The DJP Update

DJP Update 7-15-2010 Special tax break for trial lawyers? If true, this is outrageous!

Outrageous if the details of the article of July 15, 2010 in Washington Examiner are true. See article below. Thanks to Dr. John Gill for alerting me about this article.

Plaintiff attorneys are not suppose to become owners of lawsuits. in my opinion, by advancing the funds and getting tax advantages, the attorney shows ownership via contingency fee and special provisions that protect the attorney at the expense of the client. I discussed plaintiff attorneys getting ownership of lawsuits and the implications for countersuits in my Loyola Law Review, A Quest for Justice… article in Vol. 27, Number 2, 1981, pages 325-367. Write me if you want a copy.

Meanwhile, the broken liability system will get worse if this tax cut becomes reality. The Nation will be going in the wrong direction. This decreases accountability for attorneys!

No special tax cuts for wealthy trial lawyers

http://www.washingtonexaminer.com/opinion/No-special-tax-cuts-for-wealthy-trial-lawyers-1000453-98448669.html

Facing criticism over massive deficits, President Obama is in no mood to give anyone a tax cut. He’s eager to let President George W. Bush’s tax cuts expire, and he’s blown off his promise not to raise taxes on families making less than $250,000 a year with his tax-hiking health plan and cap-and-trade scheme.

Wealthy trial lawyers, however, may be a different story: Obama is on the verge of giving them a special interest tax break worth $1.6 billion. Legal Newsline reported yesterday that John Bowman, top lobbyist for the American Association for Justice, told a private briefing that Obama’s Internal Revenue Service will soon unilaterally cut their taxes without congressional approval.

The tax break would allow plaintiffs’ attorneys to deduct litigation costs in the same year that they bring contingency lawsuits. Currently, such costs are considered loans to clients, deductible only if and when a case is lost. The loan arrangement exists because most states consider it unethical or even illegal for lawyers to fund their clients’ lawsuits directly.

Last year, the group’s then-chief lobbyist (and now CEO) Linda Lipsen said Democrats in Congress might push the provision through by sneaking it into unrelated legislation. This already-underhanded strategy appears to have failed, and so a supportive Obama administration may simply bypass Congress. It is unconscionable that “spread-the-wealth” Obama should force taxpaying plumbers, waiters and bus drivers across America to shoulder up to 40 percent of the cost of wealthy trial lawyers’ litigation with this tax break. Worse, the tax break provides an effective reduction in lawsuit expenses, freeing up lawyers to file more suits that have less probability of success.

Obama has already given trial lawyers an executive order preventing federal regulations that pre-empt state lawsuits, as well as favorable new laws to increase their business. The current financial reform bill, for example, allows state attorneys general to deputize treasure-seeking trial lawyers to sue under its titles and keep the spoils. But this tax change could be the most odious favor yet to this overwhelmingly Democratic donor group — an insult at a time when small businesses struggle under soon-to-increase tax burdens and prepare to make cutbacks because of the added costs of Obamacare.

The White House declined comment on this issue, referring us instead to the Treasury Department, which also declined comment. But the White House must answer for its actions. Does AAJ, whose top lobbyists have visited the White House at least 13 times since Obama’s inauguration, own this “lobbyist-free” administration?

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Stay well,

Donald

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Donald J. Palmisano, MD, JD
Intrepid Resources® / The Medical Risk Manager Company
5000 West Esplanade Ave., #432
Metairie, Louisiana USA 70006
504-455-5895 office
504-455-9392 fax
DJP@donaldpalmisano.com
www.donaldpalmisano.com
www.onleadership.us

This DJP Update goes to 2263 leaders in Medicine representing all of the State Medical Associations and over 100 Specialty Societies plus some other friends.
You can share it with your members and it has the potential to reach 800,000 physicians.
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DJP Update 7-11-2010 General Douglas MacArthur Farewell Speech to Congress

Sometimes when crisis is upon us and each day brings more turmoil in our world I find it helpful to review the words of those who have gone before us in this great Land of Liberty called America. Their words, in time of crisis, sometimes have a lesson for the tribulations of today.

On this day I reflect on a speech I heard as it was being delivered. I was on a playground at a boarding school, St. Paul’s College, in Covington, La., sitting on the grass near a small stream trying to get a radio station to tune in on a small crystal radio, one of my earliest gadgets. Suddenly I got a station and heard General Douglas MacArthur as he gave his farewell speech to Congress after being fired by President Truman. At the time I did not know all of the details that led up to this speech but I sensed that this was serendipity at its best. I was mesmerized by the speech and reflect on the words from time to time.

So, here is the text and a link to a video of the speech. The video is not high definition but the impact, to me, is powerful. See if you find any lessons for today. Reflect, regardless if you are Democrat, Republican, or Independent.

General Douglas MacArthur Farewell Speech to Congress

April 19, 1951

Mr. President, Mr. Speaker and distinguished members of the Congress:

I stand on this rostrum with a sense of deep humility and great pride – humility in the wake of those great architects of our history who have stood here before me, pride in the reflection that this home of legislative debate represents human liberty in the purest form yet devised. Here are centered the hopes and aspirations and faith of the entire human race.

I do not stand here as advocate for any partisan cause, for the issues are fundamental and reach quite beyond the realm of partisan considerations. They must be resolved on the highest plane of national interest if our course is to prove sound and our future protected.

I trust, therefore, that you will do me the justice of receiving that which I have to say as solely expressing the considered viewpoint of a fellow American.

I address you with neither rancor nor bitterness in the fading twilight of life, with but one purpose in mind: to serve my country.

The issues are global, and so interlocked that to consider the problems of one sector oblivious to those of another is to court disaster for the whole. While Asia is commonly referred to as the gateway to Europe, it is no less true that Europe is the gateway to Asia, and the broad influence of the one cannot fail to have its impact upon the other.

There are those who claim our strength is inadequate to protect on both fronts, that we cannot divide our effort. I can think of no greater expression of defeatism.

If a potential enemy can divide his strength on two fronts, it is for us to counter his efforts. The Communist threat is a global one. Its successful advance in one sector threatens the destruction of every other sector. You cannot appease or otherwise surrender to communism in Asia without simultaneously undermining our efforts to halt its advance in Europe.

Beyond pointing out these general truisms, I shall confine my discussion to the general areas of Asia…

While I was not consulted prior to the President’s decision to intervene in support of the Republic of Korea, that decision, from a military standpoint, proved a sound one. As I say, it proved a sound one, as we hurled back the invader and decimated his forces. Our victory was complete, and our objectives within reach, when Red China intervened with numerically superior ground forces.

This created a new war and an entirely new situation, a situation not contemplated when our forces were committed against the North Korean invaders; a situation which called for new decisions in the diplomatic sphere to permit the realistic adjustment of military strategy. Such decisions have not been forthcoming.

While no man in his right mind would advocate sending our ground forces into continental China, and such was never given a thought, the new situation did urgently demand a drastic revision of strategic planning if our political aim was to defeat this new enemy as we had defeated the old.

Apart from the military need, as I saw it, to neutralize the sanctuary protection given the enemy north of the Yalu, I felt that military necessity in the conduct of the war made necessary —

1. The intensification of our economic blockade against China.

2. The imposition of a naval blockade against the China coast.

3. Removal of restrictions on air reconnaissance of China’s coastal area and of Manchuria.

4. Removal of restrictions on the forces of the republic of China on Formosa, with logistical support to contribute to their effective operations against the Chinese mainland.

