Florida Doctors Lead The Fight Against Change

Dear Friends and Colleagues:
An article in today's (12/29/2009) New York Times, "Health Lobby Takes Fight to the States," reports that Florida is debating a proposed amendment to its state constitution that would try to block, at least symbolically, much of the proposed federal health care overhaul on the grounds that it tramples individual liberty. Its 42 co-sponsors, all Republicans, were almost all recipients of outsized campaign contributions from major health care interests, a total of about $765,000 in 2008. Last year, for example, the drug industry poured more than $20 million into political contributions in states around the country. In California alone, the industry spent an additional $80 million on advertising to beat back a California ballot measure intended to push down drug prices. The idea of amending state constitutions to block the core of the federal health care legislation, including the requirement that individuals and businesses buy insurance, began at the conservative Goldwater Institute in Arizona, the state where the first such measure will appear on the ballot next year. The states where the amendment has been introduced are also places where the health care industry has spent heavily on political contributions in recent years, according to figures from the National Institute on Money in State Politics. Over the last six years, health care interests have spent $394 million on contributions in states around the country; about $73 million of that went to those 14 states. Of that, health insurance companies spent $18.2 million, according to the institute. In Florida, where health interests have given a total of about $32 million over the last six years, the state medical association has become an especially important backer of the proposed amendment. In contrast to the American Medical Association, the Florida Medical Association has come out firmly against the current Congressional proposals, and a spokeswoman said the Florida group had embraced the proposed state amendment “to protect Florida from being forced into a federal government mandate that would hurt patients.” Dr. Madelyn E. Butler, president elect of the Florida Medical Association, said, “We are trying to ameliorate the effects of national health care reform on the State of Florida.” James Greer, chairman of the Florida Republican Party, said he too supported the proposal, which could be on the ballot in 2010 or more likely in 2012. Whatever its legal weight, Mr. Greer said, its mere presence on the ballot would give it political force. Its time that doctors stand up against those powerful interest groups. In some areas in Miami (Hialeah) the Uninsured rate has surpassed 50%. Many of my patients will be forced to drop health insurance coverage in 2010 because they cannot afford the high premiums. One of my family members was told that her back pain constitutes a pre-existing condition and her employer informed her that his small group insurance premiums will increase if he decides to continue providing coverage for her. As physicians we have the moral obligation to protect our patients interests and to stand up against the powerful and mighty insurance industry. Enough is enough!

Have a Happy New Year.

Yours Bernd

Doctors in the News

Well, I guess we can add another "present" under the Christmas tree.
Attached more information about the Zachariah saga which keeps getting juicier and more embarrassing.
Why does greed and lust for power seem to affect doctors more than others?
Because we do not speak up and thereby nurture those behaviors.
Its time to change our approaches and question the format and structure of our organizations.
Merry Christmas
Bernd


Print This Article
Posted on Thu, Dec. 24, 2009
2 Broward doctors settle insider trading case

BY DAN CHRISTENSEN
browardbulldog.org
The former chairman of the Florida Board of Medicine and another Fort Lauderdale physician have agreed to pay substantial sums to settle federal civil charges of insider stock trading.

Dr. Mammen P. Zachariah, appointed to the board of medicine by Gov. Jeb Bush in 2004, and Dr. Sheldon Nassberg allegedly reaped illegal windfalls by acting on stock tips supplied by Mammen Zachariah's brother, prominent Broward heart specialist and major Republican fundraiser Dr. Zachariah P. Zachariah.

Zach Zachariah, who has raised millions of dollars for Republican causes and candidates, including both presidents Bush, faces similar charges, but has declined to settle his case. A federal magistrate has set trial for Aug. 23, 2010.

That trial promises to offer a unique look at Republican fundraising and how political access is bought and sold. Among the expected highlights is witness testimony from two of South Florida's better-known corporate chieftains -- The Geo Group's George Zoley and Phil Frost, formerly of IVAX.

The Zachariah brothers and Nassberg, all of whom practice at Fort Lauderdale's Holy Cross Hospital, were named in a May 2008 civil complaint brought by the U.S. Securities and Exchange Commission. The complaint accuses them of collecting more than a half-million dollars in illegal profits during a fraudulent stock-trading scheme in 2005.

Without admitting or denying the government's allegations, Mammen Zachariah, 61, agreed to pay nearly $136,000 in what a judge labeled ``ill-gotten gains,'' plus an equal amount as a civil penalty. Nassberg, an endocrinologist, agreed to similar payments totaling $52,668. He admitted no wrongdoing. Both men are required to pay up by the end of the month.

The final judgments signed by U.S. Magistrate Linnea Johnson on Wednesday also include permanent injunctions that restrain both doctors from future securities law violations.

Zach Zachariah, another past chairman of the Florida Board of Medicine, is alleged to have used nonpublic information to buy and sell shares of two unrelated Florida companies, Miami-based generic drug maker IVAX and Sarasota's Correctional Services Corp. (CSC).

Zachariah was on IVAX's board of directors in July 2005 when company chairman Phil Frost informed him that IVAX had agreed to be acquired by Teva Pharmaceuticals for $26 a share. Within minutes, Zachariah bought 35,000 IVAX shares for about $21 a share, the SEC said. At the time of the alleged purchase, company insiders were forbidden from trading in IVAX stock.

Zachariah also allegedly tipped off his brother, who bought 2,000 IVAX shares for about $23 a share on the last trading day before the deal was announced in July 25. Zachariah allegedly used inside information to make even more money trading shares of CSC, which was acquired by The GEO Group of Boca Raton in 2005. According to the SEC, the Zachariah brothers and Nassberg turned $380,000 in quick profits.

The government says Zachariah acquired that inside knowledge in a couple of ways. One was through his son Zachariah ``Reggie'' Zachariah, who worked in GEO's mergers and acquisitions department. Reggie Zachariah has denied under oath tipping off his father to the deal. Another was through Zachariah's own moonlighting work for GEO. The SEC says Zachariah made ``millions of dollars'' as a corporate consultant, service provider and lobbyist for GEO, a giant prison contractor once known as Wackenhut Corrections.

Zachariah, who owns a $2.3 million home on the Intracoastal Waterway in secluded Sea Ranch Lakes, said under oath last winter that he was paid to provide access for GEO chief executive George Zoley to top federal and state Republican politicians.

Those politicians include former President George W. Bush, former Senate Majority Leader Bill Frist, former Florida Senate President Tom Lee and House Speaker Alan Bense and former attorney general Charlie Crist, now Florida's governor.

Dan Christensen, a former Miami Herald reporter and columnist for The Daily Business Review, is founding editor of BrowardBulldog.org, a nonprofit online-only newspaper.

Medicare Payment Cuts Reversed

The Medicare Physician Payment Reform Act Of 2009 passed the House on 11.19.2009 with 243 Ayes and 183 Noes. The measure would reverse a 21.2% payment cut planned for Jan. 1, 2010, wipe out the accumulated physician spending debt and implement a new formula.
242 Democrtes and ONE(1) Republican (Michael Burgess,MD, Texas) voted in favor and 172 Republicans and 11 Democrates ( including Suzanne Kozmas, FL) voted against.
Lets be clear who our FRIENDS are: Democrats and NOT Republicans! But the FMA leaders are still supporting those politicians who voted AGAINST the passage of this reform act: Tom Price, Ros Lehtinen, Diaz Balart, Mack, etc.)
Go figure out there logic!!!

Bernd



For more information see AMA News.

House votes to scrap Medicare doctor pay formula
The bill, which would base pay more closely on costs, now moves to the Senate. That chamber has already rejected a similar measure this year.
By CHRIS SILVA, amednews staff. Posted Nov. 19.

Washington -- The U.S. House of Representatives passed a major bill Nov. 19 that would abandon the current Medicare physician payment formula and allow future rates to increase based more closely on doctors' costs, a revision that is expected to cost roughly $210 billion over 10 years.

By a vote of 243-183, the House approved the Medicare Physician Payment Reform Act of 2009. The measure would reverse a 21.2% payment cut planned for Jan. 1, 2010, wipe out the accumulated physician spending debt and implement a new formula.

The new spending growth rate target for physician services would be equal to the gross domestic product plus 1%. Preventive care and evaluation and management services would have a separate target of gross domestic product plus 2%, allowing primary care pay to increase at a higher rate over time.

"Without action by both houses of Congress, Medicare will cut payments to physicians by 21% in 2010, with more in years to come. Today's House vote is the first step toward preventing this cut and eliminating the formula that creates a roller coaster of uncertainty for seniors and physicians who care for them," said American Medical Association President J. James Rohack, MD, who called on the Senate to act on the legislation. "Promises have been made to seniors and military families -- and the House recognizes that those promises must be kept."

The White House in advance of the vote issued a statement strongly supporting the legislation. "The administration believes Medicare and the country need to move toward a system in which doctors receive better incentives to provide their patients with higher quality and more efficient care," said the Nov. 18 statement from the Office of Management and Budget. "A cut of this magnitude could reduce access to physicians for Medicare beneficiaries throughout the country."

The Senate must still approve the legislation before it can head to President Obama's desk. The upper chamber has already rejected a bill once this year that would have eliminated the Medicare physician payment formula. That legislation ran into opposition from Republicans and fiscally conservative Democrats who said they did not want to raise the federal deficit by hundreds of billions of dollars.

The House measure was originally part of the chamber's health system reform bill but was stripped out for separate floor consideration. The primary reason for this was to decrease the total cost of the main reform package and to keep the final dollar figure under a White House-imposed limit.

Appointment

Governor Crist appoints Past DCMA President to the Prescription Drug Monitoring Program Implementation and Oversight Taskforce.



http://www.flgov.com/release/11150

GOVERNOR CRIST APPOINTS NINE TO THE PRESCRIPTION DRUG MONITORING PROGRAM IMPLEMENTATION AND OVERSIGHT TASK FORCE

November 12, 2009

Contact:

GOVERNOR'S PRESS OFFICE
(850) 488-5394

TALLAHASSEE – Governor Charlie Crist today announced the following appointments:

Prescription Drug Monitoring Program Implementation and Oversight Task Force

· Andre Benson, 62, of Tampa, physician, Operation PAR Inc., appointed for a term beginning November 12, 2009, and ending July 1, 2012.

