Irate Rantings of a Simple Country Lung Doctor

2006-03-06T17:47:00.000-05:00

The AMA Screwed Us Redux

This is a great rant, from Aggravated DocSurg, on the AMA's covert deal with Congress over P4P - I wish I could have said it as well.

2006-02-14T20:14:00.000-05:00

The AMA Screws Physicians By Supporting Pay-for-Performance

Despite its previous policies against pay for performance, the AMA leadership buckled under to Congressional pressure and signed an agreement supporting the implementation of this disastrous policy. I can't seem to attch the agreements to this post as a downloadable file, but I've copied them to the post. If you're interested in the actual memos and would like them to be sent, please post a comment with your e-mail.

Memo to: Executive Directors
State Medical Associations
National Medical Specialty Societies
From: Michael D. Maves, MD, MBA
Date: February 7, 2006
Subject: Joint House-Senate Working Agreement with the AMA
During the Budget Reconciliation process last year, the American Medical Association (AMA) was repeatedly
pressed by key congressional leaders and senior Bush administration officials to demonstrate a commitment to
work with policymakers on physician quality reporting initiatives. Physician concerns about the initial CMS
Physician Voluntary Reporting Program proposal were interpreted on Capitol Hill as a sign of opposition to
quality reporting. Representative Bill Thomas, Chair of the House Ways and Means Committee,
Senator Charles Grassley, Chair of the Senate Finance Committee and the Bush Administration were less
inclined to address payment cuts triggered by the Sustainable Growth Rate (SGR) formula if there was
insufficient progress on the quality front.
In letters to Dr. McClellan and congressional leaders that were distributed to state and specialty society
executives in mid-December, the AMA outlined a number of steps it agreed to take to work with CMS and
Congress on quality and physician payment issues. During a subsequent meeting with Chairman Thomas,
Chairman Grassley and Representative Nathan Deal, Chair of the House Energy and Commerce Health
Subcommittee, AMA Board Chair, Dr. Duane Cady was asked to sign a joint working agreement that contained
items the AMA previously had committed to pursue. Attached is the agreement signed by Dr. Cady, Chairman
Thomas, Chairman Grassley and Chairman Deal.
Perspectives
The AMA is working through the Physician Consortium for Performance Improvement (Consortium) to refine a
starter set of evidence based quality measures for the CMS Physician Voluntary Reporting Program. CMS has
proposed scaling back the initial set of measures from 36 to 16.
The commitment to develop 140 physician performance measures and to cover a majority of Medicare
spending, represents work either already completed by the Consortium or was in the planning stages at the end
of last year.
The AMA welcomes the involvement and collaboration of other physician groups in quality reporting activities.
However, we did not commit any individual state or national specialty society to the activities outlined in the
agreement with the three congressional chairmen.
The AMA and many other physician groups opposed the Senate pay for performance provision under
consideration in the reconciliation conference negotiations. The three committee chairs were intent on securing
some commitment that physicians would work on a voluntary reporting program if the Senate provision was not
included in the final conference agreement. The Senate pay for performance provision was not included in the
conference agreement.
The AMA Board of Trustees reviewed and approved our commitment to work with CMS and Congress on the
implementation of a voluntary quality reporting program.
The attached agreement is not contrary to AMA policy. The details of a pay for performance program and
additional payments for quality reporting will have to be negotiated in subsequent legislation and regulations.
The legislative process involves decision points that require action on a real time basis. We were asked by
congressional leaders to keep this confidential. Recent press leaks broke the embargo. The agreement did not
involve any commitments that we had not previously outlined to our specialty colleagues.
There is a lot work and many challenges ahead. The AMA has substantially increased the resources allocated to
the Consortium and other quality improvement activities. We hope you will join us in developing policies that
better serve physicians and their patients.

2006-01-25T22:00:00.000-05:00

A Perspective On Healthcare

I found this at KevinMD. It really hits the nail on the head for what's wrong with healthcare in this country. If I can quote the last two paragraphs:

The changes we truly need are political. We need to reconnect people with the public consequences of their private acts. We should curb the subsidization of private insurance. Medicare recipients should pay more of their bills.
But these changes won't happen because people don't want to see the costs. We don't have the health-care system we need, but we do have the one we deserve.

2006-01-01T10:41:00.000-05:00

Happy New Year!!!

With best wishes to all of you for a happy and healthy 2006. I hope that this year will bring about badly needed changes to medicine - tort reform, health care specialty courts, reasonable reimbursement. I'm not holding my breath on the last item though. With Congress failing to act on the budget reconciliation bill, and preservation of 2005 Medicare reimbursement rates tied into the firestorm over Medicaid funding, it's not looking good for the hometeam.

2005-12-18T16:28:00.000-05:00

Can't We Keep This Civil?

Once again, I've been spending time responding to the nonsense propagated by CJD and Elliott over at KevinMD and RangelMD. One thing that has struck me in following these comments is the near lack of civil discourse that is occurring in some of the responses, both from physicians and the legal side alike. But, the ultimate insulting attack came out of nowhere from Elliott today. (http://www.kevinmd.com/blog/2005/12/plight-of-uninsured-analysis-of-10000.html#comments).

While I may be tempted to slam, slander and villify the "other side" (and I often feel that way), name calling and insults make one look utterly foolish, does nothing to advance one's cause, and just detracts from what should be a civil conversation. We, as physicians, need to listen, and counterattack with facts, not emotion.

