Saturday, January 30, 2010

Twitter Transcription

American Academy of Family Physicians president speaking re: healthcare reform at this conference; will try live tweeting during the talk.

A lot of half-truths, misperceptions have become incredibly partisan and media is not doing a good job of explaining what is really there.

AAFP has been working on healthcare refrom (HCR) for over a decade--not a partisan issue.

AAFP priorities: expand coverage (for ALL Americans--regardless of legal status), workforce issues, insurance market reform, tort reform.

Cannot expand coverage w/o expanding workforce: more primary care providers--increase income, more med student interest, residency support.

Need to get students and residents interested. Income plays a role (subspecialists make 2-3x primary care), but type of practice matters.

Patient-centered medical home is the kind of practice students want, and is at the forefront of AAFP priorities.

Insurance market reform is critical: insurance fighting care, denying care.

Tort reform is also AAFP priority, but is not priority at the national legislative level (this administration, nor the last one).

Tort reform is a state issue.

Workforce issues: MD payment needs to change; support primary care pay, care coordination fee, performance improvement are starting points.

Center for Medicare Services (CMS) has proposed regulatory changes to increase primary care payments for 2010 b/c primary care is underpaid.

Primary care bonus will come out of other peoples' budgets (over-valued services)--if Family Medicine gains, someone else loses.

Student interest: loan repayment/forgiveness, value of Family Medicine (FM) in medical school setting, ensure enough residency slots.

Most societies w/ "healthy" healthcare systems are 50/50 primary care / subspecialists; not the case in the US.

Over the last 9 yrs, employer-provided healthcare insurance is dropping--large employers (over 50 workers) not much change.

Employers w/ 3-9 workders: nearly 10% drop in providing insurance benefits; nearly 10% drop in employers w/ 10-24 workers. Too expensive.

In most states, the two largest health plans account for over 50-69% of cpverage. No real competition in many cases.

Cost of healthcare is rising in unsustainable way. 10% population accounts for 80% of costs but quality does not reflect the cost.

We spend a ton on healthcare, but patients do not receive much of the recommended care. 10th life expectancy and 27th infant mortality.

There is dramatic regional variation in the quality of care provided. FL has high costs, but quality is not very high.

Where primary care is lacking and subspecialists increase: higher cost with lower quality. This is the case in much of the US.

Having a regular source of primary care associated with: lower ER use, fewer hospital admissions, fewer tests/procedures, less illness...

...lower per-person costs, improved quality of care, higher patient satisfaction.

Too much care: # needed to treat vs. # needed to harm is hard to teach; need comparative effectiveness research.

New technologies and treatments need to show safety, but also IMPROVED outcomes that are meaningful to patients.

Delay in care worsens acute and chronic problems: care is more costly. Delay due to lack of insurance and lack of providers/physicians.

Major components of legislation: insurance mkt reform, increased coverage (Medicaid, etc), individual mandate, shared responsibility.

Senate is still the driver re: legislation. Dems concerned that walking away from healthcare will result in electoral backlash/angry voters.

Will voters be more angry if reform fails or if reform is passed? Congress trying to figure this out, and how to proceed.

Comprehensive reform still needed. Breaking into pieces will not lower the GDP costs and will not make much difference for the avg. voter.

House/Senate differences to resolve: excise tax, abortion funding restrictions, employer penalties if no insurance, insurance exchange setup, ...

...funding the legislation, concessions in public option is dropped (such as repeat of the antitrust exemption for health insurance cos).

Still a lot of politics: only 34% public "mostly" approves bill, 37% approve his handling of health care; Brown vs. Coakely (re: cloture).

HR 3962: increased Medicaid payment rates to Medicare rates, residency reforms & slot redistribution to primary care, primary care bonus.

Primary care bonus is 5%, but really a 25% bonus would likely be needed to improve medical student interest b/c of high student loan debt.

Senate bill HR 3590: increased premiums w/ more coverage from insurance company plans; 57% purchasers would pay 56-59% LESS over time.