· Lora “Lorrie” Brown, 44, of St. Petersburg, pain physician, Coastal Orthopedics, appointed for a term beginning November 12, 2009, and ending July 1, 2012.

· Kristen Cortes, 45, of Panama City, Florida Department of Law Enforcement agent, appointed for a term beginning November 12, 2009, and ending July 1, 2012.

· David Craig, 41, of Tampa, clinical pharmacist specialist, H. Lee Moffitt Cancer Center and Research Institute, appointed for a term beginning November 12, 2009, and ending July 1, 2012.

· Joel Kaufman, 57, of Ft. Lauderdale, vice president, United Way of Broward County, appointed for a term beginning November 12, 2009, and ending July 1, 2012.

· Nilesh Patel, 45, of Bradenton, interventional pain management physician, appointed for a term beginning November 12, 2009, and ending July 1, 2012.

· Donnie Reynolds, 41, of Weston, chief operating officer, Automated Healthcare Solutions, appointed for a term beginning November 12, 2009, and ending July 1, 2012.

· Paula “Pepper” Wakeland-Hewitt, 60, of Sarasota, pharmacy manager, Davidson Drugs, appointed for a term beginning November 12, 2009, and ending July 1, 2012.

· Bernd Wollschlaeger, 51, of Miramar, self-employed primary care physician, appointed for a term beginning November 12, 2009, and ending July 1, 2012.

Cover Florida

Attached an article in todays Miami Herald pointing out the problematic issues of the so-called " Cover Florida" insurance program touted by Governor Christ as the solution for the Uninsured.
Here are some facts:

* in many cases it offers a barebone service package.
* participating insurance companies still do not offer comprehensive services for competitive prices DESPITE the claims made by the Governor that" each provider was chosen by the state through a competitive bidding process."
* To date, about 4,500 people have enrolled -- about 0.1 percent of the state's uninsured population. More than 3800 Floridians loose their health insurance every week!!!

The question remains: is this program the result of an honest effort to find a solution to cover the Uninsured, or just another political campaign trick meant to boost the chances of Governor Christ to enter the US Senate?
Needless to say that he still refuses to accept a public option, but has yet to declare if Florida will opt out such an option if offered on federal level.
My gut feeling? He will do anything to get elected even if it means to scarify more Floridians on the altar of political vanity.
Yours
Bernd





Posted on Sat, Oct. 24, 2009
Crist exaggerates benefits of Cover Florida Health Care program

BY CATHARINE RICHERT
PolitiFact Staff Writer

In a recent Fox News interview, Florida Gov. Charlie Crist boasted about Cover Florida Health Care, an effort to provide low-cost healthcare coverage to the nearly four million uninsured in the state.
``There are no government mandates to it, no tax dollars utilized for it,'' Crist said on Wednesday. ``Just good, aggressive negotiating by our administration with health insurance companies. . . . And, really, the problem with healthcare is that it's expensive. And so what we've attempted to do is reduce the cost by reducing the expense and the premium of health insurance, and we've had success doing so. Usually it's about $900 a month to get health coverage. We've reduced that, on average, to about $150 a month.''

Given all the debate over the high cost of healthcare, we wondered if the plan could be as inexpensive as Crist claims. We found he was distorting the savings by mixing apples and oranges.

The program, which was started in 2008, allows individuals who have been without coverage for at least six months to pick from plans offered by six insurance companies. Each provider was chosen by the state through a competitive bidding process, and each offers at least two options -- one with catastrophic and hospital coverage, and another plan that can provide less coverage.

The program's website says that individual plans can be purchased for as little as $23 or as much as $800 a month, depending on age, gender and level of coverage. Patients pick and choose between various options offered through the six insurers. So, for example, a woman who is between 19 and 29 years of age can pay $130 a month for a plan that includes no deductible, $10 copays for doctor visits, but no hospital inpatient coverage.

NOT DOING ENOUGH

Since Cover Florida Health Care was enacted, critics have said the program hasn't done enough to cover the uninsured. To date, about 4,500 people have enrolled -- about 0.1 percent of the state's uninsured population.

The low-cost options so often touted by state officials don't offer patients much of a safety net, said Florida state Sen. Nan Rich.

``People are beginning to see that it doesn't cover anything,'' said Rich, a Democrat from Weston. ``It may be inexpensive, but it's inexpensive for a reason. It's a very low level of coverage.''

When we asked Crist's office about his claim -- that healthcare costs are on average $900 a month compared to $150 under Florida's plan -- we were told that the $900 figure cited by the governor came from the nonpartisan Kaiser Family Foundation and that it refers to the amount of money a family pays, on average, per month. Crist's office also noted that the figure is outdated (for instance, in 2006, the average monthly cost per family was about $950) and pointed us to a new Kaiser report released Sept. 15, 2009, that estimates families now pay about $1,114 a month.

So Crist is off by about $200 for family coverage.

AVERAGE COSTS

As for the average cost under the Cover Florida program, Crist's office pointed us to a document that lists the different providers and their rates for individuals. The average for the higher-end coverage, which would include hospitalization and catastrophic insurance, is about $227, while the average for the less-expensive ``preventive'' plan was $89. So Crist's $150 number is the approximate average of the two.

But wait. The first number Crist cited is the Kaiser estimate for a family. The second number is for an individual.

We went back to the Kaiser report and found that the average cost for an individual plan is actually around $400 a month, which would mean the gap was not as dramatically different as Crist claimed.

Crist spokesman Sterling Ivey acknowledged the apples and oranges comparison but said the underlying point is still valid that the Florida average is lower.

But we find Crist is using sleight-of-hand, comparing numbers that aren't comparable. He's used a higher family number with a lower number for individuals. We rate his claim False.

Herald/Times staff writer Steve Bousquet contributed to this report.

Healthcare Reform and Insurance Exchanges

Saturday, October 10, 2009


Letter To The Editor:

When reading John Dorschners article “Healthcare reform proposal on insurance exchanges was tried in Florida” I reached only one conclusion: why to try it again ?
The current system is broken. Costs are soaring and so are the numbers of uninsured Floridians.
The current reform proposal would require all Americans to purchase a flawed product: private health insurance which wastes one-third (31 percent) of Americans’ health dollars on nonsensical administration, huge profits and exorbitant executive pay. But there is one solution which few dare to explore: a single-payer system. Single-payer national health insurance is a system in which a single public or quasi-public agency organizes health financing, but delivery of care remains largely private. Single-payer financing is the only way to recapture wasted and precious healthcare dollars. The potential savings on paperwork, more than $350 billion per year, are enough to provide comprehensive coverage to everyone without paying any more than we already do. Under a single-payer system, all Americans would be covered for all medically necessary services, including: doctor, hospital, preventive, long-term care, mental health, reproductive health care, dental, vision, prescription drug and medical supply costs. Patients would regain free choice of doctor and hospital, and doctors would regain autonomy over patient care. Physicians would be paid fee-for-service according to a negotiated formulary or receive salary from a hospital or nonprofit HMO / group practice. Hospitals would receive a global budget for operating expenses. A single-payer system would be financed by eliminating private insurers and recapturing their administrative waste. Modest new taxes would replace skyrocketing insurance premiums and out-of-pocket payments currently paid by individuals and business. Costs would be controlled through negotiated fees, global budgeting and bulk purchasing. Lets not waste this opportunity for meaningful change. It’s not too late!

Bernd Wollschlaeger,MD,FAAFP,FASAM
Board Certified Family Physician & Addiction Specialist
16899 NE 15th Avenue, North Miami Beach, FL 33162
Phone: (305) 940-8717
E-mail: info@miamihealth.com

The Old Guard Reveals Itself!

In a recent member communication the President of the FMA reflects on the issue of "Advanced Medical Home" and the primary physician shortage. I agree with him that we need more primary care physicians but his remarks reveal the true attitude towards family physicians by stating that "We in organized medicine need to make sure that secondary providers don’t usurp our traditional role as captain of the ship." Who are those "secondary providers?"
Family doctors, general internists, pediatricians, ARNPs, PAs??? Are we second class citizens too???
This dismissive remark is indicative of the pervasive mind set within the leadership of the FMA which thrives on the cold war-like black-and-white view of the world. But the current healthcare industrial complex (HDIC) consists of a tight web of services delivered across a horizontally and vertically structured set of providers, including physicians and allied healthcare professionals.
Its takes an unhealthy dose of delusional thinking to claim that ANYONE will be the "captain of the ship."
Moreover, Dr.Dolan and other FMA leaders refuse to recognize this reality and want to roll-back in time to the Garden of Eden of medicine where doctors and patients lived together happily until someone introduced the forbidden fruit of health insurance and government intervention.
We have to strike back against the perpetuation of those false beliefs suggesting that family physicians are taking over medicine as THEY know it.
These ideologues are beyond education. They cannot be talked too anymore. Its also useless to work with them on any issues as it pertains to primary care!! We have to define who we are and what we want and work together with consumer groups, unions and patient advocates to create the healthcare delivery system that we all deserve. Change is tough but necessary. Success favors the prepared and open mind. The odds are in our favor. Lets not miss this opportunity.
Yours
Bernd

FMA Board Member in the News

In an (attempted) scholarly treatise Betsy McCaughey, the self-declared patient rights advocate, cited another "scholar", a fellow Florida doctor, as the new oracle of Delphi predicting the demise of medicine. Dr. David McKalip, a Florida neurosurgeon and a board member of the Florida Medical Association, predicts: "The only doctors left in Medicare will be those willing to ration care and practice cookbook medicine." Well, I am glad to know that Dr.Mc Kalip's looney-tunes are hitting the national headlines because it illustrates how he, and his fellow FMA apostles, really think about the future of medicine in this country.
The editorial is filled with half-truth, delusional confabulations using fear-based agitprop, or political propaganda promulgated chiefly in the former USSR.
Well, read it yourself to understand how our fellow FMA colleagues really feel. Enjoy and if you need something for nausea call me.
Yours
Bernd

NEW YORK POST

The 'kill granny' bill
By BETSY MCCAUGHEY
Last Updated: 11:18 AM, October 5, 2009
Posted: 1:05 AM, October 5, 2009
AS the health-reform bills move through Congress, the prognosis for Medicare pa tients gets worse and worse.

