Sunday, November 28, 2010

Health Policy Update

Attached a link to a very interesting article about the provisions offered in the Affordable Care Act for early retiree healthinsurance benefits.
Its important that we educate ourselves about the many benefits the Patient Protection and Affordable Care Act can offer to so many Americans and to be able to respond intelligently to stereotypical accusation and falsifications of this important legislation.


The number of employers offering health insurance coverage to early retirees---former employees older than 55 but not yet eligible for Medicare--has dropped sharply over the past two decades. Employers who have maintained that coverage have increased the share of premiums and other costs paid by enrollees. To help keep this type of coverage in place, the Affordable Care Act established a temporary program under which the federal government will reimburse retiree health plans for high-cost medical claims. This Early Retiree Reinsurance Program will pay 80 percent of each claim that exceeds $15,000, up to $90,000.

The program began in June 2010 and is slated to operate until the end of 2013. It is intended to slow the decline in employer health coverage for retirees and to help tide people over until 2014, when other provisions of the law go into effect. At that point, it will theoretically be easier for early retirees to obtain coverage through new state health insurance exchanges, often with the aid of subsidies. However, it isn't clear whether the $5 billion allotted for the program will cover the anticipated costs between now and 2014.

Among large employers (those with 200 or more workers) who provided health coverage in 2010, only 28 percent offered benefits to newly retired workers, down from 46 percent in 1991. State and local governments and employers with union workers were the most likely to offer retiree coverage. Only 3 percent of small employers (3-199 workers) offered retiree coverage this year . Some retirees are in the same plans as active workers, while others are in plans covering retirees only. In 2007, the most recent year for which numbers are available, an estimated 6.5 million people ages 55-64 had early retiree coverage, on their own or as dependents.

The Affordable Care Act requires the secretary of Health and Human Services (HHS) to establish a temporary reinsurance program. HHS issued implementing regulations on May 5, 2010, and the program took effect on June 1. It will continue through 2013, unless funds are exhausted sooner. Any group health plan that covers early retirees and is sponsored by an employer or union is eligible to participate. This includes private employers and state and local governments, but not federal civil and military retiree plans. Plan sponsors must file an application for each year and meet two key requirements:

1) The plan must have programs or procedures with the potential to generate cost savings for enrollees with chronic and high-cost conditions.
2) Sponsors also must use all reinsurance payments they receive to reduce the total cost of the plan or the costs paid by retirees. To receive the reinsurance payment from the government, the employer or plan sponsor must provide documentation that all the amounts included in its claim were actually paid out. This requirement raises at least two problems.
First, an employer plan commonly deducts the amount for which a participant is responsible--such as the deductible, coinsurance, or copayments--before making payment to a doctor, hospital, or other provider.
Second, there are still some health plans that pay providers on a so-called "capitated" basis, which means that the provider receives a fixed payment at a regular interval to provide all covered care for an enrollee, rather than being paid to provide care service by service. Other plans employ physicians or other professionals on a salaried basis. These plans may not always be able to calculate amounts spent for any particular patient
The Affordable Care Act appropriates $5 billion to cover claims and administrative costs for the reinsurance program through 2013. If at any time HHS anticipates that the funds are likely to be exhausted, it may stop accepting new applications from plan sponsors. To help HHS project future draws on the funds, each application is required to include a two-year projection of expected reimbursement amounts.

As of late October, HHS reported that nearly 3,600 employer plans had been accepted into the reinsurance program. These include more than half of the Fortune 500 companies, all major unions, and government entities in every state.

Some employers may not be certain that they will have enrollees with large enough claims to make applying worthwhile. The Employee Benefit Research Institute (EBRI) has estimated that 13 percent of early retirees or dependents incur claims of $15,000 or more during a year. However, this small share of enrollees accounts for 61 percent of all costs. EBRI calculates that subsidies from the reinsurance program would cover about one-fourth of total costs for an average employer's retiree plan.

