Monday, November 16, 2009
QD: News Every Day--not the intended effect
ACP Internist's daily digest of news and events continues with backlash from an analysis of proposed health care reform legislation, voices from middle American and an ACP Fellow's controversial stance on just how much money is wasted in our current health care system.
Health care reform
Medicare's chief actuary reports that legislation in the U.S. House would raise health care costs by $289 billion over the next 10 years and reduce benefits and access to services. (The Hill, Washington Post)
Meanwhile, 43% of Americans oppose the health care plans underway in Congress, 41% approve, 15% are undecided, the latest poll figures show. But opponents are more strongly against it than supporters are in favor, say numbers provided in a study by Stanford University and the Robert Wood Johnson Foundation. (AP/Washington Post)
Peter Reiter, FACP of Ottumwa, Iowa, describes the need for health care in his community, while Robert Vautrain, ACP Member, of Springfield Il., asks for a public option specifically. (Ottumwa Courier of Iowa, State Journal-Register of Illinois)
H1N1 influenza
Airlines are chafing at CDC recommendations that they filter air for H1N1 influenza even while at the terminals. They say it's costly, but just 20 minutes on the ground is long enough to spread the virus. (CBS 11 of Dallas-Forth Worth)
Primary care shortage
Concierge medicine rankles some in communities already stretched by a lack of primary care providers. Read how the controversy is playing out in Waco, Texas. (Waco Tribune-Herald)
Medical education
To accommodate the arrival of the first baby boomers, the American Geriatrics Society is proposing that elder care be added to the list of medical education's six core areas. (Boston Globe)
In case you missed it ...
Richard A. Cooper, FACP, blasts the vaunted Dartmouth Atlas for its statement that one-third of the nation's health care goes toward wasted expenses. He counters that the analysis is unfair toward urban hospitals, which treat more poor who lack primary care. His critics are just as harsh. But Dr. Cooper is not afraid of taking strong, pro-primary care position. He's taken on concierge medicine (opens as 1-hour video) and The Mayo Clinic. (Kaiser Health News)
Is Medicare fraud getting worse, or are the documentation requirements just becoming more onerous? (Washington Post)
Labels: concierge medicine, geriatrics, H1N1, health care reform, medicare, primary care shortage, QD
posted by Ryan DuBosar at
11:29 AM
0 Comments
Wednesday, October 21, 2009
QD: News Every Day--SGR cuts stalled
ACP Internist's daily digest of news and events continues with more on SGR cuts, and one physician who reformed health care in Oregon from the inside, as a legislator and later as governor.
SGR cuts
Legislation to permanently fix the annual threat of sustainable growth rate (SGR) cuts to Medicare physician payment formula has stalled. Some legislators balked on voting for it because the $247 billion price tag over 10 years wasn't offset elsewhere. Permanently ending annual SGR cuts were part of a quid pro quo deal between doctor's groups and Senate Majority Leader Harry Reid; eliminate the SGR in exchange for supporting overall health reform. The money would hold reimbursement where it is until Congress can create a better way to reimburse for Medicare.
Since political debate involves a lot of name-calling, one legislator compared the American Medical Association's position to prostitution for its support. The AMA promptly got all dolled up and released 22 "patient access hot spots" nationwide that the organization claims highlights the impact of Medicare cuts. The AMA analyzed state-level data on five access measures and declared hot spots are based on their ranking in the top 15 of at least two of five measures of access:
-- practicing physicians per 1,000 Medicare beneficiaries,
-- Medicare beneficiaries below 150% of the federal poverty level,
-- estimated underserved population living in primary care health professional shortage areas,
-- hospital emergency room visits per 1,000 population, and
-- percentage who hadn't seen a doctor in the past 12 months because of cost.
In case you missed it ...
A physician enacted health care reform in Oregon, first as president of the state's Senate and then as its Governor. The Oregon Health Plan prioritized medical services by value and the number of services covered was determined by how much money the legislature appropriated. It was radical and it worked. Kaiser Health News profiles the physician.