The Senate Finance Committee bill (generally called the Baucus bill, after Chairman Max Baucus) robs the elderly to cover the uninsured -- like snatching purses from little old ladies. The House bills already cut future funding for Medicare by $500 billion over the next decade. The Baucus bill would slash a similar amount, just when 30 percent more people enter the program as baby boomers turn 65.

The Baucus bill also puts new limits on what doctors can do for patients in Medicare:

* A "race to the bottom" provision (p. 102 of the revised chairman's mark) would take effect each year for the next five years. The provision penalizes doctors who end up in the 90th percentile or above on the cost of what they use to treat their patients, compared with national averages. The intent is to force down the cost of care, year by year. Yet this blunt instrument can't determine which care is actually wasteful -- it will punish doctors for treating high cost patients with complex conditions. Inevitably, it will lower the quality of care.

* Even more devastating is the amendment Sen. Maria Cantwell (D-Wash.) got inserted into the bill (revised chairman's mark, pp. 102-3). It gives the Secretary of Health and Human Services the power to define quality, cost-effective care for each medical condition and penalize doctors who spend more on their patients.

The law establishing Medicare in 1965 barred the federal government from interfering in doctors' treatment decisions. Slowly, Medicare regulations have begun unraveling that protection. Now the Cantwell amendment finishes the job.

This is the most extreme change to Medicare ever. Dr. David McKalip, a Florida neurosurgeon and a board member of the Florida Medical Association, predicts: "The only doctors left in Medicare will be those willing to ration care and practice cookbook medicine."

It's reasonable for Medicare administrators to strive to get value for dollars spent. In recent years, Medicare has taken a slow, tight-fisted (and sometimes arbitrary) approach to paying for new drugs or medical devices. But Cantwell aims directly at doctors' decisions.

That's not surprising. President Obama and his advisers vilify doctors for over-treating patients. Dr. Ezekiel Emanuel, brother of White House Chief of Staff Rahm Emanuel and a key Obama health-care adviser, argues that the Hippocratic Oath is largely to blame for the "overuse" of medical care.

In his view, doctors focus too much on the needs of their own patients; they should be taught to ask whether the money they're spending on a patient is worth it. To curb doctors' spending, the stimulus legislation launched a process of sending doctors protocols via computer on what the government deems "appropriate" and "cost-effective" care. Doctors who are not "meaningful users" will be punished financially.

When I warned that this meant the government would be interfering in doctors' treatment decisions, CNN and FactCheck.org said that was untrue. But Dr. David Blumenthal, appointed in March to head the new system of computer-guided medicine, settled that debate. In the New England Journal of Medicine (April 9), he confirmed that "embedded clinical-decision support" (his term for computers telling doctors what to do) would be used to reduce costs, and he predicted that some doctors might rebel against tight controls.

The Baucus bill completes the framework for tying doctors' hands when treating the elderly.

Driving all this is the misconception that doctors spend wastefully on patients who are about to die. Newsweek's recent cover story, "The Case for Killing Granny," argues that "the need to spend less money on the elderly at the end of life is the elephant in the room in the health-reform debate."

Numerous studies prove that is false. In 2006, Emory University researchers examining the records of patients in the year before they died found that doctors spend far less on patients who are expected to die than on patients expected to survive.

The Emory researchers said it's untrue that "lifesaving measures for patients visibly near death account for a disproportionate share of spending." They also found that doctors often can't predict when a patient is in the last year of life.

In any case, the health-reformers' plan to cut spending on patients 65 and older won't simply reduce end-of-life care, it will also eliminate care for patients who are perfectly capable of surviving their illness and going on with life.

Betsy McCaughey is chairman of the Committee to Reduce Infection Deaths and a former New York lieutenant-governor.

Leaving the FMA

LETTER TO THE PRESIDENT OF THE FMA,DR.JAMES DOLAN:

Dear James:
I hope that you are doing well.
For several months now I witness the relentless anti-AMA rhetoric applied by the FMA leadership and the continuous attacks on any meaningful healthcare reform efforts which are sorely needed. I am also outraged that you continue to ignore the reality of the growing number of uninsured in Florida calling it a "myth."
In Miami we reached a 36% Uninsured rate and in Hialeah alone 56%!!! This is not a myth but REALTY! Not only does this trend challenges our public health but also adversely affects the financial viability of medical practices and hospitals and we must find a solution to this problem!!
After long deliberations I finally reached the conclusion that I have no place in the FMA. I fundamentally disagree with the FMA policies and am especially appalled by the vitriolic criticism of the AMA. It already triggered an increase in the AMA member non-renewal rate and will further diminish our representation within the AMA House of Delegates. This criticism is especially difficult to understand because Cecil Wilson is the AMA's President Elect! Why are we stabbing him in the back? Therefore, I relinquish my membership privileges effective immediately. I am saddened that I was forced making this decision but I see no other option.
Stay well.
Yours truly,
Bernd

Ed Annis,MD: A Final Goodbye

Dear Friends and Colleagues:

Today, on the first day of Rosh Hashana, I attended the Memorial Service for Dr. Edward R. Annis who passed away on September 14th, 2009.
Ed's service was attended by many friends and fellow physicians including senior AMA representatives Drs. Hove,Heyman and Wilson.
Cecil gave a moving eulogy followed by very personal presentations of family members including Dr. Joe Annis. Ed's touched so many peoples hearts and minds but remained a humble and faithful person. I remember him as a patient listener who always provided me with advice and guidance. He had the ability to accept and tolerate other opinions and lead by example. I will never forget him and the seed he planted in my heart and mind will continue to grow. Thank you Ed.

Yours truly,
Bernd

Healthcare Reform: A Different Perspective

New uninsured figures show Massachusetts, touted as model for national reform, is failing to cover the uninsured

17,000-member organization of physicians says latest numbers understate the problem and show urgent need for single-payer health reform

Official estimates released this morning by the Census Bureau showing a marginal increase in the number of Americans without health insurance in 2008 - now estimated at 46.3 million, up from 45.7 million in 2007 - masks the true dimensions of the problem, a national doctors' group said.

Significantly, in Massachusetts, where an individual-mandate health reform law, much like what President Obama is proposing on a national scale, was passed in 2006, at least 352,000 people, or 5.5 percent of the population, remained uninsured in 2008. That number was actually (but non-significantly) higher than the number of uninsured in 2007, before strict enforcement of the individual and employer mandates went into effect.

"The legislation championed by the president and the congressional leadership is a virtual clone of the Massachusetts plan," said Dr. Steffie Woolhandler, professor of medicine at Harvard Medical School and co-founder of Physicians for a National Health Program (PNHP). "Today's numbers show that plans that require people to buy private insurance don't work. Obama's plan to replicate Massachusetts' reform nationally risks failure on a massive scale."

Woolhandler said last year's job losses in the recession, and the corresponding loss of health coverage by many workers and their families, are inadequately reflected in the new data. An estimated 2.6 million people lost their jobs in 2008, most of them toward the end of the year. Those who lost insurance at the end of the year would probably be counted as insured in the Census data, she said.

Census officials cited a drop of 1.1 million in the number of persons who were covered by employer-based insurance, continuing an 8-year trend. Whereas 64 percent of Americans had employer-based coverage in 1999, only 58.5 percent had such coverage in 2008.

Dr. Quentin Young, national coordinator of PNHP, said had it not been for a leap of approximately 4.4 million people newly covered by government programs like Medicaid and Medicare, the overall uninsured rate would have set a new record.

Young said the "tragic and painful persistence" of tens of millions of uninsured persons in the country is "completely unacceptable" and underscores the urgency of enacting a Medicare-for-all program.

"The only way to solve this problem is to insure everyone," he said. "And the only way to insure everyone is to enact single-payer national health insurance, an improved Medicare for all. Even President Obama has acknowledged this fact."

Young noted that Rep. Anthony Weiner, D-N.Y., is introducing an amendment to the House leadership's health reform bill, H.R. 3200, which would essentially delete its present language and substitute the language of Rep. John Conyers' single-payer bill, H.R. 676. "It's not too late for Congress to do the right thing," Young said.

Dr. Don McCanne, senior policy fellow at PNHP, noted that the Census Bureau was once again silent on the pervasive problem of "underinsurance." People are usually defined as underinsured if they spend 10 percent or more of their income (or 5 percent if they are low-income) on out-of-pocket medical expenses in the course of a year.

"Not having health insurance, or having poor quality insurance that doesn't protect you from financial hardship in the face of medical need, is a source of mounting stress, anguish and poor medical outcomes for people across our country," McCanne said. He noted that a recent study showed 62 percent of personal bankruptcies in the U.S. are now linked to medical bills or illness and three-quarters of those who went bankrupt had insurance when they got sick.

*****

State-by-state data on the uninsured from 2005-2009 can be found here: http://www.pnhp.org/uninsured2008/Uninsured-by-State-2005-2008.pdf

For more information on Massachusetts, see: http://www.pnhp.org/change/Why-MA-style-Reform-Wont-Work.pdf

Physicians for a National Health Program (www.pnhp.org), a research and educational organization of over 17,000 physicians, supports a single-payer national health insurance program. To contact a physician-spokesperson in your area, visit www.pnhp.org/stateactions or call (312) 782-6006.