However, some plans may have healthier populations or less-generous benefits, meaning that fewer enrollees would meet the $15,000 threshold. And in plans with fewer participants, claims experience is likely to fluctuate considerably from year to year. The rules appear to allow a plan sponsor to apply for the program after it has incurred the costs for which it will be seeking reimbursement. Although the estimated cost of applying is not high--about $2,000 per plan per year--some employers may be waiting to see if their potential subsidy is large enough to be worth the trouble.

Earlier this year, both EBRI and the Congressional Budget Office (CBO) projected that the $5 billion appropriation for the program would be exhausted before the program expires at the end of 2013. EBRI concluded that funds would be used up in 2011, while CBO expected them to last through part of 2012. However, EBRI assumes that all employers providing early retiree coverage will participate, and CBO's projection is likely similar. If employer participation remains low, the funds might stretch further. If the Affordable Care Act works as intended, people who retire in 2014 or later will have access to affordable and often subsidized coverage through state health insurance exchanges. This means that they may have less of a need to rely on coverage through their former employers. As a result, employer-provided retiree coverage is expected to continue to decline, and will no doubt play a steadily smaller role in the coverage of future retirees



Saturday, November 27, 2010

Siberia in Florida: GOP Senator Gets the Cold Shoulder

It used to be you'd have to start every debate thinking: compromise. Now, the only constraint is their good judgment.''

Former Rep. Tom Feeney, R-Orlando, who Speaker of the Florida House from 2000 to 200.

Today’s Miami Herald article “Veteran senator won’t toe the line,” clearly points out the power shift in Tallahassee. The new GOP leadership is flexing its ideological muscles. No one will be allowed to think or act independently. Its the party line or political exile. Senator Fasano, a strong supporter of Governor’s Christ Senate campaign, had to endure the punishment straying from the ideological talking points. Fasano took to the Senate floor during last week's half-day special session and railed against a GOP blueprint for fixing Medicaid. The symbolic ``memorial'' resolution informs Congress that Florida plans to steer its Medicaid patients into managed care networks, an idea that has gained popularity in the state House. ``This is more than intent. We are setting policy today by doing this,'' scolded Fasano, a 16-year legislative veteran. ``This should have gone through committees. If you think you got a few phone calls last year, put people in an HMO and the phones will be ringing off the hook.''

But Fasano's protests were quickly drowned out by a GOP stampede in favor of the bill. In the new Senate, where newcomers value business and economic development over Fasano's populist consumerism, he has morphed from conservative stalwart to moderate maverick.

Lets not forget that Senator Fasano was also the sponsor of the pain clinic legislation that cracked down on facilities freely dispensing medications that are being used by drug abusers who were doctor-shopping. Fasano also was critical of the Legislature for passing the new rule-making bill, arguing it needed more study. As a result the state Department of Health now must determine whether the new rules exceed the threshold and require a legislative sign-off -- if they have a $1 million adverse impact over five years on economic growth, competitiveness, employment, investment, job creation or regulatory costs. For now, the upshot is that the rules are stalled. What will happen in the meantime? "What's going to happen is nothing," said Sen. Mike Fasano, R-New Port Richey. "And seven more people will die each and every day until the Legislature ratifies these rules that are being approved by the Board of Medicine and the Department of Health."

I wish we would have more outspoken politicians in Florida like Senator Fasano who think and act according to their conscience and not according to party discipline.

History provides a treasure trove of failed attempts to scuttle dissent and to impose rigorous party discipline. I hope that Floridian’s learn soon to regret their electoral choices. Otherwise we will be in big trouble.

