Posted by Guest Blogger on Mon, Dec 07, 2009 @ 02:27 PM
By Joel A. Stettner, M.D.
Enacting a healthcare reform bill is obviously a very complicated, methodical and political process. Personally, I don't mind vigorous and open debate on legislation that has the potential to dramatically affect physicians, hospitals, insurers, and patients.
What I do mind is the inability of the House and Senate to find some middle ground and hammer out a bill. You know the drill: the Democrats, barely in charge based on votes, propose legislation - but not until many of the true reforms are removed to please the "Blue Dogs". However, that doesn't sit well with the liberals in the party, who balk at attempts to "gut" alternatives, such as a public option, out of the bill.
And then there are the Republicans - who give new meaning to the word "no". They're not budging - and they're not helping to reach the afore-mentioned middle ground. After all, the "base," or what's left of it, must be satisfied.
What's more, both parties are obligated to those many special interests that are able to buy access and peddle influence.
But now, AARP has re-entered the fray. Could this be the needed impetus to help the Democrats take advantage of their 60 seat majority in the Senate - and actually pass a bill?
According to this Associated Press article, last week the AARP "rode to the rescue" of Democrats, supporting $460 billion in Medicare cuts to help pay for health insurance legislation. AARP has played an influential role all year on health care, working with the Obama administration and Democratic congressional leaders to help pass legislation. Polls show them enjoying a large amount of trust among seniors - who tend to vote - which means their endorsement is highly regarded.
And so we wait - stuck in a political process that does not seem to change, with the concept of "bipartisanship" as elusive as ever. Lobbying reform apparently has had no real impact, and special interests, including AARP, continue to hinder meaningful reform while the number of uninsured Americans continues to climb.
Well, sooner or later something will happen. In the meantime, you might take a look at this article, which appears in HealthLeaders Media, which explains how we're going to pay for whatever is in the final bill.
I look forward to hearing your thoughts.
Posted by Guest Blogger on Fri, Dec 04, 2009 @ 12:58 PM
By Marty Ogle, M.D.
I assure you that I'm not making this up: I've just learned that more people believe in UFOs than oppose a public health insurance option. http://mediamattersaction.org/blog/200909290001
You'd never know it if you follow the U.S. Senate - who today, turned down two separate public insurance option amendments proposed by Sen. Jay Rockefeller (D-WV) and Sen. Charles Schumer (D-NY).
Rockefeller, who admitted that he knew the votes were not there for passage, aimed sharp criticism at the insurance industry-especially, he said, over their willingness to take $483 billion in new subsidies as outlined in the proposed healthcare reform bill without being asked to do much in return.
Anyone surprised? After all, the insurance industry is spending nearly $5 million per week trying to fight off health care reform. With a lobbying effort like that, why should we be surprised that real reform is looking harder to achieve??
However, outside of the Senate, and insurance company boardrooms, the support for reform including a public option is overwhelming. At least two thirds of Americans want the choice of a public plan. Fully 73% of physicians - people like us who see the need every day in our practices - want a public option http://www.moveon.org/r?r=84786&id=17382-3239975-UlDCeox&t=7
As an emergency physician, I strongly believe that an important way to ensure that our country has a strong emergency healthcare system is by supporting comprehensive health care reform that includes a public option.
ACEP has launched an unprecedented national campaign to debunk some of the key myths about healthcare reform (as it relates to emergency care) that are being perpetuated during the current federal health care reform debate. They've also outlined some of the critical problems plaguing our emergency care system, and have proposed some solutions to these problems that should be included as components of health care reform legislation. This project will be the most extensive direct communication ACEP has ever undertaken.
It's critical that we take the time to call out the major mischaracterizations of emergency care in health care reform, and propose specific solutions. To do so, CLICK HERE .
CLICK HERE to spread the word to your friends, family and colleagues.
The time is now to make sure our Senators are listening to the people - not health insurance companies or UFO watchers. I thank you for your support and encourage your comments.
Posted by Guest Blogger on Thu, Dec 03, 2009 @ 04:57 PM
By Joel A. Stettner MD.
Now that the healthcare reform discussion has taken center stage, what about the "Major Healthcare Issue" that preceded it last year? By that I mean the novel H1N1 outbreak, more popularly known as "swine flu".