Senator Nelson and the Public Option

UU.S. Sen. Nelson says “public option is dead,” believes Co-Ops will be possible alternative for nation’s 47 million medically uninsured

U.S. Sen. Bill Nelson, D-FL at the Greater Miami Chamber of Commerce monthly luncheon Wednesday said when it came to a comprehensive change in health care delivery and medical insurance being debated around the country, the Senate; a smaller body will likely craft much of the final product and believes it will involve the use of medical insurance “co-ops that are owned by the policy owners.”
Senator Nelsons support for a co-op sounds more like a cop out.
What does he really support? Few politicians can clearly define either of both entities. The only thing they know that it’s politically less risky to use the term co-op than the perceived evil word “public option.”
So what would it be? Insurance co-ops or health insurance purchasing co-ops?
An insurance co-op requires sustained funding, must develop a large network of providers offering discounted health care services, develop brand identity, figure out how to handle claims, develop actuarial expertise, establish reserves, meet state licensing requirements and solvency requirements. Once a co-op passes all those hurdles it needs to attract and retain customers, lots of customers, to compete with existing insurance companies. In contrast, health insurance purchasing co-ops are based on the idea that consumers bargain with insurance companies to buy insurance. They’re not insurance providers themselves. Most of such initiatives failed to provide the desired benefits for their member.
So what’s left? 1) a solid public option offering an insurance option for those who currently cannot afford to buy insurance or are underinsured; 2) a political consensus to strictly regulate insurance companies like we do with utilities; 3) a single-payer insurance plan, a public service financing the delivery of healthcare.
Single-payer health insurance operates by arranging the payment of services to doctors, hospitals, and other health care providers from a single source established and managed by government. This source replaces private insurance companies with a single, public entity.
These are the options and the choice is ours.Lets have a honest and unbiased debate about those options. Time (or better money) is running out!

Bernd Wollschlaeger,MD,FAAFP,FASAM
Immediate Past President, Dade County Medical Association

White House Conference Call

Dear Colleagues:

Today in the evening, I participated in a White House Office of Health Reform conference call to discuss health insurance reform. The call was intended as a briefing for physicians to discuss issues related to health reform. It started at 8:35pm and lasted for an hour. The call was moderated by Dr.Kavita Patel, who serves with Senior Adviser Valerie Jarrett and worked herself a practicing Internal medicine physician. According to her information ~ 1900 physicians participated and > 400 questions were submitted in advance.
After a briefing about the status of the current health reform efforts ( see http://www.healthreform.gov) Dr. Patel answered several questions submitted in writing and then also by people who queued for a life Q&A sessions.
Several of these questions can be grouped as follows but this does not represent a complete list:

1) Medicare Advantage plans and how they can be adjusted to provide competitive and similar-priced services to all Medicare recipients. This question focused on the preferred financing of CMS for Medicare Advantage plans.
2) Increased reimbursement for primary care services and emphasis on quality versus quantity of care. Dr.Patel clearly identified with practicing primary care docs because she herself experienced the grueling schedule and resulting deficiencies in quality of care.
3) Training of more primary care physicians by dramatically increasing funding for the National Health Service Corps programhttp://nhsc.hrsa.gov/. Unfortunately, she missed addressing the necessary funding increase and removing of restrictions for primary care residency positions.
4) One doctor suggested moving from a fee-for-service reimbursement system to a global fee schedule, which in my opinion is sorely needed.
5) Another doctor suggested an end-of-life conference at the White House to rationally discuss this controversial issue and to debunk the "death-panel" propaganda perpetuated by some media outlets and political pundits.
6) In a final question a doctor asked why CMS does not reimburse for preventive care services.Definitely, a golden opportunity to change the current reimbursement system to emphasize and validate our daily effortsd and hard work.

In summary, this was an excellent opportunity to connect, to listen and to ask questions in a relaxed, well organized and calm atmosphere. The focus is on primary care: to emphasize preventive services, and to provide funding for increased reimbursement.
I am pleased that rational thought can prevail and I applaud the White House of Health Reform for their efforts. They announced more phone calls in the future. I strongly urge each of you to participate and to engage in a thoughtful conversation.
Yours
Bernd

Bernd Wollschlaeger,MD,FAAFP,FASAM

Universal Health Insurance

Attached you find a summary of a bill (HR676)which so far has not been discussed during the current healthcare refom debate.It should be at least considered as an option and not discarded just because its politically difficult to promote.
Bernd Wollschlaeger,MD



H.R. 676, “The United States National Health Care Act,”
Or “Expanded & Improved Medicare For All”
Introduced by Rep. John Conyers, Jr.


Brief Summary of Legislation

The United States National Health Care Act (USNHC) establishes a unique American universal health insurance program with single payer financing. The bill would create a publicly financed, privately delivered health care system that improves and expands the already existing Medicare program to all U.S. residents, and all residents living in U.S. territories. The goal of the legislation is to ensure that all Americans will have access, guaranteed by law, to the highest quality and most cost effective health care services regardless of their employment, income or health care status. In short, health care becomes a human right. With 47 million uninsured Americans, and another 50 million who are underinsured, the time has come to change our inefficient and costly fragmented non-system of health care.

Who is Eligible

Every person living or visiting in the United States and the U.S. Territories would receive a United States National Health Insurance Card and ID number once they enroll at the appropriate location. Social Security numbers may not be used when assigning ID cards.

Health Care Services Covered

This program will cover all medically necessary services, including primary care, inpatient care, outpatient care, emergency care, prescription drugs, durable medical equipment, hearing services, long term care, palliative care, podiatric care, mental health services, dentistry, eye care, chiropractic, and substance abuse treatment. Patients have their choice of physicians, providers, hospitals, clinics, and practices. There no co-pays or deductibles under this act.

Conversion To A Non-Profit Health Care System

Doctors, hospitals, and clinics will continue to operate as privately entities. However, they will be unable to issue stock. Private health insurers shall be prohibited under this act from selling coverage that duplicates the benefits of the USNHC program. Exceptions to this rule include coverage for cosmetic surgery, and other medically unnecessary treatments. Those workers who are displaced as the result of the transition to a non-profit health care system will be the first to be hired and retrained under this act. Furthermore, workers would receive their same salary for up to two years, and would then be eligible for unemployment benefits. The conversion to a not-for- profit health care system will take place as soon as possible, but not to exceed a 15 year period, through the sale of U.S. treasury bonds.

Cost Containment Provisions/ Reimbursement

The USNHC program will negotiate reimbursement rates annually with physicians, allow for global budgets (monthly lump sums for operating expenses) for hospitals, and negotiate prices for prescription drugs, medical supplies and equipment. A “Medicare For All Trust Fund” will be established to ensure a dedicated stream of funding. An annual Congressional appropriation is also authorized to ensure optimal levels of funding for the program, in particular, to ensure the requisite number of physicians and nurses need in the health care delivery system.

H.R. 676 Would Reduce Overall Health Care Costs


Families Will Pay Less

Currently, the average family of four covered under an employee health plan spends a total of $4,225 on health care annually – $2,713 on premiums and another $1,522 on medical services, drugs and supplies (Employer Health Benefits 2006 Annual Survey, Kaiser Family Foundation and Health Research and Educational Trust; U.S. Department of Labor, Bureau of Labor Statistics, Consumer Expenditure Survey.) This figure does not include the additional 1.45% Medicare payroll tax levied on employees. A study by Dean Baker of the Center for Economic Research and Policy concluded that under H.R. 676, a family of four making the median family income of $56,200 per year would pay about $2,700 for all health care costs.

Business Will Pay Less

In 2006, health insurers charged employers an average of $11,500 for a health plan for a family of four. On average, the employer paid 74% of this premium, or $8,510 per year. This figure does not include the additional 1.45% payroll tax levied on employers for Medicare. Under H.R. 676, employers would pay a 4.75% payroll tax for all health care costs. For an employee making the median family income of $56,200 per year, the employer would pay about $2,700.


The Nation Will Pay About the Same, While Covering All Americans

Savings from reduced administration, bulk purchasing, and coordination among providers will allow coverage for all Americans while reducing health care inflation in the long term. Annual savings from enacting H.R. 676 are estimated at $387 billion (Baker).


Proposed Funding For USNHC Program

· Maintain current federal and state funding for existing health care programs
· Establish employer/employee payroll tax of 4.75% (includes present 1.45% Medicare tax)
· Establish a 5% health tax on the top 5% of income earners, 10% tax on top 1% of wage earners
· ¼ of 1% stock transaction tax
· Close corporate tax loopholes
· Repeal the Bush tax cuts for the highest income earners

Speak Up Against Propaganda

Sunday, August 23, 2009

Letter To The Editor:

RE: Recess Rally

Naturally, every American has the constitutional right to free speech but healthcare protesters are going too far by likening Obama to Hitler or claiming that government will control when people die. It especially puzzles me that the many of those protesters opposing meaningful and necessary healthcare reform are Medicare recipient benefiting from a government controlled, single-payer system! Would those same people be willing to turn in their Medicare cards in protest too? Would those people consider me a “death panelist” because I follow Florida Law and need to discuss advanced directives with them? According to their “logic” hospitals, nursing homes, home health agencies, hospices, and health maintenance organizations (HMOs), which are required to provide their patients with written information concerning health care advance directives, are part of the “death panels” too!
We have to tune down the hyperbolic and toxic rhetoric fueled by fearmongers and anti-government nut wings and return to a rational dialogue to resolve an urgent problem: how to provide healthcare for all Americans.