Meanwhile, ACP governors from Nebraska and North Dakota and a member from Green Bay, Wisc. chimed in their support for health care reform.
Labels: health care reform, medicare, QD, reimbursement
posted by Ryan DuBosar at
12:08 PM
1 Comments
Friday, October 16, 2009
QD: News Every Day--One stolen laptop threatens all doctors' personal data
ACP Internist's daily digest of news and events continues with a stolen laptop's threat to physician's personal info, plus the Senate voting and voting and voting on physician payments, and the reasons why the public is so divided on the way they view public health issues.
Almost all U.S. physicians, 800,000 total, have been warned that a stolen laptop had their names, addresses social security numbers and provider identification numbers on it. An employee of the trade group representing Blue Cross insurance plans moved information to a personal laptop that was then stolen, which leave as many as 20% of all doctors vulnerable to identity theft.
H1N1 influenza
The World Health Organization urged prompt antiviral treatments in people with suspected H1N1 flu because it can lead to pneumonia so quickly in young, otherwise healthy people.
Physician payments
A bill that would increase Medicare payments to physicians will require three votes by the Senate--needing 60 votes each time--before the Senate can take a fourth vote. Greatest legislative body in the world, indeed. Oh, and the Congressional Budget Office estimated the $240 billion bill will actually cost $247 billion over 10 years.
Primary care shortage
A blog post explaining the reasons why there is a primary care shortage doesn't offer any new insight so much as it puts all the reasons in one easy-to-read place. These aren't esoteric issues; they play out in real life all across the country, as this profile explains what's happening in Omaha.
In case you missed it ...
Much of the disconnect on health care reform can be explained by political beliefs, researchers reported in the American Journal of Public Health. They tested a news article describing how a lack of sidewalks and presence of fast food were linked to type 2 diabetes. Republicans were less likely to believe junk food led to a diabetes epidemic than Democrats. Researchers told ABC News that the same message has to be framed differently to the two audiences to garner support.
Labels: H1N1, medicare, physician shortage, QD
posted by Ryan DuBosar at
12:27 PM
0 Comments
Thursday, October 15, 2009
QD: News Every Day--legislative tricks, treat the underserved and banning sick kids ... from hospitals
ACP Internist's daily digest of internal medicine in the news continues with a look at legislative tricks for health legislation, a medical school that sends students into poor neighborhoods as part of their training, and hospitals that are enacting bans on minor visitors to avoid spreading H1N1.
Health care reform
Senates are seeking a bill that increases Medicare fees by $247 billion in the next decade. Because it will raise the deficit, Senators are trying a two-bill approach, a bit of legislative sleight-of-hand, to let them claim that health care reform won't cost more. At stake is a 21% reduction in Medicare reimbursement that was is scheduled to take effect in January.
In another bit of having one's cake while eating it, too, seniors will pay more for Medicare Advantage when costs increase from an average of $32 to $39 per month next year. Insurers are cutting plans that have no premiums--a federal requirement. Also being scrutinized are the free perks meant to entice traditional Medicare patients into private Medicare Advantage policies. But free to patients means paid for by the government--or sometimes hidden as higher co-pays and additional fees.
Investor's Business Daily points out a looming fight between primary care and specialty medicine. Legislation in the Senate gives primary care doctors a 10% bonus if they work in a Health Professional Shortage Area and 60% of their services are primary care. Half of the funding for the bonus comes from across-the-board cuts for specialists, who are refusing support.
Primary care shortage
Federally qualified clinics could treat more than 20 million patients this year, 2 million more than last year, the AP reports. The increase comes at a time that states are cutting their health care budgets.
To serve this need, Florida International University curriculum will send medical students to poor neighborhoods as part of their training. TIME profiles the program (and quotes ACP president Joseph W. Stubbs, FACP in the process.)