Senate bill: 94% legal residents covered, tax on "Cadillac plans" (though being negotiated b/c of labor concerns), primary care bonus...

...Dept of Health and Human Services authorized to adjust mis-valued services, pilots such as patient-centered medical home (PCMH).

Senate bill needed improvement; AAFP did NOT send a letter of support for the Senate bill (though AAFP publicly supported House bill).

House vs. Senate: similar emphasis on preventive/primary care, workforce issues, insurance exchanges and regulation...

...but different provisions re: insurance affordability, access to care and employer obligations.

Suspect that, as things move forward, the final product might look more like the Senate bill.

Sustainable Growth Rate (SGR): facing a 21% payment reduction in Medicare payment; reform passed the House but failed the Senate.

SGR cuts come up every year, and every year are deferred b/c of the risk physicians will leave Medicare. No fix so far--just yearly holds.

As a result, $209 billion behind over the next 10 yrs. AMA pushing Congress to completely fix the SGR issue TOTALLY this year.

AAFP disagrees: if we call the bluff and Congress decides to push through the 21% cut, primary care will likely suffer the most.

Not clear when Congress will address the 21% cut. There is not much time, the budget is tight, and the 21% cut is looming.

One of the big losers in CMS pay changes to improve primary care payments is Cardiology, who have tried suing and pushing Congress to change.

As a result, Cardiology has lost a fair amount of political capital and the CMS payment rule is likely going to go through.

(There is likely to be a question and answer session later this morning; I'll note any relevant information.)

An Experiment

I'm at a conference this morning, and the American Academy of Family Physicians President Lori Heim is going to be speaking about Health Care reform. I'm going to try and live tweet during the talk. We'll see how it goes--check out my Twitter feed and see what happens.

I plan to blog about it later on in case you miss the experiment.

Saturday, January 23, 2010

Another Glancing Brush With Fame

I was featured in an article in the Virginia Commonwealth University Student newspaper, the Commonwealth Times. We did a Q&A regarding my work in underserved settings, but at home and abroad.

Monday, January 18, 2010


Since the earthquake last week in Haiti, I have felt terribly conflicted about how to respond. We returned from the Dominican Republic last Saturday, just a few days before the earthquake. Had we been in the DR at the time of the disaster, we might have been in a position to have responded directly. Having just returned to the U.S., though, I found myself considering all the "practical" reasons that I could not turn around and fly right back. Family, patient schedules, work obligations, etc--many, many reasons which are valid, but which pale in relation to the scale of the disaster faced in Haiti.

So, I have no good idea how to respond. I was let of the hook--for now--when the medical relief teams in Haiti called for physician volunteers with trauma, surgery, orthopedics or emergency room experience. I lack skills in those areas, and so I could justify that I currently was not needed. Could I find another option, such as to work in the DR as diaster victims came over the border? Probably, but stateside obligations again make it easier to justify not traveling.

I feel like I am copping out: if pressed, I know I could probably do more. This would take a significant effort to get the time off work, to readjust my schedule, and to use vacation time to make the trip.

What have I done, then? I did put my name in as a volunteer willing to work after the emergency/acute reponse is over. I do not know if/when I would even be called to assist, but at least if I am called my skills and abilities will be better up to the task. I have also contributed to relief organizations already at work in Haiti.

Is that enough? Probably not. Is it enough for me to feel as though I am at least contributing somewhat? For now, yes. I have deferred the issues of how to work around time away from the office until later, but this gives me time to figure out how to handle that should I be asked to volunteer.

For now: all of us should try and help in whatever capacity we are able to. Look at the Partners in Health Stand With Haiti website to see if you can help directly. Donate to Doctors Without Borders--USA, who have already established hospital outposts to care for the injured and sick. Support the American Red Cross. All of these organizations--and many others--are already carrying out critically important work in Haiti.

Individually, we might not be able to do much. However, when unified, our smaller efforts grow into something much larger and much more significant--and we can make a difference.