For entertaining these views, all professionally designed to support our forces committed to Korea and to bring hostilities to an end with the least possible delay and at a saving of countless American and Allied lives, I have been severely criticized in lay circles, principally abroad, despite my understanding that from a military standpoint the above views have been fully shared in the past by practically every military leader concerned with the Korean campaign, including our own Joint Chiefs of Staff.

I called for reinforcements, but was informed that reinforcements were not available. I made clear that if not permitted to destroy the enemy built-up bases north of the Yalu, if not permitted to utilize the friendly Chinese force of some six hundred thousand men on Formosa, if not permitted to blockade the China coast to prevent the Chinese Reds from getting succor from without, and if there were to be no hope of major reinforcements, the position of the command from the military standpoint forbade victory.

We could hold in Korea by constant maneuver and at an approximate area where our supply-line advantages were in balance with the supply-line disadvantages of the enemy, but we could hope at best for only an indecisive campaign with its terrible and constant attrition upon our forces if the enemy utilized his full military potential.

I have constantly called for the new political decisions essential to a solution.

Efforts have been made to distort my position. It has been said in effect that I was a warmonger. Nothing could be further from the truth.

I know war as few other men now living know it, and nothing to me is more revolting. I have long advocated its complete abolition, as its very destructiveness on both friend and foe has rendered it useless as a means of settling international disputes.

Indeed, on the second day of September, 1945, just following the surrender of the Japanese nation on the battleship Missouri, I formally cautioned as follows:

“Men since the beginning of time have sought peace. Various methods through the ages have been attempted to devise an international process to prevent or settle disputes between nations. From the very start workable methods were found in so far as individual citizens were concerned, but the mechanics of an instrumentality of larger international scope have never been successful.

“Military alliances, balances of power, leagues of nations, all in turn failed, leaving the only path to be by way of the crucible of war. The utter destructiveness of war now blocks out this alternative. We have had our last chance. If we will not devise some greater and more equitable system, our Armageddon will be at our door. The problem basically is theological and involves a spiritual recrudescence, an improvement of human character that will synchronize with our almost matchless advances in science, art, literature, and all material and cultural developments of the past two thousand years. It must be of the spirit if we are to save the flesh.”

But once war is forced upon us, there is no other alternative than to apply every available means to bring it to a swift end. War’s very object is victory, not prolonged indecision.

In war there is no substitute for victory.

There are some who for varying reasons would appease Red China. They are blind to history’s clear lesson, for history teaches with unmistakable emphasis that appeasement but begets new and bloodier war. It points to no single instance where this end has justified that means, where appeasement had led to more than a sham peace.

Like blackmail, it lays the basis for new and successively greater demands until, as in blackmail, violence becomes the only alternative. Why, my soldiers asked of me, surrender military advantages to an enemy in the field? I could not answer.

Some may say to avoid spread of the conflict into an all-out war with China. Others, to avoid Soviet intervention. Neither explanation seems valid, for China is already engaging with the maximum power it can commit, and the Soviet will not necessarily mesh its actions with our moves. Like a cobra, any new enemy will more likely strike whenever it feels that the relativity in military or other potential is in its favor on a worldwide basis.

The tragedy of Korea is further heightened by the fact that its military action is confined to its territorial limits. It condemns that nation, which it is our purpose to save, to suffer the devastating impact of full naval and air bombardment while the enemy’s sanctuaries are fully protected from such attack and devastation.

Of the nations of the world, Korea alone, up to now, is the sole one which has risked its all against communism. The magnificence of the courage and fortitude of the Korean people defies description. They have chosen to risk death rather than slavery. Their last words to me were: “Don’t scuttle the Pacific.”

I have just left your fighting sons in Korea. They have met all tests there, and I can report to you without reservation that they are splendid in every way.

It was my constant effort to preserve them and end this savage conflict honorably and with the least loss of time and a minimum sacrifice of life. Its growing bloodshed has caused me the deepest anguish and anxiety. Those gallant men will remain often in my thoughts and in my prayers always.

I am closing my fifty-two years of military service. When I joined the army, even before the turn of the century, it was the fulfillment of all my boyish hopes and dreams.

The world has turned over many times since I took the oath on the plain at West Point, and the hopes and dreams have long since vanished, but I still remember the refrain of one of the most popular barracks ballads of that day which proclaimed most proudly that old soldiers never die; they just fade away.

And like the old soldier of that ballad, I now close my military career and just fade away, an old soldier who tried to do his duty as God gave him the light to see that duty. Good-bye.

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Weblink to video of speech: http://www.americanrhetoric.com/speeches/douglasmacarthurfarewelladdress.htm

General MacArthur died at age 84 on April 5, 1964 and is buried at the MacArthur Memorial in Norfolk, Virginia.

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TWEETS recently posted at www.twitter.com/DJPNEWS

Be sure to read the one about the NHS.

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4:54 PM Jul 9th via Echofon

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Stay well,

Donald

P.S. Stop by http://twitter.com/djpNEWS and sign up for DJPNEWS to get tweet alerts that may not make it into DJP Updates. Twitter is free and takes minutes to join. Put email in and pick password. Great source of breaking news and you don’t flood your email with it. You can get free app for BlackBerry or IPhone etc and you check on tweets when you want.

Also, recent selected DJP Updates can be found at: http://www.donaldpalmisano.com/html/djp_update/

Donald J. Palmisano, MD, JD
Intrepid Resources® / The Medical Risk Manager Company
5000 West Esplanade Ave., #432
Metairie, Louisiana USA 70006
504-455-5895 office
504-455-9392 fax
DJP@donaldpalmisano.com
www.donaldpalmisano.com
www.onleadership.us

This DJP Update goes to 2263 leaders in Medicine representing all of the State Medical Associations and over 100 Specialty Societies plus some other friends.
You can share it with your members and it has the potential to reach 800,000 physicians.
To join the list, send me an email stating “Join DJP Update” To get off the list, state “Remove DJP Update”. Best to put in Subject line so I can do immediately.