Yours truly,


Thursday, November 25, 2010

Money and Organized Medicine

Attached an article from the Sun Sentinel highlighting a sad chapter of organized medicine's attempts and efforts to buy political influence and cloud.
Alan Mendelson was once THE political power broker acting on behalf of the Florida Medical Association. Every ranking FMA official did not dare to miss joining one of the many political fundraiser which took place in Alan's house or office. I also participated in those events and have to ask myself why I did not see the writing on the wall! During Eleanor Sobel's Florida Senate campaign Alan Mendelsohn, then treasurer of the Florida Medical Association’s political action committee, aggressively raised money on her behalf and hailed her Aug. 26 victory in the Democratic primary as the FMA flexing its might.
We all were "encouraged" by our own county medical association and the FMA to donate at least $500 to People for a Better Florida Fund Inc. and many of us did so.
Eleanor Sobel's victory was considered a watershed moment demonstrating that Florida's doctors could buy influence in Tallahassee like so many other interest groups already did at that time and still do. When the whole house of cards collapsed everybody quickly pointed their fingers at Alan Mendelson. But did anything change ever since? We still believe that money can buy influence. Elected FMA officials still repeat the article of faith that " only money talks in Tallahassee."
Shouldn't we all take a step back from the political abyss and reconsider? Doesn't Alan Mendelson's behavior clearly demonstrate that money itself can corrode and corrupt anyone? Aren't we all susceptible to hybris? Shouldn't we reestablish core values of integrity, accountability and compassion instead? I hope that the leadership within organized medicine is listening because Alan's case is just the tip of the iceberg and the iceberg is entering hot water.
Happy Thanksgiving

Broward power broker Mendelsohn set to plead guilty in federal case
32-count indictment included accusations of using fraudulent fundraising for his own gain
November 23, 2010|By Jon Burstein, Sun Sentinel

Broward political fundraiser and power broker Alan Mendelsohn is set to cut a plea deal in what federal authorities have described as a fraudulent political fundraising and lobbying scheme that he used to line his own pockets.

Mendelsohn, a Hollywood eye doctor whose influence opened doors at the state Capitol, is scheduled to go before U.S. District Judge William Zloch on Dec. 8 for a plea hearing, according to court papers filed Tuesday.

He is ready to plead guilty to a single conspiracy charge, which can carry no more than five years in prison, said Alvin Entin, one of Mendelsohn's attorneys.

We've reserved a plea date, and we're looking forward to resolving the matter satisfactorily for both sides," Entin said.

Mendelsohn, a member of Gov. Charlie Crist's 2006 gubernatorial transition team, built the Florida Medical Association into a political force as the chief fundraiser of its political action committee. He also helped pioneer the use in Florida of political organizations known as 527s, which are allowed to raise unlimited amounts of money to make statements about candidates and issues.

Federal prosecutors leveled a 32-count indictment against Mendelsohn in September 2009, accusing him of skimming more than $350,000 from the political action committees under his control. The money came from contributors who believed he was using the funds to advance their causes in Tallahassee.

Mendelsohn used some of that money to pay his mistress, buy her a house and a car and pay for his children's schooling, according to court documents.

Five criminal tax charges were tacked on Mendelsohn's corruption indictment in June.

In Mendelsohn's plea deal, the single conspiracy charge will be related to both the tax and political fundraising charges, Entin said. Court documents show that the judge will ask for "a full confession" at the hearing.

Mendelsohn, 52, first began lobbying lawmakers in 1999 on issues related to ophthalmologists, but within a few years, he was being hired to use his political muscle to help such entities as pari-mutuels and credit counseling companies.

In 2008, Mendelsohn demonstrated his might in Broward County by aggressively raising money for Eleanor Sobel in her winning bid in the Democratic primary for a state Senate seat. The Florida Medical Association's PAC and doctors largely funded a political organization that spent more than $600,000 in advertisements boosting Sobel and attacking her opponents

E-mails made public in a defamation lawsuit filed by one of Sobel's opponents portray Mendelsohn as a no-holds-barred fighter. Mendelsohn raised $51,000 for Sobel in a single day, according to the e-mails.

After Sobel's win, he wrote in an e-mail that he believed politicians would start coming to the Florida Medical Association and asking, "What can I start to do now to help you guys?"

