Real healthcare reform could take place. 

Every doctor I have met will say they got into medicine because they wanted to help people.  Yes, they understand they can have a good income, but I also firmly believe money will not keep you doing something you don’t enjoy.  Most docs also admit they become a little more calloused after a number of years of practice.  Well, don’t we all.

Doctors are on the frontline; everyday all day.  They work long hours, are liable for their actions, but have never been able to come together as a profession.  Health insurance companies, courts, lawyers and lawsuits have routed them around for years.  And now, even more than ever, it’s the government getting their turn. 

Doctors are not the best businessmen in the world, although I have met a few that are.  But if left to them, everyone would get healthcare, insurance companies would pay a fair reimbursement for services, everyone would be able to get coverage and frivolous lawsuits would be tossed out of court. 

But for whatever reason, they can’t pull together.  It would be interesting to see if they did.  What if they said, ‘enough is enough’?  Well an urologist down in Florida is saying just that.  He posted a sign on his office door: “If you voted for Obama . . . seek urologic care elsewhere. Changes to your healthcare begin right now, not in four years.”

Wow!  What if everyone did such?  What if docs decided they did not want to see patients that are on the public option?  Certainly would not be good for “healthcare reform.” 

I am not advocating such.  Doctors are not going to turn away a patient; there are ethical ramifications.  The doctor in Florida said he would not actually turn away a patient.  You can read the full article here:

http://www.latimes.com/news/health/healthcare/la-na-gop-doctor4-2010apr04,0,6717021.story

However, this is just one more indication of the divide that has been created in this country.  I have said it before, we desperately need healthcare reform, but I question if we are going about it right.  How can it be right if it has created such a divide?  Why aren’t doctors more involved in healthcare reform?  I think their input would be invaluable.  What If Doctors Only Knew the Power They Hold?

—Marty Hudson

Healthcare Reform is upon us.  Last week the COMMITTEES ON WAYS & MEANS, ENERGY & COMMERCE, AND EDUCATION & LABOR posted an Implementation Timeline.  Certainly not all inclusive to the bill that was passed; as the timeline is only seven pages compared to well over 2,000 pages in the bill.  Also they left out some interesting things; such as, employer responsibility for the cost of health coverage, tax on individuals for non-coverage, or surcharge (tax) on high income individuals.

Regardless, I think it important we understand everything we can about the bill and how it will impact all of us.  So, here is the link to the Implementation Timeline. 

http://docs.house.gov/energycommerce/TIMELINE.pdf

My suggestion is to get all in the information you can.  Does not seem there is one place to get it, even finding the most recent copy of the bill is difficult, and amendments are not incorporated that I can find.  No one is going to cover all the facts since every news agency and government office all seem to have their own agenda for what to get out there.  For now all we are going to get are various renditions of Healthcare Reform at a Glance; Not Enough, But Take it as You Can Get It.

—Marty Hudson

Well, it’s happened.  My blog back on January 12^th, “Let the Lawsuits Begin!”, has come to pass.  This week officials from 14 states filed lawsuits to block the healthcare reform bill.  Thirteen of those officials filed suit in a federal court in Pensacola, Florida, minutes after Obama signed the Patient Protection and Affordable Care Act. The complaint calls the act an “unprecedented encroachment on the sovereignty of the states” and asks a judge to block its enforcement.  The State of Florida was joined by Alabama, Colorado, Idaho, Louisiana, Michigan, Nebraska, Pennsylvania, South Carolina, South Dakota Texas, Utah and Washington. Virginia’s attorney general, Ken Cuccinelli, filed a separate case in his state Tuesday afternoon. 

Other states have come out and said they would not pursue lawsuits including Airizona, Kentucky and Georgia; although Georgia Republican Governor Sonny Perdue petitioned Democrat Attorney General Thurbert Baker to join the lawsuit filed by the thirteen states mentioned above.  To take it even a step further, Georgia lawmakers reacted to Wednesday’s news that Baker, would not sign on to the lawsuit by filing papers to have him impeached.  Its unlikely impeachment would be successful.  Usually the requirements for such are pretty high.

20-20 hindsight, my blog in January said in reforming healthcare we need “…to take the time to do it right; get it right; and get support.”  OK, so that didn’t happen.  It didn’t take a genius to figure out what was next; lawsuits.  After all, it is the American way. 

Now some of the stuff going on, violence, threats and destruction of property is just wrong.  That is not an acceptable response.  I am not a big fan of lawsuits either, but sometimes it is the best alternative.  Bottom line, if you don’t like what they are doing in government (federal, state, local, or your school board), do something about it.  Get out and vote!  If you don’t vote, don’t complain.  I don’t care if you’re Democrat, Republican, Independent or some other party, go vote.  And don’t vote for the incumbent just because you don’t know who else to vote for.  Do some homework and vote for the best candidate.