Bernd Wollschlaeger, MD,FAAFP,FASAM
Family Physician

Lets Get Real:

Over the last few months I witnessed the almost hyperbolic rhetoric used by my colleagues in organized medicine calling for a “battle for freedom” to protect the “sacrosanct patient-physician relationship” against the perceived intrusion by “big government.” They are now joining the chorus of fearmongers who paint the apocalyptic vision of a world dominated by government rationing of healthcare and imaginary death panels forcing seniors to sign living wills condemning them to die.
Meanwhile, those of us who call for a rational discussion about the issues are being marginalized.
The worst if still to come: in exchange for their support of health care reform health insurance companies are being handed the big price: to offer insurance to the uninsured without having to change their business practice. Fiercely defended by Republicans, ideologically motivated leaders in organized medicine and conservative Democrats the CEOs of health insurance companies can continue to reap fat profits by limiting and rationing healthcare for millions of policyholders who are clueless that their policies may not deliver the promised coverage. This win-win situation for insurance companies will result in a loose-loose situation for the average healthcare consumer because the basic principle of meaningful health care reform is missing: tight regulation of the health insurance market.
Uwe Reinhardt, a renowned economics professor at Princeton, got it right. In his recent blog entry “Who Needs The Public Option?” http://economix.blogs.nytimes.com/2009/08/21/who-needs-the-public-option/#more-27531 he states that “Citizens in the rest of the industrialized world have long had easy-to-understand, reliable, life-cycle health insurance. They do not wake up at night worrying that their health insurance might be rescinded over some willful or inadvertent omission on health status during the application for insurance. Nor do they worry that they and their families will lose their health insurance coverage when the family’s breadwinner loses a job or switches jobs or location of residence. It would be very rare, indeed, in those countries to see a middle-class family lose all of its savings and perhaps even its home over unpaid medical bills……….our health insurance system leaves most Americans basically “unsured”: Private, job-based health insurance purchased in the large-group market is stable and reliable only as long as an employee keeps that job. It is not permanent, nor portable. It leaves Americans exposed to considerable financial risk over their life cycle. It is not “insurance,” but “unsurance.”
Even though, I do not agree with his assertion that a public option is not a necessary condition for healthcare reform I wholeheartedly support his argument that we “must convince the public and the legislators who do not trust it that with the help of government – including a wide set of new government regulations – the industry can transform itself into a structure that can offer Americans the same permanent, reliable, easy-to-understand life-cycle financial security that citizens in other nations take for granted and Americans crave.”
The main challenge remains: either creating a purely private-sector model that will offer individuals reliable, life-cycle health insurance with relatively stable premiums, and at premiums that are defensible, or opting for a taxpayer funded single payer health care system (Medicare For All). As long as the typical employment-based health insurance premium for family coverage is $12,688 per year - and rising exponentially – I opt for the only logical solution: single payer healthcare for all Americans!
Bernd Wollschlaeger,MD,FAFP,FASAM

Healthcare For All

Dear Friends and Colleagues:
Attached a superb article by Dr. Dennis Mayeaux,President of the Florida Academy of Family Physicians, which was published in todays Miami Herald.
Yours
Bernd


Posted on Thu, Aug. 06, 2009
Key to reform is doctor access for all

BY DENNIS MAYEAUX
dennismayeaux@yahoo.com
Comprehensive healthcare reform is a political and social challenge that has escaped this country for more than 30 years. This year, divergent interests are coming together to finally fix our healthcare system. There are proposals in Congress that would provide high quality, affordable healthcare and give people the choice of keeping their current insurance plan and their family physician, internist or other primary-care doctor.

As a family physician, I see the effects of our broken healthcare system every day. Let's face it. Access to coverage is never guaranteed. It is not easy to treat patients who are uninsured because they can't afford coverage or are unable to get coverage because of age or a pre-existing condition. Every day even insured patients are refused care because of coverage denials. I am tired of seeing my patients struggle paying for the healthcare they need. Healthcare reform can't come soon enough.

What does it take to make this happen?

• We first need legislation that covers everyone, requiring insurance companies to sell plans regardless of family history, or pre-existing conditions, and to guarantee that patients can renew their coverage after they've become sick.

• Legislation also needs to ensure that once people have insurance, they also have access to a primary-care physician. Unfortunately, there is a growing shortage of primary-care doctors to meet that need. The reformed system must value primary care if we want medical students to choose careers such as Family Medicine. We need family physicians to keep people healthy, provide early treatment for the most common health problems and coordinate comprehensive and seamless care when subspecialty attention is needed.

There is some good news. We have a vehicle that can begin making all these improvements happen. It's called the Affordable Health Choices Act being debated in the U.S. Senate. The House of Representatives is considering a similar bill, which also includes a focus on primary care. These proposals promise to ensure affordable health coverage for nearly everyone.

It's time to stop playing politics and solve the healthcare crisis. We must find a uniquely American solution that controls skyrocketing healthcare costs and gives our patients peace of mind when it comes to their healthcare.

Our Surgeon General nominee, family physician Regina Benjamin, hopes to be ``America's Family Physician.'' Having a family physician is vital to every Floridian's health. Let us support that goal by providing access to all.

Meaningful and sustainable healthcare reform is possible if Congress passes legislation that gives everyone in the United States access to a patient-centered medical home, where their doctor will ensure they get the care they need, when they need it and where they need it.

Dr. Dennis Mayeaux is president of the Florida Academy of Family Physicians.

Why our AMA Supports Healthcare Reform

I think that we need to respond to the misperception, even deliberate propaganda, that our AMA is not informing its members regarding its position towards healthcare reform.
There are multiple resources readily available from our AMA.

* AMA Web Site: http://www.ama-assn.org/ama/pub/advocacy/health-system-reform.shtml
* AMA News: http://www.ama-assn.org/amednews/
* Health System Reform Bulletin: http://www.ama-assn.org/ama/pub/news/newsletters-journals/health-system-reform-bulletin.shtml

Also a recent article highlights the important issue why our AMA supports health system reform initiatives (http://www.ama-assn.org/amednews/2009/07/27/gvl10727.htm )

"The AMA is supporting the legislation partly on the strength of its Medicare payment reform plan, which would spend an estimated $245 billion over 10 years to align physician rates more closely with the costs of providing care. But the Association also backed the bill because it would use health insurance market reforms to cover most Americans, offer a choice of plans to consumers through a health insurance exchange, dedicate new money to boost primary care services and address physician work force problems."

Lets not forget that we also face major Medicare payment cuts and our AMA is proactively involved preventing these cuts.
For more information see http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/medicare/payment-action-kit-medicare.shtml

Lets not use our AMA as the piñata de jour! Lets stand together and focus on the task ahead. Divided we will fail!

Yours
Bernd
AMA - Outreach Recruiter

Rogue Doctor Forced to Resign!

PCMA STATEMENT

July 24, 2009, For Immediate Release. The Pinellas County Medical Association
(“PCMA”) is aware of the inflammatory email sent by Dr. David McKalip regarding
President Obama and “Obama Care.”
Dr. McKalip’s act has been denounced by the Florida Medical Association. In
response to the Florida Medical Association’s request for an apology, Dr.
McKalip issued a public apology.
Following our awareness of the communication, the PCMA immediately called an
emergency special meeting of its Board of Governors and authorized the release
of this statement.
The Pinellas County Medical Association regrets and is appalled by the
statements and act of Dr. David McKalip. Dr. McKalip acted in poor taste
and on his own accord when preparing and issuing his message, with neither
the knowledge nor approval of the Pinellas County Medical Association or
its Board of Governors. The Pinellas County Medical Association joins with
the Florida Medical Association in denouncing and condemning Dr. McKalip’s
act and his offensive “Obama Care” statements. Dr. McKalip’s act in no way
reflects the opinions of the Pinellas County Medical Association or its
Board of Governors. Dr. McKalip has submitted his resignation as
President- Elect and as a member of the Board of Governors of the Pinellas
County Medical Association, and his resignation has been accepted

Rogue FMA Board Member Goes Too Far

A truly sad day for organized medicine when passion turned into blind hatred.
The attempted "apology" is pathetic and I hope that our leadership is taking the appropriate corrective action.
Our FMA deserves better and now is the time to come together to reconsider our position.
Yours
Bernd




Posted on Fri, Jul. 24, 2009
Doctor criticized over Obama e-mail

BY ADAM C. SMITH
St. Petersburg Times

A prominent St. Petersburg doctor and conservative activist has drawn a flood of criticism for e-mailing an image depicting President Obama as a witch doctor with a loin cloth, exotic head dress and bones in his nose.
``ObamaCare, coming soon to a clinic near you,'' reads the caption on the e-mail forwarded earlier this week by St. Petersburg neurosurgeon David McKalip.

Several popular liberal blogs, including Talking Points Memo, Huffington Post and Daily Kos, highlighted McKalip's e-mail Thursday and castigated him for racism. McKalip said he was flooded with calls from people attacking him over the e-mail, which he said he had forwarded to ``a limited group'' of about 150 people.

``I am not a racist. I am simply a person speaking up to make sure patients don't get hurt by the government and by insurance companies,'' said McKalip, who earlier this month organized ``tea party'' rallies across Florida denouncing Obama's healthcare overhaul proposals.

``Because I've been so effective in pointing out how the government plans are going to hurt patients in very serious ways the only way they can neutralize my message is to discredit me personally.''

McKalip, who has written guest columns for the St. Petersburg Times on tax and healthcare issues, teaches at the University of South Florida and is president-elect of the Pinellas County Medical Association and a board member of the Florida Medical Association -- which denounced McKalip's e-mail and urged him to apologize to President Obama.

He has become an increasingly visible political activist, founding advocacy groups including Cut Taxes Now, the Florida Taxpayers Alliance and Doctors for Patient Freedom.

McKalip noted that he helped organize a career counseling day several years ago for African-American Boy Scouts and blamed liberal activists for promoting the witch doctor image more than he ever did. He called the e-mail ``satire,'' but later Thursday night released a statement apologizing directly to Obama.

``I recognize that this image is offensive and hope that the nation refocuses on assuring all Americans have access to high-quality, affordable healthcare with no party interfering in the patient-physician relationship,'' McKalip said.

He is expecting protesters outside his office soon. The Daily Kos site is encouraging people to lodge complaints against him with his affiliated hospitals, USF, and the state Department of Health.