DJP Update 7-9-2010 late edition – 2nd Update of today; this for breaking news: Death of Dr. Daniel Cloud, former AMA President; Special message from AMA Board Chair re Dr. Berwick DJP Comment: I just got this information, minutes after sending DJP Update 7-9-2010 a few minutes ago. First, the wonderful Dr. Dan Cloud has died. He was AMA President 1981-82 and was an excellent caring doctor who was kind to all. I knew of him by reputation but then I met him one day in coffee shop of Hilton in Chicago after AMA meeting ended. I told him hello and he invited me to sit with him. He was a great storyteller and always helpful to me. He also wrote a terrific suspense thriller, “The Aesculapian” that dealt with the AMA. Amazon has some copies at http://www.amazon.com/Aesculapian-Dan-Cloud/dp/0913720984 It should have been a best-seller. I encourage you to read it. He will be missed. Robin and I send our sincerest condolences to his family. Second: I am passing on to you the information I just received from AMA Board Chair about Dr. Berwick and AMA’s support. No further comment by me except to say I don’t recall the 3 person candidate committee during my 9 years on the board. Maybe I need the memory medicine being developed in the NIH tweet I sent a few minutes ago. Regardless of what your view is about the person nominated, it is NOT a good procedure for 3 people to make such decisions as the decisions reflect on the entire AMA. The Board of Trustees has that responsibility for decisions that put AMA on record for such important considerations. Just my opinion! NOW THE AMA MESSAGE and all of the article quotes are sent by AMA: A Message from Dr Ardis Hoven, Chair, AMA Board of Trustees on the Berwick Appointment We want to take this opportunity to address questions and criticism of the decision by the AMA leadership to support the nomination of Dr. Donald Berwick as CMS Administrator. History The AMA’s support for Dr. Berwick as CMS Administrator is based on our work with him in his role as the CEO of the Institute for Healthcare Improvement, an award winning partnership with physicians and hospitals to improve quality and patient safety. We announced our support for Dr. Berwick in a press release on April 19, 2010 and it was reported by AM News as well as other media outlets. CMS has been directed by an Acting Administrator since 2006. AMA Process For Supporting Candidates for Federal Appointments For at least two decades, decisions regarding AMA support candidates for federal appointments have been made by the Candidate Selection Committee comprised of the AMA Chair, Chair-elect and AMA President. The full AMA Board does not vote on these matters. Controversial Statements Made by Dr. Berwick AMA support for Dr. Berwick is based on our direct involvement with him on quality improvement and patient safety initiatives. Over the years, Dr Berwick has made a number of controversial statements regarding the British health care system, single payer and other issues. The AMA remains a strong opponent of a single payer approach and we do not agree with some other views expressed by Dr. Berwick. That said, we believe Dr Berwick has the leadership track record and expertise to direct CMS activities. A broader perspective on Dr Berwick is provided in the article below developed by the Kaiser Health News. Whatever Dr Berwick’s personal views may be on policy issues, he cannot operate outside the authority prescribed by Congress. Recess Appointment The decision to utilize the authority for a recess appointment is a reflection of the Washington political environment. We do not have control or standing of process issues determined by government leaders. Like others, we believe the committee hearing process and full Senate debate is the preferred course of action. We are also cognizant that Senate rules allow a unified minority to block action by lining up 41 votes to oppose a cloture motion. The recess appointment authority has been used extensively by President of both parties. President George W. Bush used recess appointment authority 171 times and President Clinton employed this option for 139 appointments. Medicine’s Agenda Dr Berwick is legally authorized to serve as CMS Administrator through December, 2011. There is a long list of important regulatory and implementation decisions that need to be made by the CMS Administrator as a result of the health system reform law enacted in March. We believe physicians and patients will be best served by focusing on securing the desired outcome on pending policy matters such as repealing the flawed Medicare payment formula and implementation of the new health reform statute rather than dwelling on a matter that has been decided through established legal authority. From the Kaiser Health News Dr. Donald Berwick – A Resource Guide Jul 08, 2010 President Barack Obama appointed Dr. Donald Berwick head of the Centers for Medicare and Medicaid Services Wednesday. Berwick, known as a passionate advocate for improving the health care system, was nominated earlier this year but his nomination turned out to be controversial. Some Republicans accuse him of favoring health care rationing — a charge Democrats dismiss as nonsense. To shed light on Dr. Berwick, and the controversy surrounding him, KHN’s Allison Fero assembled this resource guide. Background | In His Own Words | Summaries of News Coverage Who Is Donald Berwick? Berwick is currently President and CEO of the Institute for Healthcare Improvement. An edited excerpt of his biography, from the IHI website: Donald M. Berwick, MD, MPP, FRCP, is also Clinical Professor of Pediatrics and Health Care Policy at the Harvard Medical School, and Professor in the Department of Health Policy and Management at the Harvard School of Public Health. Dr. Berwick has served as vice chair of the US Preventive Services Task Force, the first “Independent Member” of the Board of Trustees of the American Hospital Association, and chair of the National Advisory Council of the Agency for Healthcare Research and Quality. He is a recipient of numerous awards, including … the 2002 American Hospital Association’s Award of Honor … the 2007 William B. Graham Prize for Health Services Research, and the 2007 Heinz Award for Public Policy from the Heinz Family Foundation. In 2005, he was appointed “Honorary Knight Commander of the British Empire” by the Queen of England in honor of his work with the British National Health Service. Dr. Berwick is author of numerous articles and the books Curing Health Care and Escape Fire. Media Profiles Who Runs Gov : “Berwick is famous in the health-care system for advocating its destruction. An academic who has spent his career looking for ways to deliver care more efficiently and effectively, Berwick has been called a “revolutionary.” He believes the structure of the health-care system encourages good people to make harmful medical errors and waste millions of dollars. If he could, he’d blow the whole thing up and start over.” CBS Evening News : “Two years ago, he launched the 100,000 Lives Campaign. That’s the number of lives he hoped to save by getting hospitals to have standard operating procedures for the way they care for patients. Enlarge Video This includes hooking up a ventilator properly to eliminate the risk of pneumonia and ensuring that a patient’s medication is monitored from the ICU to the hospital room to home.” Berwick says even something as simple as uniform hand-washing requirements would cut hospital infections in half” (Feb. 2007). The Boston Globe : “Berwick gets irritated when health care leaders complain about a lack of resources. There’s too much money in the system already, he says. His critique takes aim at the medical profession’s exalted view of itself. He’s convinced that the fundamentals of the current system — the same fundamentals Boston used to build its reputation as the world’s medical leader — are so screwed up that it is no longer possible for the medical profession to provide reliable, high-quality care, no matter how many innovations its renowned doctors roll out, no matter how many awards they rack up.” (Jan. 4, 2004). NPR : “Berwick has built the Institute for Healthcare Improvement into a considerable force for change. … Berwick’s institute has been working on reforms with thousands of doctors offices and hospitals around the country and the world” (July 16, 2002). In His Own Words Excerpts of Berwick’s speeches or writings, with links to the entire article or video. Kaiser Health News, Checking In With Dr. Donald Berwick Enlarge Video “Hospitals and health care systems are making phenomenal strides in quality and my optimism is very high. But the structures are still broken. We have fragmented payment systems and fragmented institutional boundaries. The enemy is fragmentation. We just don’t seem to form into the coalitions, the communities we need to make progress. Until we fix structures