With fall quickly approaching, the issue will likely be on the front burner again. But a recent article in the Washington Post states that most Americans are not very concerned about swine flu.
While we Americans are well known for our short attention spans, should we be more worried? Or are we too entranced by other distracting issues such as Sarah Palin and her "Death Panel"?
The CDC reports that from April 15, 2009 to July 24, 2009, there were a total of 43,771 confirmed and probable cases of novel influenza A (H1N1) infection in the U.S. Of those, 5,011 people were hospitalized and 302 people died.
The tone of the report does not convey a sense of concern by the CDC. In fact, they have completely discontinued their confirmed and probable case counts, though aggregate national reports of hospitalizations and deaths are continuing. Their recommendations for avoiding the pitfalls of an H1N1 outbreak include avoiding sick people, washing hands frequently and covering faces with tissue when sneezing. Final recommendations on vaccination are still pending, as are details on vaccine availability.
However, the World Health Organization sees it differently. According to a recent report http://bit.ly/FYdVF the global spread of H1N1 swine flu will endanger more lives as it speeds up in the coming months. They're telling governments to boost preparations for a swift response and are predicting an explosion in case numbers.
So which is it? Should we be concerned or should we consider the current H1N1 outbreak to be simply business as usual? My feeling is that this is a potentially serious disease (especially for the at-risk groups). I think that preparation for likely patient visit surges is very important; we must find ways to more rapidly see those with mild infections and quickly move admitted patients out of the ED. Preparation now could be critical as the traditional flu season approaches.
I look forward to your comments!
Posted by Guest Blogger on Thu, Dec 03, 2009 @ 04:53 PM
By Marty Ogle M.D.
As emergency physicians and healthcare professionals, healthcare reform - whatever it ends up looking like - will affect our practice, our hospitals, and our patients.
Even though Congress is now in recess, its members are meeting with constituents around the country (as you've likely seen in the news). Congressional leaders are also currently crafting key healthcare reform bills to be considered in September.
So now's the time to contact your Senators and Representative, letting them know your healthcare reform concerns. One of the easiest ways is to go to the MGMA Advocacy Center to tell your representatives to finally repeal the Medicare physician payment formula and tell them not to link new payment systems to this flawed update system.
It's also important to encourage them to include administrative simplification proposals to reduce costs.
While you're at it, be sure to remind them that as your elected representatives, they should not delegate authority to make important Medicare-related reforms to a non-elected entity.
With the heated and oftentimes irrational discord going on at the moment, it's easy to lose sight of the fact that true healthcare reform is necessary, is prudent - and there are serious issues that will affect us as practicing physicians. Having your voice be heard is more important than ever right now!
Send Congress an email now and let's keep the healthcare discussion on track.
Posted by Guest Blogger on Thu, Dec 03, 2009 @ 11:26 AM
By David Englander, M.D.
I wanted to add my two cents to Dr. Borger's blog in the ER Forum on Tuesday re: potential funding losses to emergency health care by the Feds.
In California alone, more than 70 hospitals have closed in the past ten years due to financial pressures, even though demand for emergency care has dramatically increased.
Our state actually had the lowest national ranking (51st) in access to Emergency Care and received very low grades in other categories of the ACEP National Report Card on the State Of Emergency Medicine.
In 2003, both Democrats and Republicans came together and passed the Medicare Modernization Act (Section 1011), which included federal funding for mandated emergency care - $250 million per year to help hospitals and providers recoup a portion of the costs they incur for providing emergency medical care to patients who cannot pay their bills. This federal reimbursement has been particularly helpful to participating hospitals and providers in border states like California that are disproportionately burdened with providing care to undocumented immigrants. Unfortunately, this funding was temporary and recently expired.
Hospitals and emergency care providers should not be responsible for absorbing the costs of health care for undocumented immigrants. The federal government should bear this responsibility, as it is responsible for securing our borders.
As noted, last year the campaign to extend Section 1011 had bi-partisan support, evidenced in a May 2008 letter to legislative leaders endorsing a two-year extension of the provision under 15 signatures, including those of Barack Obama and John McCain. But that support has been supplanted by other issues.