He came on federal authorities' radar after he allegedly boasted he could use his influence and bribes to halt investigations into Mutual Benefits, a defunct investment company. Prosecutors say the Fort Lauderdale-based Mutual Benefits defrauded 30,000 investors worldwide of $837 million before the U.S. Securities and Exchange Commission shut it down in 2004.

Mendelsohn's claims helped set in motion a corruption investigation by the U.S. Department of Justice's Public Integrity Section. Mendelsohn is the only who has been arrested in it.

In Mendelsohn's indictment, though, federal authorities alleged that between 2003 and 2006, he funneled $87,000 to an unidentified then-public official.

Jon Burstein can be reached at or 954-356-4491.

Monday, November 22, 2010

The ACO Conundrum

In a recent New York Times article,” Consumer Risk Feared as Health Law Spurs Merger” the author points out that consumer advocates fear that the health care law could worsen some of the very problems it was meant to solve — by reducing competition, driving up costs and creating incentives for doctors and hospitals to stint on care, in order to retain their cost-saving bonuses. Regulatory agencies face a delicate task: balancing the potential benefits of clinical cooperation with the need to enforce fraud, abuse and antitrust laws. Congress’s purpose was to foster cooperation in a health care system that is notoriously fragmented. The hope was that the new law would push doctors, hospitals and other health care providers to come together and jointly take responsibility for the cost and quality of care of patients, especially Medicare beneficiaries.

“ ..eight months into the new law there is a growing frenzy of mergers involving hospitals, clinics and doctor groups eager to share costs and savings, and cash in on the incentives. They, in turn, have deployed a small army of lawyers and lobbyists trying to persuade the Obama administration to relax or waive a body of older laws intended to thwart health care monopolies, and to protect against shoddy care and fraudulent billing of patients or Medicare. “

Furthermore, newly formed Accountable Care Organization (ACOs) could be tempted to hold down costs, and maximize profits, by cherry-picking healthier patients and denying care when it’s needed. Under the law, Medicare can penalize organizations that avoid high-risk, high-cost patients but enforcement mechanism are not sufficient to monitor those violations.

In addition Elizabeth B. Gilbertson, chief strategist of a union health plan for hotel and restaurant employees, also worries that the consolidation of health care providers could lead to higher prices.

“In some markets,” Ms. Gilbertson said, “the dominant hospital is like the sun at the center of the solar system. It owns physician groups, surgery centers, labs and pharmacies. Accountable care organizations bring more planets into the system and strengthen the bonds between them, making the whole entity more powerful, with a commensurate ability to raise prices.”

In conclusion Dr. Donald M. Berwick, the administrator of the Centers for Medicare and Medicaid Services, hails the benefits of “integrated care.” But, Dr. Berwick said, “we need to assure both patients and society at large that destructive, exploitative and costly forms of collusion and monopolistic behaviors do not emerge and thrive, disguised as cooperation.”

As physicians we should take the initiative and form collaborative practice organizations and work together to form ACOs that truly serve the public health and not only serve to line the deep pockets of entrenched interests.

The opportunity to act is now!


Saturday, November 20, 2010

Florida Legislature Delays Crackdown on Pain Clinics

In today’s Sun Sentinel front page article entitled “Crackdown on pain clinic stalls again” Bob LaMendola reports how the Republican dominated legislature voted to delay the implementation of tough new pain clinic regulations. Subsequently, the unscrupulous clinic operators and drug dealers in white coats, wrongly called “doctors,” can continue to churn out prescriptions for powerful painkiller. As a result an average of seven Floridians per day will die from prescription drug overdose. The legislators seem to be more concerned with ideological correctness and purity than the somber facts detailed in a recent report from the Florida Department of Law Enforcement released June 30th 2010