There’s my patriotic spiel.  But now that healthcare reform passed, how will lawsuits affect it going into effect?  Will some judge order it be put on hold?  Can that happen?  Will it be months or years before reform actually happens?  Could it be repealed before it ever goes into play?  I don’t know, but one thing’s for sure what we didn’t want or need…Healthcare Reform Gone Wild!  What’s next?

—Marty Hudson

We have all heard the best offense is a good defense.  Well in the case of the health of American citizens this just isn’t the case.  To be honest this was a little bit of a new one to me, although common sense would tell you it is all too common.  On Jackson Healthcare website this past week the following article was posted.

Physicians attribute 26 percent of overall healthcare costs to the practice of defensive medicine according to a study released today by Gallup and Jackson Healthcare.

Physicians generally estimate that defensive medicine costs are higher overall when compared to their own personal practice. While physicians attribute an average of 26 percent of overall costs to defensive medicine, 13 percent believe the practice constitutes 50 percent or more of the cost.

Of the physicians surveyed, 73 percent agreed that they had practiced some form of defensive medicine in the past 12 months. Twenty-three percent of practicing physicians estimate that defensive medicine constitutes less than 10 percent of their practice while 29 percent estimate the percentage to be between 10 percent and less than 25 percent.

Physicians indicating they had practiced a form of defensive medicine in the last twelve months attribute 21 percent of their practice to be defensive in nature.

In the study, defensive medicine was defined in this manner:  “Defensive medicine is the practice of diagnostic or therapeutic measures conducted primarily not to ensure the health of the patient, but as a safeguard against possible malpractice liability. This may include tests, prescriptions, hospitalizations and referrals that may not be medically necessary, but are viewed as providing protection from a potential lawsuit.”

Jackson Healthcare retained Gallup for the study in an effort to quantify the scope and impact of defensive medicine practices in the U.S.

Results are based on telephone interviews with 462 randomly selected US physicians. Interviews were conducted in December and January.

—Credit Jackson Healthcare & Gallup

So all that said; as stated in the past on this blog, there are some real healthcare reform needed in this county and I am not sure we are focusing reform on where it needs to be.   Best offense is a good defense?  In this case, playing defense isn’t even in the best interest of Americans’ health.

—Marty Hudson

At the one year anniversary of the economic stimulus plan President Obama declares the economic stimulus plan an unequivocal success that has created or saved millions of jobs.

On the other hand, critics are pointing out a continuing dismal jobs picture and deflating public confidence as signs that the stimulus bill, as one GOP leader put it, was “fiction” and not worth the cost.

Recent comments from the President Obama include:  “We have rescued this economy from the worst of this crisis…”  The measure “was never intended to save every job.  Businesses are the true engine of growth [and] always will be. But during a recession … what government can do is provide a temporary boost.” The program “runs cleanly, smoothly and transparently.”  “We acted because failure to do so would have led to catastrophe. One year later, it is largely thanks to the recovery act that a second depression is no longer a possibility.”

Vice President Biden stated, “Without any question” the package is working and “laying the foundation” for long-term economic growth.

Senate Minority Leader Mitch McConnell, R-Ky., said, “In the first year of the trillion-dollar stimulus, Americans have lost millions of jobs, the unemployment rate continues to hover near 10 percent, the deficit continues to soar and we’re inundated with stories of waste, fraud and abuse.  This was not the plan Americans asked for or the results they were promised.”

There is the rhetoric.  Here are some facts. 

The United States of America owes $1.6 trillion more today than it did a year ago.  The national debt has reached nearly $12.4 trillion, while this fiscal year’s deficit is expected to hit about $1.6 trillion.

In the last year the jobless rate has climbed from 8.1 percent to 9.7 percent.  While employers may be shedding fewer jobs than last year, 49 states saw a net job loss in 2009.  A recent CBS News/New York Times survey showed only 6 percent of Americans believe the stimulus has created a significant number of jobs.

The bulk of the money initially allocated for the plan has not actually been spent yet. Through the end of January, roughly $334 billion in spending has been approved, of which only $179 billion has actually been released.  Another $119 billion has gone to tax cuts.  Now that the economy is no longer in free fall, the mix of spending will change, senior administration officials said. Until this point, the bulk of the spending has been on tax relief and direct aid, such as unemployment benefits.  To date, only $31 billion has been spent on projects such as infrastructure, high-speed rail, broadband and health technology.  