Extending Section 1011 funding is an important issue that needs to be addressed before it "falls through the cracks". With increased overcrowding, state budget cuts (especially in California) and likely facility closures, it's impossible to believe that quality care will be there if another source of funding for hospitals and providers is withdrawn. Our legislators need to know that this is an important issue involving a wide range of people.
To read the complete article on the topic, visit http://tinyurl.com/moos4n. For insights into ways to reach your representatives, please read a very helpful blog re: Advocacy by Carlos Medina MD. Simply click on this link: http://www.cepamericablog.com/2009/08/be-an-advocate-get-to-know-your-legislators/
I look forward to your support and to seeing any comments you may have.
Posted by Guest Blogger on Thu, Dec 03, 2009 @ 11:18 AM
By Carlos Medina, M.D.
The old saying "if you want something bad enough just try harder" could have been coined around the topic of "advocacy". But what exactly does advocacy mean to us in the medical field?
First of all, what we're talking about here is voicing your opinion about a particular piece of legislation that will affect what we do or where we practice - either negatively or positively.
Sounds easy enough, right? But in order to be a successful advocate for an important issue, you need to know how to monitor the legislative process and then how to gain access to your specific legislator(s) either in a letter or over the phone. Luckily, it doesn't have to be hard - especially if you follow a few simple rules. And as we in California know first hand thanks to our recent budget woes, it really IS important to be an advocate for a position that will affect your livelihood, your hospital, and your community. And the more you write or call, the more likely legislators are to listen.
To write to your legislator, here are a few tips to follow:
- Get a grasp of the bill and your position
- Identify yourself, what you do, where you live
- Describe how the proposed legislation will affect the community, patients and EDs
- Use local examples and refer to common interests
- Be timely and state when the bill is scheduled to be heard or voted on
- Stick to ONE subject. Be brief and to the point. Use short sentences and short paragraphs
- If calling, ask for the staffer who deals with Health Care. The key to a good relationship with the politician is through a good relationship with their staffers - they look to them for information/opinion
In addition, here are some useful links that should help you in the advocacy process:
http://www.calacep.org/advocacy/ (Advocacy Section)
http://www.acep.org/ (Advocacy Section)
http://www.legislature.ca.gov/ (Legislators and Districts)
Successful advocacy is important - and it's something we can all do! I'd love to hear your comments or ideas on this topic!
Posted by Guest Blogger on Thu, Dec 03, 2009 @ 11:16 AM
By Nancy Carlson, RN, MBA.
One more thing this recession has done is to temporarily mask the symptoms of a problem that's two decades old. That is, with older nurses staying in the work force longer and delaying retirement - and other nurses who left and then came back due to recessionary times - the trend toward nursing vacancies appears to have been reversed.
But there's still a nursing shortage. In fact, CINHC projects California will have a shortfall of 108,000 nurses in California alone by 2020. So even with fewer openings, there's a real need to increase capacity to educate and prepare new nurses.
Today, the positions are being filled by experienced nurses back in the market due to the economy. The average age of an RN in California is over 47, so when they start retiring, the statewide shortage will jump. According to the California Institute for Nursing & Health Care (CINHC) 90% of RN's under the age of 55 are working, which tightens the market for new grads more than usual.
The good news is that educational capacity for RNs statewide has increased 55% since 2004, bringing younger nurses - including men - into the workforce. But despite these successes, we can't pull back in our efforts to overcome the nursing shortage.
Increasing funding for nursing-education programs is still very important. And we can't become complacent when looking at recent economic data that indicate we've solved the nursing shortage. With an aging population and continued growth in the demand for caregivers, the need for new nurse graduates is as great as ever.
So where can new graduates get the needed "first job" experience if hospitals are not hiring them? (At least until the economic tide shifts and baby boomer nurses retire).
There are nursing jobs available. Opportunities are growing in ambulatory and non-acute settings as care shifts away from hospitals. Apply for any open position, be persistent in calling employers and consider moving to states such as Texas or the Midwest with more demand. New graduates may not get their first choice of a job or location, but there are still openings.
What ideas do you have to encourage our new nurses? Should hospitals hire more staff than they really need (or can afford to have on the payroll)? What has YOUR hospital done to keep graduate nurses in the employment pipeline?