Finally, an emergency room doctor wrote an open letter to President Obama, making the points that:
--people without health care head to ER for treatment,
--medical training is expensive and causes primary care shortages, and
--legislators would discuss the space program without involving astrophysicists, so it's time to get doctors involved in health care reform.
These are all familiar points, but the letter is worth a read.
In case you missed it ...
To avoid spreading H1N1 influenza, hospitals have begun banning visitors less than 18 years old. These are children's' hospitals, too. M.D. Anderson followed suit, as well.
Labels: flu, health care reform, medical education, medicare, primary care shortage, QD
posted by Ryan DuBosar at
12:04 PM
0 Comments
Wednesday, September 30, 2009
QD: News Every Day
ACP Internist begins a daily digest of primary care in the news, debuting with an update on health care reform's messy reconciliation in Congress, good news about Medicare access (as health care currently stands) and what a national EHR network would look like.
Most recently for health care reform:
Two Democratic proposals to create a government insurance plan to compete with private insurers failed, while members of Congress turn their attention toward paying for abortion and insurance coverage for illegal immigrants. Now, Sen. Max Baucus is looking to revise a key financing provision after an analysis showed its tax burden would fall on seniors. In the wake of voting, amendments, provisions and alternatives are being slung left and right (politically, as well as figuratively.)
Since it's not a news cycle without something on H1N1, hundreds of New York state's health care workers protested a mandate that medical professionals get seasonal and swine-flu vaccines. But state health commissioner Richard F. Daines, FACP, told Gannett News Service, "This isn't the time to pump air into a completely deflated argument about vaccine safety."
Other issues internists should also be aware of include:
The Government Accountability Office found that less than 3% of Medicare beneficiaries had major problems accessing physician services, even while more people used the benefit and the number of services per beneficiary increased. More physicians are accepting Medicare, too. Unfortunately for Medicaid, it's far too easy to fraudulently access addictive drugs--65,000 instances costing of about $65 million in 2006 and 2007.
Finally, doctors' offices and hospitals are slowly, slowly moving toward electronic health records. Another view on the issue is instead of one national database, there'd be a "network of networks."
Labels: electronic health records, electronic medical records, emr, H1N1, health care reform, medicare, QD
posted by Ryan DuBosar at
1:06 PM
1 Comments
Tuesday, August 18, 2009
A job opening for an internist
It's clear that many of our blog's readers and at least one contributor are concerned about the way Medicare is being run. So maybe it will come as good news that the top slot at the agency is available, as the New York Times reported today. Did you know that there hasn't been a Senate-confirmed administrator at CMS since 2006? Time to brush off the old resume and show them how it ought to be done.
Labels: medicare
posted by Stacey Butterfield at
4:41 PM
1 Comments
Friday, August 14, 2009
Mr. President, please fix Medicare
Dear President Obama,
I am in favor of health care reform and I agree with you that universal coverage and eliminating the abuses that both patients and doctors have suffered at the whim of the for-profit insurance industry must be curtailed.
But I also want you to fix Medicare. Medicare is so bureaucratic that expanding it in its current form would be the death knell for primary care physicians and many community hospitals. The arcane methods of reimbursement, the ever-expanding diagnosis codes, the excessive documentation rules and the poor payment to "cognitive, diagnosing, talking" physicians make the idea of expansion untenable.
May I give you one small example? I moved my medical office in April. Six weeks before the move I notified Medicare of my pending change of address and filled out 22 pages of forms. Yes, 22 pages for a change of address. It is now mid-August and I still do not have the "approval" for my address change.
I continue to care for my Medicare patients and they are a handful. Older folks have quite a number of medical issues, you see, and sometimes it takes half an hour just to go over their medications and try to understand how their condition has changed. That is before I even begin to examine them and explain tests and treatments and coordinate their care. Despite the fact that I care for these patients, according the Medicare rules I cannot submit a bill to Medicare because they have not 
approved my change of office address.
