CAT scans for your cat

Tonight's 20/20 Exposes Single-Payer Health Care ABC News "20/20" is planning to air a segment tonight with John Stossel about the health care systems of Canada and Great Britain. We understand our friend and colleague, Grace-Marie Turner of the Galen Institute, will be on the program. "20/20" airs tonight at 10 p.m. Eastern, but please check your local listings for the exact time. Stossel gives us this teaser on his blog: "We did find places in Canada where patients have quick and easy access to cutting edge technology like CT scans, endoscopy, thoracoscopy, laparoscopy. The clinics make these treatments available 24 hours a day, seven days a week, so patients rarely have to wait. But patients have to bark or meow to get that kind of treatment. "Do you want a CT scan? Canadian veterinary...

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Now it's ACO

Dear Mrs Jones; I am sorry that I no longer am responsible for your healthcare and you will not be able to pay me for services. I am now a member of the ‘accountable care organization’ of my regional health system. After much studying and implementing mandatory health insurance coverage in Massachussetts (they discovered there were not enough doctors, nor enough funds to provide the coverage that was promised. ACO was invented….this is a super large HMO. 1. The development of Accountable Care Organizations (ACOs). (Health delivery entities that can work as a team to manage the provision and coordination of care so that they are accepting responsibility for all - or most - of the care for their enrollees.) 2. Patient choice. Patients...

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Wisdom on the Health Train Express

from 'GOOZNEWS' Technology isn’t a quick fix. Just ask General Motors. In the 1980s, the auto giant spent $50 billion to automate and computerize its plants in an effort to compete with Toyota. Today, GM is emerging from bankruptcy while Toyota still leads in producing high quality, fuel-efficient vehicles. What happened? “The Japanese have a great way of describing the error that General Motors made,” said Thomas Kochan, co-director of the Institute for Work and Employment Research at the Massachusetts Institute of Technology Sloan School of Management. “It’s workers who give wisdom to these machines.” (underlining, mine) The analogy between the auto industry and health IT is obvious. Will the Obama administration’s $20...

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The Art part of Health Care Reform?

M.D.: Where Is the Art of Medicine in Health-Care Debate? Abraham Verghese MD discusses the objective of tying reimbursement to the time involved with seeing a patient. Attempts at this were made with the development of Evaluation and Management coding. (E/M coding). Unfortunately the criteria for these codes do not include many factors in patient management that have no relevant coding measures. E/M coding is strictly limited by body system evaluations, and depending upon the clinical focus are inappropriate. The coding measures have always been insufficient. There are no codes that reimburse for coordinating patient care with other providers, nor for administrative time involved in justifying payments to payers, including medicare. Everybody’s got something to say about health reform,...

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Howard Dean meets SERMO

The power of the internet has become apparent in national and local political decision making. Politicians use the internet and watch bloggers and social networking sites to measure carefully their decisions. No longer do groups have to use expensive s elf serving lobbyists to get their point across. Yesterday SERMO participated in a nationwide forum (debate) with Howard Dean on CNBC. Sermo put forth the concept that the AMA does not represent either the majority of physicians, nor their opinions. Howard Dean himself indicated that he does not belong to the AMA. It was  a very contentious meeting. Dan Palestrant who spoke for SERMO and it’s 110,000 members focused on the need for tort reform and reimbursement reform. Howard Dean expressed his belief that doctors on salary would do away...

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SERMO and the AMA

Daniel Palestrant MD of Sermo discusses health reform issues with Howard Dean, former Governor of Vermont...

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Health Reform....is Health IT mandatory?

One of the greatest discoveries a man makes, one of his great surprises, is to find he can do what he was afraid he couldn't do. Henry Ford   [Shades of the Past!   Jeff Marion of  EHR watch .com shares this commentary from Shahid Shah. Guest Article: Why do Doctors Hate EMRs??? There is also an audio cast on the web site, for those who like to multi-task, listening and /or reading content. Some interesting quotes regarding the appraisal of typical EMR software. How do we know doctors hate EMRs? Look at anemic adoption rates. When such features as e-prescribing, e-visit, and PHR integration are considered, it is likely than less than half of physicians use their EMR for...