Adam C. Smith can be reached at asmith@sptimes.com

AMA Supports Reform

Kudos to Dr.Cecil Wilson, President Elect of the AMA, whose letter to the editor was published in todays Miami Herald.
He should be applauded for standing up for what we know is right: comprehensive healthcare reform benefiting all Americans.
Thank you Dr. Wilson for your commitment to our profession and the public health.

Bernd Wollschlaeger,MD,FAAFP,FASAM
AMA Member & Outreach Recruiter
============================================================================
AMA to Miami Herald: AMA Supports Reform

July 23, 2009 (published)

Miami Herald
Letter to the Editor

Floridians without health-insurance coverage are in dire straits (Report: 3,560 Floridians will lose health insurance every week, July 16). For their sake, we must achieve meaningful healthcare reform that provides all Americans with access to affordable, high-quality coverage.

The American Medical Association is committed to health reform this year that covers the uninsured, improves quality and ensures patients get the best value from healthcare spending. Important progress has been made with the House and Senate vigorously working on legislation. The AMA will stay actively engaged to make certain health reform that will improve the health of America's patients is accomplished.

The uninsured crisis playing out in Florida is one that can be seen all across America.

We must seize the opportunity this year to pass comprehensive health reform.

Cecil B. Wilson, MD
President-elect, American Medical Association

AMA and Healthcare Reform

Attached todays press release from the AMA regarding its support for H.R. 3200. Obviously, our AMA is supporting the legislation which DOES contain a stripped down version of the public health insurance option. I wonder why their press release omits this important fact? Maybe, to avoid stirring up discussion and potential opposition from the hardliners within our AMA? Nevertheless, the press release is also a small baby step into the right direction and I hope that its not followed by two steps backwards. We will see.For more information about the bill see http://edlabor.house.gov/documents/111/pdf/publications/AAHCA-BILLSUMMARY-071409.pdf .
Yours
Bernd


NEWS FROM THE AMA

FOR IMMEDIATE RELEASE

July 16, 2009



AMA SUPPORTS H.R. 3200, “America’s Affordable Health Choices Act of 2009”

House Bill Expands Access to High Quality, Affordable Health Care for Americans



WASHINGTON– Today, the American Medical Association sent a letter to House leaders supporting H.R. 3200, “America’s Affordable Health Choices Act of 2009.”



“This legislation includes a broad range of provisions that are key to effective, comprehensive health system reform,” said J. James Rohack, M.D., AMA president. “We urge the House committees of jurisdiction to pass the bill for consideration by the full House.” H.R. 3200 includes provisions key to effective, comprehensive health reform, including:



* Coverage to all Americans through health insurance market reforms
* A choice of plans through a health insurance exchange
* An end to coverage denials based on pre-existing conditions
* Fundamental Medicare reform, including repeal of the flawed sustainable growth rate (SGR) formula
* Additional funding for primary care services, without reductions on specialty care
* Individual responsibility for health insurance, including premium assistance to those who need it
* Prevention and wellness initiatives to help keep Americans healthy
* Initiatives to address physician workforce concerns



“The status quo is unacceptable,” Dr. Rohack said. “We support passage of H.R. 3200, and we look forward to additional constructive dialogue as the long process of passing a health reform bill continues. This is an important step, but one of many steps in the process. The AMA is actively engaged with Congress and the administration to achieve health reform that best meets the needs of patients and physicians. We are committed to passing health reform this year consistent with principles of pluralism, freedom of choice, freedom of practice, and universal access for patients.”


# # #

Healthcare Reform Debate: Shall We Include Single-Payer In The Debate?

Dear Friends and Colleagues:

Attached an editorial from yesterdays Seattle Times written by Dr. John Geyman is professor emeritus of Family Medicine at the Universityof Washington, past president of Physicians for a National Health Program, and a member of the Institute of Medicine.
He argues that legislators are "only considering options that build on the present system."He adds that "after months of work, legislative committees in Congress have brought forth drafts of proposals that the Congressional Budget Office (CBO) is starting to score in terms of cost and effectiveness. As expected, the costs of these incremental proposals are high BECAUSE they are based on the CURRENT dataset of health care costs and on data provided by insurance company actuaries. "He is correct that legislators refuse to even consider a single-payer option and that the CBO has yet to score such an option and how it would compare to the models proposed during the current debate.
He ends the editorial with the following challenge: " President Obama has brought forward the concept of audacity of hope. Is it too audacious now to hope that the legislators we elect to Congress can see beyond their campaign contributions and the lobbying efforts by corporate stakeholders to require that single-payer be scored?"

Yours
Bernd




The Seattle Times
July 6, 2009
A pay-go option for health-care reform
By John Geyman

As Congress recessed for the July Fourth holiday, the debate over
health-care reform was reaching a fever pitch. Now the top domestic issue
for the Obama administration, the biggest questions are how much a reform
bill will cost and how to pay for it, quite aside from how effective a
"reform package" will be.

Skyrocketing costs that are out of control are the hallmark of our present
system. Yet legislators have already acceded to pressures and dollars from
stakeholders in the present system (within which costs are revenue) and are
only considering options that "build on the present system."

After months of work, legislative committees in Congress have brought forth
drafts of proposals that the Congressional Budget Office (CBO) is starting
to score in terms of cost and effectiveness. As expected, the costs of these
incremental proposals are high. The first number of $1.6 trillion over 10
years (while still leaving 36 million Americans uninsured) sent these
committees back to the drawing board. At the moment, leading Senate
Democrats are hailing $1 trillion over 10 years as potentially doable.

After presiding over huge deficits during their eight years in power,
Republicans are now demanding "pay as you go" (pay-go) policies. Together
with Blue Dog Democrats, they are threatening to act as spoilers of any
health-care-reform bill on its price tag alone.

Given the dimensions of these difficult economic times including a $1.8
trillion deficit for 2009, $5 trillion in new federal debt over this year
and next, and rising unemployment, pay-go makes good sense. And the
president is making the case that his health-care plan must pay for itself.

Conventional "wisdom" (as generated by the mainstream corporate media) says
that any health-care reform will cost a lot, and that there is no pay-go
option. But there is.

Single-payer financing (public financing coupled with a private delivery
system, a reformed "Medicare for All"), as embodied in Rep. John Conyers'
bill (HR 676 in the House) with its 83 co-sponsors, will yield savings of
some $400 billion a year. That's enough to assure universal coverage for all
Americans while eliminating all co-pays and deductibles ? the ultimate
pay-go. Single-payer will give us far more efficient, affordable, effective
and reliable health care than our present multipayer system. Health insurers
have known for years that they can't compete on a level playing field with
single-payer, and have only been surviving by favorable tax policies and
other subsidies from the government.

This recent testimony before the U.S. Senate Committee on Commerce, Science
and Transportation by Wendell Potter, former head of corporate
communications at Cigna, says it all: "I know from personal experience that
members of Congress and the public have good reason to question the honesty
and trustworthiness of the insurance industry. Insurers make promises they
have no intention of keeping, they flout regulations designed to protect
consumers, and they make it nearly impossible to understand or even to
obtain information we need."

Many studies over the past two decades, including those by the CBO, the
Government Accountability Office (GAO) and the nonpartisan Economic Policy
Institute, have concluded that single-payer can assure universal coverage
and still save money. HR 676 needs to be brought out of the closet and put
on the table for CBO scoring against other options being considered in
Congress, all of which cost much more and fail to provide universal
coverage.

President Obama has brought forward the concept of audacity of hope. Is it
too audacious now to hope that the legislators we elect to Congress can see
beyond their campaign contributions and the lobbying efforts by corporate
stakeholders to require that single-payer be scored?

(Dr. John Geyman is professor emeritus of Family Medicine at the University
of Washington, past president of Physicians for a National Health Program,
and a member of the Institute of Medicine.)

http://seattletimes.nwsource.com/html/opinion/2009424809_guest07geyman.html

Insurance Mandate Gains Support

Attached a letter to President Obama supporting an employer mandate SUPPORTED by the President and CEO of Walmart and the Service Employees International Union (SEIU), the largest healthcare employees union in the US.
This serves as evidence that those of us who do support an insurance mandate DO NOT belong to the extreme left-wing fringes as claimed by our colleagues in organized medicine!
Yours
Bernd


"We are for shared responsibility. Not every business can make the same contribution, but everyone must
make some contribution."

