independent Payment Advisory Board is supposed to reduce Medicare spending by $500 billion but is powerless to do anything except cut payments to providers. Small Marcus Welby-type private practices are to be squashed. The White House has told doctors, "...Physicians need to embrace rather than resist change...The economic forces put in motion by the [Affordable Care] Act are likely to lead to vertical organization of providers and accelerate physician employment by hospitals...." In other words, forget private practice; prepare to be assimilated.

But it's not just money at stake. Many doctors sense that "reforms" are undermining their integrity. While the Hippocratic Oath obligates doctors to act only in the best interest of patients, many health care activists and medical associations are pushing a "new medical ethics." This says that physicians must consider "the needs of society" in their clinical decisions. In this new age, society's needs are divined by government regulators. In his book "New Rules," President Obama's Medicare chief, Dr. Donald Berwick, explains, "Traditional medical ethics, based on the doctor-patient dyad must be reformulated...The primary function of regulation in health care, especially as it affects the quality of medical care, is to constrain decentralized individualized decision making."

For many doctors, association support for Obama care and this "new ethics" has been the final straw. Before, during and after passage of the Affordable Care Act (ACA), organizations such as the AMA, ACP and the AAFP worked hard to curry favor with the Obama administration and congressional Democrats. The AMA initially insisted on a fix for Medicare's automatic sustainable-growth-rate cuts in physician payments; it then reversed course and prominently endorsed Obama care without one. The ACP went further, calling the passage of the ACA "an extraordinary achievement" and "a cause for celebration." Not to be outdone, the AAFP wrote every Congress member who had supported the law to "congratulate you on your extraordinary commitment to better health care." Other associations simply chose to be intimidated. In a letter to members, the American College of Surgeons admitted that it had "been so quiet in voicing opposition to the legislation...[so as] to maintain a good relationship with policymakers."

What explains this behavior? Money. Once genuine advocacy groups, many medical organizations have morphed into vendors that thrive on ever more credentialing, government regulation and administrative complexity. They fight to protect revenue sources, not physicians or the practice of medicine. The AMA is typical. Its membership has declined from nearly three-quarters of physicians to fewer than one-third today. Just 16 percent of revenue comes from membership dues; chicken feed when compared to product sales or its government-sanctioned monopoly on Medicare billing codes. Other associations rake in millions hawking products from medical education and certification programs to electronic records and liability insurance. Each new government initiative is an opportunity to sell new products and services to physicians who are forced to comply.

There are two take-home lessons. First, the public and our elected leaders should be talking to real doctors about real health care reform. Those in the trenches are in the best position to see the inefficiencies and insanities firsthand and to recommend practical solutions. They'll tell you that what's really needed is a massive simplification of the system, less administrative overhead and the substitution of efficient free markets for government price-fixing.

Second, it's time for doctors to reform their own professional organizations. Powerful medicine is needed: mass membership cancellations and/or defections to true advocacy organizations such as Docs4PatientCare or the Association of American Physicians and Surgeons. The Great American Healthcare Debate is not yet over. Real doctors need to be included this time around.

Dr. Douglas A. Perednia is author of "Overhauling America's Healthcare Machine: Stop the Bleeding and Save Trillions," forthcoming from FT Press. He writes for the health care blog the Road to Hellth.

 

My thoughts, exactly……no need to expand.  I hope this brings to light the corner into which your doctor has been thrust.

 

del.icio.us Tags: sermo,docs4patientcare,ama,organized medicine,cpt codes,obamacare