and finance it is going to be very hard to make fast progress” (Nov. 12, 2009) New York Times Editorial, 10 Steps to Better Health Care “There is a lot of troubling rhetoric being thrown around in the health care debate. But we don’t need to be trapped between charges that reforms will ration care and doing nothing about costs and coverage. We must instead look at the communities that are already redesigning American health care for the better, and pursue ways for the nation to follow their lead” (Berwick was one of four authors, Aug. 12, 2009). Institute for Healthcare Improvement Video, Defining Quality: Aiming for a Better Health Care System “If you’re buying a car, there are dimensions of quality: safety, fuel efficiency, comfort, fun in driving, durability and so on. We’re used to that. But what are the dimensions of ‘goodness’ in health care?” (Oct. 2008). Speech To Britain’s National Health Service KHN Transcript of Speech Excerpts “Here, in the NHS, you have historically put primary care – general practice – where it belongs: at the forefront. The NHS is a bridge, it’s a towering bridge, between the rhetoric of justice, and the fact of justice. No one in their right mind could expect that to be easy. … You could have protected the wealthy and the well, instead of recognizing that sick people tend to be poorer and that poor people tend to be sicker, and that any health care funding plan that is just, equitable, civilized, and humane must – must – redistribute wealth from the richer among us to the poorer and less fortunate. Excellent healthcare is by definition redistribution. Britain, you chose well. … Is the NHS perfect? Far from it, far from it. I know that as well as anyone in this room. From the front line to Whitehall, I have had the privilege to observe its performance and even to help to measure its performance. … [but] the NHS has more evidence-based care, lower mortality rates for some major disease groups (especially cardiovascular diseases), you have lower waiting times for hospital, outpatient, and cancer care now, more staff and technologies are available, you have in many places better community-based mental health care, and you are starting to see falling rates of hospital infection” (July 1, 2008). NHS video of speech excerpts. The Journal of the American Medical Association, The Science of Improvement “Academic medicine has a major opportunity to support the redesign of health care systems; it ought to bear part of the burden for accelerating the pace, confidence, and pervasiveness of that change. Health care researchers who believe that their main role is to ride the brakes on change—to weigh evidence with impoverished tools, ill-fit for use—are not being as helpful as they need to be. ‘Where is the randomized trial?’ is, for many purposes, the right question, but for many others it is the wrong question, a myopic one. A better one is broader: ‘What is everyone learning?’ Asking the question that way will help clinicians and researchers see further in navigating toward improvement.” (Mar. 12, 2008). Boston Globe Editorial, Dirty Words In Healthcare “Managed healthcare was a great idea when it first emerged, before the term got hijacked by insurance companies that claimed to manage care but in many cases only managed money. … The innovations that managed care and capitation made possible were good for almost everyone. … Thousands of people avoided needless hospital visits; they got more appropriate, less expensive, better coordinated care in office settings” (Feb. 27, 2008). British Medical Journal (via the U.S. National Institutes of Health), Steadying The NHS “We believe, and refuse to be dissuaded, that the National Health Service, with its moral intent, commitment to equity, and store of knowledge, has the inherent capability to become the greatest healthcare system of any nation. Yet, lately, it seems like a boxer on the ropes, not the champion it should be…. The NHS is not just a national treasure; it is a global treasure. As unabashed fans, we urge a dialogue on possible forms of stabilisation to better provide the NHS with the time, space, and constancy of purpose to realise its enormous promise” (July 10, 2006). Newsweek Editorial, Keys to Safer Hospitals “Here’s the problem. Instead of helping me, health care might kill me. In 1999, the Institute of Medicine shocked the nation with an authoritative report on hospital errors. The report concluded that up to 98,000 Americans each year die in hospitals, not from the diseases that brought them there but from injuries caused by their medical care. … We have identified six basic measures that could save as many as 100,000 lives a year if even 2,000 hospitals adopted them. It’s surprising to learn that these standards aren’t already the norm–but the norms may finally be changing” (Dec. 12, 2005). Health Affairs, ‘A Deficiency Of Will And Ambition’: A Conversation With Donald Berwick “I have said before, and I’ll stand behind it, that the waste level in American medicine approaches 50 percent. It’s certainly in double digits, and this has to be absolutely pasted onto the quality agenda. There is no difference between quality and efficiency …. a lot of people make a lot of money on inefficiency—on production of things that have no value. So the minute you try to become truly efficient, you’re going to run into stakeholders who are going to tell you that you’re harming care, and the knee-jerk reactions of doctors and others will be to reinforce that idea” (Jan. 12, 2005). The New England Journal of Medicine, Errors Today and Errors Tomorrow “First, in local settings, our workforce largely remains blind to the enemy — patient injury. … The invisibility of injuries to patients makes them seem trivial or infrequent. Until we find ways to make errors and injuries routinely visible in local health care settings, the national will to improve safety will be hard to translate into local intent. Second, even when hospitals find ways to notice the injuries to their patients, their theories of cause often remain scientifically Neanderthal. They cling to unsound but deeply entrenched beliefs” (June 2003). Health Affairs, A User’s Manual For The Institute of Medicine’s “Quality Chasm” Report “The report therefore suggests to any careful reader that whether we wish to tackle the problem of quality as payers, regulators, executives, managers, or clinicians, we will improve health care as it needs to be improved, either all together or not at all” (May/June 2002). Escape Fire: Lessons for the Future of Health Care “This has been a tough year for my family, and especially for my wife, Ann, who last spring began developing symptoms of a rare and serious autoimmune spinal cord problem. … this has been the formative experience for me overall in the past year … The people work well, by and large, but the system often does not. Every hour of our care reminded me, and alerted Ann, about the enormous, costly, and painful gaps between what we got in our days of need, and what we needed. The experience did not actually surprise me, but it did shock me. Put in other terms, as a friend of mine said: Before this, I was concerned; now, I am radicalized” (First from a speech at the IHI National Forum, Dec. 9,1999; later part of a Commonwealth Fund book with same title). Watch the related video. * * * * * * * * * * Sent by: American Medical Association * Helping doctors help patients 515 N. State Street Chicago, IL 60654 TO UNSUBSCRIBE: click unsubscribe-hod.advocacy.update@enews.ama-assn.org to bring up a new e-mail message and click “send.” No subject line is necessary. Or send a blank email to unsubscribe-hod.advocacy.update@enews.ama-assn.org You are currently subscribed as djp@donaldpalmisano.com ————– End of this DJP Update late edition. Stay well, Donald P.S. Stop by http://twitter.com/djpNEWS and sign up for DJPNEWS to get tweet alerts that may not make it into DJP Updates. Twitter is free and takes minutes to join. Put email in and pick password. Great source of breaking news and you don’t flood your email with it. You can get free app for BlackBerry or IPhone etc and you check on tweets when you want. Also, recent selected DJP Updates can be found at: http://www.donaldpalmisano.com/html/djp_update/ Donald J. Palmisano, MD, JD Intrepid Resources® / The Medical Risk Manager Company 5000 West Esplanade Ave., #432 Metairie, Louisiana USA 70006 504-455-5895 office 504-455-9392 fax DJP@donaldpalmisano.com www.donaldpalmisano.com www.onleadership.us This DJP Update goes to 2263 leaders in Medicine representing all of the State Medical Associations and over 100 Specialty Societies plus some other friends. You can share it with your members and it has the potential to reach 800,000 physicians. To join the list, send me an email stating “Join DJP Update” To get off the list, state “Remove DJP Update”. Best to put in Subject line so I can do immediately.