• Prescription drug deaths monitored by the state Medical Examiner's Office continued to climb to 2,488 last year. That's an average of seven deaths per day.
• Oxycodone was the cause of 1,185 state deaths in 2009, a 26 percent increase from the year before and a whopping 249 percent increase from 2005.
• Deaths caused by some illegal drugs declined. Heroin deaths decreased by 20 percent to 111. And cocaine deaths decreased by 18.4 percent to 529.Law enforcement officials have attributed the opposing trends to the fact that prescription drugs are much easier and cheaper to obtain than illegal drugs.
• Prescription drugs account for 79 percent of all drug occurrences in this report when Ethyl Alcohol is excluded. Oxycodone occurrences increased by 23.8 percent in 2009 and deaths caused by Oxycodone also rose by 25.9 percent when compared to the previous year.

So what happened? According to the article the Legislature on Tuesday had taken action to override Gov. Charlie Crist's veto of HB 1565 that was passed during the 2010 legislative session. The bill, which now becomes law, says that proposed rules having significant financial impact – more than $1 million over five years – on small businesses such as pain clinics could not take effect until legislators ratified the rules. Because the pain clinic rules were not in effect on Tuesday, state officials said they cannot be enforced. One of the law's sponsors, Rep.Matt Gaetz, R-Fort Walton Beach, said he was not thinking about pill mills. The law aims to scrutinize rules that drive up regulatory costs and stop businesses from coming to Florida. As for the impact on pill mill rules, Gaetz said: "The benefits of the rulemaking bill outweighs some of the modest inconveniences." It appears to me that Mr. Gaetz lives in another universe than most of us have to live in. In his world reality has to be adapted to fit his political theory. In his world government regulation can only do harm and never do good. In his world pain clinics are successful businesses contributing to the overall economy and more regulations will drive them away from our state. He seems to forget that the regulations were carefully crafted by Democrats and Republicans to PROTECT our citizens from those unscrupulous businesses, which contribute to the DEATH of seven Floridians a day!! Now the proposed rules must be submitted to the Legislature by Feb. 4 to qualify for consideration. Those that don't make it would have to wait until the 2012 legislative session. I am not only outraged by this political checkmate but also deeply concerned about its adverse impact on public health. This issue is too important to allow politicians to gamble away the lives of Florida’s citizen. We need to return to pragmatism and sound reasoning to address and resolve the problem of prescription drug abuse in Florida. Ideological grandstanding will only worsen the situation. We do not have much time left and the clock is ticking.

Bernd Wollschlaeger,MD,FAAFP,FASAM
Board certified Family Physicians & Addiction Specialist
Member of the Prescription Drug Monitoring Implementation and Oversight Task Force

Tuesday, November 16, 2010

Defensive Medicine

The Malpractice Myth: Republicans and Doctors offer no solutions

By Bernd Wollschlaeger,MD,FAAFP,FASAM

In a recent American Medical News article, “GOP state gains expected to have broad impact on physicians,” November 15, 2010, the author points out that the substantial GOP electoral gains could affect physicians and the health system. Medical liability reform legislation probably will receive a boost from the GOP victories, said Mark A. Peterson, a professor of public policy and political science at the University of California Los Angeles. For example, Alabama Gov.-elect Robert Bentley, MD, and Florida Gov.-elect Rick Scott -- founder of urgent-care chain Solantic -- campaigned on expanding tort reform for physicians and other health professionals. Both were endorsed by their respective state medical associations. "A central feature of Republican health care policy ... has been the notion that a major driver of costs has been malpractice" lawsuits, Peterson said. Subsequently, physicians are loudly repeating the myth that defensive medicine increases healthcare costs by up to 30% and that malpractice reform will stop and even reverse the cost increase. Rep. Tom Price (R-GA), a physician, said recently on the House Republican website America Speaking Out that “ any credible attempt to rein in the cost of health care must include a plan to address the whole issue of the practice of defensive medicine. It is estimated to cost an astounding $650 billion each year. That’s 26% of all money spent on health care. Defensive medicine does not raise the quality of care, only the cost.”