So, if the bulk of the Economic Stimulus hasn’t even been spent, how can they tout that it’s working? 

You tell me – The Economic Stimulus Plan – What Changes Have You Seen?

—Marty Hudson

A few years ago we read a book by Fred Lee, “If Disney Ran Your Hospital: 9 1/2 Things You Would Do Differently.”  In reading the book we quickly realized our conviction in deploying M3-Patient Experience matched up with what Fred said in his book.  We contacted Fred, met him at the airport in Orlando for lunch and asked him to take a look at M3-Patient Experience.  After spending a considerable amount of time, this was his unsolicited comment:

“I liked all the questions in your survey and could honestly not think of anything I felt was not covered. It is really an electronic work of art. You are to be highly commended. I can recommend it highly, and you can quote me on that!”

With that I would like to share with you some of the points Fred makes in his book, as well in presentations he makes to healthcare operations around the country.

Focus on What Can’t be Measured.  When we focus on the perceptions of the patient the efficiencies will follow.  In other words, when we treat the patient with compassion, we will meet the patients’ needs efficiently and effectively.  Every patient is different, compassion helps you focus on the need of every patient. 

Make Courtesy More Important than Efficiency.  By first being courteous to the patient, which creates an external focus (focusing on the patient’s need), bringing responsiveness to the patient’s need, which promotes sharing of resources, and ultimately results in overall organizational efficiency and teamwork; creating a memorable experience for the patient.

Measure to Improve, Not to Impress.  When we measure the patient’s experience with the focus on improvement, understanding each patient is different, we continuously find ways to get better.  If we are merely measuring to impress we are more focused on average scores and if we are at least better than someone else, when “someone else” might be pretty bad.  Continually improve and your patients will not only be impressed, but will be loyal.

Closing the Gap between Knowing and Doing.  “Like losing weight, our problem is not with knowing how. When we want to enough, we figure out how and learn by doing.  Our problem is with being committed enough to do what it takes every day, and do it permanently, not just in short bursts of inspired energy.” — Fred Lee

Here is a link to a slide show from some of Fred’s speaking engagements I found posted on the web:  http://tinyurl.com/fredleeifdisney.  I encourage you to read his book.  But most importantly when providing care to your patients I challenge you to improve continuously and ask yourself, “What Will I Do Differently?”

—Marty Hudson

There is really no way to tell what the death toll is in Haiti.  The infrastructure in Haiti was so poor before the magnitude 7 earthquake; what is left is totally devastated.  Estimates are all over the board and very broad ranges are quoted.  100,000 to 200,000 dead, 250,000 injured, 1.5 million homeless…no one knows, and won’t know for a long time, but these numbers tell the story, the pictures tell the story, and the stories are endless. 

The really sad part is the corruption.  Fears of looting and violence keep aid groups and governments from moving as quickly as they would like.  The Haitian government is invisible, nobody has taken firm charge, and one report said the police have largely given up.  Getting into Haiti is a huge undertaking with the airport overly crowded with trying to increase flights in, and the port is in shambles. 

The Haitians need food and water.  Without water diarrhea is likely. Children, the weak and elderly will die unnecessarily from diarrheal disease that would be easily treated with water under normal circumstances.  Another major risk is bacterial infections where they have open untreated wounds.  Injuries are massive which include crushed or amputated limbs, compound fractures and lacerations.  Without quick treatment, these wounds will become infected.

Nashville’s former Senate Majority Leader Bill Frist, a heart-lung surgeon, is on a medical mission to earthquake-ravaged Haiti.  His office said in a news release that he arrived Monday at Port au Prince and will be stationed first at Baptist Mission Hospital.  He is working with the international relief agency Samaritan’s Purse.  Centennial Medical Center of Nashville donated both IV fluids and antibiotics among other critically needed medical supplies.

Haiti is a terribly corrupt country, but they need the world’s help.  Many innocent men, women and children are in dire need of food, water, shelter and medical help.  Do what you can to help.  Every community has something going on to collect supplies, food, water, clothing and money.  My only advice is, be careful when you give.  There are many reports of people taking advantage of this situation for personal gain.  Major organizations, Salvation Army, Red Cross, Samaritan’s Purse, and many more are legitimate ways to help.  Local churches are working together and with these organizations. 

Haiti needs our help.  For the Haitians, the worst is yet to come!

—Marty Hudson

As it comes down to the wire with the Healthcare Reform Bill being merged from the Senate and the House, cries of unconstitutionality of the bill begin.  Apparently several state attorneys general and trade associations have expressed concern.  It all comes down to the federal government ‘mandating’ insurance coverage.