DJP Update 7-9-2010 Tweets re opinions on taxes, new health system reform law, comments about recess appt Dr. Berwick, trial lawyers & departure La. DHH head

Have a great weekend! Here are a few tweets from the past two days. Great research on memory from NIH in one tweet! Hope for all of us who have been around a while.

Too bad AMA fails to mention private contracting and balance-billing in the interviews and letters to blogs etc.

When will AMA get aggressive about this mandate from House of Delegates! It is not enough to say the SGR is a disaster. Give a solution! The House of Delegates has one. It is called liberty and freedom of contract!

The doctors are looking for someone to lead them out of this government mess so they can care for their patients. And don’t forget, a substitute price-fixing formula without balance-billing option without penalty is NOT A SOLUTION.

Keep doing the same approach to Washington, DC and one can expect the same results. If this keeps up, another organization will emerge as the representative of doctors. Sad but true.

And now the tweets from www.twitter.com/DJPNEWS

——–

Taxes affect actions! RT @Heritage LeBron James is one wise “king.” Looks like he prefers lower taxes. #tcot #teaparty http://herit.ag/O64

17 minutes ago via Echofon

Via #LHA La. DHH Sec Alan Levine resigns; replace = Bruce Greenstein, Sr Dir worldwide health Microsoft Corp #hcr #Doctors

23 minutes ago via Echofon

Heat debate incl #AMA but no mention bal bill! RT @texmed AARP..recog.. the access..care crisis..the Medicare Meltdown http://fb.me/CA6CZl76

about 1 hour ago via Echofon

More debate; more surprises coming! RT @M_P_T Opinion: ObamaCare has another “surprise” http://bit.ly/9oFQ0w Agree? #tcot #hcr

about 1 hour ago via Echofon

NEJM & #SGR #hcr #Doctors RT @sonodoc99 @DJPNEWS SGR – Indispensable Abomination http://tinyurl.com/234emql

about 5 hours ago via Echofon

Thanks to @sonodoc99 for alert about Stossel article!

about 16 hours ago via web

John #Stossel article “Parasitic Tort Lawyers” http://tinyurl.com/24ycp88 #lawyers

about 16 hours ago via web

Fascinating! Potential for humans! RT @NIHforHealth News: Mental Decline Thwarted in Aging Rats http://bit.ly/dhXHv7

about 19 hours ago via Echofon

Ruth #Marcus in #WashingtonPost “Obama’s cynical recess appointment of Donald Berwick” http://tinyurl.com/28exhe5#hcr #Berwick

about 23 hours ago via web

RT @WSJopinion The Berwick Evasion: Obama dodges..Senate debate on his ideal Medicare chief http://on.wsj.com/cZuP4s #hcr #Berwick:

7:08 PM Jul 7th via Echofon

I repeat: recess appt these facts mistake RT @KeithHennessey..Pres.. recess appoint..of Dr. Donald #Berwick: http://bit.ly/9Y5yA8 #hcr

3:26 PM Jul 7th via Echofon

———

Stay well,

Donald

P.S. Stop by http://twitter.com/djpNEWS and sign up for DJPNEWS to get tweet alerts that may not make it into DJP Updates. Twitter is free and takes minutes to join. Put email in and pick password. Great source of breaking news and you don’t flood your email with it. You can get free app for BlackBerry or IPhone etc and you check on tweets when you want.

Also, recent selected DJP Updates can be found at: http://www.donaldpalmisano.com/html/djp_update/

Donald J. Palmisano, MD, JD
Intrepid Resources® / The Medical Risk Manager Company
5000 West Esplanade Ave., #432
Metairie, Louisiana USA 70006
504-455-5895 office
504-455-9392 fax
DJP@donaldpalmisano.com
www.donaldpalmisano.com
www.onleadership.us

This DJP Update goes to 2263 leaders in Medicine representing all of the State Medical Associations and over 100 Specialty Societies plus some other friends.
You can share it with your members and it has the potential to reach 800,000 physicians.
To join the list, send me an email stating “Join DJP Update” To get off the list, state “Remove DJP Update”. Best to put in Subject line so I can do immediately.

DJP Update 7-6-2010 Recent tweets – lots going on in DC and in Gulf with oil spill; LAGNIAPPE: some special meals

DJP Comments: Robin and I had delightful time this past week visiting with friends from Australia who were in New Orleans as past of a multi-city visit to USA.

Lots of photos and video done!

Very sad to see tar balls now in Lake Pontchartrain!

Below are the recent tweets found at: www.Twitter.com/DJPNEWS

And yes! Tabasco, our wonderful dog, is now 15 years old as of July 4! Be sure to see her photo in the tweet link.

I believe it is a mistake to do a recess appointment of Dr. Berwick. He is a smart man and should be able to present his views on Medicare/Medicaid and handle questions regardless of whether you agree with him or not. America longs for transparency. A recess appointment will only increase the partisan bickering. White House statement about this action is in link in first tweet below. A recess appointment only increases the division over a health system reform law that the majority of Americans oppose and believe was jammed through Congress. Actions have consequences and perhaps in November we will see the consequences of such actions. I worry about the financial stability of America. I worry about the patients who will not be able to find doctors in the hour of need.

There is lots to worry about. Time to stop partisan fighting and show leadership!

And one more item that will be tweeted shortly. Read Dr. Leah McCormack, president of Medical Society of the State of New York, declaring “independence from Medicare and Managed Care” at:

http://readme.readmedia.com/The-Fourth-of-July-Is-My-Professional-Independence-Day/1562194

Read the entire letter. Here is an excerpt:

—–

WESTBURY, NY (07/01/2010)(readMedia)– I have made a personal decision as of July 4th to terminate all of my contracts with Medicare and managed care companies as soon as the contracts allow. I think of this as my own personal independence day.

This has been a long time coming, but I can no longer bear the shackles of government and insurance company rules, the burdens of their regulations and the fear of their retributions for the paltry reward of their monetary compensation for my services. …..

———

If only Congress would listen!!

And now the tweets: www.Twitter.com/DJPNEWS

Recess=mistake! RT @marklhayesRT @MajoratWH: ..WH blog..recess appoint of Berwick to head Medicare/Medicaid Services. http://bit.ly/91g6sy

about 1 hour ago via Echofon

Yes! RT @JindalNews Gov. Jindal to Feds: No Is Not A Plan, Lead Or Get Out Of The Way http://twurl.nl/6yd0jq #BP#oilspill

about 1 hour ago via Echofon

Thanks! RT @Heritage Remember the Gulf. We aren’t forgetting…keeping the Administration accountable. http://herit.ag/XM3 #BP #oilspill

about 11 hours ago via Echofon

Facts don’t cease to exist when ignored RT @M_P_T Emergency Room Visits Increase in Mass.: http://bit.ly/bQt7EA #tcot #hcr

about 13 hours ago via Echofon

Time for principle, fiscal responsibility, & term-limits in DC. RT @ThomasSowell Column: Santa and Frank http://bit.ly/aTirzG

about 14 hours ago via Echofon

Powerful! Remember! “I fought for you” video. Thanks, Mark @Constantian http://tinyurl.com/2595hou #DDay #Liberty#Military

about 21 hours ago via web

Rats! Tar balls in Lake Pontchartrain, the lake between New Orleans & Slidell .. http://tinyurl.com/2cpjpw9 #BP #oilspill

about 22 hours ago via Echofon

RT @RasmussenPoll 60% favor repeal of health care law… just 41% think…likely to happen… http://tinyurl.com/RR1725#hcr

8:21 AM Jul 5th via Echofon

Thanks Art. More problems new #hcr RT @sonodoc99@DJPNEWS ObamaCare Takes a Bite Out of White Castle http://tinyurl.com/27q7gek

8:18 AM Jul 5th via Echofon

Update practice of Medicine RT @sonodoc99 @DJPNEWS July 4 Colleagues http://tinyurl.com/2avhv98 words prez #MSSNY#hcr

8:13 AM Jul 5th via Echofon

Rodrigue #BlueDog #SaveTheGulf Artist Rodrigue of La & his Blue Dog join quest. #BP #OilSpill #dog http://twitpic.com/22idsd

4:55 PM Jul 4th via Twitpic

Happy Birthday, Tabasco! Now 15 y.o. & 14 1/2 years ago found on highway near death. Wonder #dog! http://twitpic.com/22iabl

4:43 PM Jul 4th via Twitpic

Yes! RT @WWIImuseum As we celebrate Independence Day & our freedom, let’s remember the men & women who preserved it! www.10forThem.org

7:29 AM Jul 4th via Echofon

Wrong! Allow balance-billing! RT @amednews RT @KentBottles http://ow.ly/26EgM why is a Medicare doc payment fix so elusive? #SGR

8:50 AM Jul 3rd via Echofon

Happy Birthday, America! Enjoy #liberty this 4th of July &#RedSkelton discuss #PledgeOfAllegiance http://tinyurl.com/cnqdsj

8:23 AM Jul 3rd via web

——-

LAGNIAPPE: A few words about recent special meals

CHICAGO

West Egg Cafe

Spectacular breakfast until 3 p.m.