There is only one big problem: the political pundits within organized medicine are unable to provide any evidence to support their argument!

In a series of articles published in the September 2010 issue of Health Affairs the authors reached the following conclusions:

* Defensive medicine includes tests and procedures ordered by physicians principally to reduce perceived threats of medical malpractice liability. The practice is commonly assumed to increase health care costs. The results of studies of the costs of defensive medicine have been inconsistent. We found that estimated savings resulting from a 10 percent decline in medical malpractice premiums would be less than 1 percent of total medical care costs in every specialty. These savings are lower than most previous estimates, and they suggest that the presumed impact of tort reform on health care costs may be overstated.
* Physicians contend that the threat of malpractice lawsuits forces them to practice defensive medicine, which in turn raises the cost of health care. This argument underlies efforts to change malpractice laws through legislative tort reform. We evaluated physicians’ perceptions about malpractice claims in states where more objective indicators of malpractice risk, such as malpractice premiums, varied considerably. We found high levels of malpractice concern among both generalists and specialists in states where objective measures of malpractice risk were low. We also found relatively modest differences in physicians’ concerns across states with and without common tort reforms. These results suggest that many policies aimed at controlling malpractice costs may have a limited effect on physicians’ malpractice concerns.
* Concerns about reducing the rate of growth of health expenditures have reignited interest in medical liability reforms and their potential to save money by reducing the practice of defensive medicine. It is not easy to estimate the costs of the medical liability system, however. This article identifies the various components of liability system costs, generates national estimates for each component, and discusses the level of evidence available to support the estimates. Overall annual medical liability system costs, including defensive medicine, are estimated to be $55.6 billion in 2008 dollars, or 2.4 percent of total health care spending.

Notwithstanding all of the above quoted FACTS politicians and their physicians allies still place their bets on malpractice reform.

But we all could start reforming the system TODAY if we would firmly commit ourselves to practice DEFENSIBLE MEDICINE instead. What does that mean?

1. Following expert guidelines and recommendations in managing and treating patients.
2. Implementing patient safety measures to reduce deadly medical errors killing more than 100,000 Americans every year.
3. Collaborating medical care in teams comprised of ALL health care professionals including physicians, physician assistants and ARNPs.
4. Moving from physician centered to patient centered medicine
5. Integrating health information technology into our offices and learn to share medical information.

Even Tom Price (R-GA) admits that we need to “ adopt a set of best-practice guidelines for treatment – agreed to by physicians, not bureaucrats – to provide an affirmative legal defense.”

What are we waiting for? Lets start practicing defensible medicine today.

Yours truly,


Wednesday, November 10, 2010

Physicians Role in ACOs

"A crucial question is who will control these ACOs. We can envision two possible futures: one of physician-controlled ACOs, with physicians affiliating and contracting with hospitals, controlling the flow of funds through the marketplace; and one of hospital-controlled ACOs that will employ physicians. Whoever controls the ACOs will capture the largest share of any savings."

Attached you find a link to an important article "Physicians versus Hospitals as Leaders of Accountable Care Organizations" which was just published today on the NEJM website. I urge you to read the article and want to point out several important messages:

