Posted on Sun, Aug. 12, 2007
Med association slowly changing
BY JOHN DORSCHNER
When doctors get together, the political talk tends to the conservative and discussions are generally excruciatingly polite. That means Bernd Wollschlaeger stands out.
He uses the term ''ideological knuckleheads'' to describe some leaders of the Florida Medical Association, which represents the state's doctors. He says others ''resemble chieftains jealously guarding their tribal territory'' or are ``driven by libertarian paranoia.''
He says he's speaking up now because the shrinking FMA has lost touch with its members. He says its mostly white, male leadership doesn't include enough women, minorities and doctors trained abroad.
In fact, on some points, FMA leaders say they agree with him that the organization needs to change -- and they insist that it is changing, including a shake-up at the top as the executive vice president for the last eight years is leaving.
The issue may be, however, whether the organization is changing fast enough to suit mavericks such as Wollschlaeger, a North Miami Beach family practitioner.
He is not just a kook on the fringes. He is the president-elect of the Dade County Medical Association and a member of the House of Delegates, the legislative body of the American Medical Association.
FIGHTING FOR CHANGE
Aimed at the FMA annual convention in Fort Lauderdale in two weeks, he has launched an e-mail and blog campaign ``Take Back Our FMA Now.''
''That's ruffling a lot of feathers, to put it mildly,'' says Arthur Palamara, a Fort Lauderdale surgeon who is also advocating change.
FMA President Patrick M. J. Hutton, a Jacksonville surgeon, didn't want to say anything about Wollschlaeger. ''At this point, it's up to the House of Delegates,'' the FMA's governing body, to comment.
However, incoming FMA President Karl M. Altenburger, an Ocala allergist, acknowledges that the organization is ''in a period of transition . . . the physician community is very concerned over the next five to 10 years,'' with a huge number of healthcare reforms being discussed by politicians and other leaders, ``and organizationally we're trying to position ourselves to assist members to meet these challenges.''
Among the changes: The exit of FMA's executive vice president, the leader of its full-time staff, Sandra Mortham, who is leaving after eight years. She's a former Secretary of State and was briefly a Jeb Bush running mate.
In an e-mail to FMA leaders, Wollschlaeger wrote: ``Removal (or would firing [be] a more appropriate term?) of . . . Mortham is being celebrated as a panacea of all our problems! How naive or stupid can a leadership be to make us believe that?''
Hutton and Altenburger refused to comment about the circumstances of Mortham's leaving, and she did not respond to three phone calls from The Miami Herald.
The FMA now has about 10,000 active members -- out of about 30,000 physicians practicing in the state. The organization has led a massive, generally conservative lobbying effort in the Legislature, particularly on issues that could reduce the oft-soaring rates of doctors' malpractice premiums.
Doctor organizations, headed by the AMA, ''have a history of opposing changes,'' says Gerard Anderson, a Johns Hopkins health policy professor. ``They were opposed to Medicare, Medicaid, and they're opposed now to a national health insurance . . .
''The best days of doctors were the 1940s,'' says Anderson, ''when they could treat patients without outside interference and charge them what they felt like,'' in the days before managed care and government programs. ``And in some ways they want to return to the 1940s.''
Not Wollschlaeger. He believes American healthcare needs a lot of changes, including universal coverage, but then in many ways he's not a typical doctor.
BREAK FROM TRADITION
The son of a German tank commander in World War II who had a medal pinned on him by Hitler, Bernd Wollschlaeger learned at an early age to think for himself. After a medical education in Germany, he converted to Judaism and moved to Israel, where he practiced for some years before moving to Florida.
''I have never been afraid of ruffling feathers,'' he says. ``I have some political capital, and I'm burning it . . . This is an organization that does not allow open debate.''
He believes the FMA can grow and be relevant only if the organization's leadership becomes diverse and opens itself to more ideas.
When The Miami Herald asked a half-dozen leaders and former leaders of state and local medical associations about Wollschlaeger, none wanted to say anything negative about him.
Carl ''Rick'' Lentz, a Daytona Beach plastic surgeon and a former FMA president, said, ``Physicians come from all sorts of different backgrounds, but . . . the FMA is a really good organization that is doing great things.''
Michael Weston, an emergency medicine specialist who's head of the Broward organization, said, ''I think some of the points he makes does have merit . . . The board of the FMA may not be fully reflective of the diversity of physicians in the state, especially in South Florida.'' But he was skeptical about Wollschlaeger's frontal assault. ``I don't know if that's the best way to handle it.''
Palamara, the Broward surgeon, says, 'The FMA is in a transition . . . I'm the incoming chair of membership. I went to the board of governors meeting, and I was looking at a whole row of 25 or 30 white-haired Caucasian males, and two females, and I said, `That has to change,' and we're undergoing that change right now.''
Altenburger, the incoming FMA president, agrees. ``Yes, we can do things better. People have a little trouble with change, and we have people on all sides of this.''
He insists there is diversity at the top. He points to Madelyn Espinosa Butler, a Cuban-born obstetrician in Tampa who is speaker of the House of Delegates, and Alma Littles, a black woman who's on the board of governors. He notes that Weston, head of the Broward medical association, and Nelson Adams, current president of the Dade medical group, are both black.
`OPEN PATHWAYS'
''We are working very, very hard to make sure there are wide open pathways for leadership for anyone interested,'' Altenburger said, and he won't object to anyone speaking out.
''In science, feathers are ruffled all the time. That's how you make advances. You know there was once a knock-down, drag-out fight about washing hands before surgery. That went on for many years,'' the FMA exec said. ``In a democracy, you can argue both sides and that will make you strong.''
Wollschlaeger says he has ''the highest respect'' for Altenburger, who ''is a positive reformer in the organization.'' But they disagree on how to go about it.
One example: The nominating process for officers. Wollschlaeger believes all the members should have a hand in the nominating, rather than the present system, ''in which candidates are groomed from the elephant process,'' in which those who do the best are the ones who hook their trunks to the tails of the elephants in front of them.
Sunday, August 12, 2007
Saturday, August 11, 2007
Physicians can Take Charge of Their Practice
Dear Friends and Colleagues:
Attached an article from Sunday's Miami Herald.
I have agreed to the story to demonstrate that we as physicians can take charge of our offices, if we are willing to embrace business principles, focus on customer care and patient satisfaction, competitive pricing and the utilization of medical information technology.
Don't get bamboozled by those who suggest that Electronic Medical Records are too expensive, too intrusive and allow the "government" to take over your office.Most of those critics don't even use such systems.
I am applying an EHR in my practice for 10 years now and have learned using it as a very sophisticated tool to assess the quality of care rendered, perform chronic diseases management and to connect to my patients.
Medicine has to move into the 21st century and information technology will play an important role in this transformation process.
Let me know your thoughts and I look forward to your comments which you can post on either one of my blogs (http://floridadocs.blogspot.com/ or http://takebackfma.blogspot.com/
Yours
Bernd
==============================================================================================================
Posted on Sat, Aug. 11, 2007
Dr. Wollschlaeger redefines care
BY JOHN DORSCHNER
Imagine getting sick, going online to see what time your doctor is available and booking an appointment for the same day. You might wait 5 or 10 minutes. Later, if you have a follow-up question, it can be asked and answered by e-mail.
This is the family practice of Bernd Wollschlaeger in North Miami Beach. What he is doing offers a window into the problems and prospects of primary care in America.
Is there a catch with his concept? Of course.
A growing number of doctors are offering such services as part of a concierge practice, in which patients pay an annual fee of perhaps $1,500 plus charges for the various visits.
That's not Wollschlaeger's model. He charges about $65 or $75 for a basic office visit. The catch: You have to pay in cash. He doesn't accept insurance, not even Medicare.
That eliminates a huge amount of paperwork and bookkeeping, allowing Wollschlaeger to work by himself in a storefront operation in a strip mall.
''He's an excellent doctor,'' says Chris Lamonica, a North Miami Beach resident who has been going to him for two years. ``He's very thorough, and he cares about his patients. I do all my appointments online, and it works out great. He's very hands on -- no assistants.''
A STEP BACKWARD?
In the medical community, Wollschlaeger is known as a progressive maverick, supporting universal healthcare and the movement to all-electronic medical records. But in avoiding medical insurance, he might seem in a certain manner to be returning to the 1940s, before employer-based health plans and Medicare, when nothing interferred with the doctor-patient relationship.
Wollschlaeger insists that's not the case with him: He's not being reactionary, but a pragmatist. ''I am adapting to a changing market environment,'' focusing on the ever-growing number of uninsured people, who account for about 75 percent of his practice. Most others have high-deductible policies or are foreigners whose insurance doesn't apply here.
''I'm not opposed to third-party payers,'' he says, if they pay a reasonable fee for performance without insisting on a lot of paperwork costs.
The problem is that insurers pay primary care doctors in South Florida about $40 to $60 for a basic office visit and insist on considerable justifying paperwork. Some doctors try to survive by hiring physician assistants and bookkeepers, and race between examining rooms seeing as many patients as possible to make the low pay work.
Wollschlaeger has gone the other way and simplified: ``I am surviving in a changing marketplace and waiting for a time when the pay structure has a reasonable price.''
After immigrating from Israel, Wollschlaeger did his residency in family practice at the University of Miami, was briefly the medical director of a homeless shelter and then went to work for a physician practices company that wanted to establish an office in Aventura.
That didn't work out. Wollschlaeger said the company didn't understand how long it took to build up a primary care practice. He bought the practice from the company. ``I didn't know how to run an office. I took management courses, read books.''
As both doctor and businessman, he believed the key question was ''how can I make medicine better? It's like asking how does Toyota make better cars.'' The answer, he decided: ``Pay attention to detail and pay attention to customers.''
SERVING THOSE IN NEED
While many physicians gravitate to upscale neighborhoods to get well-off clients, Wollschlaeger decided to move to a blue-collar section of North Miami Beach, to be closer to the under-served and the uninsured. He did, however, keep the name Aventura Family Health Center.
He sees 90 percent of his patients the same day they call up. ``Timely service with the right price -- there's nothing wrong with that.''
For him, better service often means the Internet, which he knows can often make communication faster and easier in answering routine questions and requesting refills of prescriptions.
If patients want, they can e-mail him through a highly secure server operated by Medem, a tech company ''connecting physicians and patients.'' For that, he charges $15 or $20.
But the vast majority of patients simply use regular e-mail, and for that he doesn't charge. Nor does he charge for sending a PDF file of lab results.
Underlying all these services is Wollschlaeger's belief in the absolute necessity for electronic medical records, which he has been keeping since the mid-1990s.
Electronic records can be sorted and measured in so many ways that he believes they take healthcare for a new level. When warnings went out on Vioxx, for example, he could do a simple sort on his computer to find patients taking the drug and alert them with e-mails or phone calls.
Gerard Anderson, a public health professor at Johns Hopkins, says many doctors are resistant to electronic records because they're required to take on all the costs while the insurers benefit the most, because of the ease of processing claims data. ``Buying the software, buying the computer and then there's the conversion from paper to electronic. That's a huge cost.''
`YOU CANNOT WHINE'
Wollschlaeger acknowledges there are expenses. Last year, he spent about $6,000 to update his computers and software. But he insists doctors need to do that. ''You cannot whine. To make money you have to spend money.'' Postponing electronic conversion -- and many doctors are postponing -- ``your practice only gets worse.''
He believes the costs of conversion from paper are exaggerated. ''Look at the banking industry,'' once based entirely on paper checks. ``They went to online payments, online facsimiles of checks. If they can do it, why can't we?''
He says healthcare is ''generally an ineffective and inefficient industry,'' but he's not trying to change it in order to make a ton of money.
''I did not choose medicine to get rich,'' he says. His gross adjusted income in 2005 was $121,000. He drives a Honda Accord with an Obama bumper sticker. ``I have a very satisfactory lifestyle.''
Attached an article from Sunday's Miami Herald.
I have agreed to the story to demonstrate that we as physicians can take charge of our offices, if we are willing to embrace business principles, focus on customer care and patient satisfaction, competitive pricing and the utilization of medical information technology.
Don't get bamboozled by those who suggest that Electronic Medical Records are too expensive, too intrusive and allow the "government" to take over your office.Most of those critics don't even use such systems.
I am applying an EHR in my practice for 10 years now and have learned using it as a very sophisticated tool to assess the quality of care rendered, perform chronic diseases management and to connect to my patients.
Medicine has to move into the 21st century and information technology will play an important role in this transformation process.
Let me know your thoughts and I look forward to your comments which you can post on either one of my blogs (http://floridadocs.blogspot.com/ or http://takebackfma.blogspot.com/
Yours
Bernd
==============================================================================================================
Posted on Sat, Aug. 11, 2007
Dr. Wollschlaeger redefines care
BY JOHN DORSCHNER
Imagine getting sick, going online to see what time your doctor is available and booking an appointment for the same day. You might wait 5 or 10 minutes. Later, if you have a follow-up question, it can be asked and answered by e-mail.
This is the family practice of Bernd Wollschlaeger in North Miami Beach. What he is doing offers a window into the problems and prospects of primary care in America.
Is there a catch with his concept? Of course.
A growing number of doctors are offering such services as part of a concierge practice, in which patients pay an annual fee of perhaps $1,500 plus charges for the various visits.
That's not Wollschlaeger's model. He charges about $65 or $75 for a basic office visit. The catch: You have to pay in cash. He doesn't accept insurance, not even Medicare.
That eliminates a huge amount of paperwork and bookkeeping, allowing Wollschlaeger to work by himself in a storefront operation in a strip mall.
''He's an excellent doctor,'' says Chris Lamonica, a North Miami Beach resident who has been going to him for two years. ``He's very thorough, and he cares about his patients. I do all my appointments online, and it works out great. He's very hands on -- no assistants.''
A STEP BACKWARD?
In the medical community, Wollschlaeger is known as a progressive maverick, supporting universal healthcare and the movement to all-electronic medical records. But in avoiding medical insurance, he might seem in a certain manner to be returning to the 1940s, before employer-based health plans and Medicare, when nothing interferred with the doctor-patient relationship.
Wollschlaeger insists that's not the case with him: He's not being reactionary, but a pragmatist. ''I am adapting to a changing market environment,'' focusing on the ever-growing number of uninsured people, who account for about 75 percent of his practice. Most others have high-deductible policies or are foreigners whose insurance doesn't apply here.
''I'm not opposed to third-party payers,'' he says, if they pay a reasonable fee for performance without insisting on a lot of paperwork costs.
The problem is that insurers pay primary care doctors in South Florida about $40 to $60 for a basic office visit and insist on considerable justifying paperwork. Some doctors try to survive by hiring physician assistants and bookkeepers, and race between examining rooms seeing as many patients as possible to make the low pay work.
Wollschlaeger has gone the other way and simplified: ``I am surviving in a changing marketplace and waiting for a time when the pay structure has a reasonable price.''
After immigrating from Israel, Wollschlaeger did his residency in family practice at the University of Miami, was briefly the medical director of a homeless shelter and then went to work for a physician practices company that wanted to establish an office in Aventura.
That didn't work out. Wollschlaeger said the company didn't understand how long it took to build up a primary care practice. He bought the practice from the company. ``I didn't know how to run an office. I took management courses, read books.''
As both doctor and businessman, he believed the key question was ''how can I make medicine better? It's like asking how does Toyota make better cars.'' The answer, he decided: ``Pay attention to detail and pay attention to customers.''
SERVING THOSE IN NEED
While many physicians gravitate to upscale neighborhoods to get well-off clients, Wollschlaeger decided to move to a blue-collar section of North Miami Beach, to be closer to the under-served and the uninsured. He did, however, keep the name Aventura Family Health Center.
He sees 90 percent of his patients the same day they call up. ``Timely service with the right price -- there's nothing wrong with that.''
For him, better service often means the Internet, which he knows can often make communication faster and easier in answering routine questions and requesting refills of prescriptions.
If patients want, they can e-mail him through a highly secure server operated by Medem, a tech company ''connecting physicians and patients.'' For that, he charges $15 or $20.
But the vast majority of patients simply use regular e-mail, and for that he doesn't charge. Nor does he charge for sending a PDF file of lab results.
Underlying all these services is Wollschlaeger's belief in the absolute necessity for electronic medical records, which he has been keeping since the mid-1990s.
Electronic records can be sorted and measured in so many ways that he believes they take healthcare for a new level. When warnings went out on Vioxx, for example, he could do a simple sort on his computer to find patients taking the drug and alert them with e-mails or phone calls.
Gerard Anderson, a public health professor at Johns Hopkins, says many doctors are resistant to electronic records because they're required to take on all the costs while the insurers benefit the most, because of the ease of processing claims data. ``Buying the software, buying the computer and then there's the conversion from paper to electronic. That's a huge cost.''
`YOU CANNOT WHINE'
Wollschlaeger acknowledges there are expenses. Last year, he spent about $6,000 to update his computers and software. But he insists doctors need to do that. ''You cannot whine. To make money you have to spend money.'' Postponing electronic conversion -- and many doctors are postponing -- ``your practice only gets worse.''
He believes the costs of conversion from paper are exaggerated. ''Look at the banking industry,'' once based entirely on paper checks. ``They went to online payments, online facsimiles of checks. If they can do it, why can't we?''
He says healthcare is ''generally an ineffective and inefficient industry,'' but he's not trying to change it in order to make a ton of money.
''I did not choose medicine to get rich,'' he says. His gross adjusted income in 2005 was $121,000. He drives a Honda Accord with an Obama bumper sticker. ``I have a very satisfactory lifestyle.''
Monday, August 06, 2007
Take Back Our FMA - Phase II
Dear Friends and Colleagues;
In my previous e-mail I summarily expressed my concerns about the state of affairs in our FMA.