Posted by Guest Blogger on Wed, Dec 02, 2009 @ 06:27 PM
By Mark Spiro, M.D.
As an emergency physician who lives and works in California, I've been watching the never-ending budget stalemate with trepidation. Now that the plan is complete and the dust is starting to settle, it's clear that health care services will be taking a hit.
The New York Times reports that Democrats largely rejected the governor's initial plans to eliminate social safety net programs such as Healthy Families and the Children's Health Insurance Program. However, yesterday's budget plan still includes substantial funding cuts for health services. Under the agreement, the state would cut funding for Healthy Families by $144 million, which would place many eligible children on a waiting list. Capitol Weekly reports that total funding for the program would drop by $226 million.
According to Capital Notes, legislators also agreed to cut $1.3 billion in spending from Medi-Cal, California's Medicaid program. In addition, the state's In-Home Supportive Services program stands to lose millions in state funding under the budget plan. Under the budget plan, HIV/AIDS programs also would lose a significant portion of their funding, says the San Francisco Chronicle.
It's still unclear what these cuts will mean to hospitals and health care providers on a day to day basis, but I think it's obvious that we're going to be in for an uncertain - and sometimes - wild ride.
Posted by Guest Blogger on Wed, Dec 02, 2009 @ 06:21 PM
By Theo Koury, M.D.
As a medical director of an emergency department, I'm faced with a variety of challenges while striving to build a successful practice. Overcoming these challenges is dependent upon one common factor: physician engagement.
Having said this, getting a group of physicians to become engaged is often a challenge. However, in order to build a prosperous and thriving practice, ensuring physician engagement must be overcome early on. So how to address a physician's lack of interest?
It's important to start with the right foundation. When hiring a new physician, it's important to set expectations early so they understand how they're expected to contribute to the practice. More importantly, you want to look for physicians who are inherently interested in being active members of a team. However, starting with a clean slate is the easy part - getting existing physicians to buy in can be harder.
As medical director, it's your responsibility to persuade your colleagues that their engagement is imperative. As basic as it seems, you may be required to point out the correlation between the success of their careers and that of the practice. In order for the practice to successfully exist, physicians need to engage their ED staff, medical staff and administration. By doing so, relationships are created that lead to cooperative efforts in solving the various patient care challenges, meeting the needs of the department, as well as creating an enjoyable work environment. Finally, one must understand that we practice in a very fluid environment. In order to keep our practice flowing in the right direction, we must remain engaged at all times and in all aspects of our practice.
As logical as all this may seem, there will always be those physicians who just won't be persuaded. Instead, other options may prove to be useful, including financial incentives. However, in the end, the medical director must make the difficult decision as to whether these inactive physicians truly fit into their practice or would be better suited elsewhere.
How do you address lack of physician engagement?
Posted by Guest Blogger on Wed, Dec 02, 2009 @ 02:15 PM
By Jay Kaplan, M.D.
The nature of emergency medicine is that we give medical care to patients who present us with problems that have either arisen suddenly or are chronic conditions which suddenly worsen.
Consequently our focus is most commonly on what we can do for the patient in that moment rather than on the long-term consequences of the illness to the patient's overall health. What role (if any) do emergency physicians and mid-level practitioners play in encouraging healthy behavior on a more long-term basis? What role SHOULD we play?"
When patients present to the Emergency Department there is a unique opportunity as care providers to make an intervention to help people change. They have come to us because something has happened and they feel out of control or in pain or anxious. We're being asked for advice and are seen as experts. Patients are more open to change at this moment when they don't feel in control.
It's a perfect opportunity for us to play the role of expert and leverage their anxiety.
For example, the teenager who gets drunk and comes in somnolent can be counseled that he/she just put their life in danger and made a mistake and don't have to repeat this experience again. Or the smoker who develops pneumonia and is wheezing and has not yet developed emphysema can be painted the picture of needing to have oxygen in a tank to help with breathing. Then there's the middle-aged man who presents with chest pain which we determine is musculoskeletal in nature, but is also over weight and smokes and is noncompliant with his blood pressure medication.
So yes, as emergency physicians and mid-level practioners we have a rare opportunity to educate our patients and encourage them to become healthier and prevent illness in the future. I welcome your comments.