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A Voice in the Wilderness

How many times do you or other specialists watch the current issues affecting medical care, and go back to seeing patients, either because of lack of interest, or more likely time pressures and patient care overwhelm your ability to deliver quality care to patients? Specialists rely upon their societies to get the  news to the AMA via their specialty representatives or through their local and county medical societies and again through their state medical societies.  Is this effective? CNBC Debate To Feature Sermo Physicians Live survey results on CNN Recently SERMO conducted a survey regarding physician opinions of the AMA's effectivenss in representing physicians. Does their public image and lobbying truly reflect the grass...

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The Nitty Gritty

The following is part of a series of original guest columns by the American Medical Association. by J. James Rohack, M.D. Physicians started this month with some good news from the White House. After intense AMA education and outreach, the administration announced that it would remove physician-administered drugs from the archaic formula used to determine Medicare physician payment rates. This important development will significantly lower the costs of a permanent repeal of the current payment formula that projects yearly payment cuts to all physicians. This is key. There is no debate that the current formula is broken, but the cost of permanent reform has stood in the way of long-term action. Instead, Congress has stepped in at the eleventh...

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Pandora's Box, Covert Rationing,

Last week Health Care Reform took a brief break surpassed by the passing of Michael Jackson. The news cycle remained in that mode for an unprecedented 72 hours. This week confusion, chaos, and indecision reigns once again. Numerous bloggers, official and unofficial weigh in on “Pandora’s Box”. Dr Rich posting on Better Health: Even with the soaring popularity of our new President, and the general feelings of goodwill projected toward him by Americans and non-Americans alike, and despite the fact that the party he leads holds large majorities in both houses of Congress, and despite the general agreement by both political parties and by all the major stakeholders in the healthcare universe that the time has finally arrived for substantial...

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Plagiarism

I could not resist plagiarizing this from Dr Wes' blog. An Open Letter To Patients Regarding Health Reform By DrWes Dear Mr. and Ms. Patient, It has come to my attention that in order for you to enjoy success as patients in the new era of health care reform, you must start working now to prevent illnesses that might befall you. Do not, under any circumstances, eat or drink too much. Fast food might as well be considered illegal. Exercise three, four, five times a day, even if it means take time off from work. It goes without saying that you should not smoke. The government has data that demonstrates how you have become fat, lazy, and a huge burden on our health care system. Your non-compliance threatens the very fiber of our economy. Even employers realize this, and are using calculators...

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1 x 10 to the ninth

A trillion here, a trillion there. In the words of Governor Bobby Jindall of Louisiana fame, “This here is a fine pot of gumbo”. He continues in his comments for the WSJ “I honestly do not know one single individual who is happy with this situation. Not one. Not a Republican, a Democrat or an independent. These actions are all problematic individually, but taken as a whole, they are devastating. So against that backdrop, we enter the health care reform debate. I honestly do not know one single individual who is happy with this situation. Not one. Not a Republican, a Democrat or an independent. These actions are all problematic individually, but taken as a whole, they are devastating. So against that backdrop, we enter the health care...

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AMA flip-flop

As I stated in one of my recent blogs, The American Medical Association recently did a 180 degree turnabout to support HR 3000. The American College of Surgeons today sent a letter also supporting HR 3000 . The text of it’s support: The American College of Surgeons has endorsed the House’s healthcare reform bill, joining the American Medical Association in backing the Democratic initiative. “On behalf of the more than 74,000 members of the American College of Surgeons,” Executive Director Thomas Russell wrote in a letter, “I write to express the College’s support.” What is not apparent in their letter of support is: The house of medicine is far from unified in support of the House Democrats’ bill, however. The American Association of Neurological Surgeons and Congress of Neurological...