June 30, 2009
President Barack Obama
The White House
1600 Pennsylvania Avenue, NW
Washington, DC 20500
Dear President Obama,
As the Congress considers legislation reforming our health care system, many difficult choices lie ahead.
During the debate, we must keep our eyes trained on one clear imperative: reforming health care is
necessary not just to improve the health of all Americans, but also to remove the burden that is crushing
America’s businesses and hampering our competitiveness in the global economy.
As the nation’s largest private employer, the nation’s largest union of health care workers with over one
million members, and a think tank that has been a leader on health care policy, we have worked closely in
support of health care reform since 2006, when we came together to help break the stalemate that had
defined the health care debate for too long. Now, to move the debate forward once again, we are coming
together to advance what we believe are important proposals that should be included in the current efforts
to reform our nation’s health care system.
We believe now is the time for action on this vital issue. We commend the leadership of elected officials
who are committed to enactment of reform, and we appreciate the commitment to inclusion and
transparency which has been present thus far.
We are entering a critical time during which all of us who will be asked to pay for health care reform will
have to make a choice on whether to support the legislation. This choice will require employers to
consider the trade off of agreeing to a coverage mandate and additional taxes versus the promise of
reduced health care cost increases.
Today, health care costs more because we don’t cover everyone – the average family premium costs an
additional $1,100 because our system fails to provide continuous coverage for all Americans. And losing
coverage pushes people already dealing with financial hardship to the verge of financial collapse. One
accident or unexpected illness can financially ruin them. In 2008, half of all people filing for home
foreclosure cited medical problems as a cause.
A large and growing uninsured population also cripples our broader economic growth. The higher taxes
and premiums needed to meet rising health care costs threaten to consume the benefits of nearly all
economic growth over the next four decades, according to research published in the journal Health
Affairs. And the U.S. economy is losing up to $244 billion every year in lost productivity due to the
uninsured according to a new analysis by the Center for American Progress.
From a business perspective, health reform could not be more critical. A majority of Americans—158
million—receive their coverage through their job or their spouse’s job, according to the Kaiser Family
Foundation. But few businesses will be able to keep up with the pace at which premiums are rising.
Premiums are expected to rise by 20 percent in less than four years, according to research by professors at
Harvard University -- costing 3.5 million workers their jobs, and cutting insured workers’ average annual
incomes by $1,700.
Fiscally, the growing cost of health care is poised to drive our federal budget over a cliff. A recent report
by the Senate Finance Committee found that by 2017, “health care expenditures are expected to consume
nearly 20 percent of the GDP.” In his former role as Director of the Congressional Budget Office (CBO),
current Office of Management and Budget Director Peter Orszag testified to Congress that, “the single
most important factor influencing the federal government’s long-term fiscal balance is the rate of growth
in health care costs.”
We believe payment reform and efficiency initiatives need to be at the center of healthcare reform. The
President and the Congress have put forward good ideas to improve the productivity of our health care
sector. These policies need to be strengthened and adopted because health care reform without controlling
costs is no reform at all.
We are for shared responsibility. Not every business can make the same contribution, but everyone must
make some contribution. We are for an employer mandate which is fair and broad in its coverage, but any
alternative to an employer mandate should not create barriers to hiring entry level employees. We look
forward to working with the Administration and Congress to develop a requirement that is both sensible
and equitable.
Support for a mandate also requires the strongest possible commitment to rein in health care costs.
Guaranteeing cost containment is essential. One way to ensure savings was recently advanced by former
Senate Majority Leaders Howard Baker, Tom Daschle and Bob Dole, “Implement pre-specified targets
for spending growth and enact a “trigger” mechanism that automatically enforces reductions,” (Crossing
Our Lines, Bipartisan Policy Center) President Obama suggested strengthening the role of Med Pac to
help enforce spending discipline.
With smart, targeted policies, we can create a financially-viable health care system that enables workers
to change jobs without losing their care, and allows businesses to become more nimble. Health care costs
will no longer stand in the way of their ability to retool for the 21st century. Focusing on health care cost
savings – and demonstrating a strong commitment to achieving these savings– would make this bill a win
/ win for employers, individuals and America’s competitiveness.

Respectfully,
John Podesta President & CEO Center for American Progress (CAP)
Andrew L. Stern President & CEO Service Employees International Union (SEIU)
Mike Duke President Wal-Mart Stores, Inc.

Is Our AMA in Trouble?

s our American Medical Association in trouble? Well, an article by Nicholas Kristoff published in the New York Times on June 25th provided some food for thought.
Yes, we know now that our AMA's position regarding a public insurance option is a maybe but not an outright no. Nevertheless, the heated debate within our organization and the ideological rigidity displayed by some has created the impression that the AMA is AGAIN opposed to a meaningful reform of our healthcare system. Right or wrong, the impression counts and its out there.
Furthermore, our membership is indeed dwindling and as an outreach recruiter I can attest to the fact that its getting harder and harder to convince doctors to join or rejoin. For some we are too soft and for others not tough enough. For some we are too much on the right, for others too much on the left. The media reports regarding our recent Annual meeting does not help in that effort either.
In Florida alone our membership decreased by 14%! Having listened and spoken to hundreds of doctors in South Florida I can list a few reasons that our leadership must consider:
1)Doctors in private practice want to have their problems addressed and resolved today, rather than tomorrow. They are afraid that they are being forced to close shop and merge with larger groups , or to end up as hospital employees. I visit private offices every week and many are on the verge of financial insolvency!
2)Far too much time is being wasted on ideologically-motivated debate, and too little on the development and deployment of practical practice solutions. Talk the Talk, or Walk the Walk?
3)Our AMA delegation is comprised of individuals representing their own political interest and are detached from the constituents they supposedly should represent.
Therefore, I have resigned from the AMA delegation and return to where I came from: union style grass-root organizing, listening to our members and to find alternative modalities of membership representation. The Web 2.0 technology demonstrates what a few can do using these tools, and they can successfully bypass the encrusted and inflexible structures of organized medicine.
The time for change has come even for our AMA. The questions remains: will our AMA embrace or resist change? Thats an existential question for our organization and circling the wagons will only hasten our demise.
Looking forward to your comments.

Bern Wollschlaeger,MD,FAAFP,FASAM
AMA Member


June 25, 2009
OP-ED COLUMNIST
The Prescription From Obama’s Own Doctor
By NICHOLAS D. KRISTOF
As a society, we trust doctors to be more concerned with the pulse of their patients than the pulse of commerce. Yet the American Medical Association is using that trust to try to block a robust public insurance option as part of health reform.
In fact the A.M.A. now represents only 19 percent of practicing physicians (that’s my calculation, which the A.M.A. neither confirms nor contests). Its membership has declined in part because of its embarrassing historical record: the A.M.A. supported segregation, opposed President Harry Truman’s plans for national health insurance, backed tobacco, denounced Medicare and opposed President Bill Clinton’s health reform plan.
So I hope President Obama tunes out the A.M.A. and reaches out instead to somebody to whom he’s turned often for medical advice. That’s Dr. David Scheiner, a Chicago internist who was Mr. Obama’s doctor for more than two decades, until he moved into the White House this year.
“They’ve always been on the wrong side of things,” Dr. Scheiner told me, speaking of the A.M.A. “They may be protecting their interests, but they’re not protecting the interests of the American public.
“In the past, physicians have risked their lives to take care of patients. The patient’s health was the bottom line, not the checkbook. Today, it’s just immoral what’s going on. It’s abominable, all these people without health care.”
Dr. Scheiner, 70, favors the public insurance option and would love to go further and see Medicare for all. He greatly admires Mr. Obama but worries that his health reforms won’t go far enough.
Dr. J. James Rohack, the president of the A.M.A., insisted to me that his group is committed to making health insurance accessible for all Americans, and that its paramount concern is patient health.
“When you don’t have health insurance, you live sicker and you die younger,” he said. “And that’s not something we’re proud of as Americans.”
He added that the A.M.A. is not necessarily opposed to a public option, and I have the impression that it might accept a pallid one built on co-ops. Dr. Rohack wouldn’t repudiate his association’s letter to the Senate Finance Committee warning against a new public plan. That letter declared: “The introduction of a new public plan threatens to restrict patient choice by driving out private insurers.”
I don’t mind the A.M.A. lobbying on behalf of doctors in the many areas where physicians and patients have common interests. The association is dead right, for example, in calling for curbs on lawsuits, which raise medical costs for everyone.
An excellent study published in 2006 in The New England Journal of Medicine found that for every dollar paid in compensation as a result of lawsuits against doctors, 54 cents goes to legal and administrative costs.
That’s an absurd waste of money. Moreover, aggressive law leads to defensive medicine, in the form of extra medical tests that waste everybody’s money. Tort reform should be a part of health reform.
Yet when the A.M.A. uses its lobbying muscle to oppose major health reform — yet again! — that feels like a betrayal. Doctors work hard to keep us healthy when we’re in their offices, and that’s why they win our trust and admiration — yet the A.M.A.’s lobbying has sometimes undermined the health of the very patients whom the doctors have sworn to uphold.
I might expect the American Association of Used Car Dealers to focus exclusively on wallet-fattening, but we expect better of physicians.
In fairness, most physicians expect better as well, which is why the A.M.A. is on the decline.
“It’s what has led to the decline of the A.M.A. over the last half century,” said Dr. David Himmelstein, a Massachusetts physician who also teaches at Harvard Medical School. “At this point only one in five practicing doctors are in the A.M.A., and even among its members about half disagree with its policies.” To back that last point, Dr. Himmelstein pointed to surveys showing a surprising number of A.M.A. members who support a single-payer system.
For his part, Dr. Himmelstein co-founded Physicians for a National Health Program, which now has more than 16,000 members. The far larger American College of Physicians, which is composed of internists and is the second-largest organization of doctors, is also open to a single-payer system and a public insurance option. It also quite rightly calls for emphasizing primary care.
The American Medical Student Association has issued a sharp statement disagreeing with the A.M.A.
The student association declared that it "not only supports but insists upon a public health insurance option."
Look, a public option is no panacea, and it won’t automatically set right the many shortcomings in our health system. But if that option is killed in gestation, then we’re back to Square 1 and there’s little hope of progress in solving the vast challenges confronting us.
So, President Obama, don’t listen to the A.M.A. on this issue. Instead, for starters, call your doctor!

Prescription Drug Overdose

On June 23, 2009 Florida Gov. Charlie Crist has signed legislation aimed at curbing the growing black market of illegal prescription drugs flowing from South Florida pain clinics across the eastern United States. The new law, passed nearly unanimously in the Legislature, will require doctors and pharmacists to record patient prescriptions for most drugs in a state-controlled database.
Its about pain to reign in on the explosive growth of "pain clinics" in South Florida operated by unscrupulous owners, some associated with the criminal underworld and organized crime.
The number of overdose deaths are soaring, too!
Unfortunately, the prescription drug monitoring program cannot be implemented until the end of 2011 and so far funding is pending.
As physicians we must continue to push for the comprehensive implementation of such program because our patients and fellow citizens are being harmed by drug dealers in a white coat.
Lets not be complacent but proactive. We just won ONE battle but not the war against drugs.
Yours
Bernd
Posted on Tue, Jun. 30, 2009

Prescription drug overdose deaths soar in Florida

BY SCOTT HIAASEN
shiaasen@MiamiHerald.com

Florida continues to see a rapid rise in fatal overdoses caused by prescription-drug abuse -- a trend fueled by a cottage industry of cash-only pain clinics -- while deaths from illegal drugs wane, according to a report from the state's medical examiners released Tuesday.
Nearly 1,000 deaths were caused in 2008 by the potent painkiller oxycodone -- a 33 percent increase from 2007, the report says. Four years ago, only 340 deaths statewide were attributed to oxycodone, the most popular drug in the black-market pill trade supplied by pain clinics.