Opposition states that the federal government has no authority to mandate health coverage or impose fines on those who don’t obtain coverage.  Supporters say it falls under the legislative power to levy taxes.

Florida Attorney General Bill McCollum released a statement in December saying:

“I have grave concerns about the constitutionality of this mandate. Such a ‘living tax’ is worrisome because it would be levied on a person who does nothing, a person who simply wishes not to be forced to buy health insurance coverage. Upon initial review, this appears to be contrary to the freedoms we, as Americans, have enjoyed for the past 233 years … Given these concerns, my office will conduct a review of the constitutionality of the healthcare bill’s individual mandate, specifically in regards to the Commerce Clause and Taxing Power set forth in the U.S. Constitution, and will evaluate Florida’s legal options.”   

Texas Attorney General Greg Abbott has sent a letter to legislators in Texas stating that Congress’s power to levy taxes is “not unlimited”. 

South Carolina Attorney General Henry McMaster and other state attorneys general challenged constitutionality over what is called the “Cornhusker Kickback,” which has the cost of all newly eligible Medicaid enrollees in Nebraska be paid for by the federal government, apparently to obtain the vote of Nebraska Senator Ben Nelson.  Seems there is a U.S. Supreme Court case that states that Congress does not possess the right under the Spending Power to demonstrate a ‘display of arbitrary power.’  

Word has it that several trade associations will challenge the Healthcare Reform Bill as well, arguing that the federal government is beyond its scope of authority in passing the bill or that the bill violates the equal protection clause of the constitution.

If any of this is true; if the expectation is that lawsuits will start to fly as soon as the Healthcare Reform Bill is passed; all because the Obama Administration and the Democrats are trying to ‘hurry’ the bill along; doesn’t it make sense to take the time to do it right; get it right; and get support?  How will it possibly help the American people if we pass a bill that will be tied up in court for years?  Force this bill and all I can say is… Let the Lawsuits Begin!

—Marty Hudson

Of course we saw, or at least should have seen, some of this coming.  The healthcare reform bill now being voted on by the Senate would change Medicare physician reimbursements to include nationwide quality measurements, according to a release from the Minnesota Medical Association, who is in support of the quality measurements.  While the AMA opposes the Senate provision, the Minnesota Medical Association has campaigned for it, saying its members receive relatively low Medicare reimbursements even though they perform well on quality measurements.  The proposed Medicare value index, to begin in 2012, would incorporate quality measures into payment rates.

Now don’t get me wrong.  I believe in good, quality healthcare.  I also happen to believe the USA has the best, high quality healthcare on the planet.  I also believe when you have free choice patients are allowed to choose high quality healthcare.  I am somewhat concerned under the current proposal patients will be told where to receive healthcare, high quality or low quality will have little to do with the decision; however, low quality care won’t pay as much as high quality care.  I am a firm believer in that docking a physician’s pay will not make him a better doctor.

The Secretary of Health and Human Services would work to establish uniform definitions for quality that would form the basis for the index.  The proposal is budget neutral and would take into account justifiable differences in Medicare spending.  Hence the title of this blog.  Throughout this bill it reeks of robbing Peter to pay Paul.  Someone has to pay for all the changes that will take place.  A quote I read a while back; “A government policy to rob Peter to pay Paul can be assured of the support of Paul.”  So, there is the question of the day; are you a Peter or a Paul?

—Marty Hudson

Recently I read an article in Becker’s ASC Review which helped me understand three reasons why the AMA should NOT support the healthcare plan, and a little insight as to why they do.  The three reasons why they should not:

1. On average, physicians receive 20 – 30 percent better reimbursement from commercial payors than from Medicare.  Healthcare reform will bring along with it a shift from commercial payors to Medicare. 

2.  The AMA only represents about 15 – 17 percent of the physicians in the country.  The average citizen does not understand this; they believe the AMA is THE voice of physicians. 

3.   The healthcare plan will reduce physician leverage when negotiating contracts when the primary payors will be Medicare and the public option.

You can read the article in Becker’s ASC Review by clicking here: http://tinyurl.com/ama-healthcare-support

The AMA has provided its support to the president’s healthcare reform plan with the promise from the president to provide help with Medicare reimbursement, when in actuality it will likely weaken the American health care system.  With the state Medicare is already in, it is doubtful that the president will be able to deliver to the AMA the reimbursement protections he promised.

Let us hear back from you, pro or con, on your opinion – Why is the AMA Supporting the President’s Healthcare Reform Plan?

—Marty Hudson