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Is Laughter the Best Medicine??

How important is blogging? Well, according to our American Academy of Medical Bloggers, it is essential to the survival of medical care as we would like it to be. (The AAOMB has just been founded by myself). The membership has expanded rapidly in the past week from 0 members to 1 member. Board certification is NOT required, and would actually place one at a disadvantage. I am the sole voter, and hold immediate veto powers over myself. I am inviting you to a tea party, during which I hope to be overthrown. Were it not so serious our present condition is laughable. If laughter is the best medicine, (Norman Vincent Peale) would be hard pressed to apply our situation to better health....

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Senator Tom Coburn's Bill SB 1099

I received an email from my good friend and colleague this morning. Jim Rowsey MD, a now retired academic physician (fellow ophthalmologist) has been working with Senator Tom Coburn (Okla), also a physician for the past several years. Dr. Rowsey, in response to one of my recent blog posts refreshed my memory on alternative proposals spearheaded by Dr. Coburn for health reform. It is published below: “I am still teaching every state medical society that I can reach, or their Board of Trustees, and the subspecialty societies the value of Tom Coburn, MD's legislation Senate Bill 1099, (and House companion bill 2025) which covers tort reform, Medicaid reform, HSA, and a Patient Driven Health Care system. It the the point of action for physicians to take back control of health care. Jim Rowsey,...

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Erratum

This post has been deleted........

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Obama-care

Last evening I watched the whitehouse news conference, during which President Obama outlined his 'vision" for healthcare in America.  Unfortunately his speech had little specifics other than how wonderful life would be with his reform measures. As in most political campaigns the message was what would happen if we did not adopt these changes. Surely the sky would fall. It sounds a bit like "Chicken Little". The message from Congress is becoming quite clear. SLOW DOWN! Providers, both in small practices and in large integrated health care organizations, such as the Mayo Clinic have exposed some basic flaws in reform measures being considered in Congress. This from the WSJ Health Blog: Mayo Clinic CEO: Medicare Payment Model Is a ‘Catastrophe’...

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HR 3200

My conclusion regarding health reform was confirmed by the congressional budget office today. With the present plan there will be no savings. The plan as proposed does nothing to eliminate the parasitic bureaucratic insurance environment, nor the regulatory environment, In fact the plan would merely transfer these costs to the government. Unfortunately the AMA in an effort to boost it’s credibility came out today to support the House Bill. No surprise there….just when most sensible people rose up and told congress it’s too expensive. Obama is creating a ‘health care crisis’ much as he did with the fiancial markets promising to pull it out with ‘stimulus funding’. Congress is begiing to say “enough is enough’.No one is going to be panicked into a hasty decision. Obama wants all or nothing...

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The Death of the SGR

Way back in the early 90s the Sustainable Growth Rate was introduced to us by Congress and Medicare.  This would result in an annual reduction of physician's fees annually, unless congress took action to either eliminate that year's adjustment or postpone it until the next fiscal year.  After 4 years of 'deferrals' the amount  pending is 20%. In the midst of heated congressional examination and proposals for health reform, this 'adjustment' has not publicly been discussed.  It however is a major bone of contention amongst providers of medicare services.  It becomes more important in the face of other payors who base their reimbursements upon Medicare's fee schedule. The SGR  includes the costs of drugs and other items billed by the     ...

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HR Discussion Bill

I began reading the 850 page draft discussion bill for health care reform that the House of Representatives is now considering. The bill is now in committee. The contents of the proposal are frightening, and impacts not only reimbursements but also how, and what type and numbers of residency programs will be offered.  It usurps the role of established specialty boards and overides the goals of program directors. Every academic physician must read this document, and react immediately.  The content of the entire bill  goes beyond my limited time to discuss it's entirety here, but can be found at: HR discussion Draft. Considerable length is given to the formation and administration of a "Health Care Exchange".  The extent of regulation and enforcement dwarfs the already...

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