Conversely, deaths from cocaine overdoses declined by 23 percent, to 648 in 2008.

Overall, prescription drugs accounted for 75 percent of the drugs found in overdose victims last year, the report says.

''The magnitude and severity of prescription drug abuse calls for strong, coordinated action,'' said Bill Janes, the director of the state's Office of Drug Control, in a written statement.

Florida took a step in that direction when the Legislature passed a law creating a statewide database to monitor prescription sales and increasing oversight of pain clinics, which operate with little scrutiny.

The prescription database is designed to detect addicts and drug dealers buying pills from multiple doctors -- often by faking ailments or medical records -- a practice known as ``doctor shopping.''

''It's almost impossible to monitor different people shopping doctors,'' said Dr. Joshua Perper, Broward County's medical examiner. ``A person can get hundreds or thousands of pills.''

This can also lead to dangerous drug combinations. Perper said the most common overdoses involve mixing several drugs, with oxycodone and anti-anxiety drugs such as Xanax and Valium among the most common combinations.

Though the new prescription monitoring law takes effect Wednesday, the database is not expected to begin operating until late next year.

Broward has become the nation's capital of illegal prescription drug trafficking, police say, with nearly 100 storefront pain clinics feeding a black market in pain pills stretching through Kentucky, Ohio, Tennessee, West Virginia and Massachusetts. Florida leads the nation in oxycodone sales -- largely because of these clinics -- according to U.S. Drug Enforcement Administration data.

In 2008, Perper's office detected oxycodone in 171 Broward County overdose deaths -- more than twice the number found in 2005.

The highest number of oxycodone overdoses were reported in Pinellas and Pasco counties, where the drug was detected in 308 deaths last year.

The medical examiner in that district, Dr. Jon Thogmartin, attributes the unusually high number to advanced detection techniques employed by his lab.

''Prescription drugs have really begun, to a significant degree, to replace illicit drugs,'' Thogmartin said.

Thogmartin said many victims overdose on pills prescribed to them by licensed doctors.

To health advocates, this shows that doctors practicing as pain-management specialists need more training and more oversight from the state medical board.

''It's unacceptable to open up a practice and call yourself a pain management physician and start writing prescriptions,'' said Dr. Laura Brown, a Bradenton physician on the board of the American Society of Interventional Pain Physicians. ``That's not pain management.''

Resignation from the Florida AMA Delegation

I herewith notify you about my decision to resign from the AMA delegation for the reason stated in my e-mail sent to the delegation on June 15th.
I am saddened that I am forced taking this step but our AMA delegation does not represent the diverse opinions of the AMA members it claims to represent.
Furthermore, no attempts are being made to change that!
Therefore, I think its for the benefit of our FMA to select another AMA Delegate at the upcoming FMA Annual meeting who conforms with the political ideology of this delegation. I certainly do NOT!
Hopefully, my decision will not affect our friendship and I look forward seeing you again soon.
Yours truly,
Bernd

Medicare Fraud Continues!

Crackdown on Medicare fraud

On several occasions I reported on this blog http://floridadocs.blogspot.com/ about the audacious and callous Medicare fraud and abuse activity here in South Florida. During my tenure as DCMA President I met twice with representatives and senior executives of First Coast Service Options (FCSO) , the regional Medicare administrator, to discuss and understand why on one hand doctors in South Florida are being nickeled and dimed for legitimate services rendered but on the other hand billions of dollars are being paid out for obvious fraudulent claims. The most egregious example is the ongoing payment for HIV infusion “treatments” which, according to the court testimony of a leading HIV treatment expert, are obsolete, replaced for years by more effective oral antiretroviral drugs and not being utilized in clinical practice anymore. In most cases unscrupulous clinic owners, aided and abetted by medical doctors, set up such HIV Infusion clinics, recruited Medicare recipients suffering from HIV/AIDS and billed Medicare for services never rendered, In a series of award winning articles published in the Miami Herald Jay Weaver pointed out the continuous payment for those “services “ despite assurance made by First Coast Service Options that the payment were ceased. In a meeting with FCSO I personally received assurances that “ no such checks are being issued anymore.” Obviously, thats not the truth. I a recent article published on Saturday, June 27th 2009 http://www.miamiherald.com/news/front-page/v-print/story/1116390.html Experts estimate Medicare loses at least $60 billion to fraud every year, with Miami-Dade County at the center of the national crisis. I a recent crackdown agents broke up a Miami-based ring that allegedly schemed to defraud Medicare of $100 million by filing false claims for obsolete HIV therapy across five states. Two of the eight suspects have fled to Cuba.The organization, which was paid $30 million by the federal health insurance program, exported a fraudulent local business enterprise to Georgia, Louisiana, North Carolina and South Carolina by using empty storefronts and post office boxes, authorities said. What is being done to stop the bleeding of precious Medicare dollars? Well, I personally have written letters to the editors of local newspapers pointing out the obvious mismanagement of funds by FCSO. I have written to each and every member of the congressional delegation from Florida and only ONE responded advising me to contact the Officer of Inspector General to file a complaint! Thats it! Meanwhile, Medicare still considers such treatment "reasonable and necessary" and continues to pay hundreds of millions of dollars for fraudulent claims every year. FCSO refuses to consider the one and ONLY option: stop payment of ALL HIV infusion therapy claims in Florida/South Florida. The response: We can't because patients who actually need the treatment would be denied services -- a policy no-no at Medicare. But experts have testified that no one needs this treatments anymore!! If any patient would require such treatment it would be an exception and Medicare could consider payment on a case by case basis! Lets be clear: Medicare officials know the claims are fraudulent. Medicare says it has adopted technology to block false claims for HIV infusion treatment, yet the government program still misses hundreds of millions of dollars annually. To add insult to injury on September 12th, 2008 the Centers for Medicare & Medicaid Services (CMS) announced that First Coast Service Options, Inc. (FCSO) has been awarded a contract of up to five years for the combined administration of Part A and Part B Medicare claims payment in Florida, Puerto Rico, and U.S. Virgin Islands. This represents not only a contract renewal but EXPANSION! In a press release CMS emphasized that “ with this award, CMS continues its progress in reengineering the way in which the government contracts for claims administration for the largest part of the Medicare program. CMS is seeking the best value, from a cost and technical perspective for this critical function.” The “best value” they probably get from FCSO is the waste of Medicare dollars! But they do not stop here! FCSO will be financially awarded too! In the same press release CMS officials emphasized that “ the contract for FCSO includes a base period and four one-year options and will provide FCSO with an opportunity to earn award fees based on its ability to meet or exceed the performance requirements set by CMS.” So they can earn extra dollars on the fraudulent claims amount?

So what can be done:

1)Call, e-mail or write your representative and/or Senator to hold FCSO responsible for every dollar wasted.
2)Petition the Office of Inspector General of the US Department of Health & Human Services at HHSTips@oig.hhs.gov to investigate FCSO business activities.
3)Force FCSO to repay each and every dollar of fraudulent claims paid and hold company executives legally accountable for their actions (or inactions)

In times of financial crisis we all have to act in a cautious manner exercising our duties , obligations and responsibilities as citizens. The blatant abuse of the Medicare system has to stop!

Yours
Bernd

Does our AMA delegation represent our interests?

Copy of an E-mail to FMA AMA Delegates:

Dear Friends and Colleagues:
I regret that I was unable to stay until the end of the meeting and especially that I missed the opportunity to witness our President's speech.
But I had to return to Miami to attend to my ever increasing patient load at my my family medicine office and my voluntary teaching commitments at the University of Miami.
I shared my frustrations regarding our delegation with our Delegation Chair and Vice-Chair and now with you:
During my almost fifteen year of service for organized medicine I now witness an increasing intolerance towards open discussion, political extremism and radicalization within our delegation.
Fear mongering, political stereotyping and demagoguery is now prevailing in the so-called " discussions", whereas the attempt to introduce opinions based on rational thoughts, tolerance for the diversity of opinions and the ability to reach a consensus is being marginalized. As a consequence hardly anyone dares to introduce his/her ideas or thoughts. I observed that many carefully gauge the political thermometer and based on the prevailing mood introduce their thoughts.Voice volume has replaced the value of rational consideration.
Most of us are more concerned to fall into political lockstep because otherwise they may not get elected into desired position within the AMA or jeopardize their delegate status. As an AMA Top-Outreach -Recruiter I speak to many different people trying to convince them to join our organization. In the last year I have witnessed a steady drop in AMA membership numbers within Florida. This does not surprise me anymore, because our AMA Delegation has lost touch with the members they supposedly should represent. Delegates often articulate the MOST extreme political opinions and even question the legitimacy of BELONGING to the AMA! How shall I recruit members if members of our delegation are openly ridiculing our AMA policies and leadership? Unless our delegation changes its behavior I cannot serve as a delegate in its midst.
This is a painful realization after years of service for an organization I admire and respect. But I have lost hope that our AMA delegation can be the platform for pragmatic political action especially in those exciting and challenging times.
Our leadership alone has the opportunity and responsibility to change that!
Change has to include: 1) Open debate and sanctioning of incendiary language,2) Respect for diverse opinions, 3) Fully transparent resolution development process, 4) Candidate and Leadership development based on personal qualification and not years of service.
These are the minimum requirements needed to avoid the political implosion of or Delegation.
Many will disagree with me but I honestly do not care how many times I am going to be called Fascist, Communist or Socialist. Those using this language are demagogues and wannabe "thinkers."
I remain focused on growing our AMA as a professional organization and NOT as a trade association. I remain focused to motivate a diverse spectrum of practicing physicians to join and rejoin our AMA. If these goals are not OUR goals then I have to part with you.

Yours truly,


Bernd