Walking distance from Hyatt on Wacker where AMA June 2010 Annual Meeting held

620 North Fairbanks Court

Chicago, IL 60611-3011

(312) 280-8366

——–

New Orleans

Ralph’s On The Park

Across from City Park

900 City Park Avenue

New Orleans, La. 70119

Best Turtle Soup I have tasted and I taste turtle soup at every restaurant I visit when it is available.

——–

Tony Angello’s Restaurant

Don’t order from menu, tell Dale to feed you. Recent meal in “Wine Room” terrific.

See details at: http://www.donaldpalmisano.com/html/restaurants.shtml

Stay well,

Donald

P.S. Stop by http://twitter.com/djpNEWS and sign up for DJPNEWS to get tweet alerts that may not make it into DJP Updates. Twitter is free and takes minutes to join. Put email in and pick password. Great source of breaking news and you don’t flood your email with it. You can get free app for BlackBerry or IPhone etc and you check on tweets when you want.

Also, recent selected DJP Updates can be found at: http://www.donaldpalmisano.com/html/djp_update/

Donald J. Palmisano, MD, JD
Intrepid Resources® / The Medical Risk Manager Company
5000 West Esplanade Ave., #432
Metairie, Louisiana USA 70006
504-455-5895 office
504-455-9392 fax
DJP@donaldpalmisano.com
www.donaldpalmisano.com
www.onleadership.us

This DJP Update goes to 2262 leaders in Medicine representing all of the State Medical Associations and over 100 Specialty Societies plus some other friends.
You can share it with your members and it has the potential to reach 800,000 physicians.
To join the list, send me an email stating “Join DJP Update” To get off the list, state “Remove DJP Update”. Best to put in Subject line so I can do immediately.

DJP Update 7-1-2010 What others are saying “health care reform law”; comment; Lagniappe re longevity!

Health Affairs Blog article by Stephen Langel – interview with Rep. (Dr.) Michael Burgess of Texas.

Read entire article at: http://healthaffairs.org/blog/2010/07/01/rep-burgess-gives-physicians’-take-on-new-health-care-law/

EXCERPTS

Texas Republican Rep. Michael Burgess took a strong stand on the new health care reform law yesterday morning, arguing that opponents must stop its implementation by targeting its funding. He also predicted that there would not be a permanent fix to the Medicare sustainable growth rate until at least after the 2010 election.

……

The congressman also panned the bill’s widely supported effort to base doctors’ payment upon quality, rather than quantity, of care. Instead, Burgess came to the defense of the current fee-for-service system where the provider is paid for each individual service rendered to a patient. The congressman argued that doctors are “so goal directed that we need that impetus” of FFS as motivation to provide the best possible care. But he conceded that the vast majority of people do not take this view.

……

His hope is that even if Democrats maintain control of the House, the heat they take for this new law will make many of them more open to stopping it. He also predicted a possible “sea change” in Congress, with more physicians seeking House seats than any time in the past 100 years. There are 46 doctors, 40 of whom are Republicans, who are vying for seats, he added. This is the result of doctors’ dissatisfaction with the new law and the way it was passed, Burgess said.

Part of physicians’ concerns involve Congress’ failure to fix funding of the sustainable growth rate (SGR), which ties physician payment rates to Medicare spending for physician services and the growth rate of the overall economy. Doctors recently faced a 21.5 percent cut in their fees, which was later addressed by a temporary extension. Instead, lawmakers should have found a permanent fix for the SGR, Burgess said, adding that the specter of cuts is the number one roadblock for the elderly to get health care.

Part of the blame for this falls on the American Medical Association, who helped negotiate the final bill language. They failed to adequately represent their members, he said. “Why they didn’t do a better job, I don’t know.”

Despite this pressing need, Burgess told reporters that there is no chance a permanent fix will take place before the 2010 election. The temporary extension runs out on November 30, but there just isn’t the time for the lame duck Congress to make long-term changes, he said. Instead, another short-term extension or “budget gimmick” will be necessary. However, when an attempt at a permanent fix occurs, Republicans are not unified on whether the permanent fix needs to be completely paid for or if it can add to the deficit, he said.

Finally, Burgess saw no benefit in the law’s plan to reduce Medicare costs through a payment advisory board. Even though Congress could not be trusted to act on its own to fix the SGR, an independent panel is also not the answer to problems with the healthcare system, he said, counting repeal of the proposed Medicare Independent Payment Advisory Board as one of his top targets. Other targets include a new tax on medical device manufacturers.

……

DJP Comment: Too bad Dr. Burgess doesn’t mention balance-billing and private contracting! Perhaps he did and the reporter did not write about that part of the discussion. Balance-billing and private contracting need to be emphasized in every interview! Price-fixing and central control by government are doomed to failure. We need patient-centered care; patients in control with the doctor as trusted advisor; patients making decisions and having responsibility for making prudent decisions. Let not the greatness of America diminish. Let us not repeat the errors of failed economies. How many times do we have to see the repeat of this admonition from Nobel Prize winner William Butler Yeats. America found the golden fleece in the Declaration of Independence and the U.S. Constitution. We don’t need to reinvent and revert to the failures of other countries. Unchain the people and America will shine brightly again. That is our goal & gold.

EXCERPT:

Another Troy must rise and set,

Another lineage feed the crow,

Another Argo’s painted prow

Drive to a flashier bauble yet.

——

And don’t forget the warning in Ozymandias by Percy Bysshe Shelley

EXCERPT:

`My name is Ozymandias, King of Kings:

Look on my works, ye mighty, and despair!’

Nothing beside remains. Round the decay

Of that colossal wreck, boundless and bare,

The lone and level sands stretch far away”.

—

DJP Comment: Let not pride and arrogance in Washington, DC lead to our demise. The people want LEADERS, not power-brokers. Stop coercion. Listen up, Washington!

Lagniappe: Here is a fascinating story about a new discovery concerning longevity.

www.twitter.com/DJPNEWS

Exciting RT @WSJ Scientists..discovered a genetic signature of longevity; free test will be available to public http://on.wsj.com/9DcgBf

——-

Stay well,

Donald

P.S. Stop by http://twitter.com/djpNEWS and sign up for DJPNEWS to get tweet alerts that may not make it into DJP Updates. Twitter is free and takes minutes to join. Put email in and pick password. Great source of breaking news and you don’t flood your email with it. You can get free app for BlackBerry or IPhone etc and you check on tweets when you want.

Also, recent selected DJP Updates can be found at: http://www.donaldpalmisano.com/html/djp_update/

Donald J. Palmisano, MD, JD
Intrepid Resources® / The Medical Risk Manager Company
5000 West Esplanade Ave., #432
Metairie, Louisiana USA 70006
504-455-5895 office
504-455-9392 fax
DJP@donaldpalmisano.com
www.donaldpalmisano.com
www.onleadership.us

This DJP Update goes to 2262 leaders in Medicine representing all of the State Medical Associations and over 100 Specialty Societies plus some other friends.
You can share it with your members and it has the potential to reach 800,000 physicians.
To join the list, send me an email stating “Join DJP Update” To get off the list, state “Remove DJP Update”. Best to put in Subject line so I can do immediately.