* The next few years will be a period of what economists call “creative destruction”: our fragmented, fee-for-service health care delivery system will be transformed into a higher-quality, higher-productivity system with strong incentives for efficient, coordinated care. Consequently, the actions of physicians and hospitals during this period will determine the structure of the delivery system for many years. The implications will be profound for hospitals’ dominant role in the health care system and for physicians’ income, autonomy, and work environments.
* The Affordable Care Act (ACA) aims to improve the quality of care and reduce costs. Doing so will require focused efforts to improve care for the 10% of patients who account for 64% of all U.S. health care costs.2 Much of this cost derives from high rates of unnecessary hospitalizations and potentially avoidable complications,3 and these, in turn, are partially driven by fee-for-service incentives that fail to adequately reward coordinated care that effectively prevents illness. The ACA includes numerous provisions designed to catalyze transformation of the delivery system, moving it away from fee for service and toward coordinated care.
* Incentives for the development of the information systems and infrastructure are necessary for better and more efficient management of chronic conditions.
* Achievement of this level of care coordination will require the development of larger integrated delivery organizations — preferably, accountable care organizations (ACOs) that incorporate primary care practices structured as patient-centered medical homes and that can support new investments in information systems and care teams and can maintain service hours resembling those of retailers. A move toward ACOs will mean major changes in the structure of physicians’ practices, since even physician-group–based ACOs may include one or more hospitals, though they may instead contract with hospitals for specific services chosen on the basis of their relative value.
* A crucial question is who will control these ACOs. We can envision two possible futures: one of physician-controlled ACOs, with physicians affiliating and contracting with hospitals, controlling the flow of funds through the marketplace; and one of hospital-controlled ACOs that will employ physicians. Whoever controls the ACOs will capture the largest share of any savings.
* For physicians to control ACOs, they would have to overcome several hurdles. The first is collaboration: ACOs will require clinical, administrative, and fiscal cooperation, and physicians have seldom demonstrated the ability to effectively organize themselves into groups, agree on clinical guidelines, and devise ways to equitably distribute money.
* If hospitals are to control ACOs, they, too, will need to overcome barriers. First, they will need to trade near-term revenue for long-term savings. Hospitals are typically at the center of current health care markets, and by focusing on procedures and severely ill patients, most have been fairly profitable. Building an ACO will require hospitals to shift to a more outpatient-focused, coordinated care model and forgo some profits from procedures and admissions.
* Holding off on creating ACOs is likely to be a bad long-term strategy for physicians.
* Therefore, the actor who moves first effectively is likely to assume the momentum and dominate the local market. A wait-and-see approach could succeed if the first mover executes poorly, failing to coordinate care and manage risk. But rather than controlling destiny, cautious actors will be hanging their fate on the mistakes of others.


Tuesday, November 09, 2010

How Medicare Killed the Family Doctor

Attached a link to an article published in the November 8th issues of the Wall Street Journal entitled " How Medicare Killed the Family Doctor."
The author correctly states that “The primary-care doctor has become a piece-rate worker focused on the volume of patients seen every day. As Medicare and insurers focused on trimming the costs of the most common procedures, the income and job satisfaction of primary-care doctors eroded.”

Furthermore, he points out that a possible solution includes “ making primary-care physicians the captains of the ship. They must have the time and financial resources necessary to take care of their patients, tailoring care to patients' specific conditions and needs. And they need the data to track their patients' results, so they can guide patient progress. They will then be able to slow (and sometimes reverse) their patients' illnesses, keeping them out of hospital emergency rooms and specialists' offices. The end result: reduced costs and improved quality of care.”

But it is of interest to note that he discards “new health-care service models, such as the concierge practice and the Patient-Centered Medical Home, [that] drew doctors away from the standard service models that most patients rely on for coverage.”

He obviously misunderstands the PCMH which essentially will empower the primary care physician.

What do you think?



Fewer Practices are Doctor-Owned

Attached a link to an article published in the November 8th issues of the Wall Street Journal entitled " Fewer Practices are Doctor-Owned."
The authors summarized the trend that the share of responding practices that were hospital-owned last year hit 55%, up from 50% in 2008 and around 30% five years earlier.
"The traditional model of doctors hanging up their own shingles is fading fast, as more go to work directly for hospitals that are building themselves into consolidated health-care providers." No knew revelation that "the trend is tied to the needs of both doctors and hospitals, as well as to emerging changes in how insurers and government programs pay for care. Many doctors have become frustrated with the duties involved in practice ownership, including wrangling with insurers, dunning patients for their out-of-pocket fees and acquiring new technology. Some young physicians are choosing to avoid such issues altogether and seeking the sometimes more regular hours of salaried positions."
What I consider as problematic that doctors are surrendering the autonomy to hospitals which are seeking to position themselves for new methods of payment, including an emerging model known as accountable-care organizations. These entities are supposed to save money and improve quality by better integrating patient care, with the health-care provider sharing in the financial benefits of new efficiencies BUT the consolidation wave is raising red flags among some regulators, researchers and health insurers, who warn that bigger health systems can use their leverage to push for higher rates. So what can doctors do? We need to learn the business of medicine and form collaborative primary care practices, or merge our practices to gain market share and leverage.
Surrendering our practices is not a solution. Salaried physicians can get fired too but their former practices remain in the hand of hospitals.