Ever since I received many e-mails and the overwhelming majority of those responses were POSITIVE and SUPPORTIVE. I want to thank all of those who have come forward with their concerns and am grateful and honored to call you my friends. I forgive those who called for my immediate resignation from all FMA positions or cautioned me to keep my mouth shut. Obviously, I won't follow their "advice" but look forward working with them in the future cognizant of the fact that we can agree to disagree.
I also had the opportunity to speak with past and present senior FMA leaders and listened to their point of views and reaction to my opinions expressed
Based on all of the above and on the input provided by so many of you I can only reach the following conclusions:
1. The FMA leadership is embroiled in an intractable battle with its political action committee (FLAMPAC). Its a typical case of the " tail wags the dog" syndrome.This situation has to be remedied immediately! We elected our FMA leaders to lead the organization and NOT the FLAMPAC Board !
2. The termination of our EVP Sandy Mortham has been planned and executed by a small group of senior leaders. As a result of the premature termination of her contract the FMA faces ~ $650,000 in total expenditures to buy out her contract, which represent about 10% or our reserve fund. The other option would have been to work with Sandy until the end of her contract, allow her to participate in training a new EVP and to at the end to thank her for her years of dedicated services. I know Sandy for several years and I have the highest respect for her superb performance. Based on all of the responses I received and the facts provided I can only conclude that our Executive Committee and the BOG have violated the principles of their fiduciary responsibility and potentially have caused grave harm to our organization. They have to face the consequences of their actions and the HOD should reach a decision regarding their positions within our organization.
3. The leadership structure and the decision making process is obscured and clouded in secrecy. Several e-mail responses referred to it as follows "Those in leadership have lined themselves up for the FMA Presidency for about the next 6-7 years—and they do it by not challenging anything that anyone else does, no matter how egregious the activity might be.
"....this group does everything in the back room behind closed doors—snipe and gripe. They are unwilling to let their ideas see daylight until they have lined up a group of “yes” people on the BOG..."
4. Policies are not being determined by our FMA HD but the BOG and our leadership. Several e-mails referred to it as follows:
"...In our delegation we were told by leadership that the entire agenda and the leadership in the FMA the next 5 to 10 years has been decided. This was said as if this was a virtue with no understanding on how demoralizing it was to our members. The most common statement was "why am I participating?"
WHAT CAN BE DONE TO REMEDY THIS SITUATION? HOW CAN WE TAKE BACK OUR FMA?
1. Our FMA must and will return to the following principles of organizational management:
* Accountability of its leadership
* Transparency of the decision making process
* System of checks and balances and reestablish democratic principles
* NO MORE secret deals and "behind the closed doors" decision-making.
2. Prior to upcoming FMA meeting I call for the introduction of the following resolutions:
* Creation of a Nominating Committee to provide a slate of qualified leadership candidates
* Creation of a committee investigating the circumstances and the impact of our EVP's termination . This committee should be comprised of senior CMS leaders from throughout the State.Current BOG or Executive Members or recent Past Presidents should be excluded.
Committee Task: Taking statements from Executive members, BOG members, review of internal audit committee material, etc.
A report should be generated and submitted to members prior to the HOD meeting. This committee should have top priority, work expeditiously and its recommendation should be binding.
I have initiated this discussion because I love our FMA, recognize its importance as an umbrella organization for doctors in Florida, and have been a humble servant for > 10 years.
But now its time to change and I call upon all of you to take collective responsibility in this herculean effort to reform and restructure our great FMA.
With your support we can achieve it. Each individual member will play an important role in this process and I hope by doing so we can send a signal to many other doctors to join or rejoin the FMA.
I will continue to fight for the interest of our docs in Florida and will continue to serve this organization.
Please help and support each other in this task. Its worthwhile the effort!
Lets TAKE BACK OUR FMA!
Yours truly,
Bernd
In my previous e-mail I summarily expressed my concerns about the state of affairs in our FMA.
Ever since I received many e-mails and the overwhelming majority of those responses were POSITIVE and SUPPORTIVE. I want to thank all of those who have come forward with their concerns and am grateful and honored to call you my friends. I forgive those who called for my immediate resignation from all FMA positions or cautioned me to keep my mouth shut. Obviously, I won't follow their "advice" but look forward working with them in the future cognizant of the fact that we can agree to disagree.
I also had the opportunity to speak with past and present senior FMA leaders and listened to their point of views and reaction to my opinions expressed
Based on all of the above and on the input provided by so many of you I can only reach the following conclusions:
1. The FMA leadership is embroiled in an intractable battle with its political action committee (FLAMPAC). Its a typical case of the " tail wags the dog" syndrome.This situation has to be remedied immediately! We elected our FMA leaders to lead the organization and NOT the FLAMPAC Board !
2. The termination of our EVP Sandy Mortham has been planned and executed by a small group of senior leaders. As a result of the premature termination of her contract the FMA faces ~ $650,000 in total expenditures to buy out her contract, which represent about 10% or our reserve fund. The other option would have been to work with Sandy until the end of her contract, allow her to participate in training a new EVP and to at the end to thank her for her years of dedicated services. I know Sandy for several years and I have the highest respect for her superb performance. Based on all of the responses I received and the facts provided I can only conclude that our Executive Committee and the BOG have violated the principles of their fiduciary responsibility and potentially have caused grave harm to our organization. They have to face the consequences of their actions and the HOD should reach a decision regarding their positions within our organization.
3. The leadership structure and the decision making process is obscured and clouded in secrecy. Several e-mail responses referred to it as follows "Those in leadership have lined themselves up for the FMA Presidency for about the next 6-7 years—and they do it by not challenging anything that anyone else does, no matter how egregious the activity might be.
"....this group does everything in the back room behind closed doors—snipe and gripe. They are unwilling to let their ideas see daylight until they have lined up a group of “yes” people on the BOG..."
4. Policies are not being determined by our FMA HD but the BOG and our leadership. Several e-mails referred to it as follows:
"...In our delegation we were told by leadership that the entire agenda and the leadership in the FMA the next 5 to 10 years has been decided. This was said as if this was a virtue with no understanding on how demoralizing it was to our members. The most common statement was "why am I participating?"
WHAT CAN BE DONE TO REMEDY THIS SITUATION? HOW CAN WE TAKE BACK OUR FMA?
1. Our FMA must and will return to the following principles of organizational management:
* Accountability of its leadership
* Transparency of the decision making process
* System of checks and balances and reestablish democratic principles
* NO MORE secret deals and "behind the closed doors" decision-making.
2. Prior to upcoming FMA meeting I call for the introduction of the following resolutions:
* Creation of a Nominating Committee to provide a slate of qualified leadership candidates
* Creation of a committee investigating the circumstances and the impact of our EVP's termination . This committee should be comprised of senior CMS leaders from throughout the State.Current BOG or Executive Members or recent Past Presidents should be excluded.
Committee Task: Taking statements from Executive members, BOG members, review of internal audit committee material, etc.
A report should be generated and submitted to members prior to the HOD meeting. This committee should have top priority, work expeditiously and its recommendation should be binding.
I have initiated this discussion because I love our FMA, recognize its importance as an umbrella organization for doctors in Florida, and have been a humble servant for > 10 years.
But now its time to change and I call upon all of you to take collective responsibility in this herculean effort to reform and restructure our great FMA.
With your support we can achieve it. Each individual member will play an important role in this process and I hope by doing so we can send a signal to many other doctors to join or rejoin the FMA.
I will continue to fight for the interest of our docs in Florida and will continue to serve this organization.
Please help and support each other in this task. Its worthwhile the effort!
Lets TAKE BACK OUR FMA!
Yours truly,
Bernd
Friday, August 03, 2007
Take Back Our FMA
Dear Friends and Colleagues:
As we are getting ready for our Annual Meeting in Hollywood I want to use this opportunity to share some of my frustrations and suggestions regarding the sad state of affairs of our FMA.
As a member and humble servant of our FMA since 1994, after years of service on several committees, Chair of the CME committee, Delegate to the AMA, and representing the FMA on state level and contributor to educational initiatives throughout Florida I have reached a point of where I cannot stay silent anymore.
Our FMA is in crisis! Those of us who do not want or cannot see it must wake up!
What are the problems?
1. Continuous and intractable infighting within our leadership which has shattered our FMA into factions spearheaded by “leaders” who resemble chieftains jealously guarding their tribal territory (FMA vs. FLAMPAC etc.). As a result our FMA has lost its standing among members and non-members alike.
2. A Board of Governors comprised of members who DO NOT resemble the face of our FMA. Women now constitute over fifty percent of all physicians but only TWO women are represented in leadership positions. International Medical Graduates and Minorities constitute more than thirty percent of all doctors but NO designated positions are allotted for them.
3. The leadership style of former and current FMA leaders resembles an authoritarian directive driven modus operandi. Critical, constructive and open discussion is being discouraged and even suppressed. Critics are being shouted down and criticism is being frowned upon if it does not represent the “official” party line.
4. Ideological knuckleheads are being promoted to leadership positions because they endorse a paradigm of political thinking that fits into the black-and-white world view of our leaders. For example, in a pamphlet authored by one of those “aspiring leaders” medical information technology is being depicted as the devils cure for our health care system because they “ ..do provide easy to manage information to the government and others who use the data to rate doctor’s compliance.” I invite the clueless author to visit practices which have successfully implemented such systems and reaping the benefits. Furthermore the author alleges that “ real solutions to the economic problems of cost control may lie in economic empowerment of consumers through tax-protected HSA’s linked to high-deductible health insurance.” Such” solutions” may suit a certain segment of our populations but it will provide for most others the final nail in their coffin of financial unmanageability. Driven by libertarian paranoia such positions will move our FMA toward the extreme political spectrum unable (or unwilling) to reach consensus with other healthcare participants (i.e. employers, government, insurance companies)
5. Aggressive membership recruitment drives have been conducted within certain counties WITHOUT inviting or informing the local county medical societies. The intent was and IS to siphon valuable membership dues from local physicians into the FMA coffers. Now, with dwindling FMA membership we suddenly witness the revival of the “ unity principal” to reunify our organization. What’s the motivation? $$$$$ and not unity!
6. Removal of our EVP Sandra Mortham is being celebrated as the panacea of all of our problems! Interestingly, the details of her departure are still being concealed in a cloud of secrecy. How naïve or stupid can a leadership be to make us believe that? The above listed problems are related to the system and structure of our FMA and not the result of the action or inaction of ONE person! I want to thank Sandra for all the years of her dedicated services!
I guess the above litany of complaints is enough for now and will definitely provide sufficient gun powder for those who want to fire or neutralize a critic like myself.
Well, make my day and go ahead!
But I have not given up on our great Florida Medical Association still comprised of dedicated and hard-working men and women whom I love and respect.
CMS executives who have dedicated their professional lives to their organization.
Fellow colleagues who work hard to improve education and medical care within our profession. Committed doctors who silently but persistently work in various committees to improve the relationship with the Center for Medicare & Medicaid Services, the management of their respective hospitals, consumer and employer groups, unions and diverse state entities.
Let’s rise from the ashes and work together to accomplish the following goals:
1. Wrestle our FMA from those “leaders” who consider their leadership positions as the reward for time served.
2. Establish a “Take Back Our FMA Now” initiative to reform our organization and return it to whom it belongs: the members.
3. Force the present leadership to drop their photo ops and speeches and meet those they supposedly represent: our members. Compel them to meet with member and non-members throughout our State of Florida and LISTEN to their needs and wants.
4. Measure our leader’s quality by assessing their ability to tolerate criticism, their capacity to base their opinion(s) on facts and reason, and their willingness to reach a solution based on compromise.HOLD THEM ACCOUNTABLE FOR WHAT THEY DO NOT WHAT THEY SAY THEY WILL DO!!!
5. Restructure and rejuvenate our Board of Governors to reflect the diversity of the physician’s workforce.
6. Establish or re-establish relationships with other organizations and healthcare entities to influence their decision making and strive towards common interests based on practicality and reason and not on ideology and political correctness.
7. Reunify our FMA first before we consider reunifying organized medicine.
8. Demand the cessation of petty infighting and identify those who fan the flames of discontent.
Those proposals may be considered as the lofty ideas of an angry individual.
I want to emphasize that I am motivated by the dedication for the continuous existence of our great organization and not solely by anger.
But anger helps to express what I really feel.
If my suggestions fall on calcified and deaf ears then I will continue raising my voice!I will NOT STOP until CHANGE occurs
I know that colleagues and friends may hurry to distance themselves from me but some will stand by.
Some may call for my ouster from committee positions but I do not care. I care for the future of our FMA and not the bruised EGO of some FMA head honcho.
I urge you to start taking back our organization from the political apparatchiks and return it to the docs in the trenches.
Ask questions and DEMAND answers!
Now is the time to change. Are you ready?
And by the way if you choose to respond to this e-mail please have the virtual balls and integrity to identify yourself.
Yours truly,
Bernd Wollschlaeger,MD
E-mail: info@miamihealth.com
Phone: (305) 940-8717
As we are getting ready for our Annual Meeting in Hollywood I want to use this opportunity to share some of my frustrations and suggestions regarding the sad state of affairs of our FMA.
As a member and humble servant of our FMA since 1994, after years of service on several committees, Chair of the CME committee, Delegate to the AMA, and representing the FMA on state level and contributor to educational initiatives throughout Florida I have reached a point of where I cannot stay silent anymore.
Our FMA is in crisis! Those of us who do not want or cannot see it must wake up!
What are the problems?
1. Continuous and intractable infighting within our leadership which has shattered our FMA into factions spearheaded by “leaders” who resemble chieftains jealously guarding their tribal territory (FMA vs. FLAMPAC etc.). As a result our FMA has lost its standing among members and non-members alike.
2. A Board of Governors comprised of members who DO NOT resemble the face of our FMA. Women now constitute over fifty percent of all physicians but only TWO women are represented in leadership positions. International Medical Graduates and Minorities constitute more than thirty percent of all doctors but NO designated positions are allotted for them.
3. The leadership style of former and current FMA leaders resembles an authoritarian directive driven modus operandi. Critical, constructive and open discussion is being discouraged and even suppressed. Critics are being shouted down and criticism is being frowned upon if it does not represent the “official” party line.
4. Ideological knuckleheads are being promoted to leadership positions because they endorse a paradigm of political thinking that fits into the black-and-white world view of our leaders. For example, in a pamphlet authored by one of those “aspiring leaders” medical information technology is being depicted as the devils cure for our health care system because they “ ..do provide easy to manage information to the government and others who use the data to rate doctor’s compliance.” I invite the clueless author to visit practices which have successfully implemented such systems and reaping the benefits. Furthermore the author alleges that “ real solutions to the economic problems of cost control may lie in economic empowerment of consumers through tax-protected HSA’s linked to high-deductible health insurance.” Such” solutions” may suit a certain segment of our populations but it will provide for most others the final nail in their coffin of financial unmanageability. Driven by libertarian paranoia such positions will move our FMA toward the extreme political spectrum unable (or unwilling) to reach consensus with other healthcare participants (i.e. employers, government, insurance companies)
5. Aggressive membership recruitment drives have been conducted within certain counties WITHOUT inviting or informing the local county medical societies. The intent was and IS to siphon valuable membership dues from local physicians into the FMA coffers. Now, with dwindling FMA membership we suddenly witness the revival of the “ unity principal” to reunify our organization. What’s the motivation? $$$$$ and not unity!
6. Removal of our EVP Sandra Mortham is being celebrated as the panacea of all of our problems! Interestingly, the details of her departure are still being concealed in a cloud of secrecy. How naïve or stupid can a leadership be to make us believe that? The above listed problems are related to the system and structure of our FMA and not the result of the action or inaction of ONE person! I want to thank Sandra for all the years of her dedicated services!
I guess the above litany of complaints is enough for now and will definitely provide sufficient gun powder for those who want to fire or neutralize a critic like myself.
Well, make my day and go ahead!
But I have not given up on our great Florida Medical Association still comprised of dedicated and hard-working men and women whom I love and respect.
CMS executives who have dedicated their professional lives to their organization.
Fellow colleagues who work hard to improve education and medical care within our profession. Committed doctors who silently but persistently work in various committees to improve the relationship with the Center for Medicare & Medicaid Services, the management of their respective hospitals, consumer and employer groups, unions and diverse state entities.
Let’s rise from the ashes and work together to accomplish the following goals:
1. Wrestle our FMA from those “leaders” who consider their leadership positions as the reward for time served.
2. Establish a “Take Back Our FMA Now” initiative to reform our organization and return it to whom it belongs: the members.
3. Force the present leadership to drop their photo ops and speeches and meet those they supposedly represent: our members. Compel them to meet with member and non-members throughout our State of Florida and LISTEN to their needs and wants.
4. Measure our leader’s quality by assessing their ability to tolerate criticism, their capacity to base their opinion(s) on facts and reason, and their willingness to reach a solution based on compromise.HOLD THEM ACCOUNTABLE FOR WHAT THEY DO NOT WHAT THEY SAY THEY WILL DO!!!
5. Restructure and rejuvenate our Board of Governors to reflect the diversity of the physician’s workforce.
6. Establish or re-establish relationships with other organizations and healthcare entities to influence their decision making and strive towards common interests based on practicality and reason and not on ideology and political correctness.
7. Reunify our FMA first before we consider reunifying organized medicine.
8. Demand the cessation of petty infighting and identify those who fan the flames of discontent.
Those proposals may be considered as the lofty ideas of an angry individual.
I want to emphasize that I am motivated by the dedication for the continuous existence of our great organization and not solely by anger.
But anger helps to express what I really feel.
If my suggestions fall on calcified and deaf ears then I will continue raising my voice!I will NOT STOP until CHANGE occurs
I know that colleagues and friends may hurry to distance themselves from me but some will stand by.
Some may call for my ouster from committee positions but I do not care. I care for the future of our FMA and not the bruised EGO of some FMA head honcho.
I urge you to start taking back our organization from the political apparatchiks and return it to the docs in the trenches.
Ask questions and DEMAND answers!
Now is the time to change. Are you ready?
And by the way if you choose to respond to this e-mail please have the virtual balls and integrity to identify yourself.
Yours truly,
Bernd Wollschlaeger,MD
E-mail: info@miamihealth.com
Phone: (305) 940-8717
Friday, July 20, 2007
Renew SCHIP
Dear Friends and Colleagues;
I am seeking your help in mobilizing support to extend and expand the SCHIP (State Children's Health Insurance Program).
SCHIP was established in 1997 through a bipartisan effort to provide health insurance for several million uninsured children that do not qualify for Medicaid and otherwise would have fallen through the cracks of our so-called "healthcare system."
SCHIP is being funded by the federal and the state government(s) at an ~ 70/40 ratio.
It is set to expire and faces mounting criticism focusing on the following issues: a) including adults, b) including children from families whose income exceed 3-4 the poverty level, c) lack of physicians participation due to low reimbursement, d) allegations that it undermines the private health insurance system.
The AMA and other organizations SUPPORT the reauthorization of SCHIP. President Bush threatens to veto any new bill and objects on "philosophical grounds" to a bipartisan Senate proposal to boost the State Children's Health Insurance program by $35 billion over five years. Bush has proposed $5 billion in increased funding and has threatened to veto the Senate compromise and a more ambitious expansion being contemplated in the House.
Providing health insurance for approximately 4-5 million children has nothing to do with ideology, philosophy or faith. Its a common sense issue: provide primary care services for children now thereby preventing illnesses and costly treatment later in life.
Private insurance companies have FAILED to offer such services. I have spoken with many of my patients about that and have heard the same story over and over: in the beginning the insurance rates are affordable and then progressively increase until they cant afford it anymore.
Lets not get bamboozled by ideological knuckleheads at both extremes of the political spectrum.
Call your Senator and Congressman/woman and demand a reauthorization of the SCHIP program. Call the White House and remind our President that his veto is a veto against our children's health!
Yours
Bernd
============================================================================================================
Miami Herald, Posted on Thu, Jul. 19, 2007
For healthy children, better opportunity
More than eight million U.S. children are starting out life with poor prospects because they lack health insurance. This is reason enough to support a federal program with a strong track record of helping Florida and other states provide coverage to needy children. Better yet, Congress appears poised to expand the program. It is the right move when the need to protect vulnerable children is so great.
In a rare instance of bipartisanship, there is widespread support in the Senate and House for an expansion of the State Children's Health Insurance Program. President Bush, however, threatens a veto. He believes the plans under discussion would unacceptably expand ''government-run healthcare.'' Surely there is reason to enact a bill with adequate controls that will significantly increase the number of children with ready access to healthcare.
Unacceptable proposal
The federal program insures children from working-poor families through state plans such as Florida's KidCare. Yet the current annual funding level of $5 billion doesn't stretch enough to cover all eligible children. This is why the Senate and House are discussing plans that would double or triple the funding.
President Bush is proposing a $1 billion increase per year, but that isn't enough. His proposal would result in a reduction in the number of children in the program be cause the funding wouldn't cover rising healthcare costs. This isn't acceptable.
The Senate bill is a compromise agreed upon last week. It would increase funding to $12 billion per year. It would also:
• Be financed by raising the cigarette tax to $1 a pack. This would discourage smoking and promote better health.
• Encourage states to enroll the poorest children and discourage enrollment of higher-income children. This targets the most vulnerable population.
• Leave out a key group that should be covered: up to 750,000 legal immigrant children who are not yet citizens. This is unfair and unhealthy. They should be included.
The House is considering a bigger expansion to $15 billion a year -- the estimated cost of covering all uninsured children.
President Bush and others argue that such an expansion would displace private coverage. But the vast majority of the millions of needy children who would benefit from the Senate plan currently are uninsured or would lose state coverage without increased funding. Tax subsidies proposed by President Bush would most benefit children who already have private coverage.
Insured children are more likely to get preventive healthcare, stay healthier, attend school and avoid the emergency room. Healthy children are better prepared to learn, which improves their future economic prospects. Expanding the federal program should radically improve children's access to healthcare nationwide.
=============================================================================================================
Miami Herald, Posted on Thu, Jul. 19, 2007
Senate panel OKs child health bill
By KEVIN FREKING
Brushing aside threats of a presidential veto, a Senate committee on Thursday approved a five-year, $35 billion expansion of a children's health insurance program that would be financed through higher tobacco taxes.
A majority of Republicans on the Senate Finance Committee joined all of the committee's Democrats in voting to reauthorize the State Children's Health Insurance Program. The program subsidizes insurance for children and some adults with incomes too high for Medicaid but not high enough to afford private insurance. The vote was 17-4.
"There are more kids without health insurance than there are kids in the first and second grades," said Sen. Max Baucus, D-Mont., the committee chairman. "Americans overwhelmingly support getting kids covered."
The additional spending the committee approved would bring total SCHIP funding to $60 billion over five years - double what the administration has proposed. The tax on a pack of cigarettes would increase by 61 cents to help pay for the expansion. Taxes on cigars and chewing tobacco also would jump.
The committee's Democratic leaders had wanted to add $50 billion to the program, and their House counterparts are determined to pursue that amount. The compromise forged by the committee could become extremely fragile if GOP senators are forced to vote on an expansion much beyond what the committee approved.
"I hope they understand it takes 60 votes to get anything done in the United States Senate," said Sen. Charles Grassley, R-Iowa.
The 60 votes would be needed to overcome a filibuster. Baucus said he believes his proposal has enough support to overcome such a hurdle, as well as a promised veto from the president.
"The vote speaks for itself," Baucus said.
Lawmakers said the $35 billion expansion would allow 6.6 million people to maintain their current health coverage, and it would provide coverage for another 3.2 million uninsured children.
The administration reacted to the vote by saying that sending the president a bill he cannot sign puts at risk millions of needy children who would lose health insurance when the program's funding expires Sept. 30.
"We are ready to renew our commitment to low-income children today, but we cannot agree to a gradual government takeover of health care - and neither will the American people," said Health and Human Services Secretary Mike Leavitt.
Some dissenters on the committee believe the legislation raises taxes unnecessarily and does not do enough to refocus the program on low-income children.
"The Democrats are playing a game of reverse Robin Hood with this legislation," said Sen. Trent Lott, R-Miss.
The program began 10 years ago. It was generally designed to help families whose income does not exceed 200 percent of the poverty level, or $34,340 for a family of three. But several states have extended coverage to children with higher incomes and to adults. The latter expansion has particularly incensed some lawmakers who disapprove of waivers the Bush administration has granted to those states.
The SCHIP program is going in the opposite direction from where it should be going, said Sen. John Ensign, R-Nev., who voted against the proposal along with Lott, Jim Bunning, R-Ky., and Jon Kyl, R-Ariz.
The Senate proposal would gradually move adults who don't have children out of the program. States would have the option to cover them through Medicaid. The federal government also would lower the percentage, or matching rate, that it pays for parents' coverage. In addition, the federal government won't be allowed to grant new waivers to states allowing them to cover parents. But states will have the option of providing coverage to pregnant women through SCHIP.
Congressional Budget Office officials testified that spending on adults would drop by $1 billion over the next five years under the Senate proposal.
"We've been handed a mess by this administration," said Sen. Kent Conrad, D-N.D., referring to the adult coverage. "This takes steps to change that. That's a fact."
Several advocacy groups are supporting the higher tobacco tax because it would not only fund the program's expansion, but because higher taxes also lead to less smoking.
For every 10 percent increase in the price of cigarettes, overall cigarette consumption drops by about 4 percent, and the rate drops even more for children.
"Research shows a clear health benefit from higher tobacco taxes," said William Carr, executive director of the Campaign for Tobacco-Free Kids.
Overall, the federal tax on a pack of cigarettes would go up to $1 a pack
The tax on cigars is much more complicated to calculate. But Norm Sharp, president of the Cigar Association of America, said the tax for large cigars could go from a cap of about 5 cents a cigar to a cap of $10 a cigar.
"We're looking at cigars going up in price at retail 2.5 times to 3 times current prices," Sharp said.
"How do we explain that, justify that, or do we even care?" Lott said at one point when asking colleagues about the tax increase on cigars.
"A $10 cap on a very expensive cigar would not be terribly onerous," Baucus replied
============================================================================================================
Miami Herald, Posted on Thu, Jul. 19, 2007
Bush rejects children's health plan boost
BY CHRISTOPHER LEE
President Bush on Wednesday rejected entreaties by his Republican allies that he compromise with Democrats on legislation to renew a popular program that provides health coverage to poor children, saying that expanding it would enlarge the role of the federal government at the expense of private insurance.
The president said he objects on philosophical grounds to a bipartisan Senate proposal to boost the State Children's Health Insurance program by $35 billion over five years. Bush has proposed $5 billion in increased funding and has threatened to veto the Senate compromise and a more costly expansion being contemplated in the House.
''I support the initial intent of the program,'' Bush said during an interview after a factory tour and discussion on healthcare with small-business owners in Landover, Md. ``My concern is that when you expand eligibility . . . you're really beginning to open up an avenue for people to switch from private insurance to the government.''
The 10-year-old program, which is set to expire Sept. 30, costs the federal government $5 billion a year and helps provide health coverage to 6.6 million low-income children whose families do not qualify for Medicaid but cannot afford insurance on their own.
About 3.3 million additional children would be covered under the proposal developed by Senate Finance Committee Chairman Max Baucus, D-Mont., and Republican Sens. Charles Grassley of Iowa and Orrin Hatch of Utah, among others. It would provide a total of $60 billion over five years, compared with $30 billion under Bush's proposal. And it would rely on a 61-cent increase in the federal excise tax on cigarettes, to $1 a pack, an increase Bush opposes.
Grassley and Hatch, in a joint statement this week, implored the president to rescind his veto threat. They warned that Democrats might seek an expansion of $50 billion or more if there is no compromise. They also said Bush should drop efforts to link the program's renewal to his six-month-old proposal to replace the long-standing tax break for employer-based health insurance with a new tax deduction that would help people pay for insurance regardless of whether they get it through their jobs or purchase it on their own.
''Tax legislation to expand health insurance coverage is badly needed, but there's no Democratic support for it in the SCHIP debate,'' said Grassley, the ranking Republican on the finance committee. ``In the meantime, our SCHIP initiative in the finance committee takes care of a program that's about to expire in a way that's more responsible than current law and $15 billion less than the budget resolution calls for.''
But Bush said he was not persuaded.
''I'm not going to surrender a good and important idea before the debate really gets started,'' Bush said. ``And I think it's going to be very important for our allies on Capitol Hill to hear a strong, clear message from me that expansion of government in lieu of making the necessary changes to encourage a consumer-based system is not acceptable.''
The Senate committee is scheduled to consider the compromise legislation today, and the House is expected to try to pass its own version before the congressional recess in August.
Rep. Rahm Emanuel, D-Ill., the Democratic caucus chairman, said he was ''bewildered'' that Bush was fighting expanded funding for a program supported by Republicans and Democrats alike. ''This is the chance for him to finally be a uniter and not a divider,'' Emanuel said.
=============================================================================================================
I am seeking your help in mobilizing support to extend and expand the SCHIP (State Children's Health Insurance Program).
SCHIP was established in 1997 through a bipartisan effort to provide health insurance for several million uninsured children that do not qualify for Medicaid and otherwise would have fallen through the cracks of our so-called "healthcare system."
SCHIP is being funded by the federal and the state government(s) at an ~ 70/40 ratio.
It is set to expire and faces mounting criticism focusing on the following issues: a) including adults, b) including children from families whose income exceed 3-4 the poverty level, c) lack of physicians participation due to low reimbursement, d) allegations that it undermines the private health insurance system.
The AMA and other organizations SUPPORT the reauthorization of SCHIP. President Bush threatens to veto any new bill and objects on "philosophical grounds" to a bipartisan Senate proposal to boost the State Children's Health Insurance program by $35 billion over five years. Bush has proposed $5 billion in increased funding and has threatened to veto the Senate compromise and a more ambitious expansion being contemplated in the House.
Providing health insurance for approximately 4-5 million children has nothing to do with ideology, philosophy or faith. Its a common sense issue: provide primary care services for children now thereby preventing illnesses and costly treatment later in life.
Private insurance companies have FAILED to offer such services. I have spoken with many of my patients about that and have heard the same story over and over: in the beginning the insurance rates are affordable and then progressively increase until they cant afford it anymore.
Lets not get bamboozled by ideological knuckleheads at both extremes of the political spectrum.
Call your Senator and Congressman/woman and demand a reauthorization of the SCHIP program. Call the White House and remind our President that his veto is a veto against our children's health!
Yours
Bernd
============================================================================================================
Miami Herald, Posted on Thu, Jul. 19, 2007
For healthy children, better opportunity
More than eight million U.S. children are starting out life with poor prospects because they lack health insurance. This is reason enough to support a federal program with a strong track record of helping Florida and other states provide coverage to needy children. Better yet, Congress appears poised to expand the program. It is the right move when the need to protect vulnerable children is so great.
In a rare instance of bipartisanship, there is widespread support in the Senate and House for an expansion of the State Children's Health Insurance Program. President Bush, however, threatens a veto. He believes the plans under discussion would unacceptably expand ''government-run healthcare.'' Surely there is reason to enact a bill with adequate controls that will significantly increase the number of children with ready access to healthcare.
Unacceptable proposal
The federal program insures children from working-poor families through state plans such as Florida's KidCare. Yet the current annual funding level of $5 billion doesn't stretch enough to cover all eligible children. This is why the Senate and House are discussing plans that would double or triple the funding.
President Bush is proposing a $1 billion increase per year, but that isn't enough. His proposal would result in a reduction in the number of children in the program be cause the funding wouldn't cover rising healthcare costs. This isn't acceptable.
The Senate bill is a compromise agreed upon last week. It would increase funding to $12 billion per year. It would also:
• Be financed by raising the cigarette tax to $1 a pack. This would discourage smoking and promote better health.
• Encourage states to enroll the poorest children and discourage enrollment of higher-income children. This targets the most vulnerable population.
• Leave out a key group that should be covered: up to 750,000 legal immigrant children who are not yet citizens. This is unfair and unhealthy. They should be included.
The House is considering a bigger expansion to $15 billion a year -- the estimated cost of covering all uninsured children.
President Bush and others argue that such an expansion would displace private coverage. But the vast majority of the millions of needy children who would benefit from the Senate plan currently are uninsured or would lose state coverage without increased funding. Tax subsidies proposed by President Bush would most benefit children who already have private coverage.
Insured children are more likely to get preventive healthcare, stay healthier, attend school and avoid the emergency room. Healthy children are better prepared to learn, which improves their future economic prospects. Expanding the federal program should radically improve children's access to healthcare nationwide.
=============================================================================================================
Miami Herald, Posted on Thu, Jul. 19, 2007
Senate panel OKs child health bill
By KEVIN FREKING
Brushing aside threats of a presidential veto, a Senate committee on Thursday approved a five-year, $35 billion expansion of a children's health insurance program that would be financed through higher tobacco taxes.
A majority of Republicans on the Senate Finance Committee joined all of the committee's Democrats in voting to reauthorize the State Children's Health Insurance Program. The program subsidizes insurance for children and some adults with incomes too high for Medicaid but not high enough to afford private insurance. The vote was 17-4.
"There are more kids without health insurance than there are kids in the first and second grades," said Sen. Max Baucus, D-Mont., the committee chairman. "Americans overwhelmingly support getting kids covered."
The additional spending the committee approved would bring total SCHIP funding to $60 billion over five years - double what the administration has proposed. The tax on a pack of cigarettes would increase by 61 cents to help pay for the expansion. Taxes on cigars and chewing tobacco also would jump.
The committee's Democratic leaders had wanted to add $50 billion to the program, and their House counterparts are determined to pursue that amount. The compromise forged by the committee could become extremely fragile if GOP senators are forced to vote on an expansion much beyond what the committee approved.
"I hope they understand it takes 60 votes to get anything done in the United States Senate," said Sen. Charles Grassley, R-Iowa.
The 60 votes would be needed to overcome a filibuster. Baucus said he believes his proposal has enough support to overcome such a hurdle, as well as a promised veto from the president.
"The vote speaks for itself," Baucus said.
Lawmakers said the $35 billion expansion would allow 6.6 million people to maintain their current health coverage, and it would provide coverage for another 3.2 million uninsured children.
The administration reacted to the vote by saying that sending the president a bill he cannot sign puts at risk millions of needy children who would lose health insurance when the program's funding expires Sept. 30.
"We are ready to renew our commitment to low-income children today, but we cannot agree to a gradual government takeover of health care - and neither will the American people," said Health and Human Services Secretary Mike Leavitt.
Some dissenters on the committee believe the legislation raises taxes unnecessarily and does not do enough to refocus the program on low-income children.
"The Democrats are playing a game of reverse Robin Hood with this legislation," said Sen. Trent Lott, R-Miss.
The program began 10 years ago. It was generally designed to help families whose income does not exceed 200 percent of the poverty level, or $34,340 for a family of three. But several states have extended coverage to children with higher incomes and to adults. The latter expansion has particularly incensed some lawmakers who disapprove of waivers the Bush administration has granted to those states.
The SCHIP program is going in the opposite direction from where it should be going, said Sen. John Ensign, R-Nev., who voted against the proposal along with Lott, Jim Bunning, R-Ky., and Jon Kyl, R-Ariz.