DJP Update 6-30-2010 Some tweets Oil Spill in Gulf, Supreme Ct decision re gun ownership, HSAs & SGR/private contracting, and “Mockingbird”

First, let us all hope the folks in Texas and in Mexico and neighboring areas are not hurt by the Hurricane. Those who have suffered from past hurricanes understand the anxiety, pain, and loss.

Tweets follow. Powerful YouTube video of Plaquemines Parish President Billy Nungesser. Sad times for those in his parish, the state, and all lovers of seafood and nature.

On one of my lecture trips to China, I was picked up at the airport by students assigned to take me to hotel. One asked me in the car if I had ever read “To Kill a Mockingbird”. He told me that was his favorite book. His comment told me a lot about the universal love of justice, liberty, fair play, and the antagonism against discrimination. See tweet about author, Harper Lee.

——–

www.Twitter.com/DJPNEWS

Gulf #oilspill #BP Gov #Jindal “time for the feds to lead or get out of the way” http://tinyurl.com/3xns4hy @BobbyJindal

2 minutes ago via web

Disaster if forced out RT @HeartlandInst Another victim of Obamacare- Say goodbye to your health savings accounts http://bit.ly/cVu92Q #hcr

about 3 hours ago via Echofon

Powerful view #leadership Billy #Nungesser Prez #Plaquemines Parish #oilspill #BP http://www.youtube.com/watch?v=1jQUfOZTK-Y

about 18 hours ago via web

A reasoned view RT @ThomasSowell Column: Gun Control Laws http://bit.ly/cKtivG #guns #2ndAmendment

1:13 AM Jun 29th via Echofon

RT @DrBob_Southlake PrivContracting/FreeEnterprise will Fix Medicare. Gov Price Fixing..impacting access to care.http://tinyurl.com/254xp44

11:24 PM Jun 28th via Echofon

Yes & allow balance-billing RT @DrBob_Southlake Our Coalition responds to Medicare Meltdown in USAToday http://tinyurl.com/22olrwx #hcr

9:55 PM Jun 28th via Echofon

Leadership RT @JindalNews Governor Jindal Calls On Feds To Get In The War To Win It http://twurl.nl/q5pyk2 #oilspill #BP#Jindal

9:04 PM Jun 28th via Echofon

Big deal, for sure! #SupremeCourt decision right to bear arms @WSJopinion http://tinyurl.com/27ugpl7 #guns #IIAmendment

6:58 PM Jun 28th via Echofon

#Mockingbird ! RT @PublishersWkly Harper Lee speaks to Daily Mail: long article, very short interview http://bit.ly/b9ZPfJ

6:43 PM Jun 28th via Echofon

———

Stay well,

Donald

P.S. Stop by http://twitter.com/djpNEWS and sign up for DJPNEWS to get tweet alerts that may not make it into DJP Updates. Twitter is free and takes minutes to join. Put email in and pick password. Great source of breaking news and you don’t flood your email with it. You can get free app for BlackBerry or IPhone etc and you check on tweets when you want.

Also, recent selected DJP Updates can be found at: http://www.donaldpalmisano.com/html/djp_update/

Donald J. Palmisano, MD, JD
Intrepid Resources® / The Medical Risk Manager Company
5000 West Esplanade Ave., #432
Metairie, Louisiana USA 70006
504-455-5895 office
504-455-9392 fax
DJP@donaldpalmisano.com
www.donaldpalmisano.com
www.onleadership.us

This DJP Update goes to 2262 leaders in Medicine representing all of the State Medical Associations and over 100 Specialty Societies plus some other friends.
You can share it with your members and it has the potential to reach 800,000 physicians.
To join the list, send me an email stating “Join DJP Update” To get off the list, state “Remove DJP Update”. Best to put in Subject line so I can do immediately.

DJP Update 6-27-2010 Negative view of AMA by Wall Street Journal; “If Dr. Wilson is lucky, Congress will give his members another helping of gruel.” I certainly agree with The Wall Street Journal editorial criticizing AMA’s approach to health system reform and the issue of the SGR. But once again, I will be repeating myself to give my opinion of the flaws in the AMA’s negotiating position. Read the DJP Updates of the past year. Suffice it to say that Congress should be told that doctors and patients have a right to be free of coercion and price-fixing. And remember, changing from the SGR price-fixing formula to another price-fixing formula with a Orwellian name is no win! Too many brave people died giving us liberty in America and we should not dishonor them and ourselves by genuflecting to power-brokers in Washington, DC. More “gruel”? That nails it. That is the impression of the world about AMA. And only AMA and the House of Delegates can change that impression. Be strong, have courage, be a leader! With every action, ask the question: Is this in the best interest of the patients AND DOES IT ALLOW THE DOCTORS TO REMAIN FREE AND THEIR PRACTICES VIABLE? If no doctors, no patient care. New AMA leadership in place. Let’s see the performance. Let’s see if AMA waits until after the November elections and thus lose more negotiating power. The 6 month “fix” of the SGR was not a random number. Remember, the folks in Congress do no heart transplants and no removal of blood clots from brains. Nor any of the other wonderful life-saving acts that doctors do every day. That is reality. Stop being a victim. Learn from failure. Thomas Edison did. Hard to be forgiving when an organization refuses to listen, learn, and change direction. Here is the article: —— The Wall Street Journal http://online.wsj.com/article/SB10001424052748703615104575328761237843010.html?mod=rss_opinion_main REVIEW & OUTLOOK JUNE 26, 2010 A Beltway Public Service Stimulus III goes down. World cheers. EXCERPT: The night’s most conspicuous loser was the American Medical Association, the doctors lobby that endorsed ObamaCare as a quid pro quo for ending the Medicare price-control formula that automatically cuts physician payments every year. Democrats were game until they realized that ending this “sustainable growth rate” would add a quarter-trillion dollars to ObamaCare’s total cost and thus make it harder to pretend to reduce the deficit. Inexplicably, AMA president James Rohack accepted liberal blandishments and, in return for being played like a Stradivarius, his successor Cecil Wilson and doctors nationwide got a five-month patch plus a reversal of the 21.5% cut that kicked in June 1. Mrs. Pelosi then finally allowed a vote on this separate “doc fix” bill that the Senate passed a week ago but she had withheld from the floor as tax-extenders leverage. The cuts will be delayed until January, when they’ll hit 30% and if Dr. Wilson is lucky Congress will give his members another helping of gruel. Even to “pay for” this $6.4 billion doc fix, Democrats had to game the budget window via tweaks to pension-funding laws. Democrats have exhausted every “fiscal responsibility” trick in the book, except actual fiscal responsibility, which they inadvertently committed on Thursday. ——- Two of my tweets today at www.Twitter.com/DJPNEWS Failure discussed! How others- @WSJopinion – see #AMA and the #hcr & #SGR debacle http://tinyurl.com/33k9y8w 25 minutes ago via Echofon A tale of graft vs “donations” by excellent editorial writer @jarvisdeberrytp http://tinyurl.com/2449nfj #NOLA #church #S&WB about 6 hours ago via Echofon —- Stay well, Donald P.S. Stop by http://twitter.com/djpNEWS and sign up for DJPNEWS to get tweet alerts that may not make it into DJP Updates. Twitter is free and takes minutes to join. Put email in and pick password. Great source of breaking news and you don’t flood your email with it. You can get free app for BlackBerry or IPhone etc and you check on tweets when you want. Also, recent selected DJP Updates can be found at: http://www.donaldpalmisano.com/html/djp_update/ Donald J. Palmisano, MD, JD Intrepid Resources® / The Medical Risk Manager Company 5000 West Esplanade Ave., #432 Metairie, Louisiana USA 70006 504-455-5895 office 504-455-9392 fax DJP@donaldpalmisano.com www.donaldpalmisano.com www.onleadership.us This DJP Update goes to 2262 leaders in Medicine representing all of the State Medical Associations and over 100 Specialty Societies plus some other friends. You can share it with your members and it has the potential to reach 800,000 physicians. To join the list, send me an email stating “Join DJP Update” To get off the list, state “Remove DJP Update”. Best to put in Subject line so I can do immediately.