Monday, November 08, 2010

Protect Medicare

Republicans are still gloating over their election victory but even they cannot escape reality. They successfully mislead seniors that Obama will take away their Medicare benefits and promised to maintain, even expand, the current Medicare system. Now John Boehner announced that he would push " to repeal $550 billion worth of Medicare cuts BUT omits to explain how he would pay for such a repeal.
But instead of solutions this position creates more problems!!! has pointed out the truth to counter the misleading "Medicare cuts" propaganda and summarized the FACTS as follows:

" Medicare, a government-run health insurance program, provides health care coverage for the vast majority of Americans over age 65. It accounts for about 12 percent of the federal budget. It's important to note that the law does not take $500 billion out of the current Medicare budget. Rather, the bill attempts to slow the program's future growth, curtailing just over $500 billion in future spending over the next 10 years. Medicare spending will still increase -- the nonpartisan Congressional Budget Office projects Medicare spending will reach $929 billion in 2020, up from $499 billion in actual spending in 2009....

Some of the savings are for relatively minor programs, such as $36 billion for increases in premiums for higher-income beneficiaries and $12 billion for administrative changes. The law directs a new national board to identify $15.5 billion in savings, but the board -- the Independent Payment Advisory Board -- is prohibited from proposing anything that would ration care or reduce or modify benefits. More significantly, there's also $136 billion in projected savings that would come from changes to the Medicare Advantage program. About 25 percent of Medicare beneficiaries are enrolled in a Medicare Advantage plan....

The Medicare Advantage program was intended to bring more efficiency from the private sector to the Medicare program, but it hasn't worked as planned. A June 2009 analysis from the Medicare Payment Advisory Commission said that the Advantage programs costs taxpayers on average of 14 percent more than the traditional Medicare plan. President Barack Obama has said repeatedly that the Medicare Advantage plan wastes public money that could be put to better use.
The health care law that President Obama signed in March phases out extra payments for Medicare Advantage programs over the next three to six years to bring their costs in line with traditional Medicare and institutes other rules for the program.....

Finally, there's $220 billion in Medicare savings achieved by reducing annual increases in payments health care providers would otherwise receive from Medicare. The reductions are part of programs intended to improve care and make it more efficient, such as reducing payments for preventable hospital re-admissions. These adjustments are aimed at hospitals, skilled nursing facilities, and home health agencies.
The Office of the Actuary for Medicare and Medicaid Services questioned in an April 2010 report whether these levels of savings are realistic, saying that some health care providers would become unprofitable if payments were reduced. The actuary's report suggests that Congress will intervene to change the payment formula to avoid health care providers dropping out of Medicare.....

The $500 billion aren't actual cuts but reductions to future spending for a program that will still grow significantly in the next 10 years .... the reductions are ways to make Medicare more efficient [including] benefits to seniors, such as improved prescription drug coverage. "

Sometimes FACTS trump FICTION!!! Still we have yet to find a solution on how to protect the Medicare program and most stake holders are avoiding to contribute their share to avoid the inevitable financial meltdown. Unfortunately, they a re busy to get ready for the 2012 campaign. What can you do? Speak up. Collaborate to offer workable solutions. Stop ideologues from dominating the agenda. Too much is at stake and we should not stay silent!