I have spent countless hours on the phone with Medicare and have sent additional documentation that they requested. I sent the forms and information "overnight, registered" because a documented trail is needed to avoid having to start over at the beginning again and again. I was even required to send a signature from my "bank officer" and a utility bill from the office. Mr President, I don't have a close relationship with a bank officer so this required a bank visit and took time away from caring for patients...but I certainly did comply.
I am still waiting to hear from Medicare. At my last call they said they had not received yet another document, but when I gave them the post office tracking number, they said it was received after all. They could not tell me when or if they will accept my address change.
I have bills stacking up since April and I just found out that they will not accept them if they are over 30 days old. I have cared for patients for five months and will not receive any reimbursement from Medicare. The rules state I cannot bill the patients or their supplemental Medicare insurance either.
Believe me, Mr. President, I commend you for taking on such a huge task. Please also know that Medicare reform is needed along with health care reform.
Sincerely,
An internal medicine (read: primary care) physician
Toni Brayer, FACP, is an ACP Internist editorial board member who blogs at EverythingHealth, designed to address the rapid changes in science, medicine, health and healing in the 21st Century.
Labels: medicare
posted by Toni Brayer MD at
1:27 AM
3 Comments
Friday, February 13, 2009
Still doing it the hard way
Medicare is probably not going to pay for virtual colonoscopies, according to a story in today's New York Times. The agency found insufficient evidence to support the alternative technology. Not surprisingly, the endoscopic gastroenterologists cheered, while supporters of the CT scans jeered.
Who's right? Hard to say, since no one knows exactly how many more people would sign up for colonoscopies if they had access to the virtual technology. But based on the preliminary CMS decision, it looks like we won't be finding out anytime soon. The agency is accepting public comment for 30 days before making a final ruling on the subject, which experts expect to be against virtual scans.
An article and video in ACP Internist recently assessed (and offered some solutions to) the challenges of getting patients to submit to colonoscopy.
Labels: medicare, screenings
posted by Stacey Butterfield at
1:47 PM
0 Comments
ACP Internist hosted Grand Rounds on June 16, wrapping up the best of the medical blogosphere. Click here for the complete wrap-up.
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Send comments to ACP Internist staff at acpinternist@acponline.org.
Previous Posts
- QD: News Every Day--Santa's take on H1N1 influenza...
- Rethink pink: breast cancer screening evidence met...
- QD: News Every Day--Santa's take on H1N1 influenza...
- QD: News Every Day--when evidence and politics col...
- Ghostwriting haunts Congress' hallowed halls
- QD: News Every Day--payment fix inches forward (fo...
- QD: News Every Day--not the intended effect
- Medical news of the obvious
- QD: News Every Day--flu's growing tally
- QD: News Every Day--no holidays for Congress
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Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.
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A collaborative medical blog started by Neil Shapiro, ACP Member, associate program director at New York University Medical Center's internal medicine residency program. Faculty, residents and students contribute case studies, mystery quizzes, news, commentary and more.
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Robert M. Centor, FACP, contributes short essays contemplating medicine and the health care system.
Everything Health
EverythingHealth is designed to address the rapid changes in science, medicine, health and healing in the 21st Century.
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Getting Better is the continuation of Dr. Val Jones' previous blog at Revolution Health. It is devoted to helping people understand health issues from a balanced, scientifically sound perspective.
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A roundup of health policy news drawn from a database of hundreds of Web sites.
Interact MD
Michael Benjamin, ACP member, doesn't accept industry money so he can create an independent, clinician-reviewed space on the Internet for physicians to report and comment on the medical news of the day.
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The alter ego of Kevin Pho, ACP Member, is the closest thing to royalty in the medical blog world.
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The Public Library of Science's open access materials include a blog.
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One of the most popular anonymous blogs written by a doctor.