DJP Update 6-24-2010 AMA featured in Roll Call article & some recent tweets PLUS breaking news from AMA about SGR

http://www.rollcall.com/issues/55_152/lobbying/47622-1.html

AMA Chief Has Internal Divisions to Stitch Up

By Bennett Roth

Roll Call Staff

June 23, 2010, 12 a.m.

In a speech last week marking his ascension to the presidency of the American Medical Association, Cecil Wilson, an avid sailor and former Navy doctor, couldn’t resist tossing out some precautionary sea tales.

….

Excerpts:

Son of a Preacher Man

Wilson’s backers say the 75-year-old former naval surgeon, who grew up in south Georgia as the son of a Methodist minister, possesses the even temperament needed to lead the organization in this fractious period.

“One thing about him, he always keeps his cool,” said Russ Jackson, senior vice president of Florida Medical Association, where Wilson once served as president.

———

Despite the considerable resources it pours into influencing Congress and the executive branch, some health care experts say AMA’s clout has waned.

Robert Moffit, a health care specialist at the conservative Heritage Foundation, said at one time “the AMA was not only respected, it was feared.”

But he said over the years the proliferation of specialist groups has diluted the group’s influence.

Many of these specialists, particularly surgeons, were among the most critical of the Democratic health care reform proposals. Among AMA members, there was vocal dissent when the group threw its support behind the House and Senate bills, endorsements that were viewed as crucial in swaying some undecided Democratic lawmakers.

……..

Intensive Care

But in his address at the AMA convention in Chicago last week, Wilson promised to mend those divisions and hold regular conference calls to reach out to the group’s members.

The tensions over the direction of the organization were reflected in a rare three-way race to become the group’s next president-elect, which was held at their Chicago meeting.

Peter Carmel, a pediatric neurosurgeon from New Jersey, won that race, and he will take the helm of the organization in June 2011.

Carmel vowed to take a tougher stand toward Washington.

“The AMA is going to be more insistent and little edgier with its relationships with Congress and the administration in demanding some of the things we doctors need,” Carmel told the Chicago Tribune.

But for the time being, even one of the more outspoken AMA members said he was willing to give the new leadership a chance.

Donald Palmisano, a New Orleans physician who was active in the conservative faction opposing health care reform, called Wilson “a fine gentleman.”

But Palmisano, a former AMA president, noted that the group’s leaders are bound by policies set by its board of delegates. The test for Wilson, he said, is whether he will be able to effectively communicate those policies on issues such as Medicare physician payment formula.

“I’m going to give Dr. Wilson the benefit of the doubt,” he said.

———-

DJP Comment: I just wrote the reporter who was very nice during the interview, complimented him on the article, and thanked him for calling and interviewing me. I also pointed out:

————

You wrote: “policies set by its board of delegates.”

It should be “policies set by its House of Delegates.” (approximately 535 delegates)

Second point:

You wrote: “…faction opposing health care reform, ”

It should be: “…faction supporting health system reform but opposing the bill that became law.”

If there is an opportunity to put that in a posting on your Website, you have my permission.

———–

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————

Breaking news from AMA:

The AMA learned that the House intends to consider the Senate-passed bill (H.R. 3962) that would provide a 2.2 percent Medicare fee schedule update for physician services through November 2010. This update would replace the 21 percent cut currently in effect, and be applied retroactively to claims for services provided on or after June 1. The bill will be considered on the House floor under suspension of the rules at about 5:30 EDT this evening.

Terri Marchiori

American Medical Association

Director, Federation Relations

312.464.5271

terri.marchiori@ama-assn.org

————————–

Stay well,

Donald

P.S. Stop by http://twitter.com/djpNEWS and sign up for DJPNEWS to get tweet alerts that may not make it into DJP Updates. Twitter is free and takes minutes to join. Put email in and pick password. Great source of breaking news and you don’t flood your email with it. You can get free app for BlackBerry or IPhone etc and you check on tweets when you want.

Also, recent selected DJP Updates can be found at: http://www.donaldpalmisano.com/html/djp_update/

Donald J. Palmisano, MD, JD
Intrepid Resources® / The Medical Risk Manager Company
5000 West Esplanade Ave., #432
Metairie, Louisiana USA 70006
504-455-5895 office
504-455-9392 fax
DJP@donaldpalmisano.com
www.donaldpalmisano.com
www.onleadership.us

This DJP Update goes to 2261 leaders in Medicine representing all of the State Medical Associations and over 100 Specialty Societies plus some other friends.
You can share it with your members and it has the potential to reach 800,000 physicians.
To join the list, send me an email stating “Join DJP Update” To get off the list, state “Remove DJP Update”. Best to put in Subject line so I can do immediately.

ITEM ONE: DJP Update 6-21-2010 “Grandfathered” Health Plans regulation issued by HHS And now the regulations start! Be alert and monitor these regulations that implement the disaster in the details new law. We are moving in the direction of more government control of Medicine and lack of choice by patients of Free Enterprise alternatives. You can count on it. My CPA send me some information about “Grandfathered” health plans from a summary of the regulation at: http://www.sebsla.com/n-news/article.asp?id=40 and that link also gives the link to the Federal Website that has information of new regulation by HHS. The HHS press release of June 14, 2010 can be found at: http://www.hhs.gov/news/press/2010pres/06/20100614e.html Here is info from Federal Government Website that includes discussion of “Grandfathered” Health Plans and how that status can be lost. http://www.healthreform.gov/newsroom/keeping_the_health_plan_you_have.html Today, the Departments of Health and Human Services, Labor, and Treasury issued a new regulation for health coverage in place on March 23, 2010 that makes good on that promise by… Another excerpt: Plans will lose their grandfathered status if they choose to make significant changes that reduce benefits or increase costs to consumers. If a plan loses its grandfathered status, then consumers in these plans will gain additional new benefits including: Coverage of recommended prevention services with no cost sharing; and Patient protections such as guaranteed access to OB-GYNs and pediatricians. Under the Affordable Care Act, these requirements are applicable to all new plans, and existing plans that choose to make the following changes that would cause them to lose their grandfathered status. Compared to their polices in effect on March 23, 2010, grandfathered plans: Cannot Significantly Cut or Reduce Benefits. For example, if a plan decides to no longer cover care for people with diabetes, cystic fibrosis or HIV/AIDS. Cannot Raise Co-Insurance Charges. Typically, co-insurance requires a patient to pay a fixed percentage of a charge (for example, 20% of a hospital bill). Grandfathered plans cannot increase this percentage. Cannot Significantly Raise Co-Payment Charges. Frequently, plans require patients to pay a fixed-dollar amount for doctor’s office visits and other services. