President's Speech to AMA House of Delegates

President Obama Speech to AMA. June 15th 2009

From the moment I took office as President, the central challenge we have confronted as a nation has been the need to lift ourselves out of the worst recession since World War II. In recent months, we have taken a series of extraordinary steps, not just to repair the immediate damage to our economy, but to build a new foundation for lasting and sustained growth. We are creating new jobs. We are unfreezing our credit markets. And we are stemming the loss of homes and the decline of home values.
But even as we have made progress, we know that the road to prosperity remains long and difficult. We also know that one essential step on our journey is to control the spiraling cost of health care in America.
Today, we are spending over $2 trillion a year on health care – almost 50 percent more per person than the next most costly nation. And yet, for all this spending, more of our citizens are uninsured; the quality of our care is often lower; and we aren’t any healthier. In fact, citizens in some countries that spend less than we do are actually living longer than we do.
Make no mistake: the cost of our health care is a threat to our economy. It is an escalating burden on our families and businesses. It is a ticking time-bomb for the federal budget. And it is unsustainable for the United States of America.
It is unsustainable for Americans like Laura Klitzka, a young mother I met in Wisconsin last week, who has learned that the breast cancer she thought she’d beaten had spread to her bones; who is now being forced to spend time worrying about how to cover the $50,000 in medical debts she has already accumulated, when all she wants to do is spend time with her two children and focus on getting well. These are not worries a woman like Laura should have to face in a nation as wealthy as ours.
Stories like Laura’s are being told by women and men all across this country – by families who have seen out-of-pocket costs soar, and premiums double over the last decade at a rate three times faster than wages. This is forcing Americans of all ages to go without the checkups or prescriptions they need. It’s creating a situation where a single illness can wipe out a lifetime of savings.
Our costly health care system is unsustainable for doctors like Michael Kahn in New Hampshire, who, as he puts it, spends 20 percent of each day supervising a staff explaining insurance problems to patients, completing authorization forms, and writing appeal letters; a routine that he calls disruptive and distracting, giving him less time to do what he became a doctor to do and actually care for his patients.
Small business owners like Chris and Becky Link in Nashville are also struggling. They’ve always wanted to do right by the workers at their family-run marketing firm, but have recently had to do the unthinkable and lay off a number of employees – layoffs that could have been deferred, they say, if health care costs weren’t so high. Across the country, over one third of small businesses have reduced benefits in recent years and one third have dropped their workers’ coverage altogether since the early 90’s.
Our largest companies are suffering as well. A big part of what led General Motors and Chrysler into trouble in recent decades were the huge costs they racked up providing health care for their workers; costs that made them less profitable, and less competitive with automakers around the world. If we do not fix our health care system, America may go the way of GM; paying more, getting less, and going broke.
When it comes to the cost of our health care, then, the status quo is unsustainable. Reform is not a luxury, but a necessity. I know there has been much discussion about what reform would cost, and rightly so. This is a test of whether we – Democrats and Republicans alike – are serious about holding the line on new spending and restoring fiscal discipline.
But let there be no doubt – the cost of inaction is greater. If we fail to act, premiums will climb higher, benefits will erode further, and the rolls of uninsured will swell to include millions more Americans.
If we fail to act, one out of every five dollars we earn will be spent on health care within a decade. In thirty years, it will be about one out of every three – a trend that will mean lost jobs, lower take-home pay, shuttered businesses, and a lower standard of living for all Americans.
And if we fail to act, federal spending on Medicaid and Medicare will grow over the coming decades by an amount almost equal to the amount our government currently spends on our nation’s defense. In fact, it will eventually grow larger than what our government spends on anything else today. It’s a scenario that will swamp our federal and state budgets, and impose a vicious choice of either unprecedented tax hikes, overwhelming deficits, or drastic cuts in our federal and state budgets.
To say it as plainly as I can, health care reform is the single most important thing we can do for America’s long-term fiscal health. That is a fact.
And yet, as clear as it is that our system badly needs reform, reform is not inevitable. There’s a sense out there among some that, as bad as our current system may be, the devil we know is better than the devil we don’t. There is a fear of change – a worry that we may lose what works about our health care system while trying to fix what doesn’t.
I understand that fear. I understand that cynicism. They are scars left over from past efforts at reform. Presidents have called for health care reform for nearly a century. Teddy Roosevelt called for it. Harry Truman called for it. Richard Nixon called for it. Jimmy Carter called for it. Bill Clinton called for it. But while significant individual reforms have been made – such as Medicare, Medicaid, and the children’s health insurance program – efforts at comprehensive reform that covers everyone and brings down costs have largely failed.
Part of the reason is because the different groups involved – physicians, insurance companies, businesses, workers, and others – simply couldn’t agree on the need for reform or what shape it would take. And another part of the reason has been the fierce opposition fueled by some interest groups and lobbyists – opposition that has used fear tactics to paint any effort to achieve reform as an attempt to socialize medicine.
Despite this long history of failure, I am standing here today because I think we are in a different time. One sign that things are different is that just this past week, the Senate passed a bill that will protect children from the dangers of smoking – a reform the AMA has long championed – and one that went nowhere when it was proposed a decade ago. What makes this moment different is that this time – for the first time – key stakeholders are aligning not against, but in favor of reform. They are coming together out of a recognition that while reform will take everyone in our health care community doing their part, ultimately, everyone will benefit.
And I want to commend the AMA, in particular, for offering to do your part to curb costs and achieve reform. A few weeks ago, you joined together with hospitals, labor unions, insurers, medical device manufacturers and drug companies to do something that would’ve been unthinkable just a few years ago – you promised to work together to cut national health care spending by two trillion dollars over the next decade, relative to what it would otherwise have been. That will bring down costs, that will bring down premiums, and that’s exactly the kind of cooperation we need.
The question now is, how do we finish the job? How do we permanently bring down costs and make quality, affordable health care available to every American?
That’s what I’ve come to talk about today. We know the moment is right for health care reform. We know this is an historic opportunity we’ve never seen before and may not see again. But we also know that there are those who will try and scuttle this opportunity no matter what – who will use the same scare tactics and fear-mongering that’s worked in the past. They’ll give dire warnings about socialized medicine and government takeovers; long lines and rationed care; decisions made by bureaucrats and not doctors. We’ve heard it all before – and because these fear tactics have worked, things have kept getting worse.
So let me begin by saying this: I know that there are millions of Americans who are content with their health care coverage – they like their plan and they value their relationship with their doctor. And that means that no matter how we reform health care, we will keep this promise: If you like your doctor, you will be able to keep your doctor. Period. If you like your health care plan, you will be able to keep your health care plan. Period. No one will take it away. No matter what. My view is that health care reform should be guided by a simple principle: fix what’s broken and build on what works.
If we do that, we can build a health care system that allows you to be physicians instead of administrators and accountants; a system that gives Americans the best care at the lowest cost; a system that eases up the pressure on businesses and unleashes the promise of our economy, creating hundreds of thousands of jobs, making take-home wages thousands of dollars higher, and growing our economy by tens of billions more every year. That’s how we will stop spending tax dollars to prop up an unsustainable system, and start investing those dollars in innovations and advances that will make our health care system and our economy stronger.
That’s what we can do with this opportunity. That’s what we must do with this moment.
Now, the good news is that in some instances, there is already widespread agreement on the steps necessary to make our health care system work better.
First, we need to upgrade our medical records by switching from a paper to an electronic system of record keeping. And we have already begun to do this with an investment we made as part of our Recovery Act.
It simply doesn’t make sense that patients in the 21st century are still filling out forms with pens on papers that have to be stored away somewhere. As Newt Gingrich has rightly pointed out, we do a better job tracking a FedEx package in this country than we do tracking a patient’s health records. You shouldn’t have to tell every new doctor you see about your medical history, or what prescriptions you’re taking. You should not have to repeat costly tests. All of that information should be stored securely in a private medical record so that your information can be tracked from one doctor to another – even if you change jobs, even if you move, and even if you have to see a number of different specialists.
That will not only mean less paper pushing and lower administrative costs, saving taxpayers billions of dollars. It will also make it easier for physicians to do their jobs. It will tell you, the doctors, what drugs a patient is taking so you can avoid prescribing a medication that could cause a harmful interaction. It will help prevent the wrong dosages from going to a patient. And it will reduce medical errors that lead to 100,000 lives lost unnecessarily in our hospitals every year.
The second step that we can all agree on is to invest more in preventive care so that we can avoid illness and disease in the first place. That starts with each of us taking more responsibility for our health and the health of our children. It means quitting smoking, going in for that mammogram or colon cancer screening. It means going for a run or hitting the gym, and raising our children to step away from the video games and spend more time playing outside.
It also means cutting down on all the junk food that is fueling an epidemic of obesity, putting far too many Americans, young and old, at greater risk of costly, chronic conditions. That’s a lesson Michelle and I have tried to instill in our daughters with the White House vegetable garden that Michelle planted. And that’s a lesson that we should work with local school districts to incorporate into their school lunch programs.
Building a health care system that promotes prevention rather than just managing diseases will require all of us to do our part. It will take doctors telling us what risk factors we should avoid and what preventive measures we should pursue. And it will take employers following the example of places like Safeway that is rewarding workers for taking better care of their health while reducing health care costs in the process. If you’re one of the three quarters of Safeway workers enrolled in their "Healthy Measures" program, you can get screened for problems like high cholesterol or high blood pressure. And if you score well, you can pay lower premiums. It’s a program that has helped Safeway cut health care spending by 13 percent and workers save over 20 percent on their premiums. And we are open to doing more to help employers adopt and expand programs like this one.
Our federal government also has to step up its efforts to advance the cause of healthy living. Five of the costliest illnesses and conditions – cancer, cardiovascular disease, diabetes, lung disease, and strokes – can be prevented. And yet only a fraction of every health care dollar goes to prevention or public health. That is starting to change with an investment we are making in prevention and wellness programs that can help us avoid diseases that harm our health and the health of our economy.
But as important as they are, investments in electronic records and preventive care are just preliminary steps. They will only make a dent in the epidemic of rising costs in this country.
Despite what some have suggested, the reason we have these costs is not simply because we have an aging population. Demographics do account for part of rising costs because older, sicker societies pay more on health care than younger, healthier ones. But what accounts for the bulk of our costs is the nature of our health care system itself – a system where we spend vast amounts of money on things that aren’t making our people any healthier; a system that automatically equates more expensive care with better care.
A recent article in the New Yorker, for example, showed how McAllen, Texas is spending twice as much as El Paso County – not because people in McAllen are sicker and not because they are getting better care. They are simply using more treatments – treatments they don’t really need; treatments that, in some cases, can actually do people harm by raising the risk of infection or medical error. And the problem is, this pattern is repeating itself across America. One Dartmouth study showed that you’re no less likely to die from a heart attack and other ailments in a higher spending area than in a lower spending one.
There are two main reasons for this. The first is a system of incentives where the more tests and services are provided, the more money we pay. And a lot of people in this room know what I’m talking about. It is a model that rewards the quantity of care rather than the quality of care; that pushes you, the doctor, to see more and more patients even if you can’t spend much time with each; and gives you every incentive to order that extra MRI or EKG, even if it’s not truly necessary. It is a model that has taken the pursuit of medicine from a profession – a calling – to a business.
That is not why you became doctors. That is not why you put in all those hours in the Anatomy Suite or the O.R. That is not what brings you back to a patient’s bedside to check in or makes you call a loved one to say it’ll be fine. You did not enter this profession to be bean-counters and paper-pushers. You entered this profession to be healers – and that’s what our health care system should let you be.
That starts with reforming the way we compensate our doctors and hospitals. We need to bundle payments so you aren’t paid for every single treatment you offer a patient with a chronic condition like diabetes, but instead are paid for how you treat the overall disease. We need to create incentives for physicians to team up – because we know that when that happens, it results in a healthier patient. We need to give doctors bonuses for good health outcomes – so that we are not promoting just more treatment, but better care.
And we need to rethink the cost of a medical education, and do more to reward medical students who choose a career as a primary care physicians and who choose to work in underserved areas instead of a more lucrative path. That’s why we are making a substantial investment in the National Health Service Corps that will make medical training more affordable for primary care doctors and nurse practitioners so they aren’t drowning in debt when they enter the workforce.
The second structural reform we need to make is to improve the quality of medical information making its way to doctors and patients. We have the best medical schools, the most sophisticated labs, and the most advanced training of any nation on the globe. Yet we are not doing a very good job harnessing our collective knowledge and experience on behalf of better medicine. Less than one percent of our health care spending goes to examining what treatments are most effective. And even when that information finds its way into journals, it can take up to 17 years to find its way to an exam room or operating table.
As a result, too many doctors and patients are making decisions without the benefit of the latest research. A recent study, for example, found that only half of all cardiac guidelines are based on scientific evidence. Half. That means doctors may be doing a bypass operation when placing a stent is equally effective, or placing a stent when adjusting a patient’s drugs and medical management is equally effective – driving up costs without improving a patient’s health.
So, one thing we need to do is figure out what works, and encourage rapid implementation of what works into your practices. That’s why we are making a major investment in research to identify the best treatments for a variety of ailments and conditions.
Let me be clear: identifying what works is not about dictating what kind of care should be provided. It’s about providing patients and doctors with the information they need to make the best medical decisions.
Still, even when we do know what works, we are often not making the most of it. That’s why we need to build on the examples of outstanding medicine at places like the Cincinnati Children’s Hospital, where the quality of care for cystic fibrosis patients shot up after the hospital began incorporating suggestions from parents. And places like Tallahassee Memorial Health Care, where deaths were dramatically reduced with rapid response teams that monitored patients’ conditions and "multidisciplinary rounds" with everyone from physicians to pharmacists. And places like the Geisinger Health system in rural Pennsylvania and the Intermountain Health in Salt Lake City, where high-quality care is being provided at a cost well below average. These are islands of excellence that we need to make the standard in our health care system.
Replicating best practices. Incentivizing excellence. Closing cost disparities. Any legislation sent to my desk that does not achieve these goals does not earn the title of reform. But my signature on a bill is not enough. I need your help, doctors. To most Americans, you are the health care system. Americans – me included – just do what you recommend. That is why I will listen to you and work with you to pursue reform that works for you. And together, if we take all these steps, we can bring spending down, bring quality up, and save hundreds of billions of dollars on health care costs while making our health care system work better for patients and doctors alike.
Now, I recognize that it will be hard to make some of these changes if doctors feel like they are constantly looking over their shoulder for fear of lawsuits. Some doctors may feel the need to order more tests and treatments to avoid being legally vulnerable. That’s a real issue. And while I’m not advocating caps on malpractice awards which I believe can be unfair to people who’ve been wrongfully harmed, I do think we need to explore a range of ideas about how to put patient safety first, let doctors focus on practicing medicine, and encourage broader use of evidence-based guidelines. That’s how we can scale back the excessive defensive medicine reinforcing our current system of more treatment rather than better care.
These changes need to go hand-in-hand with other reforms. Because our health care system is so complex and medicine is always evolving, we need a way to continually evaluate how we can eliminate waste, reduce costs, and improve quality. That is why I am open to expanding the role of a commission created by a Republican Congress called the Medicare Payment Advisory Commission – which happens to include a number of physicians. In recent years, this commission proposed roughly $200 billion in savings that never made it into law. These recommendations have now been incorporated into our broader reform agenda, but we need to fast-track their proposals in the future so that we don’t miss another opportunity to save billions of dollars, as we gain more information about what works and what doesn’t in our health care system.
As we seek to contain the cost of health care, we must also ensure that every American can get coverage they can afford. We must do so in part because it is in all of our economic interests. Each time an uninsured American steps foot into an emergency room with no way to reimburse the hospital for care, the cost is handed over to every American family as a bill of about $1,000 that is reflected in higher taxes, higher premiums, and higher health care costs; a hidden tax that will be cut as we insure all Americans. And as we insure every young and healthy American, it will spread out risk for insurance companies, further reducing costs for everyone.
But alongside these economic arguments, there is another, more powerful one. It is simply this: We are not a nation that accepts nearly 46 million uninsured men, women, and children. We are not a nation that lets hardworking families go without the coverage they deserve; or turns its back on those in need. We are a nation that cares for its citizens. We are a people who look out for one another. That is what makes this the United States of America.
So, we need to do a few things to provide affordable health insurance to every single American. The first thing we need to do is protect what’s working in our health care system. Let me repeat – if you like your health care, the only thing reform will mean is your health care will cost less. If anyone says otherwise, they are either trying to mislead you or don’t have their facts straight.
If you don’t like your health coverage or don’t have any insurance, you will have a chance to take part in what we’re calling a Health Insurance Exchange. This Exchange will allow you to one-stop shop for a health care plan, compare benefits and prices, and choose a plan that’s best for you and your family – just as federal employees can do, from a postal worker to a Member of Congress. You will have your choice of a number of plans that offer a few different packages, but every plan would offer an affordable, basic package. And one of these options needs to be a public option that will give people a broader range of choices and inject competition into the health care market so that force waste out of the system and keep the insurance companies honest.
Now, I know there’s some concern about a public option. In particular, I understand that you are concerned that today’s Medicare rates will be applied broadly in a way that means our cost savings are coming off your backs. These are legitimate concerns, but ones, I believe, that can be overcome. As I stated earlier, the reforms we propose are to reward best practices, focus on patient care, not the current piece-work reimbursement. What we seek is more stability and a health care system on a sound financial footing. And these reforms need to take place regardless of what happens with a public option. With reform, we will ensure that you are being reimbursed in a thoughtful way tied to patient outcomes instead of relying on yearly negotiations about the Sustainable Growth Rate formula that’s based on politics and the state of the federal budget in any given year. The alternative is a world where health care costs grow at an unsustainable rate, threatening your reimbursements and the stability of our health care system.
What are not legitimate concerns are those being put forward claiming a public option is somehow a Trojan horse for a single-payer system. I’ll be honest. There are countries where a single-payer system may be working. But I believe – and I’ve even taken some flak from members of my own party for this belief – that it is important for us to build on our traditions here in the United States. So, when you hear the naysayers claim that I’m trying to bring about government-run health care, know this – they are not telling the truth.
What I am trying to do – and what a public option will help do – is put affordable health care within reach for millions of Americans. And to help ensure that everyone can afford the cost of a health care option in our Exchange, we need to provide assistance to families who need it. That way, there will be no reason at all for anyone to remain uninsured.
Indeed, it is because I am confident in our ability to give people the ability to get insurance that I am open to a system where every American bears responsibility for owning health insurance, so long as we provide a hardship waiver for those who still can’t afford it. The same is true for employers. While I believe every business has a responsibility to provide health insurance for its workers, small businesses that cannot afford it should receive an exemption. And small business workers and their families will be able to seek coverage in the Exchange if their employer is not able to provide it.
Insurance companies have expressed support for the idea of covering the uninsured – and I welcome their willingness to engage constructively in the reform debate. But what I refuse to do is simply create a system where insurance companies have more customers on Uncle Sam’s dime, but still fail to meet their responsibilities. That is why we need to end the practice of denying coverage on the basis of preexisting conditions. The days of cherry-picking who to cover and who to deny – those days are over.
This is personal for me. I will never forget watching my own mother, as she fought cancer in her final days, worrying about whether her insurer would claim her illness was a preexisting condition so it could get out of providing coverage. Changing the current approach to preexisting conditions is the least we can do – for my mother and every other mother, father, son, and daughter, who has suffered under this practice. And it will put health care within reach for millions of Americans.
Now, even if we accept all of the economic and moral reasons for providing affordable coverage to all Americans, there is no denying that it will come at a cost – at least in the short run. But it is a cost that will not – I repeat, not – add to our deficits. Health care reform must be and will be deficit neutral in the next decade.
There are already voices saying the numbers don’t add up. They are wrong. Here’s why. Making health care affordable for all Americans will cost somewhere on the order of one trillion dollars over the next ten years. That sounds like a lot of money – and it is. But remember: it is less than we are projected to spend on the war in Iraq. And also remember: failing to reform our health care system in a way that genuinely reduces cost growth will cost us trillions of dollars more in lost economic growth and lower wages.
That said, let me explain how we will cover the price tag. First, as part of the budget that was passed a few months ago, we’ve put aside $635 billion over ten years in what we are calling a Health Reserve Fund. Over half of that amount – more than $300 billion – will come from raising revenue by doing things like modestly limiting the tax deductions the wealthiest Americans can take to the same level it was at the end of the Reagan years. Some are concerned this will dramatically reduce charitable giving, but statistics show that’s not true, and the best thing for our charities is the stronger economy that we will build with health care reform.
But we cannot just raise revenues. We also have to make spending cuts in part by examining inefficiencies in the Medicare program. There will be a robust debate about where these cuts should be made, and I welcome that debate. But here’s where I think these cuts should be made. First, we should end overpayments to Medicare Advantage. Today, we are paying Medicare Advantage plans much more than we pay for traditional Medicare services. That’s a good deal for insurance companies, but not the American people. That’s why we need to introduce competitive bidding into the Medicare Advantage program, a program under which private insurance companies offer Medicare coverage. That will save $177 billion over the next decade.
Second, we need to use Medicare reimbursements to reduce preventable hospital readmissions. Right now, almost 20 percent of Medicare patients discharged from hospitals are readmitted within a month, often because they are not getting the comprehensive care they need. This puts people at risk and drives up costs. By changing how Medicare reimburses hospitals, we can discourage them from acting in a way that boosts profits, but drives up costs for everyone else. That will save us $25 billion over the next decade.
Third, we need to introduce generic biologic drugs into the marketplace. These are drugs used to treat illnesses like anemia. But right now, there is no pathway at the FDA for approving generic versions of these drugs. Creating such a pathway will save us billions of dollars. And we can save another roughly $30 billion by getting a better deal for our poorer seniors while asking our well-off seniors to pay a little more for their drugs.
So, that’s the bulk of what’s in the Health Reserve Fund. I have also proposed saving another $313 billion in Medicare and Medicaid spending in several other ways. One way is by adjusting Medicare payments to reflect new advances and productivity gains in our economy. Right now, Medicare payments are rising each year by more than they should. These adjustments will create incentives for providers to deliver care more effectively, and save us roughly $109 billion in the process.
Another way we can achieve savings is by reducing payments to hospitals for treating uninsured people. I know hospitals rely on these payments now because of the large number of uninsured patients they treat. But as the number of uninsured people goes down with our reforms, the amount we pay hospitals to treat uninsured people should go down, as well. Reducing these payments gradually as more and more people have coverage will save us over $106 billion, and we’ll make sure the difference goes to the hospitals that most need it.
We can also save about $75 billion through more efficient purchasing of prescription drugs. And we can save about one billion more by rooting out waste, abuse, and fraud throughout our health care system so that no one is charging more for a service than it’s worth or charging a dime for a service they did not provide.
But let me be clear: I am committed to making these cuts in a way that protects our senior citizens. In fact, these proposals will actually extend the life of the Medicare Trust Fund by 7 years and reduce premiums for Medicare beneficiaries by roughly $43 billion over 10 years. And I’m working with AARP to uphold that commitment.
Altogether, these savings mean that we have put about $950 billion on the table – not counting some of the longer-term savings that will come about from reform – taking us almost all the way to covering the full cost of health care reform. In the weeks and months ahead, I look forward to working with Congress to make up the difference so that health care reform is fully paid for – in a real, accountable way. And let me add that this does not count some of the longer-term savings that will come about from health care reform. By insisting that reform be deficit neutral over the next decade and by making the reforms that will help slow the growth rate of health care costs over coming decades, we can look forward to faster economic growth, higher living standards, and falling, not rising, budget deficits.
I know people are cynical we can do this. I know there will be disagreements about how to proceed in the days ahead. But I also know that we cannot let this moment pass us by.
The other day, my friend, Congressman Earl Blumenauer, handed me a magazine with a special issue titled, "The Crisis in American Medicine." One article notes "soaring charges." Another warns about the "volume of utilization of services." And another asks if we can find a "better way [than fee-for-service] for paying for medical care." It speaks to many of the challenges we face today. The thing is, this special issue was published by Harper’s Magazine in October of 1960.
Members of the American Medical Association – my fellow Americans – I am here today because I do not want our children and their children to still be speaking of a crisis in American medicine fifty years from now. I do not want them to still be suffering from spiraling costs we did not stem, or sicknesses we did not cure. I do not want them to be burdened with massive deficits we did not curb or a worsening economy we did not rebuild.
I want them to benefit from a health care system that works for all of us; where families can open a doctor’s bill without dreading what’s inside; where parents are taking their kids to get regular checkups and testing themselves for preventable ailments; where parents are feeding their kids healthier food and kids are exercising more; where patients are spending more time with doctors and doctors can pull up on a computer all the medical information and latest research they’d ever want to meet that patient’s needs; where orthopedists and nephrologists and oncologists are all working together to treat a single human being; where what’s best about America’s health care system has become the hallmark of America’s health care system.
That is the health care system we can build. That is the future within our reach. And if we are willing to come together and bring about that future, then we will not only make Americans healthier and not only unleash America’s economic potential, but we will reaffirm the ideals that led you into this noble profession, and build a health care system that lets all Americans heal. Thank you.

"Medical Fascism:' Fact or Fiction?

I was initially surprised but then dismayed reading in an e-mail message and later on a web site posting by the same author that the

" the greatest threat to American patients in the history of our country.. is the rise of Medical Fascism. Some may wonder - what happened to socialized medicine, isn't that the great threat? While it is true that there are attempts to socialize medical care, the fact is that the power players in Washington are ready to set the rules and then hand the keys of health care spending over to large health insurance companies. This is the definition of fascism: the state decides what corporations will do and the corporations do their bidding while making a profit. As it turns out the very corporations making the profit also control the government."

In a different e-mail the author also calls upon the Florida Medical Association to support a series of public events to " Join up with your local tea party group for marches across the nation on Medical freedom planned by July 4th. Let Congress know you want medical freedom, not medical fascism."

I am concerned not only because I witnessed the devastating effect of REAL Fascism in Europe but because I feel very strongly that the inappropriate use of such a term applied to current politics is an insult to the sacrifice of American patriots who fought in WWII to liberate Europe from Fascism and an affront to the millions of victims of Fascist genocide and mass murder.

What is Fascism? Well, according to Merriam-Webster's Online Dictionary Fascism is " a political philosophy, movement, or regime (as that of the Fascisti) that exalts nation and often race above the individual and that stands for a centralized autocratic government headed by a dictatorial leader, severe economic and social regimentation, and forcible suppression of opposition."
According to Robert O. Paxton, a professor emeritus at Columbia University, he defines fascism in his book "The Anatomy of Fascism" as:

"A form of political behavior marked by obsessive preoccupation with community decline, humiliation or victimhood and by compensatory cults of unity, energy and purity, in which a mass-based party of committed nationalist militants, working in uneasy but effective collaboration with traditional elites, abandons democratic liberties and pursues with redemptive violence and without ethical or legal restraints goals of internal cleansing and external expansion."

NONE of these descriptions define our current political system, in which we have democratically elected a President, democratically elected our representatives on state and national level and maintain the separation of power to PREVENT the emergence of authoritarian and dictatorial rule.
I therefore URGE the leadership of the Florida Medical Association NOT to endorse or support any activities intended to promote the dissemination of such falsehoods which are intended to incite anger and fear and which will separate but not unite us.
I wholeheartedly support the freedom of expression. Nevertheless, such freedom implies responsibility to abstain from any incitement, too.
Our leadership has to decide if we want to represent all doctors in our State, even if we may have different political, social and religious views, or if we want to amplify the radical view of a minority!!
Thats the choice and so far I have not heard ONE of our leaders distancing him- or herself from the opinion expressed by the author who introduce the term "Medical Fascism."
I definitely do so here in public and I will continue reminding others to do the same.

Yours truly,

Bernd Wollschlaeger,MD,FAAFP, FASAM

Prescription Drug Legislation

Dear Friends and Colleagues:

Three local Republican Representatives ( Adam Hasner of Boca Raton, Anitere Flores of Miami, Ellyn Bogdanoff of Fort Lauderdale) voted either against the bill to create a prescription drug database in Florida and/or sent a letter to Gov. Charlie Crist on Thursday, asking him to veto a bill one of their fellow GOP leaders sponsored.
This bill will create a statewide prescription drug monitoring system to track those ''doctor shopping'' for addictive pills.
So why do they oppose it? In the letter those Republicans argue that " the sensitive personal and medical information contained
in such a database would be susceptible to cyber terrorists and criminals who would use information against the citizens of Florida."
This argument is ludicrous! Does that mean we will also stop using ATMs and Internet banking because our data could be misused by cyber terrorists or criminals? When do politicians learn that fear-based politics is leading us nowhere? We need to save lives and also stop those drug-dealers in a white coat who claim to be doctors! They are not! They are drug dealers and they know it!
I URGE you to contact the offices of those three lawmakers listed below to ask them to withdraw their opposition to the legislation.

Make your call today!!!


* Adam Hasner
o Capitol Office:
o 322 The Capitol
o 402 South Monroe Street
o Tallahassee, FL 32399-1300
o Phone: (850) 488-1993
o District Office:
o 33 NE 4th Avenue
o Delray Beach, FL 33483-4528
o Phone: (561) 279-16
o

* Ellyn Bogdanoff

* Capitol Office:
* 418 The Capitol
* 402 South Monroe Street
* Tallahassee, FL 32399-1300
* Phone: (850) 488-0635
* District Office:
* 1421 South Andrews Avenue
* Fort Lauderdale, FL 33316-1839
* Phone: (954) 762-375

* Anitere Flores
o Capitol Office:
324 The Capitol
402 South Monroe Street
Tallahassee, FL 32399-1300
Phone: (850) 488-2831
District Office:
Suite 205 C
1405 SW 107th Avenue
Miami, FL 33174-2523
Phone: (305) 227-7626

Prescription Drug Legislation Faces Opposition

Attached an article from the Palm Beach Post regarding the prescription drug legislation. I hope that our organization speaks up in FAVOR of the legislation and AGAINST the request to torpedo this bill.
This legislation is the first step towards curbing the narcotic abuse.
The argument that " the sensitive personal and medical information contained in such a database would be susceptible to cyber terrorists and criminals who would use information against the citizens of Florida," is ludicrous!
Does that mean we will also stop using ATMs and Internet banking because our data could be misused by cyber terrorists or criminals?
When do politicians learn that fear-based politics is leading us nowhere?
We need to save lives and stop those drug-dealers in a white coat who claim to be doctors! They are not! They are drug dealers and they know it!
Please visit South Florida to understand the enormity of the problems. The number of pain clinics skyrocketed almost 100 % since last year! The nations TOP 30 narcotic drug prescriber's practice in Dade and Broward county! Hard to believe but its true. Doctors can be drug dealers, too!!
Yours
Bernd

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Drug database access worries some in Florida House

By MICHAEL C. BENDER

Palm Beach Post Capital Bureau

Thursday, May 07, 2009

TALLAHASSEE — Thirteen state House Republicans sent a letter to Gov. Charlie Crist on Thursday, asking him to veto a bill one of their fellow GOP leaders sponsored.

Ten of the 13 lawmakers voted against the bill to create a prescription drug database in Florida. Three of the Republicans - Adam Hasner of Boca Raton, Anitere Flores of Miami and Dean Cannon of Winter Park - did not vote on the original bill.

The bill, sponsored by House budget co-chairman Marcelo Llorente, R-Miami, is aimed at curbing drug abuse. It was approved unanimously in the Senate and on a 113-10 vote in the House.

But a similar database was recently hacked in Virginia, according to TheWashington Post. House Republicans cited that story in their letter to Crist.

"This request is based on a well founded fear that the sensitive personal and medical information contained in such a database would be susceptible to cyber terrorists and criminals who would use information against the citizens of Florida," according to the letter.

Crist's press office did not comment.

Llorente said the bill (SB 462) creates a task force that will "ensure the protection of personal information."

"The tragic deaths of almost 10 Floridians a day must stop," Llorente said. "I urge the governor to sign this bill expeditiously in an effort to end the practice of doctor shopping."

In addition to Hasner, other local Republican lawmakers signing the letter were Reps. Ellyn Bogdanoff of Fort Lauderdale and Carl Domino of Jupiter.

Tamiflu and Public Health

I am gravely concerned about the generous use (or abuse) of Tamiflu. Lately, I have been pressured by patients to prescribe Tamiflu " just in case to have it at home." I often deny the request to avoid the prophylactic use of Tamiflu and argue as follows:
• The " regular flu" kills approximately 36,000 Americans annually and I still have a hard time convincing people to get their flu shot. In comparison,17 countries have reported 653 cases of H1N1 and 17 Mexicans have died.In the US 160 cases have been confirmed and only one patient has died in the US so far!
• Outside Mexico the virus does not appear to be severe, and this virus might not be any more virulent than normal seasonal flu infections.
• Scientists are encouraged by initial analyses of the DNA sequence of the virus, which has found it lacks the traits that led to the death of nearly 50m people in the 1918 Spanish flu outbreak.
• A WHO medical health officer, said the biggest concern was that the virus could mutate and become resistant to Tamiflu, the anti-viral drug. This could be accelerated by the indiscriminate use of Tamiflu fueled by doctors who mean well but may cause greater harm to the public health by prescribing the drug to any one requesting it.
• The Centers for Disease Control in Atlanta, Georgia, says 98% of existing H1 flu strains were resistant to Tamiflu in the last flu season. Scientists are struggling to understand why this is.Dr Nikki Shindo, a WHO medical health officer, said that he worst-case scenario is the virus will mutate and become Tamiflu-resistant. The best-case scenario is that it causes only mild illness and continues to respond to Tamiflu.

What Can We Do?

Please DO NOT prescribe Tamifu unless their is a reasonable concern that the patient suffers from the flu and diagnostic testing was initiated (nasal swab). For more information about proper testing procedures see http://www.cdc.gov/h1n1flu/.
Tamiflu overuse can lead to resistance and the drug itself can cause significant side affects and even serious reactions (see http://www.drugs.com/sfx/tamiflu-side-effects.html)

I hope someone will listen and please forward this e-mail to anyone interested.

Yours
Bernd

Swine Flu, 04/26/2009

Investigation and Interim Recommendations:

Swine Influenza (H1N1)



CDC, in collaboration with public health officials in California and Texas, is investigating cases of febrile respiratory illness caused by swine influenza (H1N1) viruses. As of 11 AM (EDT) April 25, 2009, 8 laboratory confirmed cases of Swine Influenza infection have been confirmed in the United States. Four cases have been reported in San Diego County, California. Two cases have been reported in Imperial County California. Two cases have been reported in Guadalupe County, Texas. Of the 8 persons with available data, illness onsets occurred March 28-April 14, 2009. Age range was 7-54 y.o. Cases are 63% male.

The viruses contain a unique combination of gene segments that have not been reported previously among swine or human influenza viruses in the U.S. or elsewhere. At this time, CDC recommends the use of oseltamivir or zanamivir for the treatment of infection with swine influenza viruses. The H1N1 viruses are resistant to amantadine and rimantadine but not to oseltamivir or zanamivir. It is not anticipated that the seasonal influenza vaccine will provide protection against the swine flu H1N1 viruses.

CDC has also been working closely with public health officials in Mexico, Canada and the World Health Organization (WHO). Mexican public health authorities have reported increased levels of respiratory disease, including reports of severe pneumonia cases and deaths, in recent weeks. CDC is assisting public health authorities in Mexico by testing specimens and providing epidemiological support. As of 11:00 AM (EDT) April 25, 2009, 7 specimens from Mexico at CDC have tested positive for the same strain of swine influenza A (H1N1) as identified in U.S. cases. However, no clear data are available to assess the link between the increased disease reports in Mexico and the confirmation of swine influenza in a small number of specimens. WHO is monitoring international cases. Further information on international cases may be found at: http://www.who.int/csr/don/2009_04_24/en/index.html

Clinicians should consider swine influenza infection in the differential diagnosis of patients with febrile respiratory illness and who 1) live in San Diego or Imperial counties, California, or Guadalupe County, Texas, or traveled to these counties or 2) who traveled recently to Mexico or were in contact with persons who had febrile respiratory illness and were in one of the three U.S. counties or Mexico during the 7 days preceding their illness onset.

Patients who meet these criteria should be tested for influenza, and specimens positive for influenza should be sent to public health laboratories for further characterization. Clinicians who suspect swine influenza virus infections in humans should obtain a nasopharyngeal swab from the patient, place the swab in a viral transport medium, refrigerate the specimen, and then contact their state or local health department to facilitate transport and timely diagnosis at a state public health laboratory. CDC requests that state public health laboratories promptly send all influenza A specimens that cannot be subtyped to the CDC, Influenza Division, Virus Surveillance and Diagnostics Branch Laboratory.

Persons with febrile respiratory illness should stay home from work or school to avoid spreading infections (including influenza and other respiratory illnesses) to others in their communities. In addition, frequent hand washing can lessen the spread of respiratory illness.

CDC has not recommended that people avoid travel to affected areas at this time. Recommendations found at http://wwwn.cdc.gov/travel/contentSwineFluUS.aspx will help travelers reduce risk of infection and stay healthy.

Clinical guidance on laboratory safety, case definitions, infection control and information for the public are available at:http://www.cdc.gov/swineflu/investigation.htm.

* Swine Influenza A (H1N1) Virus Biosafety Guidelines for Laboratory Workers: http://www.cdc.gov/swineflu/guidelines_labworkers.htm
* Interim Guidance for Infection Control for Care of Patients with Confirmed or Suspected Swine Influenza A (H1N1) Virus Infection in a Healthcare Setting: http://www.cdc.gov/swineflu/guidelines_infection_control.htm
* Interim Guidance on Case Definitions for Swine Influenza A (H1N1) Human Case Investigations: http://www.cdc.gov/swineflu/casedef_swineflu.htm

Morbidity and Mortality Weekly Reports Dispatch (April 24) provide detailed information about the initial cases at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm58d0424a1.htm


For more information about swine flu: http://www.cdc.gov/swineflu

Drug Dealers in a White Coat

Miami Herald, Letter To The Editor

Posted on Mon, Apr. 13, 2009
Public health should be legislative priority



Re the April 8 editorial Belatedly, Florida takes on prescription-drug dealers: The unprecedented concentration of ''pain clinics'' in our community contributes to out-of-control opioid abuse, narcotic-drug dealing and endangers public health. It requires the concerted efforts of law enforcement, political leadership and the medical community to root out this problem. Several steps can be taken right now:
• Impose a moratorium on dispensing narcotics in physician's offices unless the prescribing physician is board certified in anesthesiology and pain medicine and operates within a licensed and certified facility to be approved by a designated agency.

• Make mandatory monthly inspections of all pain clinics in South Florida. Skilled inspectors can be trained to randomly audit charts and on-site pharmacies and monitor patient flow.

• Conduct criminal background checks of all operators and their financial backers, which will be reviewed and updated quarterly.

• Implement a prescription-drug monitoring system to identify drug-seekers and doctor-shoppers.

• Require the Board of Medicine to suspend the license of any physician who violates the standards of care as it pertains to inappropriate prescription of narcotics.

Let's act together to rid our community of these narco-cowboys. Let's protect our families, friends and patients from such predators. We can't be afraid to call them by their name: drug dealers in white coats.

BERND WOLLSCHLAEGER, MD, president, Dade County Medical Association, North Miami Beach

Every American is entitled to affordable healthcare!

Saturday, April 4, 2009


Letter To The Editor

“Every American is entitled to affordable healthcare!”


The Miami Herald Editorial Board is correct: every American should have access to affordable healthcare delivered by a physician of their choice. But expanding coverage only increases the volume of healthcare services and costs! This shortsighted focus misses the bigger picture.
We have to realign our payment system and reward quality and not the quantity of medical services rendered. The current reimbursement system is centered on a volume-based model and must shift towards a value-based system instead. We have to rebuild our primary care system and reward family physicians who spent valuable time with patients teaching healthy lifestyle and nutrition to prevent the incidence of chronic diseases. We should motivate and reward physicians to integrate their practices within collaborative practice models or groups. Utilizing shared Electronic Health Records based on Web 2.0 technologies physicians can communicate easily and securely. Such systems can measure and compare their performance, create a framework for quality and not quantity based reimbursement. Furthermore, physicians will learn to work within a team of medical professionals to optimize the treatment outcome for their patients.
As a result of the above outlined steps we can finally provide a Patient Centered Medical Home with a high degree of personalized care coordination, access beyond the acute care episode, and identification of key medical and community resources to meet the patients’ needs.
We as physicians have the choice to proactively change the delivery of healthcare today! We have the tools available to make this happen. Lets not miss this opportunity!

Bernd Wollschlaeger,MD,FAAFP,FASAM - President, Dade County Medical Association
16899 NE 15th Avenue, North Miami Beach, FL 33162
Phone: (305) 940-8717
E-mail: info@miamihealth.com

=======================================================================================

MIAMI HERALD

Posted on Fri, Apr. 03, 2009
Health insurance out of balance

Among the many issues on America's healthcare-reform agenda, one deserving a high priority should be to level the playing field for people looking to buy health insurance. As it now stands, insurers have most of the advantages. Example: rejecting potential customers because of ''preexisting conditions.'' Congress and President Barack Obama should put a stop to this practice. Meanwhile, Florida Insurance Commissioner Kevin McCarty should ask the Legislature for reforms.
Patients blacklisted

In a Page One story last Sunday, Miami Herald reporter John Dorschner described how some insurers use secretive underwriting guidelines to blacklist people with certain ailments or who take certain drugs. For example, one insurer's guideline recommends rejecting people who have diabetes, multiple sclerosis, schizophrenia, Parkinson's Disease, Hepatitis C or AIDS/HIV. Other guidelines suggest automatic denial of people who take the anti-clotting drug Plavix or Seroquel, of those who use prescribed anti-psychotic medications, and anyone who uses certain medications for sleep apnea.

Insurers should not be expected to automatically enroll anyone who applies for a policy. They must be able to determine the amount of risk they are taking on in order to price policies appropriately and to earn a profit. Insurers also need to be able to protect themselves from people who lie about ailments in order to get coverage. At the same time, though, honest consumers should get a fair shake, which means not having to demonstrate a level of pristine health that virtually no one can attain. Without the right rules in place, insurers would cover only healthy people and have no risk at all.

Insurers say that their underwriting rules are based on standards set by the industry and by the state and federal governments. This is where change should begin. President Obama has said he wants to make insurance much more affordable and that having nearly 50 million Americans without health coverage is unacceptable. He stops short, however, of embracing universal healthcare.

A bit of progress

In December, some of the country's top insurers said they were willing to stop using preexisting conditions as a basis for pricing policies in return for laws requiring universal coverage. This, at least, is a start. Universal healthcare may, or may not, be the best solution, but it is clear that too many Americans have been squeezed out of the insurance market -- and that must change.

Commissioner McCarty can get the ball rolling by asking the Legislature to adopt underwriting guidelines that protect consumers. Congress should help President Obama make health insurance available to every American.

Ultrasound and Scope of Practice

A measure that would require women seeking an abortion to get an ultrasound exam and have the option to view the scan was revived Wednesday.
State law already requires sonograms for any abortion done more than three months into a pregnancy. The proposed bill would extend that provision to the first trimester, when most abortions take place.
Under the proposed law, doctors must allow the woman a chance to see the scan, unless she signs a waiver declining that option. Doctors also would be required to provide information on fetal development.
The bill provides exceptions to the ultrasound requirement in cases of medical emergencies or when the woman can provide documentation that she's a victim of rape, incest, domestic violence or human trafficking.
Proponents of the measure argue that the ultrasound provision helps women make informed medical decisions and helps doctors prevent complications.
Opponents argue the provision is a veiled effort to create an added hurdle for women. They say doctors -- not the Legislature -- should make the decision to perform an ultrasound.
Personally, I am surprised that organized medicine would support such a measure which clearly provides the legislator the authority to dictate how a doctor should practice medicine.
We struggle every year to prevent the expansion of the scope of practice.
Now,legislators WITHOUT medical training or license to practice medicine is telling us HOW to practice medicine?
I urge all of my colleagues to STOP this measure!
Contact your legislator and ask them NOT to support this legislation.

Posted on Thu, Mar. 19, 2009
Ultrasound abortion provision revived in Florida House

BY BREANNE GILPATRICK
A measure that would require women seeking an abortion to get an ultrasound exam and have the option to view the scan was revived Wednesday, after the state Senate rejected a similar proposal last year in a dramatic 20-20 tie vote.
Following more than an hour of debate, the House Health Care Regulation Policy Committee cast a party-line vote in favor of the bill, with Republican supporters saying the ultrasound provision helps women make informed medical decisions and helps doctors prevent complications.

''I think that any time that anybody has more information when they're going in for a medical procedure I think that's a good thing,'' said Rep. Anitere Flores, a Miami Republican who is sponsoring the bill along with Rep. Rachel Burgin, R-Brandon.

Opponents argue the provision is a veiled effort to create an added hurdle for women. They say doctors -- not the Legislature -- should make the decision to perform an ultrasound.

''I think that this is a very difficult decision that women make and we should not continue to put hurdles up and chip away at current law,'' said Rep. Kelly Skidmore, D-Boca Raton, who voted against the bill along with Rep. Ari Porth, a Coral Springs Democrat.

State law already requires ultrasound scans -- also referred to as sonograms -- for any abortion done more than three months into a pregnancy. The proposed bill would extend that provision to the first trimester, when most abortions take place.

Under the proposed law, doctors must allow the woman a chance to see the scan, unless she signs a waiver declining that option. Doctors also would be required to provide information on fetal development.

The bill provides exceptions to the ultrasound requirement in cases of medical emergencies or when the woman can provide documentation that she's a victim of rape, incest, domestic violence or human trafficking.

Lawmakers in several other states also have proposed bills imposing various ultrasound requirements. Ultrasounds are currently required before all abortions in Alabama, Mississippi, Louisiana and South Dakota. This is the third year in a row that the Florida Legislature has debated similar ultrasound bills. The proposal cleared the GOP-dominated House in previous attempts but failed once because the Senate would not take up the issue, and most recently when seven Republican senators joined 13 Democrats to defeat the bill.

This year, Sen. Andy Gardiner, R-Orlando, is sponsoring the Senate version of the proposal.

Some of the bill's supporters believe the measure has a better chance of passing this session because at least one of the senators who previously voted against the bill has been replaced by a more conservative member.

However, the bill is set to pass through the Senate Health Regulation Committee, where five of the committee's eight members say they are opposed to the bill or have voted against it in the past.

Breanne Gilpatrick can be reached at bgilpatrick@MiamiHerald.com

South Florida Doctor Cares For The Uninsured

Attached some bad and good news regarding the situation of the Uninsured in Florida.

Whats the BAD news?

The Miami Herald today reported that according to recent Census Bureau report more than five million Floridians were uninsured for at least a month during 2007 and 2008.

That works out to 38.1 percent of residents under 65. Almost four out of five of those were uninsured for six months or more, the report said.

Those figures reveal that Florida is slightly worse than the national average of 33.1 percent uninsured at some point during 2007 and 2008.

Other information from the study about Florida:

• More than four out of five uninsured Floridians, or 80.8 percent, were in working families.''

• More than three-fifths, or 60.7 percent, were individuals or families with incomes below twice the poverty line -- $42,400 of annual income for a family of four.''

Hispanics and African Americans were much more likely to be uninsured than non-Hispanic whites: 54.4 percent of Hispanics, 42.5 percent of African Americans, compared to 30.2 percent of non-Hispanic whites.

The study was based on the most recent Census Bureau reports and the Agency for Health Care Research and Quality.

Whats the GOOD news?

Some doctors are doing something about it and one of them, a South Miami radiologist, was featured in the Miami Herald.
Congratulation Dr. Kallos and we should honor her as an outstanding doctor and humanist.

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Posted on Thu, Mar. 19, 2009
South Florida doctors offer options for uninsured

BY JOHN DORSCHNER
With the number of uninsured rising daily, a prominent South Miami radiologist is offering free mammogram screenings for women who have lost their jobs and health insurance.
''In the spirit of Barack Obama, we need to volunteer to help our country,'' said Nilza Kallos, who operates the Breast Health Center and Diagnostic Ultrasound.

She challenged other physicians to make similar offers. ''This could be like an invitation to other doctors to step up,'' she said.

``I've heard surgeons say they don't have enough work. Well, how about helping those who need help?''

Kallos' offer comes as many financially pressed patients are curtailing care because they can't afford it. Some are insured and can't even afford the co-payments. Few doctors in South Florida are matching Kallos' free offer, but many in Broward and Miami-Dade are offering discounts to those who need them.

''The situation has reached the crisis stage,'' says Bernd Wollschlaeger, a North Miami Beach physician and president of the Dade County Medical Association.

``I think we need to do something.''

He says he and others are lowering their prices for their uninsured patients or giving them other help if they can't afford to pay. ''If you donate some of your time, it comes back to help you,'' because patients will remember helpful doctors when the economy improves.

Tony Prieto, president of the Broward County Medical Association, said in a statement: ``Patients need to understand that doctors have bills to pay, staff salaries, and office expenses, but we are compassionate, reasonable people who want to help our patients.

``Patients who have lost their insurance should know that most doctors are willing to work with their patients, set up payment plans and give cash discounts so that the patients can still have access to care.''

Those doctors include Barbara Martin, a Tamarac internist. ''In my office we are not charging for any visits to patients who are in bad situations,'' Martin wrote in an e-mail. ``Also we are trying to get them medications that they can afford at Wal-Mart, and samples at the office.''

''I would be happy to offer services discounted to anyone who has lost a job,'' wrote Richard Rubenstein, a Tamarac dermatologist, in an e-mail.

Some doctors note they have always offered help to the uninsured.

Alan Routman, a Fort Lauderdale orthopedic surgeon, said: ``I've been giving patients without insurance 30 percent discounts for cash or credit-card payments forever.''

The burden of more people seeking cheaper healthcare often falls on publicly-funded health centers, who take all patients regardless of whether they have insurance. Jennifer Capezzuti, a primary care doctor at Broward Health, notes that she has been spending ``excessive amounts of time evaluating patient's prescriptions and switching to generic alternatives.''

At the Breast Center in South Miami, Kallos has long been known as a doctor who reached out to help the community.

In 2008, she was honored as a ''Woman of Vision'' by the American Committee for the Weizmann Institute of Science.

''The worst thing,'' Kallos said, 'is when I hear a woman say, `Oh, I lost my job and my insurance. I'll skip my mammogram this year.' Well, this could cost her a life,'' if a cancer went untreated for a year.

Kallos said she might have to spread out the appointments over time if she is inundated by request for free services.

''If it's a regular mammogram, it can wait a little bit. But if she says she has a lump, we'll do that right away,'' she said.



Edited and Published by

Berdn Wollschlaeger,MD,FAAFP,FASAM
President,Dade County Medical Association

Home Health Care Fraud

Miami - Dade county tops the list again.
Investigators of the Government Accountability Office (GAO) cited that:
> Unusually large share of diabetic patients receiving home healthcare in the county -- 50 percent. That's nearly triple the
average rate in all other major metro areas nationwide.
> The number of Medicare-licensed home healthcare agencies reached 8,463 in 2006 -- up from 6,553 in 2002. More than
half of that increase occurred in two states, Florida and Texas.
> In 2006 Medicare spent about $13 billion for homebound patients nationwide receiving skilled nursing, aide and other visits
-- up about 44 percent from expenses in 2002. Yet over that five-year period, the number of home healthcare patients
using Medicare home services grew by 17 percent.
> In Miami-Dade in 2007, home healthcare agencies received more than $550 million from Medicare for treating patients.
That was four times greater than all Medicare payments for similar services billed in Chicago, Dallas, Houston and Atlanta,
even though there are more people over age 65 in each of those metro areas, the report says.

What are the factors contributing to the problem?
> Unscrupulous business people who can open a home-health company without any background screening or proper vetting
procedure.
> Unethical doctors who expect and receive CASH payment in brown bags (yes, its true) for each patient referral, even though
home health care is not indicated.
> Medicare outsourced home health administration to private contractors who are not being watched or being held
accountable for their services.

SOLUTIONS:
> Stop private contracting process(Moratorium)
> Freeze licensure of all home health companies in Dade County and review their business practices. Unfortunately, South
Florida politicians do not have the guts (or cannot afford being cut-off from a guaranteed money flow) to stand up to that
Home Health lobby.
> Revoke the license of each and every doctor who accepts kickbacks.

Radical solutions? Yes they are! But something has to be done to stop the bleeding!

PS: Please send all hate mail and threats to the State Attorneys office.



Posted on Fri, Mar. 13, 2009
Study blasts rampant healthcare fraud, especially in Miami-Dade

BY JAY WEAVER
A U.S. government watchdog agency has singled out Miami-Dade County for acute fraud in the $13 billion home healthcare industry, in a newly released report that spotlights runaway costs due to suspicious Medicare billing.
The Government Accountability Office cited the unusually large share of diabetic patients receiving home healthcare in the county -- 50 percent. That's nearly triple the average rate in all other major metro areas nationwide.

GAO investigators blamed Medicare for poor oversight of home healthcare agencies, citing hundreds of millions of dollars in ''improper payments'' for fraudulent claims in Miami, Houston, Los Angeles and other metropolitan areas.

The findings of the report, which analyzed 2002-2006 Medicare billings, angered the ranking Republican member of the Senate Finance Committee. U.S. Sen. Charles E. Grassley, R-Iowa, warned top officials of the nation's health insurance program for the elderly that they must confront fraud as part of President Barack Obama's goal to reform Medicare.

''I regret to say that it seems to me that [Medicare] is out of touch with the home health benefit and has yet to recognize the vulnerabilities inherent in the system,'' Grassley wrote Medicare's acting administrator.

``In order to bring much needed integrity into this program, [Medicare] needs to stop dropping the ball.''

Several of the troubling findings in the GAO report -- including questionable Medicare billing by Miami-Dade home healthcare agencies for services either not necessary or not provided -- were disclosed in The Miami Herald last November. The story showed that the problem has continued beyond the five years covered in the GAO report, with billings reaching $16.5 billion last year.

Medicare officials said they have taken steps to stop fraud -- including suspending more than $100 million in annual payments to 13 home healthcare agencies in Miami-Dade last fall. They're suspected of overbilling for nurses treating homebound diabetic patients who don't need help injecting their insulin.

Medicare is also conducting audits of claims and payments to determine whether services were actually prescribed by doctors and provided by agencies.

BACKGROUND CHECKS

But Medicare said it isn't screening home healthcare applicants for criminal backgrounds, as recommended by the watchdog agency.

The GAO report found that in 2006 Medicare spent about $13 billion for homebound patients nationwide receiving skilled nursing, aide and other visits -- up about 44 percent from expenses in 2002. Yet over that five-year period, the number of home healthcare patients using Medicare home services grew by 17 percent.

Overall, home healthcare spending was highest in California, Florida, Louisiana, Nevada, Oklahoma, Texas and Utah.

Another startling statistic: the number of Medicare-licensed home healthcare agencies reached 8,463 in 2006 -- up from 6,553 in 2002. More than half of that increase occurred in two states, Florida and Texas.

'UPCODING' RAMPANT

GAO investigators said that as those numbers have soared, so have fraudulent and abusive billing practices. Among them: ``upcoding -- overstating the severity of a beneficiary's condition.''

That practice is rampant in Miami-Dade, where home healthcare agencies are suspected of paying kickbacks to homebound patients diagnosed with diabetes who don't need nurses to inject their insulin twice daily.

The GAO report noted that in Miami-Dade in 2007, home healthcare agencies received more than $550 million from Medicare for treating patients. That was four times greater than all Medicare payments for similar services billed in Chicago, Dallas, Houston and Atlanta, even though there are more people over age 65 in each of those metro areas, the report says.

Primary Care in Crisis

Dear Friends and Colleagues:
Attached a great article from todays Miami Herald focusing on efforts to boost primary care funding.
I wholeheartedly support such efforts but am concerned to direct the funding for community health center only!
Lets not forget that the overwhelming majority of primary care visits are being rendered in private doctors offices!
In order to adapt to the rapidly changing healthcare market place those offices need the following:

* Logistical support to form collaborative practice networks to leverage their purchasing power, reduce administrative overhead, optimize practice management, access to skilled and trained human resources etc.
* Educate physicians and staff on how to integrate their practices into the medical home delivery system
* Optimize practice workflow to reduce patient error, increase quality and ascertain outcome
* Install and implement state-of-the art medical information technology tools
* Continuous assistance and support in the transformation process

This requires financial incentives, loans and grants and the active participation of specialty societies and other physician groups.
We must double our efforts to increase the workforce of primary care physicians. The clock is ticking.
Bernd


Posted on Sat, Mar. 14, 2009
Study: Florida would save money by boosting primary care
BY JOHN DORSCHNER
Legislators are expected to receive next week a research paper that concludes the state could save $700 million a year in healthcare costs by making sure Floridians had a place to go for primary care.

More basic screenings and preventive care would keep many people out of expensive trips to the emergency room, wrote four researchers from The George Washington University. At present, 3.8 million Floridians don't have insurance, the study reports, and eight million ``lack access to a regular source of primary healthcare.''

The report comes at a time when the Obama administration is pouring $10 million into Florida's community health centers as part of the stimulus package, and more money may be on the way.

The Florida Association of Community Health Centers plans to use the George Washington University study to make a case that the Legislature should double funding for public clinics next year -- from $15.3 million to $31 million. The group also favors a $1 per pack increase in cigarette taxes.

''We're not asking for a lot,'' said Andrew Behrman, president of the association. ``And it could do a lot to help Florida.''

Both Democratic and Republican policymakers say more emphasis on primary care is the best way to reduce overall healthcare costs, but finding the dollars to finance it has been a challenge.

Behrman's group advocates getting the $31 million from the billion-dollar Lower Income Pool, made up of federal and local tax dollars intended for institutions that do the most for the poor and uninsured, such as the large public hospitals.

Anthony Carvalho, president of the Safety Net Hospital Alliance of Florida, which includes the Broward and Miami-Dade public hospitals, said, ''We think primary care initiatives are good,'' but he wasn't certain whether LIP is the best way to fund.

At present an LIP council, led by large public hospitals, recommends to the Legislature how the pool money should be spent. The Safety Net group, whose members form the bulk of the council, favors its retention. The Health Centers group supports a bill to abolish the council.

Meanwhile, money is rolling in from Washington. The Broward Community and Family Health Centers in Hollywood is getting $1.3 million in stimulus money to expand operations.

Community Health of South Florida (was just informed by a federal agency that it could receive $995,000 to help its seven clinics assist the poor and uninsured.

CHI Chief Executive Brodes Hartley said the group's clinics treated 58,000 patients in 2007, 65,000 in 2008 and are expecting increased growth this year. Hartley said he hopes to use the new funds to hire another obstetrician-gynecologist to deliver babies in South Dade and for other matters.

Walmart and EHR

Great idea? Successful EHR integration boils down to three components:
Installation-Implementation-Transformation
Most companies do a good job to install and implement a system but hardly provide any service on how to use an EHR to reduce costs, maximize outcome and improve quality. Basic question: how do they help me to transform my practice to achieve ROI (Return on Investment) and utilize the collected data to improve my financial performance.
Walmart may sell the product but what's happening afterwards if you need individualized support?
Bernd

March 11, 2009
Wal-Mart Plans to Market Digital Health Records System

By STEVE LOHR
Wal-Mart Stores is striding into the market for electronic health records, seeking to bring the technology into the mainstream for physicians in small offices, where most of America’s doctors practice medicine.

Wal-Mart’s move comes as the Obama administration is trying to jump-start the adoption of digital medical records with $19 billion of incentives in the economic stimulus package.

The company plans to team its Sam’s Club division with Dell for computers and eClinicalWorks, a fast-growing private company, for software. Wal-Mart says its package deal of hardware, software, installation, maintenance and training will make the technology more accessible and affordable, undercutting rival health information technology suppliers by as much as half.

“We’re a high-volume, low-cost company,” said Marcus Osborne, senior director for health care business development at Wal-Mart. “And I would argue that mentality is sorely lacking in the health care industry.”

The Sam’s Club offering, to be made available this spring, will be under $25,000 for the first physician in a practice, and about $10,000 for each additional doctor. After the installation and training, continuing annual costs for maintenance and support will be $4,000 to $6,500 a year, the company estimates.

Wal-Mart says it had explored the opportunity in health information technology long before the presidential election. About 200,000 health care providers, mostly doctors, are among Sam Club’s 47 million members. And the company’s research showed the technology was becoming less costly and interest was rising among small physician practices, according to Todd Matherly, vice president for health and wellness at Sam’s Club.

The financial incentives in the administration plan — more than $40,000 per physician over a few years, to install and use electronic health records — could accelerate adoption. When used properly, most health experts agree, digital records can curb costs and improve care.

But many, especially physicians in small offices, doubt the wisdom of switching to electronic health records, given their cost and complexity.

Only about 17 percent of the nation’s physicians are using computerized patient records, according to a government-sponsored survey published last year in The New England Journal of Medicine. The use of electronic health records is widespread in large physician groups, but three-fourths of the nation’s doctors work in small practices of 10 physicians or fewer.

Wal-Mart, however, has the potential to bring not only lower costs but also an efficient distribution channel to cater to small physician groups. Traditional health technology suppliers, experts say, have tended to shun the small physician offices because it has been costly to sell to them. Taken together, they make up a large market, but they are scattered.

“If Wal-Mart is successful, this could be a game-changer,” observed Dr. David J. Brailer, former national coordinator for health information technology in the Bush administration.

In the package, Dell is offering either a desktop or a tablet personal computer. Many physicians prefer tablet PCs because they more closely resemble their familiar paper notepads and make for easier communication with the patient, since the doctor is not behind a desktop screen.

EClinicalWorks, which is used by 25,000 physicians, mostly in small practices, will provide the electronic record and practice management software, for billing and patient registration, as a service over the Internet. This “software as a service” model can trim costs considerably and make technical support and maintenance less complicated, because less software resides on the personal computer in a doctor’s office.

Dell will be responsible for installation of the computers, while eClinicalWorks will handle software installation, training and maintenance. Wal-Mart is using its buying power for discounts on both the hardware and software.

Wal-Mart’s role, according to Mr. Osborne, is to put the bundle of technology into an affordable and accessible offering. “We’re the systems integrator, an aggregator,” he said.

The company’s test bed for the technology it will soon offer physicians has been its own health care clinics, staffed by third-party physicians and nurses. Started in September 2006, 30 such clinics are now in stores in eight states. The clinics use the technology Wal-Mart will offer to physicians.

“That’s where the learning came from, and they were the kernel of this idea,” Mr. Osborne said.

Pain Clinics

Wednesday, February 11, 2009

MESSAGE FROM YOUR PRESIDENT:

Painless Choices: Cocaine Cowboys Version 2.0

“Cocaine Cowboys” is a 2006 documentary film, which chronicles the development of the illegal drug trade in Miami during the 1970s and 1980s with interviews of both law enforcement and organized crime leaders. The film reveals that much of the economic growth, which took place in Miami during this time period, was a benefit of the drug trade. As members of the drug trade made immense amounts of money, this money flowed in large amounts into legitimate businesses. As a result, drug money indirectly financed the construction of many of the modern high-rise buildings in southern Florida. Later, when law enforcement pressure drove many major players out of the picture, many high-end stores and businesses closed because of plummeting sales.
But drug dealers and their cronies do have learned their lessons and refined their approach. Their basic premise: why going underground if one can deal narcotics legally. What ingredients do you need? A medical office, a doctor’s license,a DEA number, on-site drug dispensing and plenty of advertisement space. All of the above results in a booming cash business in our midst, attracting clients from as far away as Alabama, Kentucky and Georgia. One street newspaper features a “Health & Wellness” section brimming with almost fifty (50) pain clinic ads strategically following the “adult business” section.
In those ads “renowned” pain “doctors” want you to “ get back the life you once knew”, to help you to “ break free from pain” and suggest that “in all this madness good doctors matter.” Naturally, most of those clinics are happy to provide you with any narcotics of your choice if you provide the “proof” to be in pain. An MRI indicating an abnormality suffices to qualify you as a legitimate pain patients. From then on one can receive a variety of narcotics of choice from their menu, dispensed on-site, and with an almost guaranteed refill option, otherwise their business model would suffer. In many cases these unscrupulous modern narco cowboys make millions of dollars a year in CASH!
I have had the “pleasure” encountering several of those “colleagues” who in many cases have no formal training in pain medicine, are semi-retired, had licensure problems, and appear to be board certified in predatory medicine.
The unprecedented concentration of those “pain clinics” in midst our community contributes to out-of-control opioid abuse, narcotic drug dealing and endangers the public health. In my opinion, several of those pain clinics are financed and operated by criminal gangs and the proceeds of their activities are being invested in local businesses, including real estate.It requires the concerted efforts of law-enforcement, political leadership and the medical community to root out his problem. Several steps can be taken right now:
1) Impose a moratorium of dispensing narcotics in physician’s offices, unless the prescribing physician is board-certified in anesthesiology and pain medicine and operates within a licensed and certified facility to be approved by a designated agency. This will immediately reduce the phenomenon of “ pill shoppers” who are pretending to suffer from pain, receive narcotics in numerous pain clinics and then sell those for a huge profit on the street.
2) Mandatory monthly inspection of all pain clinics in South Florida. Skilled inspectors can be trained to randomly audit charts, on-site pharmacies and monitor the patient flow at so-called pain clinics.
3) Criminal background checks of all operators and their financial backers to be reviewed and updated on a quarterly basis.
4) Implementation of a prescription drug monitoring system as a tool to identify drug-seekers and doctor-shoppers.
5) Requiring the Board of Medicine to suspend the license of any physician who violates the standards of care as it pertains to inappropriate prescription of narcotics.
I want to emphasize that the above proposed sanction DO NOT APPLY to most physicians in private practice who in almost all cases legitimately prescribe narcotics for pain. The “physicians” in questions in those pain clinics prescribe hundreds of powerful narcotics at a time to anyone pretending to be in pain! Their “standard of practice” does NOT equate our high standards of care. Les act together to rid our community from these narco cowboys. Lets protect our families, friends and patients from those predators.
Don’t be afraid to call them by their name: drug dealers in a white coat.

Health Care On Life Support

Wednesday, March 11, 2009


MESSAGE FROM YOUR PRESIDENT:

Health Care on Life Support: Challenges and Opportunities


By now, most of you have heard that every business in America is buckling under the increasing costs of healthcare expenses. Year after year, health care costs grow faster than the rest of the economy, straining families, businesses, and government budgets. The Center for Medicare and Medicaid Services reported this week that total health care spending rose 6.1 percent in 2007; slightly less than the growth of 6.7 percent in 2006. Even so, it continued to expand faster than the overall economy, which is contracting., reaching a total of $ 2.2 Trillion in 2007, or 16.2 percent of the gross domestic product (GDP). Americans will spend $2.4 trillion on health care in 2008, which is equal to $7,900 a person! Despite the record spending there are 46 million Americans (and growing) without health insurance. No industrialized nation in the world comes even close to the percentage of GDP America spends on healthcare. There is strong evidence that much of this spending does not contribute to better health. Americans spend twice as much per person as the average among other industrialized countries, and yet our life expectancy and infant mortality rates are below average. At least one-third of medical procedures have questionable benefits, according to the Rand Corporation. Based on a study of regional variation, Dartmouth researchers concluded that Medicare spending could be reduced by 29 percent without reducing effective care or affecting health outcomes. The finding suggests that the entire American health care system spends roughly $700 billion a year that does not improve health outcomes. On top of it, in Dade county alone billions of precious health care dollars disappear every year and wind up in the pockets of crooks and criminals. Many businesses also face unique challenges. They lack the negotiating clout needed to obtain favorable rates from insurance companies, and their inability to spread risk across a large group of employees means that the health problems of a single employee can drive premiums up to unaffordable levels. Without economies of scale, small businesses also face larger administrative costs for each worker covered. Small business owners and their employees account for an estimated 27 million of the 47 million Americans without health insurance. Some employers are dropping health insurance, while employment is growing more quickly in industries that are less likely to cover their workers. As a result, fewer and fewer Americans receive health coverage from work. The percentage of Americans covered by employers dropped from 62 percent in 2003 to 59 percent in 2008, the equivalent of 8 million people losing coverage. And for tens of millions of Americans ineligible for Medicare, Medicaid, or another public program, no viable alternative exists to employer-sponsored insurance. There are several issues that need to be fixed to address the health care cost explosion :
1) We must transform health care from a fragmented system into a coordinated and integrated delivery system utilizing information technology, thereby enabling healthcare professionals to measure cost, quality and outcome at the point-of-care.
2) Fundamental payment reforms that encourages doctors and hospitals to improve management of chronic diseases and adopt proven treatments. We have to shift from a volume-based to a value-based reimbursement system. This will reward doctors to spend time with their patients and to focus on the core value of patient care. Otherwise, we will use an entire generation of urgently needed primary care physicians.
3) Promote the application of business management principles in medical offices to help doctors to work smarter and NOT harder.
4) Emphasize the use of generic drugs that can provide equally or even more effective treatment at lower cost. Retail spending on prescription drugs rose only 4.9 percent in 2007, versus 8.6 percent growth in 2006, which is due to the increased use of generic drugs.


5) Stop the preferred funding for Medicare Advantage Plans leading to higher reimbursement and higher costs (115 percent of fee-for-service traditional Medicare). The only beneficiaries are commercial insurance companies which rake in higher profits per member and drain public coffers.

These are just a few ideas that should be assessed and evaluated. As doctors we should take a proactive position and start reshaping our practices. Many of us are stuck in the daily routine and are afraid to change. Organized medicine can and will play a greater role to leverage the risk and assist the individual doctors along the process of change. If we do not adjust to the changing market now, others will enforce painful solutions. Let’s be proactive and not reactive!

EHR Implementation

Medical Information Technology
Your Monthly IT Guide since 1995!

EHR Or Not EHR: That’s Still A Question?

By Bernd Wollschlaeger,MD,FAAFP,FASAM


Many doctors are still debating passionately the merits of an Electronic Health Record (EHR). Some claim that the government has no right to mandate its use, others are suspicious that such systems provide government with the tool to peek into their practice and that “big brother” should stay out of their office.
The majority of doctors I have spoken with are mostly concerned about the costs of the switch from paper to electronic record system. With the average traditional EHR systems running about $50,000 per physician, not including monthly maintenance costs, many docs are hesitant to sign-off on such an expense, especially in those challenging economic times.
Furthermore, doctors have been fed horror stories of EHR implementation failures and the fact that thirty percent of medical practices that adopt a full-fledged EHR system deinstall it later!
It’s also of interest to consider the detrimental short term impact of the stimulus package upon adoption of Electronic Health Records systems. Some have attributed an almost Kafkaesque quality to stimulus package because it will probably serve as a speed bump to EHR adoption until the details of the act have been spelled out. Up until the passage of the stimulus package, adoption of EHR systems has been proceeding slowly but steadily. However, the vaguely defined promise of $17 billion in reimbursements for EHR if unknown criteria are met could result in gridlock among purchasers, i.e. doctors and hospitals, in the short term while they wait for finalization of the provisions of the stimulus package’s Health Information Technology for Economic and Clinical Health Act (HITECH Act). At this point I can state with a high likelihood of certainty that our government will NOT provide financial support to doctors to purchase hard- and software but will incentivize their use. In plain English: you will get paid MORE for demonstrating and proving the “meaningful” use of an EHR system in your practice. This undefined description will likely deter healthcare organizations from rushing to purchase an EHR system.
Another speed bump of the HITECH Act pertains to the reimbursement modality which would only be provided if a certified EHR was implemented. However, the certification standard is to be developed by an office (ONCHIT) that has not been staffed yet, with a coordinator that has not been named yet and by the Secretary of HHS, who has just been appointed.
So what do I advise you to do?
1) Start preparing your practice for the switch toward an EHR. That requires thorough workflow assessment and the careful parsing of essential information out of your existing paper record. This will achieve two goals: a) that your future EHR will model your current workflow, b) that you can transfer the extracted patient information quickly into your new EHR system.
2) Do NOT focus on the big number ($50,000/per physician). This number pertains to the OLD legacy system on which most current EHR software is based. These systems require costly installation, maintenance, updates and can not be adjusted to your practice. Focus instead on the new technologies. The Web 2.0, or second generation of web development and design, aims to facilitate communication, secure information sharing, interoperability and collaboration on the Internet. Web 2.0 websites allow users to do more than just retrieve information. They can build on the interactive facilities of “Web 1.0” to provide the Internet as computing platform, allowing users to run software-applications entirely through a browser. Users can own the data on a Web 2.0 site and exercise control over that data. These sites may have an architecture of participation that encourages users to add value to the application as they use it. This will dramatically cut costs to ~ $6000/year/physician.
3) The new Web 2.0 technologies offer interactive web-based software application with modular design components. For example, you can use an appointment scheduler, a patient registry and lab module to manage your information flow and allow patient to choose their doctors appointment whenever and whereever they want to do it. I am successfully applying such a module for > 2 years and my patients are loving it.

Jumping on the EHR bandwagon NOW gives you a competitive edge and allows use to benefit from the multitude of additional reimbursement opportunities including e-prescribing, quality of care reporting and chronic disease management.
Don’t way and be proactive. Change does not offer only financial opportunities but will provide greater job satisfaction.
We will help you along the way!
Disclosure: The author is a practicing family physician, addiction specialist and computer consultant. In addition, he is a founder and managing partner of a medical IT company.