The Senate proposal would gradually move adults who don't have children out of the program. States would have the option to cover them through Medicaid. The federal government also would lower the percentage, or matching rate, that it pays for parents' coverage. In addition, the federal government won't be allowed to grant new waivers to states allowing them to cover parents. But states will have the option of providing coverage to pregnant women through SCHIP.
Congressional Budget Office officials testified that spending on adults would drop by $1 billion over the next five years under the Senate proposal.
"We've been handed a mess by this administration," said Sen. Kent Conrad, D-N.D., referring to the adult coverage. "This takes steps to change that. That's a fact."
Several advocacy groups are supporting the higher tobacco tax because it would not only fund the program's expansion, but because higher taxes also lead to less smoking.
For every 10 percent increase in the price of cigarettes, overall cigarette consumption drops by about 4 percent, and the rate drops even more for children.
"Research shows a clear health benefit from higher tobacco taxes," said William Carr, executive director of the Campaign for Tobacco-Free Kids.
Overall, the federal tax on a pack of cigarettes would go up to $1 a pack
The tax on cigars is much more complicated to calculate. But Norm Sharp, president of the Cigar Association of America, said the tax for large cigars could go from a cap of about 5 cents a cigar to a cap of $10 a cigar.
"We're looking at cigars going up in price at retail 2.5 times to 3 times current prices," Sharp said.
"How do we explain that, justify that, or do we even care?" Lott said at one point when asking colleagues about the tax increase on cigars.
"A $10 cap on a very expensive cigar would not be terribly onerous," Baucus replied
============================================================================================================
Miami Herald, Posted on Thu, Jul. 19, 2007
Bush rejects children's health plan boost
BY CHRISTOPHER LEE
President Bush on Wednesday rejected entreaties by his Republican allies that he compromise with Democrats on legislation to renew a popular program that provides health coverage to poor children, saying that expanding it would enlarge the role of the federal government at the expense of private insurance.
The president said he objects on philosophical grounds to a bipartisan Senate proposal to boost the State Children's Health Insurance program by $35 billion over five years. Bush has proposed $5 billion in increased funding and has threatened to veto the Senate compromise and a more costly expansion being contemplated in the House.
''I support the initial intent of the program,'' Bush said during an interview after a factory tour and discussion on healthcare with small-business owners in Landover, Md. ``My concern is that when you expand eligibility . . . you're really beginning to open up an avenue for people to switch from private insurance to the government.''
The 10-year-old program, which is set to expire Sept. 30, costs the federal government $5 billion a year and helps provide health coverage to 6.6 million low-income children whose families do not qualify for Medicaid but cannot afford insurance on their own.
About 3.3 million additional children would be covered under the proposal developed by Senate Finance Committee Chairman Max Baucus, D-Mont., and Republican Sens. Charles Grassley of Iowa and Orrin Hatch of Utah, among others. It would provide a total of $60 billion over five years, compared with $30 billion under Bush's proposal. And it would rely on a 61-cent increase in the federal excise tax on cigarettes, to $1 a pack, an increase Bush opposes.
Grassley and Hatch, in a joint statement this week, implored the president to rescind his veto threat. They warned that Democrats might seek an expansion of $50 billion or more if there is no compromise. They also said Bush should drop efforts to link the program's renewal to his six-month-old proposal to replace the long-standing tax break for employer-based health insurance with a new tax deduction that would help people pay for insurance regardless of whether they get it through their jobs or purchase it on their own.
''Tax legislation to expand health insurance coverage is badly needed, but there's no Democratic support for it in the SCHIP debate,'' said Grassley, the ranking Republican on the finance committee. ``In the meantime, our SCHIP initiative in the finance committee takes care of a program that's about to expire in a way that's more responsible than current law and $15 billion less than the budget resolution calls for.''
But Bush said he was not persuaded.
''I'm not going to surrender a good and important idea before the debate really gets started,'' Bush said. ``And I think it's going to be very important for our allies on Capitol Hill to hear a strong, clear message from me that expansion of government in lieu of making the necessary changes to encourage a consumer-based system is not acceptable.''
The Senate committee is scheduled to consider the compromise legislation today, and the House is expected to try to pass its own version before the congressional recess in August.
Rep. Rahm Emanuel, D-Ill., the Democratic caucus chairman, said he was ''bewildered'' that Bush was fighting expanded funding for a program supported by Republicans and Democrats alike. ''This is the chance for him to finally be a uniter and not a divider,'' Emanuel said.
=============================================================================================================
Wednesday, July 11, 2007
Addiction Research In The News
I hope you didn't miss todays (07/10/07) great interview with Dr. Volkow on NPR (Fresh Air) entitled "No,really, this is your brain on drugs."
Nora Volkow, director of the National Institute on Drug Abuse, ranks as one of the U.S.'s leading addiction researchers. She's helped demonstrate that addiction is in fact a disease — a disease of the brain — and that all addictions, whether it's to drugs, alcohol, tobacco, sex, gambling or even food, are more alike than was previously thought.Volkow, who's the great-granddaughter of Russian revolutionary Leon Trotsky, grew up in Mexico City — in the house where her famous ancestor was assassinated.
Very informative and fascinating.
A MUST for anybody who is interested in addiction and want to draw others towards other profession.
LINK: http://www.npr.org/templates/story/story.php?storyId=11847222
Yours
Bernd
Nora Volkow, director of the National Institute on Drug Abuse, ranks as one of the U.S.'s leading addiction researchers. She's helped demonstrate that addiction is in fact a disease — a disease of the brain — and that all addictions, whether it's to drugs, alcohol, tobacco, sex, gambling or even food, are more alike than was previously thought.Volkow, who's the great-granddaughter of Russian revolutionary Leon Trotsky, grew up in Mexico City — in the house where her famous ancestor was assassinated.
Very informative and fascinating.
A MUST for anybody who is interested in addiction and want to draw others towards other profession.
LINK: http://www.npr.org/templates/story/story.php?storyId=11847222
Yours
Bernd
Tuesday, July 10, 2007
Muslim Doctors and Terrorism Charges
Dear Friends and Colleagues:
The recent terror attacks in Great Britain unleashed a new wave of anti-Muslim sentiments. The fact that medical doctors from the Middles East and India were involved coined a new phrase " Doctors of Terror" and questions the loyalty and reliability of "Muslim Doctors."
A recent article in the New York Times highlights the fact that seven doctors are tied to the terror plots that unfolded in Britain. Furthermore, the US press has reported that at least two of the doctors have inquired about US licensure and residency training programs.
A recent letter to the editor "Doctors of Terror" in an Orlando newspaper was written by an IMG (International Medical Graduate)and ends with the gloomy prediction,
"Sadly, nothing is immune to terror, hate and murder -- not even one of the noblest professions that is dedicated to the welfare and health of mankind."
Right wing bloggers and talk show hosts are whipping up a frenzy to mislead people in believing that Muslim doctors are "Doctors of Terror."
As an International Medical Graduate, Jew and Israeli citizen I am appalled by the frontal assault on my fellow colleagues of the Muslim faith.
Terrorists are motivated by hate and the delusion of grandeur to control other peoples fate and life. Religion is just the cover to vaguely conceal their distorted narcissistic characters and to justify their nihilistic world view.
Even though many terrorists are Muslims, most Muslims are NOT terrorists! Singling out Muslim doctors alienates Muslims instead of recruiting them in our joint struggle to fight terrorism and to build a better world.
Its time for IMGs in organized medicine to speak up against any attempts to stigmatize our fellow Muslim colleagues and to defend their rights.
Join me in this effort!
Bernd Wollschlaeger,MD
Past Chair AMA IMG Section
Chair Florida Medical Association IMG Section
The recent terror attacks in Great Britain unleashed a new wave of anti-Muslim sentiments. The fact that medical doctors from the Middles East and India were involved coined a new phrase " Doctors of Terror" and questions the loyalty and reliability of "Muslim Doctors."
A recent article in the New York Times highlights the fact that seven doctors are tied to the terror plots that unfolded in Britain. Furthermore, the US press has reported that at least two of the doctors have inquired about US licensure and residency training programs.
A recent letter to the editor "Doctors of Terror" in an Orlando newspaper was written by an IMG (International Medical Graduate)and ends with the gloomy prediction,
"Sadly, nothing is immune to terror, hate and murder -- not even one of the noblest professions that is dedicated to the welfare and health of mankind."
Right wing bloggers and talk show hosts are whipping up a frenzy to mislead people in believing that Muslim doctors are "Doctors of Terror."
As an International Medical Graduate, Jew and Israeli citizen I am appalled by the frontal assault on my fellow colleagues of the Muslim faith.
Terrorists are motivated by hate and the delusion of grandeur to control other peoples fate and life. Religion is just the cover to vaguely conceal their distorted narcissistic characters and to justify their nihilistic world view.
Even though many terrorists are Muslims, most Muslims are NOT terrorists! Singling out Muslim doctors alienates Muslims instead of recruiting them in our joint struggle to fight terrorism and to build a better world.
Its time for IMGs in organized medicine to speak up against any attempts to stigmatize our fellow Muslim colleagues and to defend their rights.
Join me in this effort!
Bernd Wollschlaeger,MD
Past Chair AMA IMG Section
Chair Florida Medical Association IMG Section
Friday, July 06, 2007
P4P: An Evidence Based Approach
By Bernd Wollschlaeger,MD,FAAFP
" The fact that nearly three-quarters of the general internists we surveyed support financial incentives for quality could be surprising, given their concerns about unintended consequences, possible fear of the unknown, and literature on physician professionalism suggesting that physicians prefer not to subject their performance to external oversight. Respondents might simply have seen such incentives as a way to gain more income; this belief might have outweighed
any resistance they had to external oversight."
"The majority supported financial incentives for quality, although they conditioned their support on measures’ being accurate."
Dear Friends and Colleagues:
In the heated discussion about the so-called Pay-For Performance (P4P) Programs we often forget to consider the views of those we claim to represent: the practicing physicians.
I am concerned that ideological tainted viewpoints distort rational approaches towards this issue, thereby failing to consider the pros and cons of a topic that may affect us all.
In a series of reviews I will therefore present on my blog a variety of different articles discussing evidence-based P4P applications:
In the first article ( see attached abstract) the authors present the views of General Internists and their attitude towards public reporting of quality scores.
DESIGN:
To learn more about physicians’ views, the authors conducted a national survey of general internists. Their views, although not necessarily representative of all physicians, are important both because of the large numbers of general internists and because most physician P4P programs focus on primary care.
METHODS:
The sampling frame included 1,668 randomly selected general internists listed in the AMA Physician Masterfile as working in one of the twelve broadly nationally representative metropolitan areas included in the Community Tracking Study (CTS) of the Center for Studying Health System Change (HSC).A cover letter and a seven-page self-administered questionnaire were mailed to the sample in April 2005, with follow-up surveys to nonrespondents mailed in four subsequent waves. The survey was developed after review of the relevant literature, input from experts in P4P and public reporting, and pilot testing with academic and community physicians. The Institutional Review Board (IRB) at the University of Chicago approved the study protocol.
Of the 1,668 physicians selected, 500 were ineligible: 188 surveys were undeliverable; 14 were returned uncompleted with a note stating that the physician was no longer in practice; 46 respondents were not general internists; and 252 additional physicians were not at the address to which the survey had been mailed, according to the phone calls made to nonrespondents’ offices. Of the 1,168 remaining subjects, we received 556 completed surveys, for an adjusted response rate of 48 percent.
RESULTS:
Attitudes toward P4P and public reporting. Almost three-fourths of responding physicians agreed that "if the measures are accurate, physicians should be given financial incentives for quality"
However, only 4 percent strongly agreed and 26 percent somewhat agreed that measures of quality are generally accurate at present. Most respondents had little confidence that this will change: 38 percent believed that health plans will try hard to make the measures accurate, and 35 percent believed that government will do so
There was much less support for public reporting than for financial incentives for quality. Only 45 percent of respondents supported public reporting of medical group performance , and only 32 percent supported reporting of individual physicians’ performance. One in three physicians strongly supported financial incentives, but only one in twelve strongly supported public reporting for medical groups, and one in nineteen strongly supported it for individuals
Attitudes toward quality measures and possible unintended consequences. Only 30 percent of physicians agreed that measures of quality are generally accurate. Eighty-eight percent believed that measures are not adequately adjusted for patients’ medical conditions; 85 percent believed that they are not adequately adjusted for patients’ socioeconomic status; and 82 percent stated that quality measures could lead physicians to avoid high-risk patients. Many physicians added written comments stating that poorly compliant patients would also be avoided: For example, "If my pay depended on A1c values, I have 10–15 patients whom I would have to fire. The poor, unmotivated, obese, and noncompliant would all have to find new physicians."
The survey results suggest that physicians are also concerned that "measuring quality will divert physicians’ attention from important types of care for which quality is not measured." Sixty-one percent strongly or somewhat agreed with this statement; many added written comments stating that many quality measures cover physician activities that they do not consider very important compared with many other things they do.
Are some physicians more likely to support P4P or public reporting? The authors performed bivariate and multivariate analyses to learn whether physician support for P4P or public reporting is associated with whether the physician has financial incentives for quality, sees relatively poor patients (measured by percentage of Medicaid patients), and has an income that is primarily based on patient volume.They also tested they associations with physicians’ age, sex, and board certification.
The main finding on bivariate analyses was that physicians who now have financial incentives for quality were more likely to support such incentives than those who do not. These physicians were also more likely to support public reports on medical groups. One-fourth of respondents (130 physicians) reported having financial incentives for quality;for most, the incentive amounted to 5 percent or less of their income (data not shown). Multivariate analysis produced results consistent with the bivariate analyses.
DISCUSSION:
" Support for P4P. Our results suggest that there is a sizable potential reservoir of physician support for P4P: Nearly three in four internists stated that physicians should be given financial incentives for quality if the measures are accurate. However, responses also suggest that there are barriers to overcome if P4P programs are to gain physicians’ support: Fewer than one-third of internists stated that quality measures are accurate at present, and only slightly more than one-third believed that health plans and the government will try hard to make measures accurate.
Support for public reporting. Internists were far less supportive of public reporting than of financial incentives for quality: One-third supported public reporting of individual physicians’ quality scores, and only 45 percent supported public reporting at the medical group level.
Concerns about financial incentives for quality. Although the majority of respondents supported financial incentives for quality in principle, they appear to have been very concerned about possible unintended and undesirable consequences. Large majorities of respondents stated that quality measures are not adequately adjusted for patients’ medical conditions or socioeconomic status; that measuring quality may lead physicians to avoid high-risk patients; and that measuring quality will divert physicians’ attention from important but unmeasured areas of clinical care.
Concerns about public reporting. Although a large majority of respondents supported financial incentives for quality, a large majority opposed public reporting, especially reporting of individual physicians’ performance. To our knowledge, this is the first survey to report this gap. We do not have data to explain this finding; it is possible that respondents believed that they were unlikely to lose much from having financial incentives for quality but feared that a poor public quality rating would be humiliating and might lead to losses of patients and of peer approval.
Other relevant studies. To our knowledge, this is the first national survey to be published of physicians’ views on P4P and public reporting. Some relevant studies have been conducted in more limited settings. In an e-mail survey of nearly 6,000 Massachusetts physicians (response rate was 7 percent; 29 percent were internists), the Massachusetts Medical Society (MMS) found that respondents were open to quality measurement but did not believe that current measures were accurate. Four physician surveys related to public reporting have been conducted; each surveyed either cardiologists or cardiac surgeons in New York or Pennsylvania, where data on cardiac procedures are publicly reported.The results were similar across the surveys: The majority of respondents stated that the measures were not adequately risk-adjusted and believed that public reporting was leading physicians to avoid doing bypass surgery or angioplasty on high-risk patients.
Possible rationales for survey results. The fact that nearly three-quarters of the general internists we surveyed support financial incentives for quality could be surprising, given their concerns about unintended consequences, possible fear of the unknown, and literature on physician professionalism suggesting that physicians prefer not to subject their performance to external oversight.12 Respondents might simply have seen such incentives as a way to gain more income; this belief might have outweighed any resistance they had to external oversight.
An alternative, or complementary, explanation is that physicians would like to improve the quality of care and believe that P4P would finally give them a "business case" for investing in improving quality.Respondents who reported having financial incentives for quality were more likely to support such incentives: Their experience with incentives might have been positive, although it is also possible that physicians who are open to financial incentives for quality are more likely to join practices that have such incentives.
A third possible explanation is that physicians who oppose P4P were less likely to respond to the survey and that our results therefore overstate the degree of support. However, nonrespondents were very similar to respondents, except that nonrespondents were less likely to be board-certified. Since non-board-certified respondents were equally or slightly more likely to favor financial incentives for quality, this potential source of nonrespondent bias seems unlikely to greatly alter our results.
Possible study limitations. Several possible limitations should be considered in evaluating our results. First, the results are not representative of all U.S. physicians; rather, they are limited to general internists in twelve metropolitan areas. Although these twelve areas are not precisely statistically representative of U.S. metropolitan areas, they represent a broad cross-section of such areas in the country and have been used as the sampling frame for major studies of health care quality.
Second, our response rate was modest, though not atypical for physician surveys; it appears, for the reasons detailed above, that nonresponse bias is unlikely to have greatly affected our results. Third, the survey asked about "financial incentives for quality" in general, not about any specific incentive program, so different physicians might have had different programs in mind when responding.
Implications for quality improvement in public and private programs. Our findings suggest three main implications for Medicare and for other public and private policymakers seeking ways to improve the quality of health care. First, there is a large potential reservoir of physician support for P4P, at least among general internists. However, respondents’ concerns about unintended consequences, and their lack of trust that health plans and government will work hard to make quality measures accurate, suggest that physician support could disappear very rapidly if these consequences do occur. Recent experience with such highly touted innovations as utilization review and primary care gatekeeping suggest that potentially useful policies might generate a strong backlash if they are not framed and implemented with attention to physicians’ concerns.
Second, respondents’ concerns suggest that evaluations of P4P and public reporting programs should be explicitly designed to assess possible unintended consequences on disparities in health care, on physicians who practice in areas of low socioeconomic status, and on the quality of care in important areas of physician practice not included in the program being evaluated.
Third, if further research replicates the large gap we found between physician support for P4P and support for public reporting, policymakers might want to consider whether and how to deal with this difference when designing and sequencing their programs. Although respondents expressed a lack of trust in health plans and in the government, they did not simply oppose change: The majority supported financial incentives for quality, although they conditioned their support on measures’ being accurate. They doubted that measures are adequately risk-adjusted for patients’ medical conditions or socioeconomic status—doubts that are supported in the literature.They were considerably more supportive of public reporting at the medical-group level than at the individual-physician level—a reservation that is supported by research demonstrating the difficulty of creating reliable and valid quality measures for individual primary care physicians.And they were concerned about possible unintended consequences of measuring and rewarding quality—a concern that is supported by economic theory and by experience in other industries.Policymakers might wish to pay close attention to physicians’ concerns both to increase physician support for programs and because these concerns could be quite important for improving the quality of care.
EVALUATIONS OF P4P and public reporting programs should be explicitly designed to assess possible unintended consequences on disparities in health care delivery, on physicians who practice in areas of low socioeconomic status, and on the quality of care in important areas of physician practice not included in the program being evaluated.
MARKETWATCH
General Internists’ Views On Pay-For-Performance And Public Reporting Of Quality Scores: A National Survey
Lawrence P. Casalino, G. Caleb Alexander, Lei Jin and R. Tamara Konetzka
Very little is known about rank-and-file physicians’ views on pay-for-performance (P4P) and public reporting. In a national survey of general internists, we found strong potential support for financial incentives for quality, but less support for public reporting. Large majorities of respondents stated that these programs will result in physicians’ avoiding high-risk patients and will divert attention from important types of care for which quality is not measured. Public and private policymakers might avoid a physician backlash and better succeed at improving health care quality if they consider these concerns when designing P4P and public reporting programs.
Health Affairs, 26, no. 2 (2007): 492-499
doi: 10.1377/hlthaff.26.2.492
" The fact that nearly three-quarters of the general internists we surveyed support financial incentives for quality could be surprising, given their concerns about unintended consequences, possible fear of the unknown, and literature on physician professionalism suggesting that physicians prefer not to subject their performance to external oversight. Respondents might simply have seen such incentives as a way to gain more income; this belief might have outweighed
any resistance they had to external oversight."
"The majority supported financial incentives for quality, although they conditioned their support on measures’ being accurate."
Dear Friends and Colleagues:
In the heated discussion about the so-called Pay-For Performance (P4P) Programs we often forget to consider the views of those we claim to represent: the practicing physicians.
I am concerned that ideological tainted viewpoints distort rational approaches towards this issue, thereby failing to consider the pros and cons of a topic that may affect us all.
In a series of reviews I will therefore present on my blog a variety of different articles discussing evidence-based P4P applications:
In the first article ( see attached abstract) the authors present the views of General Internists and their attitude towards public reporting of quality scores.
DESIGN:
To learn more about physicians’ views, the authors conducted a national survey of general internists. Their views, although not necessarily representative of all physicians, are important both because of the large numbers of general internists and because most physician P4P programs focus on primary care.
METHODS:
The sampling frame included 1,668 randomly selected general internists listed in the AMA Physician Masterfile as working in one of the twelve broadly nationally representative metropolitan areas included in the Community Tracking Study (CTS) of the Center for Studying Health System Change (HSC).A cover letter and a seven-page self-administered questionnaire were mailed to the sample in April 2005, with follow-up surveys to nonrespondents mailed in four subsequent waves. The survey was developed after review of the relevant literature, input from experts in P4P and public reporting, and pilot testing with academic and community physicians. The Institutional Review Board (IRB) at the University of Chicago approved the study protocol.
Of the 1,668 physicians selected, 500 were ineligible: 188 surveys were undeliverable; 14 were returned uncompleted with a note stating that the physician was no longer in practice; 46 respondents were not general internists; and 252 additional physicians were not at the address to which the survey had been mailed, according to the phone calls made to nonrespondents’ offices. Of the 1,168 remaining subjects, we received 556 completed surveys, for an adjusted response rate of 48 percent.
RESULTS:
Attitudes toward P4P and public reporting. Almost three-fourths of responding physicians agreed that "if the measures are accurate, physicians should be given financial incentives for quality"
However, only 4 percent strongly agreed and 26 percent somewhat agreed that measures of quality are generally accurate at present. Most respondents had little confidence that this will change: 38 percent believed that health plans will try hard to make the measures accurate, and 35 percent believed that government will do so
There was much less support for public reporting than for financial incentives for quality. Only 45 percent of respondents supported public reporting of medical group performance , and only 32 percent supported reporting of individual physicians’ performance. One in three physicians strongly supported financial incentives, but only one in twelve strongly supported public reporting for medical groups, and one in nineteen strongly supported it for individuals
Attitudes toward quality measures and possible unintended consequences. Only 30 percent of physicians agreed that measures of quality are generally accurate. Eighty-eight percent believed that measures are not adequately adjusted for patients’ medical conditions; 85 percent believed that they are not adequately adjusted for patients’ socioeconomic status; and 82 percent stated that quality measures could lead physicians to avoid high-risk patients. Many physicians added written comments stating that poorly compliant patients would also be avoided: For example, "If my pay depended on A1c values, I have 10–15 patients whom I would have to fire. The poor, unmotivated, obese, and noncompliant would all have to find new physicians."
The survey results suggest that physicians are also concerned that "measuring quality will divert physicians’ attention from important types of care for which quality is not measured." Sixty-one percent strongly or somewhat agreed with this statement; many added written comments stating that many quality measures cover physician activities that they do not consider very important compared with many other things they do.
Are some physicians more likely to support P4P or public reporting? The authors performed bivariate and multivariate analyses to learn whether physician support for P4P or public reporting is associated with whether the physician has financial incentives for quality, sees relatively poor patients (measured by percentage of Medicaid patients), and has an income that is primarily based on patient volume.They also tested they associations with physicians’ age, sex, and board certification.
The main finding on bivariate analyses was that physicians who now have financial incentives for quality were more likely to support such incentives than those who do not. These physicians were also more likely to support public reports on medical groups. One-fourth of respondents (130 physicians) reported having financial incentives for quality;for most, the incentive amounted to 5 percent or less of their income (data not shown). Multivariate analysis produced results consistent with the bivariate analyses.
DISCUSSION:
" Support for P4P. Our results suggest that there is a sizable potential reservoir of physician support for P4P: Nearly three in four internists stated that physicians should be given financial incentives for quality if the measures are accurate. However, responses also suggest that there are barriers to overcome if P4P programs are to gain physicians’ support: Fewer than one-third of internists stated that quality measures are accurate at present, and only slightly more than one-third believed that health plans and the government will try hard to make measures accurate.
Support for public reporting. Internists were far less supportive of public reporting than of financial incentives for quality: One-third supported public reporting of individual physicians’ quality scores, and only 45 percent supported public reporting at the medical group level.
Concerns about financial incentives for quality. Although the majority of respondents supported financial incentives for quality in principle, they appear to have been very concerned about possible unintended and undesirable consequences. Large majorities of respondents stated that quality measures are not adequately adjusted for patients’ medical conditions or socioeconomic status; that measuring quality may lead physicians to avoid high-risk patients; and that measuring quality will divert physicians’ attention from important but unmeasured areas of clinical care.
Concerns about public reporting. Although a large majority of respondents supported financial incentives for quality, a large majority opposed public reporting, especially reporting of individual physicians’ performance. To our knowledge, this is the first survey to report this gap. We do not have data to explain this finding; it is possible that respondents believed that they were unlikely to lose much from having financial incentives for quality but feared that a poor public quality rating would be humiliating and might lead to losses of patients and of peer approval.
Other relevant studies. To our knowledge, this is the first national survey to be published of physicians’ views on P4P and public reporting. Some relevant studies have been conducted in more limited settings. In an e-mail survey of nearly 6,000 Massachusetts physicians (response rate was 7 percent; 29 percent were internists), the Massachusetts Medical Society (MMS) found that respondents were open to quality measurement but did not believe that current measures were accurate. Four physician surveys related to public reporting have been conducted; each surveyed either cardiologists or cardiac surgeons in New York or Pennsylvania, where data on cardiac procedures are publicly reported.The results were similar across the surveys: The majority of respondents stated that the measures were not adequately risk-adjusted and believed that public reporting was leading physicians to avoid doing bypass surgery or angioplasty on high-risk patients.
Possible rationales for survey results. The fact that nearly three-quarters of the general internists we surveyed support financial incentives for quality could be surprising, given their concerns about unintended consequences, possible fear of the unknown, and literature on physician professionalism suggesting that physicians prefer not to subject their performance to external oversight.12 Respondents might simply have seen such incentives as a way to gain more income; this belief might have outweighed any resistance they had to external oversight.
An alternative, or complementary, explanation is that physicians would like to improve the quality of care and believe that P4P would finally give them a "business case" for investing in improving quality.Respondents who reported having financial incentives for quality were more likely to support such incentives: Their experience with incentives might have been positive, although it is also possible that physicians who are open to financial incentives for quality are more likely to join practices that have such incentives.
A third possible explanation is that physicians who oppose P4P were less likely to respond to the survey and that our results therefore overstate the degree of support. However, nonrespondents were very similar to respondents, except that nonrespondents were less likely to be board-certified. Since non-board-certified respondents were equally or slightly more likely to favor financial incentives for quality, this potential source of nonrespondent bias seems unlikely to greatly alter our results.
Possible study limitations. Several possible limitations should be considered in evaluating our results. First, the results are not representative of all U.S. physicians; rather, they are limited to general internists in twelve metropolitan areas. Although these twelve areas are not precisely statistically representative of U.S. metropolitan areas, they represent a broad cross-section of such areas in the country and have been used as the sampling frame for major studies of health care quality.
Second, our response rate was modest, though not atypical for physician surveys; it appears, for the reasons detailed above, that nonresponse bias is unlikely to have greatly affected our results. Third, the survey asked about "financial incentives for quality" in general, not about any specific incentive program, so different physicians might have had different programs in mind when responding.
Implications for quality improvement in public and private programs. Our findings suggest three main implications for Medicare and for other public and private policymakers seeking ways to improve the quality of health care. First, there is a large potential reservoir of physician support for P4P, at least among general internists. However, respondents’ concerns about unintended consequences, and their lack of trust that health plans and government will work hard to make quality measures accurate, suggest that physician support could disappear very rapidly if these consequences do occur. Recent experience with such highly touted innovations as utilization review and primary care gatekeeping suggest that potentially useful policies might generate a strong backlash if they are not framed and implemented with attention to physicians’ concerns.
Second, respondents’ concerns suggest that evaluations of P4P and public reporting programs should be explicitly designed to assess possible unintended consequences on disparities in health care, on physicians who practice in areas of low socioeconomic status, and on the quality of care in important areas of physician practice not included in the program being evaluated.
Third, if further research replicates the large gap we found between physician support for P4P and support for public reporting, policymakers might want to consider whether and how to deal with this difference when designing and sequencing their programs. Although respondents expressed a lack of trust in health plans and in the government, they did not simply oppose change: The majority supported financial incentives for quality, although they conditioned their support on measures’ being accurate. They doubted that measures are adequately risk-adjusted for patients’ medical conditions or socioeconomic status—doubts that are supported in the literature.They were considerably more supportive of public reporting at the medical-group level than at the individual-physician level—a reservation that is supported by research demonstrating the difficulty of creating reliable and valid quality measures for individual primary care physicians.And they were concerned about possible unintended consequences of measuring and rewarding quality—a concern that is supported by economic theory and by experience in other industries.Policymakers might wish to pay close attention to physicians’ concerns both to increase physician support for programs and because these concerns could be quite important for improving the quality of care.
EVALUATIONS OF P4P and public reporting programs should be explicitly designed to assess possible unintended consequences on disparities in health care delivery, on physicians who practice in areas of low socioeconomic status, and on the quality of care in important areas of physician practice not included in the program being evaluated.
MARKETWATCH
General Internists’ Views On Pay-For-Performance And Public Reporting Of Quality Scores: A National Survey
Lawrence P. Casalino, G. Caleb Alexander, Lei Jin and R. Tamara Konetzka
Very little is known about rank-and-file physicians’ views on pay-for-performance (P4P) and public reporting. In a national survey of general internists, we found strong potential support for financial incentives for quality, but less support for public reporting. Large majorities of respondents stated that these programs will result in physicians’ avoiding high-risk patients and will divert attention from important types of care for which quality is not measured. Public and private policymakers might avoid a physician backlash and better succeed at improving health care quality if they consider these concerns when designing P4P and public reporting programs.
Health Affairs, 26, no. 2 (2007): 492-499
doi: 10.1377/hlthaff.26.2.492
Thursday, June 28, 2007
AMA 2007 Annual Meeting Update
Dear Friends and Colleagues;
Attached an AMA endorsed summary of important decisions made at the AMA Annual meeting.
For more information see http://www.ama-assn.org/ama/pub/category/17266.html .
Yours
Bernd
AMA Delegate
* Amendments to Constitution & Bylaws
* The AMA adopted new policy to protect patients’ ability to get legally valid prescriptions filled, or to be referred to an appropriate
alternative, without interference from pharmacists’ objection`to certain medications. This new policy resolves that the
AMA work with state medical societies to advocate for state legislation that will allow physicians to dispense medicine to
their patients when there is no pharmacist able and willing to dispense that medication within a 30-mile radius.
* The AMA adopted policy from CEJA that calls on all physicians to reduce disparities in care in their practices by taking into account language barriers, culture and ethnic characteristics and biased behavior.
* The AMA adopted CEJA policy that makes a physician who gives a diagnostic imaging test to a patient—without referral from another physician—responsible for relevant clinical evaluation, as well as pre- and post-test counseling concerning the test. Post-test counseling, however, may be referred as long as the other physician accepts the referral.
* The AMA reaffirmed policy condemning physicians’ participation in torture and other cruel, inhuman or degrading treatment or punishment of prisoners or detainees. Additionally, the AMA now encourages medical schools to include ethics training on this issue.
* Reference Committee A
* The AMA adopted several recommendations regarding state options to improve coverage for the poor. It urged specialty societies and state and county agencies to support state demonstration projects to expand health insurance to low-income patients. It also would encourage state governments to maintain an inventory of private health plans and design an information clearinghouse for individuals, families and small businesses.
* The AMA voted to research and publicize existing studies on how health care money is spent. The intent is to identify the amount of public and private health care spending that is transferred to insurance administration compared to industry standards.
* After a lengthy and impassioned debate between delegates, the AMA resolved to prepare legislation that will allow physicians to balance bill all payers—including Medicare patients—and seek sponsors for the measure in Congress. The AMA also will support federal legislation allowing physicians and hospitals to cancel or reduce co payments for hardship cases without a change in fee schedules.
* Reference Committee B
* The AMA adopted as official policy principles and guidelines on pay for performance (PfP). It also adopted enhancements to these principles and guidelines, which include, among other items, that the AMA would reject any PfP program put forth by a private or public payer that is not consistent with those guidelines.
* Delegates reaffirmed that a high priority be placed on securing a repeal to the current sustainable growth rate formula, replacing it with a more predictable system that recognizes the true costs of providing physician services.
* The AMA reaffirmed that it will advocate that section 215 of the U.S.A. Patriot Act—which demands that physicians disclose patients’ medical information to law enforcement agencies without telling patients—be replaced or modified if reauthorized by Congress.
* Delegates have referred to the Board of Trustees a resolution that asks the AMA to advocate for state and federal legislation that requires an advance directive at the time of enrollment in a health insurance plan or at the time of application for a driver’s license.
* Reference Committee C
* There is now a shortage of physicians (at least in some regions and specialties) and evidence exists for additional shortages in the future. The AMA will work with members of the Federation and national and regional policy makers to address the current and predicted physician shortages.
* Delegates adopted policy to ensure adequate funding for medical schools, graduate medical education programs and teaching institutions where medical education occurs, including creating mechanisms to fund additional medical school positions. The AMA will seek federal legislation requiring all health insurers to support graduate medical education through an all-payer trust fund created for this purpose.
* The AMA will support national efforts to improve the health services to underserved minority communities and encourage recruitment of qualified underrepresented minorities to the profession of medicine.
* The AMA will partner with all relevant stakeholders to petition Congress to reinstate funding for Title VII and to inform legislators in Congress about how Title VII-supported programs address health professional shortages, increase the diversity of the workforce, equip health professions students to work in health centers and underserved communities and ensure that health professionals are ready to address health-related emerging issues.
* Reference Committee D
* The AMA adopted new policy to reduce health disparities suffered because of unequal treatment of minor children and adults in gay, lesbian, bisexual and transgender families.
* Delegates also adopted policy to promote consumption and availability of nutritious beverages as a healthy alternative to carbonated sodas and sugar-added juices in public schools.
* Delegates referred to the Board of Trustees a recommendation to study the utilization of new and old Medicare preventive service benefits, including the Tobacco Cessation Benefit. The goal is to provide proper quality preventive services to Medicare patients.
* Delegates adopted a revised policy to encourage periodic pediatric eye screenings based on AAP, AAFP and AAO evidence based guidelines, with referral to an ophthalmologist for a comprehensive, professional evaluation as appropriate.
* Reference Committee E
* A Council of Scientific Affairs Report deals with the safety and efficacy of selective serotonin reuptake inhibitors (SSRIs) in children and adolescents. This report was adopted, with the caveat that while the AMA supports the Food and Drug Administration’s (FDA) black box on SSRIs, it wants the FDA to monitor the impact of the black box, to ensure it does no affect appropriate access to patient care.
* Direct-to-consumer advertising was another important area of debate. The AMA will evaluate strategies to minimize the potential negative impact of direct-to-consumer marketing.
* There were several dietary supplement resolutions handled by the reference committee. In general, our AMA’s goal has been to change the existing Dietary Supplement Health Education Act (DSHEA) to make the regulation of dietary supplements comparable to the drug model and the AMA continues to make significant effort to address the DSHEA inadequacies.
* Delegates adopted policy that addresses the need to clean up the Internet regarding the illegal sales of prescription drugs,such as utilizing actions with credit card companies.
* Reference Committee F
* The AMA has recommended investigating the feasibility of developing and marketing a health insurance plan tailored for medical students. The AMA will work with the AMA Insurance Agency and issue a report at the 2005 Interim Meeting.
* Due to proposed congressional action, the AMA will work with specialty organizations to express concern to the NIH and others, to oppose mandatory submission of manuscripts, and to address the issue of direct linking from PubMed Central to not-for-profit journals.
* The AMA adopted the recommendation to work with state medical societies and their legislatures to ensure that the title “physician” is used only by those who have completed a qualified medical school and have received an MD or DO degree.
* The AMA will encourage the media strongly to require that an`actual degree be affixed to the name of all individuals who`endorse health-related products.
* Reference Committee G
* Delegates adopted policy that supports the principle that when`physicians receive financial assistance from inpatient facilities to`obtain health information technology or “HIT” systems, their`choice of which system to purchase should not be unreasonably`constrained, nor should they, the physicians, be required to`share confidential patient information with the facility.
* With the aim of ensuring that “cost-based medicine” is`not allowed to masquerade as “evidence-based medicine,” the`AMA adopted new policy that asks the AMA to work with`state and specialty societies and other organizations`to educate the Centers for Medicare & Medicaid Services,`state legislatures and state Medicaid agencies about the appropriate use of evidence-based medicine, in addition to the dangers of making policies based on cost-based medicine inappropriately characterized as evidence-based.
* The AMA will encourage JCAHO to require that certain issues related to medical staff governance be delineated in medical staff bylaws, rather than in separate administrative documents. Among the issues the AMA will recommend for inclusion are application, reapplication, credentialing and privileging standards; fair hearing and appeal processes; and the structure of the medical staff organization.
* The AMA agreed to study both the responsibilities of the physician who allows a manufacturer’s representative to observe and provide technical support in patient treatment, as well as the manufacturer’s representative’s duties to the patient and physician.
Bernd Wollschlaeger,MD,FAAFP
Attached an AMA endorsed summary of important decisions made at the AMA Annual meeting.
For more information see http://www.ama-assn.org/ama/pub/category/17266.html .
Yours
Bernd
AMA Delegate
* Amendments to Constitution & Bylaws
* The AMA adopted new policy to protect patients’ ability to get legally valid prescriptions filled, or to be referred to an appropriate
alternative, without interference from pharmacists’ objection`to certain medications. This new policy resolves that the
AMA work with state medical societies to advocate for state legislation that will allow physicians to dispense medicine to
their patients when there is no pharmacist able and willing to dispense that medication within a 30-mile radius.
* The AMA adopted policy from CEJA that calls on all physicians to reduce disparities in care in their practices by taking into account language barriers, culture and ethnic characteristics and biased behavior.
* The AMA adopted CEJA policy that makes a physician who gives a diagnostic imaging test to a patient—without referral from another physician—responsible for relevant clinical evaluation, as well as pre- and post-test counseling concerning the test. Post-test counseling, however, may be referred as long as the other physician accepts the referral.
* The AMA reaffirmed policy condemning physicians’ participation in torture and other cruel, inhuman or degrading treatment or punishment of prisoners or detainees. Additionally, the AMA now encourages medical schools to include ethics training on this issue.
* Reference Committee A
* The AMA adopted several recommendations regarding state options to improve coverage for the poor. It urged specialty societies and state and county agencies to support state demonstration projects to expand health insurance to low-income patients. It also would encourage state governments to maintain an inventory of private health plans and design an information clearinghouse for individuals, families and small businesses.
* The AMA voted to research and publicize existing studies on how health care money is spent. The intent is to identify the amount of public and private health care spending that is transferred to insurance administration compared to industry standards.
* After a lengthy and impassioned debate between delegates, the AMA resolved to prepare legislation that will allow physicians to balance bill all payers—including Medicare patients—and seek sponsors for the measure in Congress. The AMA also will support federal legislation allowing physicians and hospitals to cancel or reduce co payments for hardship cases without a change in fee schedules.
* Reference Committee B
* The AMA adopted as official policy principles and guidelines on pay for performance (PfP). It also adopted enhancements to these principles and guidelines, which include, among other items, that the AMA would reject any PfP program put forth by a private or public payer that is not consistent with those guidelines.
* Delegates reaffirmed that a high priority be placed on securing a repeal to the current sustainable growth rate formula, replacing it with a more predictable system that recognizes the true costs of providing physician services.
* The AMA reaffirmed that it will advocate that section 215 of the U.S.A. Patriot Act—which demands that physicians disclose patients’ medical information to law enforcement agencies without telling patients—be replaced or modified if reauthorized by Congress.
* Delegates have referred to the Board of Trustees a resolution that asks the AMA to advocate for state and federal legislation that requires an advance directive at the time of enrollment in a health insurance plan or at the time of application for a driver’s license.
* Reference Committee C
* There is now a shortage of physicians (at least in some regions and specialties) and evidence exists for additional shortages in the future. The AMA will work with members of the Federation and national and regional policy makers to address the current and predicted physician shortages.
* Delegates adopted policy to ensure adequate funding for medical schools, graduate medical education programs and teaching institutions where medical education occurs, including creating mechanisms to fund additional medical school positions. The AMA will seek federal legislation requiring all health insurers to support graduate medical education through an all-payer trust fund created for this purpose.
* The AMA will support national efforts to improve the health services to underserved minority communities and encourage recruitment of qualified underrepresented minorities to the profession of medicine.
* The AMA will partner with all relevant stakeholders to petition Congress to reinstate funding for Title VII and to inform legislators in Congress about how Title VII-supported programs address health professional shortages, increase the diversity of the workforce, equip health professions students to work in health centers and underserved communities and ensure that health professionals are ready to address health-related emerging issues.
* Reference Committee D
* The AMA adopted new policy to reduce health disparities suffered because of unequal treatment of minor children and adults in gay, lesbian, bisexual and transgender families.
* Delegates also adopted policy to promote consumption and availability of nutritious beverages as a healthy alternative to carbonated sodas and sugar-added juices in public schools.
* Delegates referred to the Board of Trustees a recommendation to study the utilization of new and old Medicare preventive service benefits, including the Tobacco Cessation Benefit. The goal is to provide proper quality preventive services to Medicare patients.
* Delegates adopted a revised policy to encourage periodic pediatric eye screenings based on AAP, AAFP and AAO evidence based guidelines, with referral to an ophthalmologist for a comprehensive, professional evaluation as appropriate.
* Reference Committee E
* A Council of Scientific Affairs Report deals with the safety and efficacy of selective serotonin reuptake inhibitors (SSRIs) in children and adolescents. This report was adopted, with the caveat that while the AMA supports the Food and Drug Administration’s (FDA) black box on SSRIs, it wants the FDA to monitor the impact of the black box, to ensure it does no affect appropriate access to patient care.
* Direct-to-consumer advertising was another important area of debate. The AMA will evaluate strategies to minimize the potential negative impact of direct-to-consumer marketing.
* There were several dietary supplement resolutions handled by the reference committee. In general, our AMA’s goal has been to change the existing Dietary Supplement Health Education Act (DSHEA) to make the regulation of dietary supplements comparable to the drug model and the AMA continues to make significant effort to address the DSHEA inadequacies.
* Delegates adopted policy that addresses the need to clean up the Internet regarding the illegal sales of prescription drugs,such as utilizing actions with credit card companies.
* Reference Committee F
* The AMA has recommended investigating the feasibility of developing and marketing a health insurance plan tailored for medical students. The AMA will work with the AMA Insurance Agency and issue a report at the 2005 Interim Meeting.
* Due to proposed congressional action, the AMA will work with specialty organizations to express concern to the NIH and others, to oppose mandatory submission of manuscripts, and to address the issue of direct linking from PubMed Central to not-for-profit journals.
* The AMA adopted the recommendation to work with state medical societies and their legislatures to ensure that the title “physician” is used only by those who have completed a qualified medical school and have received an MD or DO degree.
* The AMA will encourage the media strongly to require that an`actual degree be affixed to the name of all individuals who`endorse health-related products.
* Reference Committee G
* Delegates adopted policy that supports the principle that when`physicians receive financial assistance from inpatient facilities to`obtain health information technology or “HIT” systems, their`choice of which system to purchase should not be unreasonably`constrained, nor should they, the physicians, be required to`share confidential patient information with the facility.
* With the aim of ensuring that “cost-based medicine” is`not allowed to masquerade as “evidence-based medicine,” the`AMA adopted new policy that asks the AMA to work with`state and specialty societies and other organizations`to educate the Centers for Medicare & Medicaid Services,`state legislatures and state Medicaid agencies about the appropriate use of evidence-based medicine, in addition to the dangers of making policies based on cost-based medicine inappropriately characterized as evidence-based.
* The AMA will encourage JCAHO to require that certain issues related to medical staff governance be delineated in medical staff bylaws, rather than in separate administrative documents. Among the issues the AMA will recommend for inclusion are application, reapplication, credentialing and privileging standards; fair hearing and appeal processes; and the structure of the medical staff organization.
* The AMA agreed to study both the responsibilities of the physician who allows a manufacturer’s representative to observe and provide technical support in patient treatment, as well as the manufacturer’s representative’s duties to the patient and physician.
Bernd Wollschlaeger,MD,FAAFP
Wednesday, June 13, 2007
HSAs In The News
Dear Friends and Colleagues:
Attached an interesting article from todays Wall Street Journal reviewing the obstacles regarding the implementation of Health Savings Accounts.
These are the facts:
* Only about 8-10 Million Americans are enrolled in Health Savings Accounts and that number increased among US workers only slightly, to 2.7 million in 2006 from 2.4 million in 2005.
* Few employers are focusing on the costly measures -- such as offering better coverage or more consumer education, and instead shifting healthcare costs to the employees.
* Where employees do have a choice, only 19% choose the newfangled plans, the Kaiser study estimates. In the Federal Employees Health Benefits Program, which has offered the plans for several years, only about 50,000 of its eight million members were enrolled in them in 2006. Guess, our elected officials prefer to use traditional plans ,whereas us common folk should swallow the bait.
* Employers are often HSAs as the cheapest and only insurance alternative forcing employees to use them, even though those plans are not suitable for them.40% of employees in a consumer-directed plan say it was the only choice available from their employer!!!
HSAs may be ONE solution among the many insurance options available for US consumers, but should not marketed as THE solution.
Personally, I would like our government to spend as much energy and money promoting existing and traditional solutions as they do with HSAs.
If cost shifting is the goal, then the common folk will loose.
Yours
Bernd
Health Savings Plans Start to Falter
Despite Employer Enthusiasm for Consumer-Directed Approach, Patients Express Dissatisfaction With How the Accounts Work
By VANESSA FUHRMANS
Wall Street Journal June 12, 2007; Page D1
President Bush and many big employers have hailed "consumer-directed" health plans and savings accounts as an effective weapon in the battle against runaway medical costs. But several years after the plans got off to a fast start, the approach appears to be stumbling -- largely because of consumers' unease in using them.
Eight million to 10 million Americans are enrolled in consumer-directed plans, which involve a high-deductible insurance policy that can be combined with a savings account to help pay for out-of-pocket health costs. The plans, which have lower premiums but shift more of the responsibility for health-care spending onto consumers, got a big boost in late 2003 after Congress created portable health-savings accounts that participants can use to sock away pretax dollars and let them grow tax-free. Employers often put money in the accounts to subsidize the higher deductibles.
SPEED BUMP
[Speed Bump]
Enrollment in consumer-driven health plans
• Number of U.S. workers (excluding dependents) enrolled in such plans through work was 2.7 million in 2006, vs. 2.4 million in 2005.
• 40% of employees in a consumer-directed plan say it was the only choice available from their employer.
• Where employees have a choice of health-plan options, only 19% choose consumer-driven plans.
Source: The Kaiser Family Foundation
The plans are accomplishing some of what they intended: A raft of data show that people enrolled in the plans do tend to spend less on care than others. That is encouraging more employers to introduce such plans to their workers over the next two years.
But low enrollment and low satisfaction among workers who are offered them raise the question of whether consumer-directed plans will stall before they ever hit the mainstream. Few employers are focusing on the costly measures -- such as offering better coverage or more consumer education -- that may be needed to accelerate these plans.
The numbers of U.S. workers enrolled in such plans through their jobs (excluding dependents and those in firms with fewer than three workers) grew only slightly, to 2.7 million in 2006 from 2.4 million in 2005, according to the Kaiser Family Foundation. Most do it because either their companies give them no choice or the premiums are the cheapest. Enrollment is growing faster on the individual market and among sole proprietors, but that may be because the plans are often the only affordable option.
Where employees do have a choice, only 19% choose the newfangled plans, the Kaiser study estimates. In the Federal Employees Health Benefits Program, which has offered the plans for several years, only about 50,000 of its eight million members were enrolled in them in 2006, according to industry estimates. At lightbulb-maker Osram Sylvania, just 5% of employees enrolled in the plans in 2006, their first year.
In addition, those who are in consumer-directed health plans often report lower satisfaction and confusion about how the plans are supposed to work. The general idea is for patients to conserve money in their savings accounts, which are meant to pay for care until they reach their high insurance deductible. In theory, patients who shop carefully could have money left over, which they can keep and let build into savings for bigger health-care costs down the line.
[Consumer-Directed Plans]
In a survey published last month by Towers Perrin, an employee-benefits firm, employees enrolled in them said they felt less capable of finding a quality doctor or hospital, though they often were in the same network as colleagues in other plans. Only 29% said they tried to save money in their accounts for future medical expenses.
Though the consulting firm says consumer-directed plans have much potential, its executives were surprised consumer responses were so negative.
"If I were a product manager in any other industry and saw scores this low in customer satisfaction and understanding, I'd be thinking of pulling that product from the shelves or retooling it," says David Guilmette, managing director of Towers Perrin's health-care consulting practice.
One reason for the frustration is the uphill battle many consumers describe in trying to shop for their health care. Six years ago, Howard Katz, an industrial-design research consultant in rural eastern Pennsylvania, bought a family health plan with a savings account and a deductible that is now $5,650. But getting specific price information on which to base purchase decisions for MRIs, doctor visits and blood work has been difficult, he says.
And the money in the health savings account gets spent; only once has enough remained to roll over to the next year.
Now, he says, he has rejoined a company as an employee after working on his own, and one of the perks is regaining traditional health coverage. "Now I don't have to act like a medical examiner anymore," he says.
Proponents of consumer-directed plans point out that their overall enrollment continues to grow at a faster clip than enrollment in HMOs did when they were introduced in the 1970s. Among those who enroll, the vast majority stay in and don't switch back to another type of plan.
In cases where employers spend months informing workers about how the plans work and offer them more financial incentives than just cheaper premiums, workers report higher satisfaction and often get more preventive care than people in other plans. "But the vast majority of companies still do not have the time, effort or resources to prime the pump," says Larry Boress, president of the Midwest Business Group on Health, a coalition of large employers.
A growing number of industry experts believe that for consumer-directed plans to succeed, they have to offer coverage that is at least as rich as traditional plans. That means providing upfront coverage of most preventive services and treatments and a generous contribution to employees' accounts.
"If you're just trying to cost shift, and you only get 10% of your employees in, they are the youngest and healthiest, and you haven't accomplished anything in terms of health-care costs," says Bill Sharon, a senior vice president at Aon Consulting, the human-resources consulting arm of insurance broker Aon Corp.
Osram Sylvania introduced a consumer-directed health plan with a health savings account with premiums 15% to 20% cheaper than its traditional plans, but employees were responsible for the entire deductible. Just 5% of employees enrolled. In preparation for 2007, it introduced another similar plan alongside it, but with 100% preventive-care coverage and a $600 contribution into the health reimbursement account, and older generation of the health savings account.
"We'd heard concerns from employees that they weren't going to get the right care," says Julie Thibodeau, co-director of human resources at Osram Sylvania. This year enrollment between the two consumer-directed plans rose to 15%.
Aon has offered its own employees two consumer-directed options since 2002, with deductibles between $2,500 and $6,250. Nearly 20% of employees are enrolled in one, and the majority of them have money left to roll over from the $500 to $2,500 that Aon contributes to their account each year. Employee premiums are about 30% lower than in the more-traditional plans Aon offers, says John Reschke, Aon Corp.'s vice president of benefits. Considering that the coverage is at least as rich for most employees as in the traditional plans, "we should have a lot more people enrolled," he says. "But this is a different kind of insurance, and it can be scary at first until people understand."
Write to Vanessa Fuhrmans at vanessa.fuhrmans@wsj.com1
Attached an interesting article from todays Wall Street Journal reviewing the obstacles regarding the implementation of Health Savings Accounts.
These are the facts:
* Only about 8-10 Million Americans are enrolled in Health Savings Accounts and that number increased among US workers only slightly, to 2.7 million in 2006 from 2.4 million in 2005.
* Few employers are focusing on the costly measures -- such as offering better coverage or more consumer education, and instead shifting healthcare costs to the employees.
* Where employees do have a choice, only 19% choose the newfangled plans, the Kaiser study estimates. In the Federal Employees Health Benefits Program, which has offered the plans for several years, only about 50,000 of its eight million members were enrolled in them in 2006. Guess, our elected officials prefer to use traditional plans ,whereas us common folk should swallow the bait.
* Employers are often HSAs as the cheapest and only insurance alternative forcing employees to use them, even though those plans are not suitable for them.40% of employees in a consumer-directed plan say it was the only choice available from their employer!!!
HSAs may be ONE solution among the many insurance options available for US consumers, but should not marketed as THE solution.
Personally, I would like our government to spend as much energy and money promoting existing and traditional solutions as they do with HSAs.
If cost shifting is the goal, then the common folk will loose.
Yours
Bernd
Health Savings Plans Start to Falter
Despite Employer Enthusiasm for Consumer-Directed Approach, Patients Express Dissatisfaction With How the Accounts Work
By VANESSA FUHRMANS
Wall Street Journal June 12, 2007; Page D1
President Bush and many big employers have hailed "consumer-directed" health plans and savings accounts as an effective weapon in the battle against runaway medical costs. But several years after the plans got off to a fast start, the approach appears to be stumbling -- largely because of consumers' unease in using them.
Eight million to 10 million Americans are enrolled in consumer-directed plans, which involve a high-deductible insurance policy that can be combined with a savings account to help pay for out-of-pocket health costs. The plans, which have lower premiums but shift more of the responsibility for health-care spending onto consumers, got a big boost in late 2003 after Congress created portable health-savings accounts that participants can use to sock away pretax dollars and let them grow tax-free. Employers often put money in the accounts to subsidize the higher deductibles.
SPEED BUMP
[Speed Bump]
Enrollment in consumer-driven health plans
• Number of U.S. workers (excluding dependents) enrolled in such plans through work was 2.7 million in 2006, vs. 2.4 million in 2005.
• 40% of employees in a consumer-directed plan say it was the only choice available from their employer.
• Where employees have a choice of health-plan options, only 19% choose consumer-driven plans.
Source: The Kaiser Family Foundation
The plans are accomplishing some of what they intended: A raft of data show that people enrolled in the plans do tend to spend less on care than others. That is encouraging more employers to introduce such plans to their workers over the next two years.
But low enrollment and low satisfaction among workers who are offered them raise the question of whether consumer-directed plans will stall before they ever hit the mainstream. Few employers are focusing on the costly measures -- such as offering better coverage or more consumer education -- that may be needed to accelerate these plans.
The numbers of U.S. workers enrolled in such plans through their jobs (excluding dependents and those in firms with fewer than three workers) grew only slightly, to 2.7 million in 2006 from 2.4 million in 2005, according to the Kaiser Family Foundation. Most do it because either their companies give them no choice or the premiums are the cheapest. Enrollment is growing faster on the individual market and among sole proprietors, but that may be because the plans are often the only affordable option.
Where employees do have a choice, only 19% choose the newfangled plans, the Kaiser study estimates. In the Federal Employees Health Benefits Program, which has offered the plans for several years, only about 50,000 of its eight million members were enrolled in them in 2006, according to industry estimates. At lightbulb-maker Osram Sylvania, just 5% of employees enrolled in the plans in 2006, their first year.
In addition, those who are in consumer-directed health plans often report lower satisfaction and confusion about how the plans are supposed to work. The general idea is for patients to conserve money in their savings accounts, which are meant to pay for care until they reach their high insurance deductible. In theory, patients who shop carefully could have money left over, which they can keep and let build into savings for bigger health-care costs down the line.
[Consumer-Directed Plans]
In a survey published last month by Towers Perrin, an employee-benefits firm, employees enrolled in them said they felt less capable of finding a quality doctor or hospital, though they often were in the same network as colleagues in other plans. Only 29% said they tried to save money in their accounts for future medical expenses.
Though the consulting firm says consumer-directed plans have much potential, its executives were surprised consumer responses were so negative.
"If I were a product manager in any other industry and saw scores this low in customer satisfaction and understanding, I'd be thinking of pulling that product from the shelves or retooling it," says David Guilmette, managing director of Towers Perrin's health-care consulting practice.
One reason for the frustration is the uphill battle many consumers describe in trying to shop for their health care. Six years ago, Howard Katz, an industrial-design research consultant in rural eastern Pennsylvania, bought a family health plan with a savings account and a deductible that is now $5,650. But getting specific price information on which to base purchase decisions for MRIs, doctor visits and blood work has been difficult, he says.
And the money in the health savings account gets spent; only once has enough remained to roll over to the next year.
Now, he says, he has rejoined a company as an employee after working on his own, and one of the perks is regaining traditional health coverage. "Now I don't have to act like a medical examiner anymore," he says.
Proponents of consumer-directed plans point out that their overall enrollment continues to grow at a faster clip than enrollment in HMOs did when they were introduced in the 1970s. Among those who enroll, the vast majority stay in and don't switch back to another type of plan.
In cases where employers spend months informing workers about how the plans work and offer them more financial incentives than just cheaper premiums, workers report higher satisfaction and often get more preventive care than people in other plans. "But the vast majority of companies still do not have the time, effort or resources to prime the pump," says Larry Boress, president of the Midwest Business Group on Health, a coalition of large employers.
A growing number of industry experts believe that for consumer-directed plans to succeed, they have to offer coverage that is at least as rich as traditional plans. That means providing upfront coverage of most preventive services and treatments and a generous contribution to employees' accounts.
"If you're just trying to cost shift, and you only get 10% of your employees in, they are the youngest and healthiest, and you haven't accomplished anything in terms of health-care costs," says Bill Sharon, a senior vice president at Aon Consulting, the human-resources consulting arm of insurance broker Aon Corp.
Osram Sylvania introduced a consumer-directed health plan with a health savings account with premiums 15% to 20% cheaper than its traditional plans, but employees were responsible for the entire deductible. Just 5% of employees enrolled. In preparation for 2007, it introduced another similar plan alongside it, but with 100% preventive-care coverage and a $600 contribution into the health reimbursement account, and older generation of the health savings account.
"We'd heard concerns from employees that they weren't going to get the right care," says Julie Thibodeau, co-director of human resources at Osram Sylvania. This year enrollment between the two consumer-directed plans rose to 15%.
Aon has offered its own employees two consumer-directed options since 2002, with deductibles between $2,500 and $6,250. Nearly 20% of employees are enrolled in one, and the majority of them have money left to roll over from the $500 to $2,500 that Aon contributes to their account each year. Employee premiums are about 30% lower than in the more-traditional plans Aon offers, says John Reschke, Aon Corp.'s vice president of benefits. Considering that the coverage is at least as rich for most employees as in the traditional plans, "we should have a lot more people enrolled," he says. "But this is a different kind of insurance, and it can be scary at first until people understand."
Write to Vanessa Fuhrmans at vanessa.fuhrmans@wsj.com1
Wednesday, May 30, 2007
Doctors Go Online !
Dear Friends and Colleagues:
Attached an interesting article from todays New York Times.
The author makes a good point:
"Health care providers have been dreaming about electronic records for so long that the idea has begun to seem like vaporware, a never-to-be-realized fantasy similar to flying cars and jetpacks."
The question remains if his preference for WorldVista is really the solution for the problem. A one-size-fit-all product may not be the solution. But a cost-effective, customizable and scaleable solution could lower the threshold for those doctors who are still looking for a suitable product.
Look forward to your comments.
Yours
Bernd
New York Times
May 30, 2007
Op-Ed Contributor
Physician, Upgrade Thyself
By THOMAS GOETZ
SAN FRANCISCO
GO into almost any medical office, hospital or clinic in the United States and your records will still be handled the old-fashioned way — on paper. You can use a computer to pay your taxes, to program your TiVo or to read a message from your great-aunt, but your doctor has to practically level a forest just to examine your medical files. The cost, however, isn’t calculated in trees but in human lives: Electronic medical records would reduce the risk of medical errors and spare hospitals the expense of missing records and unnecessary treatment.
Health care providers have been dreaming about electronic records for so long that the idea has begun to seem like vaporware, a never-to-be-realized fantasy similar to flying cars and jetpacks. But there is already a clear software standard, an open-source system that’s low-cost, easy to use and readily available. It could be the key to the health care system we ought to have already.
The program, WorldVistA, is based on the Veterans Affairs Department’s electronic-records system, called VistA (short for Veterans Health Information Systems and Technology Architecture — and yes, they beat Bill Gates to the name). VistA stands as perhaps the greatest success story for government-developed information technology since the Internet itself.
Using the VistA record system, the veterans department has managed to improve nearly every benchmark of quality in health care. In a decade, the department increased its pneumonia vaccination rate among at-risk patients to 94 percent from only 29 percent. That translates into 6,000 saved lives and $40 million saved each year from fewer pneumonia hospitalizations. On a host of other benchmarks — beta blocker use, cancer screening, cholesterol screening and so on — the department outperforms the nation’s best care.
Thanks to VistA, costs per patient at the Veterans Health Administration system are 32 percent lower, using inflation-adjusted dollars, than they were a decade ago. Over the same period, the medical consumer price index has increased 50 percent for the country as a whole.
The patients are happy, too. For the past eight years, the Veterans Health Administration has outscored private-sector health care in the independent American Customer Satisfaction Index. And because VistA is government-developed software, we all own it — it’s in the public domain. But while the government will mail you a copy, it won’t help install it or maintain it. The Department of Veterans Affairs is, in fact, prohibited by law to stray from its mission to serve veterans.
So in 2002, a group of former Veterans Affairs programmers and open-source advocates formed WorldVistA. They set about making a version of VistA that was simple for health care providers to use, and the fruit of their effort is now ready for market. Like VistA, WorldVistA is robust and fast. In April, the software was approved by the Certification Commission for Healthcare Information Technology. The certification means that WorldVistA is ready for broad adoption.
The effort to promote WorldVistA is supported by a grant from the Centers for Medicare and Medicaid Services, the agency that sets the prices for Medicare and Medicaid payments. The agency wants to provide clinics and public hospitals, especially those that serve uninsured and underserved patients, with an inexpensive system for electronic medical records. The agency was also just getting tired of seeing another year go by without a significant increase in the adoption of digital records. Right now, only a quarter of office-based doctors use them.
The problem isn’t a lack of software. There are hundreds of companies hawking electronic-records systems. But they don’t come cheap. The average cost is about $33,000 per doctor, plus another $1,500 a month per doctor for maintenance, according to a study published in the policy journal Health Affairs. For a small clinic with one or two doctors, that price is usually out of reach. For major hospitals, installing a new system can quickly become a multimillion-dollar experiment.
WorldVistA, thanks to its public-domain origins, costs about one-tenth of what a proprietary system does for a license fee and a support contract. And like any good open-source project, it’s constantly improving. A community of programmers fixes glitches and adds features, just as is done for the open-source Firefox browser and the Linux operating system.
And WorldVistA can be scaled up or down. It can work for neighborhood clinics, small-town hospitals, hospital systems, or, well, the Department of Veterans Affairs. WorldVistA’s big promise is that it can become the nationwide standard for electronic medical records, the backbone of a national network of health care. Your medical records could be read instantly and understood (perhaps less instantly) by any provider, anywhere.
Want to see the best knee surgeon in the country? If he’s using WorldVistA, he can check out your online records at his house or office. If you switch jobs and move to a new insurance plan, you won’t need to build a new medical history and FedEx old records around. With your permission, your files will be accessible to your new providers instantly. In this way, electronic medical records generate better care and lower costs.
WorldVistA isn’t perfect. It isn’t as customizable as some proprietary systems, and its graphical interface isn’t as intuitive or as polished. Worse, its back-office functions — staffing and billing — aren’t all that strong. Major hospitals and health maintenance organizations in search of a Cadillac are free to spend the dollars to buy one.
But for the vast majority of health care providers, WorldVistA is what they’ve been waiting for: a low-cost, simple-to-use system that makes it easier to provide quality health care. If only it could upgrade the waiting-room magazines, too.
Thomas Goetz is the deputy editor of Wired magazine and author of the blog Epidemix.
Attached an interesting article from todays New York Times.
The author makes a good point:
"Health care providers have been dreaming about electronic records for so long that the idea has begun to seem like vaporware, a never-to-be-realized fantasy similar to flying cars and jetpacks."
The question remains if his preference for WorldVista is really the solution for the problem. A one-size-fit-all product may not be the solution. But a cost-effective, customizable and scaleable solution could lower the threshold for those doctors who are still looking for a suitable product.
Look forward to your comments.
Yours
Bernd
New York Times
May 30, 2007
Op-Ed Contributor
Physician, Upgrade Thyself
By THOMAS GOETZ
SAN FRANCISCO
GO into almost any medical office, hospital or clinic in the United States and your records will still be handled the old-fashioned way — on paper. You can use a computer to pay your taxes, to program your TiVo or to read a message from your great-aunt, but your doctor has to practically level a forest just to examine your medical files. The cost, however, isn’t calculated in trees but in human lives: Electronic medical records would reduce the risk of medical errors and spare hospitals the expense of missing records and unnecessary treatment.
Health care providers have been dreaming about electronic records for so long that the idea has begun to seem like vaporware, a never-to-be-realized fantasy similar to flying cars and jetpacks. But there is already a clear software standard, an open-source system that’s low-cost, easy to use and readily available. It could be the key to the health care system we ought to have already.
The program, WorldVistA, is based on the Veterans Affairs Department’s electronic-records system, called VistA (short for Veterans Health Information Systems and Technology Architecture — and yes, they beat Bill Gates to the name). VistA stands as perhaps the greatest success story for government-developed information technology since the Internet itself.
Using the VistA record system, the veterans department has managed to improve nearly every benchmark of quality in health care. In a decade, the department increased its pneumonia vaccination rate among at-risk patients to 94 percent from only 29 percent. That translates into 6,000 saved lives and $40 million saved each year from fewer pneumonia hospitalizations. On a host of other benchmarks — beta blocker use, cancer screening, cholesterol screening and so on — the department outperforms the nation’s best care.
Thanks to VistA, costs per patient at the Veterans Health Administration system are 32 percent lower, using inflation-adjusted dollars, than they were a decade ago. Over the same period, the medical consumer price index has increased 50 percent for the country as a whole.
The patients are happy, too. For the past eight years, the Veterans Health Administration has outscored private-sector health care in the independent American Customer Satisfaction Index. And because VistA is government-developed software, we all own it — it’s in the public domain. But while the government will mail you a copy, it won’t help install it or maintain it. The Department of Veterans Affairs is, in fact, prohibited by law to stray from its mission to serve veterans.
So in 2002, a group of former Veterans Affairs programmers and open-source advocates formed WorldVistA. They set about making a version of VistA that was simple for health care providers to use, and the fruit of their effort is now ready for market. Like VistA, WorldVistA is robust and fast. In April, the software was approved by the Certification Commission for Healthcare Information Technology. The certification means that WorldVistA is ready for broad adoption.
The effort to promote WorldVistA is supported by a grant from the Centers for Medicare and Medicaid Services, the agency that sets the prices for Medicare and Medicaid payments. The agency wants to provide clinics and public hospitals, especially those that serve uninsured and underserved patients, with an inexpensive system for electronic medical records. The agency was also just getting tired of seeing another year go by without a significant increase in the adoption of digital records. Right now, only a quarter of office-based doctors use them.
The problem isn’t a lack of software. There are hundreds of companies hawking electronic-records systems. But they don’t come cheap. The average cost is about $33,000 per doctor, plus another $1,500 a month per doctor for maintenance, according to a study published in the policy journal Health Affairs. For a small clinic with one or two doctors, that price is usually out of reach. For major hospitals, installing a new system can quickly become a multimillion-dollar experiment.
WorldVistA, thanks to its public-domain origins, costs about one-tenth of what a proprietary system does for a license fee and a support contract. And like any good open-source project, it’s constantly improving. A community of programmers fixes glitches and adds features, just as is done for the open-source Firefox browser and the Linux operating system.
And WorldVistA can be scaled up or down. It can work for neighborhood clinics, small-town hospitals, hospital systems, or, well, the Department of Veterans Affairs. WorldVistA’s big promise is that it can become the nationwide standard for electronic medical records, the backbone of a national network of health care. Your medical records could be read instantly and understood (perhaps less instantly) by any provider, anywhere.
Want to see the best knee surgeon in the country? If he’s using WorldVistA, he can check out your online records at his house or office. If you switch jobs and move to a new insurance plan, you won’t need to build a new medical history and FedEx old records around. With your permission, your files will be accessible to your new providers instantly. In this way, electronic medical records generate better care and lower costs.
WorldVistA isn’t perfect. It isn’t as customizable as some proprietary systems, and its graphical interface isn’t as intuitive or as polished. Worse, its back-office functions — staffing and billing — aren’t all that strong. Major hospitals and health maintenance organizations in search of a Cadillac are free to spend the dollars to buy one.
But for the vast majority of health care providers, WorldVistA is what they’ve been waiting for: a low-cost, simple-to-use system that makes it easier to provide quality health care. If only it could upgrade the waiting-room magazines, too.
Thomas Goetz is the deputy editor of Wired magazine and author of the blog Epidemix.
Saturday, May 05, 2007
Abortion Measure Fails
Attached an article from the Miami Herald reporting that the abortion measure introduced by Rep. Trey Traviesa, a Tampa Republican, died in the Senate.
The proposed measure would have made it more diffcult for women tto access family planning services.
Obviously, in the Senate cooler heads prevailed recognzing that women's right to choose should not be curtailed.
Bernd Wollschlaeger,MD
Posted on Sat, May. 05, 2007
Lawmakers can't reach a consensus on abortion bill
BY BREANNE GILPATRICK
No 24-hour wait periods. No preabortion sonograms. No court-appointed guardians for underaged girls trying to bypass the state's parental notification laws.
In fact, Florida won't see any abortion-law changes at all this year, after a controversial bill bounced back and forth between the state House and Senate in the final hours of session, dooming the proposal.
The legislative tennis match started when senators stripped the controversial proposal by Rep. Trey Traviesa, a Tampa Republican, of its controversial provisions.
Among them: a mandated 24-hour wait period and a sonogram before all abortions, with the requirement that doctors give women a chance to see the ultrasound scan.
But when the bill left the Senate and headed back to the House, it contained a list of criteria judges must consider when granting pregnant girls a waiver to Florida's parental-notification requirement.
In the House, Traviesa rejected the bare bones bill and sent it back to the Senate.
That's where the proposal died. The Senate ended the session without taking the bill up again.
The Senate compromise just wasn't acceptable for House supporters, Traviesa said.
''Do we take something small and call it something good?'' Traviesa asked. ``No, we don't.''
The proposed measure would have made it more diffcult for women tto access family planning services.
Obviously, in the Senate cooler heads prevailed recognzing that women's right to choose should not be curtailed.
Bernd Wollschlaeger,MD
Posted on Sat, May. 05, 2007
Lawmakers can't reach a consensus on abortion bill
BY BREANNE GILPATRICK
No 24-hour wait periods. No preabortion sonograms. No court-appointed guardians for underaged girls trying to bypass the state's parental notification laws.
In fact, Florida won't see any abortion-law changes at all this year, after a controversial bill bounced back and forth between the state House and Senate in the final hours of session, dooming the proposal.
The legislative tennis match started when senators stripped the controversial proposal by Rep. Trey Traviesa, a Tampa Republican, of its controversial provisions.
Among them: a mandated 24-hour wait period and a sonogram before all abortions, with the requirement that doctors give women a chance to see the ultrasound scan.
But when the bill left the Senate and headed back to the House, it contained a list of criteria judges must consider when granting pregnant girls a waiver to Florida's parental-notification requirement.
In the House, Traviesa rejected the bare bones bill and sent it back to the Senate.
That's where the proposal died. The Senate ended the session without taking the bill up again.
The Senate compromise just wasn't acceptable for House supporters, Traviesa said.
''Do we take something small and call it something good?'' Traviesa asked. ``No, we don't.''
Wednesday, May 02, 2007
Politicians At The Bedside
Dear Friends and Colleagues:
Attached a troubling news item reporting how politicians are interfering in the physician-patient relationship. I know that within our organization and our society at large , women’s right to choose their reproductive life is being hotly debated.
Unfortunately, the US Supreme Court not only decided to uphold the “Partial Birth Abortion” ban, but also adopted the terminology of the Pro-Life movement calling doctors providing such services “abortion doctors” and described the procedure known as intact dilation and evacuation or dilation and extraction as "partial-birth abortion".
In a further blow to the physician-patient relationship the Florida House voted last week
to impose a 24-hour wait period and a sonogram before almost all abortions.
This decision not only encroaches on women’s reproductive rights, but also inserts the politician into the physician-patient relationship.
Most women I have provided pregnancy termination advice and counsel come to my office after days or deliberation and do not need rules and regulation imposed by paternalistic politicians.
As a physician and my patients advocate I protest such government intrusion into the practice of medicine and call upon organized medicine to speak up in defense of women’s reproductive rights.
Yours truly,
Bernd
===============================================================
Posted on Sat, Apr. 28, 2007
Abortion bill heads to Senate
BY BREANNE GILPATRICK
A controversial proposal requiring a 24-hour wait period and a sonogram before almost all abortions passed the state House of Representatives on Friday and is on its way to the Florida Senate.
The House voted 71-42 in favor of the provisions, after roughly two hours of contentious debate. Both proposals were added to a bill by Rep. Trey Traviesa, a Tampa Republican, that would require judges to appoint a guardian for underage girls who want an abortion and seek to get around the state's parental-notification law.
''On every other medical procedure there is time, time for those important two words: informed consent,'' Traviesa said. ``And anyone who seeks to deny a woman the ability to achieve informed consent is not advocating for the rights of women. They're advocating for an idea.''
Women who are victims of rape, incest, domestic violence or human trafficking would be exempt from the sonogram requirement.
SUPREME COURT BAN
The House vote comes nine days after the U.S. Supreme Court upheld a federal government ban on a particular kind of late-term abortion, a decision pro-choice activists have said would encourage some states to attempt to chip away at abortion rights.
Legislatures in Georgia and South Carolina are considering similar ultrasound requirements. One South Carolina proposal also would require women to view the scans.
The proposal faces rough going in the Senate, where the version by Sen. Ronda Storms, a Valrico Republican, addresses only the parental-notification changes. And senators from both parties have said they are opposed to expanding Storms' bill to encompass the new House provisions.
Gov. Charlie Crist said he is unsure what he thinks about the 24-hour wait period.
''That might concern me,'' Crist said Friday. ``I better look at it, though.''
Supporters say the ultrasound and 24-hour waiting period help women make better medical decisions. The state already requires sonograms before abortions in the second and third trimesters. The proposal would add that requirement for the first three months of pregnancy, when most abortions take place.
The bill also gives women the option not to view the scan.
''If you read this bill, it doesn't do anything to take a way a woman's right to choose,'' said Rep. Kevin Ambler, a Lutz Republican. ``What it does is put a thoughtful deliberative process in place.''
`WHAT AN OUTRAGE'
But opponents say anti-abortion advocates have hijacked the parental notification bill to add provisions designed to create more abortion hurdles that trivialize a woman's decision to have an abortion.
''This bill demeans me in a way I have never felt demeaned before,'' said Rep. Kelly Skidmore, a Boca Raton Democrat. ``It suggests that I would be so cavalier about the decision to terminate a pregnancy that I should go back home and think it over as if I was out shopping and passed by a clinic and decided to pop in for an abortion. What an outrage.''
Miami Herald staff writer Marc Caputo contributed to this report.
Attached a troubling news item reporting how politicians are interfering in the physician-patient relationship. I know that within our organization and our society at large , women’s right to choose their reproductive life is being hotly debated.
Unfortunately, the US Supreme Court not only decided to uphold the “Partial Birth Abortion” ban, but also adopted the terminology of the Pro-Life movement calling doctors providing such services “abortion doctors” and described the procedure known as intact dilation and evacuation or dilation and extraction as "partial-birth abortion".
In a further blow to the physician-patient relationship the Florida House voted last week
to impose a 24-hour wait period and a sonogram before almost all abortions.
This decision not only encroaches on women’s reproductive rights, but also inserts the politician into the physician-patient relationship.
Most women I have provided pregnancy termination advice and counsel come to my office after days or deliberation and do not need rules and regulation imposed by paternalistic politicians.
As a physician and my patients advocate I protest such government intrusion into the practice of medicine and call upon organized medicine to speak up in defense of women’s reproductive rights.
Yours truly,
Bernd
===============================================================
Posted on Sat, Apr. 28, 2007
Abortion bill heads to Senate
BY BREANNE GILPATRICK
A controversial proposal requiring a 24-hour wait period and a sonogram before almost all abortions passed the state House of Representatives on Friday and is on its way to the Florida Senate.
The House voted 71-42 in favor of the provisions, after roughly two hours of contentious debate. Both proposals were added to a bill by Rep. Trey Traviesa, a Tampa Republican, that would require judges to appoint a guardian for underage girls who want an abortion and seek to get around the state's parental-notification law.
''On every other medical procedure there is time, time for those important two words: informed consent,'' Traviesa said. ``And anyone who seeks to deny a woman the ability to achieve informed consent is not advocating for the rights of women. They're advocating for an idea.''
Women who are victims of rape, incest, domestic violence or human trafficking would be exempt from the sonogram requirement.
SUPREME COURT BAN
The House vote comes nine days after the U.S. Supreme Court upheld a federal government ban on a particular kind of late-term abortion, a decision pro-choice activists have said would encourage some states to attempt to chip away at abortion rights.
Legislatures in Georgia and South Carolina are considering similar ultrasound requirements. One South Carolina proposal also would require women to view the scans.
The proposal faces rough going in the Senate, where the version by Sen. Ronda Storms, a Valrico Republican, addresses only the parental-notification changes. And senators from both parties have said they are opposed to expanding Storms' bill to encompass the new House provisions.
Gov. Charlie Crist said he is unsure what he thinks about the 24-hour wait period.
''That might concern me,'' Crist said Friday. ``I better look at it, though.''
Supporters say the ultrasound and 24-hour waiting period help women make better medical decisions. The state already requires sonograms before abortions in the second and third trimesters. The proposal would add that requirement for the first three months of pregnancy, when most abortions take place.
The bill also gives women the option not to view the scan.
''If you read this bill, it doesn't do anything to take a way a woman's right to choose,'' said Rep. Kevin Ambler, a Lutz Republican. ``What it does is put a thoughtful deliberative process in place.''
`WHAT AN OUTRAGE'
But opponents say anti-abortion advocates have hijacked the parental notification bill to add provisions designed to create more abortion hurdles that trivialize a woman's decision to have an abortion.
''This bill demeans me in a way I have never felt demeaned before,'' said Rep. Kelly Skidmore, a Boca Raton Democrat. ``It suggests that I would be so cavalier about the decision to terminate a pregnancy that I should go back home and think it over as if I was out shopping and passed by a clinic and decided to pop in for an abortion. What an outrage.''
Miami Herald staff writer Marc Caputo contributed to this report.
Sunday, April 22, 2007
Stop Corporate Welfare Programs
Dear Friends and Colleagues:
Attached an interesting editorial from yesterdays New York Times focusing on the issue of government subsidies for health insurance companies offering Medicare Advantage plans.
What is the problem?
About a fifth of elderly Americans now belong to private Medicare Advantage plans, which — thanks to government subsidies — often charge less or offer more than traditional Medicare. The government pays private plans 12 percent more, on average, than the same services would cost in the traditional Medicare fee-for-service program. The private plans use some of this money to make themselves more attractive to beneficiaries — by reducing premiums or adding benefits not covered by basic Medicare — and siphon off the rest to add to profits and help cover the plans’ high administrative costs ( and boost their CEO salaries)
What are the results?
The biggest subsidies — averaging 19 percent above cost — go to private fee-for-service plans, which are the fastest-growing part of the Medicare Advantage program. Those companies receive $54 Billion over five years resulting in an average premium increase of $2 to pay for those subsidies.
"If private health plans are supposedly so great at delivering high-quality care while holding down costs, why does the government have to keep subsidizing them so lavishly to participate in the Medicare program?"
What Should Be Done?
* Eliminate the subsidies
* Offer traditional Medicare plans with lower premiums and less adminstrtaive overhead
* Force private companies to compete with traditional Medicare plans
The proponents of market based health care services often forget that more then 50% of each dollar spent spent for health care services is provided by the government NOT INCLUDED the tax subsidies for employer-based health insurance.
Instead of calling for market based health care (which even conservatives do not support) , we should hold our government accountable on how it spends our health care dollars and eliminate corporate welfare programs (i.e subsidies).
Yours
Bernd
====================================================================================
April 21, 2007
Editorial
The Medicare Privatization Scam
If private health plans are supposedly so great at delivering high-quality care while holding down costs, why does the government have to keep subsidizing them so lavishly to participate in the Medicare program?
About a fifth of elderly Americans now belong to private Medicare Advantage plans, which — thanks to government subsidies — often charge less or offer more than traditional Medicare. As Congress struggles to find savings that could offset the costs of other important health programs, it should take a long and hard look at those subsidies.
The authoritative Medicare Payment Advisory Commission estimates that the government pays private plans 12 percent more, on average, than the same services would cost in the traditional Medicare fee-for-service program. The private plans use some of this money to make themselves more attractive to beneficiaries — by reducing premiums or adding benefits not covered by basic Medicare — and siphon off the rest to add to profits and help cover the plans’ high administrative costs.
Although the insurance industry insists that the subsidies are much lower and are warranted by the benefits provided, Thomas Scully, who headed the Medicare program for the Bush administration until 2003, told reporters recently that the subsidies were too large and ought to be reduced by Congress.
The largest private enrollment is in health maintenance organizations, which typically deliver care a bit more cheaply than standard Medicare and should not need their 10 percent subsidies, on average, to compete. The biggest subsidies — averaging 19 percent above cost — go to private fee-for-service plans, which are the fastest-growing part of the Medicare Advantage program. Unlike the H.M.O.’s, which at least manage a patient’s care and bargain hard with doctors and hospitals, these plans ride on the coattails of standard Medicare, typically providing access to the same doctors and paying them at the same rates. Thanks to the big subsidies they get, such plans are often a good deal for beneficiaries, charging less for the same benefits or adding benefits without raising prices.
The main losers are the beneficiaries in the standard Medicare program, whose monthly premiums are roughly $2 higher to help pay for the subsidies, and the taxpayers who pick up part of the tab. The subsidies also erode the long-term solvency of Medicare, which needs to rein in costs, not increase them with handouts to insurance companies.
When the Democrats first won control of Congress, it seemed possible that they might eliminate the subsidies — saving some $54 billion over five years — to finance a $50 billion expansion of a health insurance program for low-income children. But the insurance industry has mounted a furious lobbying campaign to head off any cuts.
Congress ought to eliminate the subsidies completely unless it is willing to subsidize the same benefits — at enormous cost — for the far greater number of people enrolled in standard Medicare. It is time to level the playing field and force private plans to really compete with traditional Medicare.
Attached an interesting editorial from yesterdays New York Times focusing on the issue of government subsidies for health insurance companies offering Medicare Advantage plans.
What is the problem?
About a fifth of elderly Americans now belong to private Medicare Advantage plans, which — thanks to government subsidies — often charge less or offer more than traditional Medicare. The government pays private plans 12 percent more, on average, than the same services would cost in the traditional Medicare fee-for-service program. The private plans use some of this money to make themselves more attractive to beneficiaries — by reducing premiums or adding benefits not covered by basic Medicare — and siphon off the rest to add to profits and help cover the plans’ high administrative costs ( and boost their CEO salaries)
What are the results?
The biggest subsidies — averaging 19 percent above cost — go to private fee-for-service plans, which are the fastest-growing part of the Medicare Advantage program. Those companies receive $54 Billion over five years resulting in an average premium increase of $2 to pay for those subsidies.
"If private health plans are supposedly so great at delivering high-quality care while holding down costs, why does the government have to keep subsidizing them so lavishly to participate in the Medicare program?"
What Should Be Done?
* Eliminate the subsidies
* Offer traditional Medicare plans with lower premiums and less adminstrtaive overhead
* Force private companies to compete with traditional Medicare plans
The proponents of market based health care services often forget that more then 50% of each dollar spent spent for health care services is provided by the government NOT INCLUDED the tax subsidies for employer-based health insurance.
Instead of calling for market based health care (which even conservatives do not support) , we should hold our government accountable on how it spends our health care dollars and eliminate corporate welfare programs (i.e subsidies).
Yours
Bernd
====================================================================================
April 21, 2007
Editorial
The Medicare Privatization Scam
If private health plans are supposedly so great at delivering high-quality care while holding down costs, why does the government have to keep subsidizing them so lavishly to participate in the Medicare program?
About a fifth of elderly Americans now belong to private Medicare Advantage plans, which — thanks to government subsidies — often charge less or offer more than traditional Medicare. As Congress struggles to find savings that could offset the costs of other important health programs, it should take a long and hard look at those subsidies.
The authoritative Medicare Payment Advisory Commission estimates that the government pays private plans 12 percent more, on average, than the same services would cost in the traditional Medicare fee-for-service program. The private plans use some of this money to make themselves more attractive to beneficiaries — by reducing premiums or adding benefits not covered by basic Medicare — and siphon off the rest to add to profits and help cover the plans’ high administrative costs.
Although the insurance industry insists that the subsidies are much lower and are warranted by the benefits provided, Thomas Scully, who headed the Medicare program for the Bush administration until 2003, told reporters recently that the subsidies were too large and ought to be reduced by Congress.
The largest private enrollment is in health maintenance organizations, which typically deliver care a bit more cheaply than standard Medicare and should not need their 10 percent subsidies, on average, to compete. The biggest subsidies — averaging 19 percent above cost — go to private fee-for-service plans, which are the fastest-growing part of the Medicare Advantage program. Unlike the H.M.O.’s, which at least manage a patient’s care and bargain hard with doctors and hospitals, these plans ride on the coattails of standard Medicare, typically providing access to the same doctors and paying them at the same rates. Thanks to the big subsidies they get, such plans are often a good deal for beneficiaries, charging less for the same benefits or adding benefits without raising prices.
The main losers are the beneficiaries in the standard Medicare program, whose monthly premiums are roughly $2 higher to help pay for the subsidies, and the taxpayers who pick up part of the tab. The subsidies also erode the long-term solvency of Medicare, which needs to rein in costs, not increase them with handouts to insurance companies.
When the Democrats first won control of Congress, it seemed possible that they might eliminate the subsidies — saving some $54 billion over five years — to finance a $50 billion expansion of a health insurance program for low-income children. But the insurance industry has mounted a furious lobbying campaign to head off any cuts.
Congress ought to eliminate the subsidies completely unless it is willing to subsidize the same benefits — at enormous cost — for the far greater number of people enrolled in standard Medicare. It is time to level the playing field and force private plans to really compete with traditional Medicare.
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