2005-12-18T16:25:00.000-05:00

Just May Be The Best Doonesbury Ever

I couldn't stop laughing after my wife showed me today's strip.

http://www.uclick.com/client/wpc/db/2005/12/18/index.html

2005-12-12T21:06:00.000-05:00

Cures sought for ER doctor shortages
(via KevinMD)

The problem with specialist call in the ER isn't just happening in Florida (link). It's also occurring in the ER at the hospital where I work in South Jersey, and all over the country. The major problem is one of liability risk, whether real or percieved. Given the current lawsuit happy climate in this country, it's no wonder that there are decreasing numbers of specialist physicians who want to take any ER call at all. Factor in the increasing numbers of ER cases, the crappy lifestyle of adding ER coverage to on call responsibilities, and the lack of reimbursement (ie large numbers of indigent/charity care) patients, who can blame these physicians for not wanting to cover the ER. Our neurosurgeon (and we're damn lucky to have him) only covers the ER part time, and when intracranial cases come into the ER when he's not on call, they get transferred into Philly. Obviously, this poses a risk to the patient in terms of possible delays in treatment, and potential increases in morbidity and mortality. Plastics and hand surgical coverage are problematic for us also.

While nowhere near an ideal solution, payment for ER coverage by the hospital may make taking call a little more palatable. A better solution would be to decrease the legal risks in taking ER call (ie tort reform, etc), because right now the only way to avoid that risk is to avoid the ER altogether.

2005-12-11T17:58:00.000-05:00

Random Thoughts

Sorry I haven't posted in awhile. Mom's been in the hospital - she's doing OK, and will hopefully be discharged tomorrow. I've also spent way too much time responding to CJD over at KevinMD - I should know better and just let him spout his nonsense.

Anyway, looks like healthcare in NJ will be going further down the tubes in the coming months. Senator Corzine, a foe of caps, has been elected governor. I had the chance of meeting with his Senate and campaign healthcare advisors during the last few months, and caps are definitely dead in this state. The future of specialty healthcare courts is very cloudy. Further malpractice and tort reform is unlikely. The Corzine healthcare insurance plan is vague and undoubtedly will be onerous to physicians. The new Speaker in the Assembly, George Norcross - oops! Joe Roberts - is no friend of ours, and so the ambulatory tax will continue to plague us, as will charity care reimbursement. Cooper Hospital will continue its slow takeover of medicine in South Jersey. There is hope of some managed care reform bills on the horizon, but I a'int holding my breath. More to come on these subjects.

2005-11-20T17:36:00.000-05:00

The Way We Die In The US

Today's Philadelphia Inquirer had a very well written and reasoned article on how tortuous the process of dying can be in this country. The article can be found here, though you may need to register to be able to read it.

2005-11-20T09:27:00.000-05:00

Medicare Cuts Will Hurt Access To Care For All Patients

As reiterated here by the ACP, should the Medicare rate cuts go into effect on January 1, the decline of physicians entering primary care will accelerate. This is going to affect access to care for all of us, not just seniors, as many of the health insurance plans tie their rates to Medicare. Please call your Congressman and Senators to bring sanity back to reimbusements.

2005-11-19T17:08:00.000-05:00

Medical Declaration of Independence

The Politically Active Physicians Association of New Jersey has a Medical Declaration of Independence on their website (link). If you agree with it's principles, and are from New Jersey, please sign on at admin@papanj.com.

2005-11-19T09:14:00.000-05:00

FDA calls for stronger warnings on asthma drugs

These warnings apply to Advair, Serevent and Foradil (link). Anecdotally, I've used these drugs extensively and haven't seen the problems noted by the FDA. At this point, I'm not convinced that I should be changing my treatment patterns.

2005-11-16T22:09:00.000-05:00

About Pat Robertson: I Couldn't Have Said It Any Better

One of my partners published a letter in the Philadelphia Inquirer yesterday, commenting on the latest idiotic comments from Pat Robertson. Here's the letter, in full.

When I read Pat Robertson's latest raving, against the citizens of Dover, Pa. - who had the wisdom and courage to vote out a school board seemingly intent on taking the teaching of biological science back to the prehistoric era - I had two thoughts. First was that there could be no doubt to anyone that intelligent design is in fact nothing but a euphemism for creationism, something that intelligent design supporters have long denied. Why else would Robertson, a voice of the evangelical Christian movement and a longtime George Bush ally, be portending fire and brimstone for the taxpayers of this Pennsylvania hamlet?
Second was that, as a man who believes in not just the U.S. Constitution but also in God, I wondered what vengeful, vindictive God Robertson was referring to. The God I worship would not punish people who showed enough courage and conviction in their beliefs to act upon them, especially by performing that most secular action, voting. Robertson's ravings sound like the threats made by other religious fanatics around the world, who ironically are also determined to disrupt and destroy our American way of life - in the name of God.

I really couldn't have said it any better. Thanks, Scott!

2005-11-14T21:34:00.000-05:00

Medical Malpractice Discussion at PointOfLaw.com

One of my favorite legal blog sites is PointOfLaw.com. Today's postings (here) include a featured discussion of medical malpractice. One of the participants is Bill Sage, who's a physician turned lawyer, and who makes some interesting points about how the debate over caps has overshadowed discussions on health care policy in general.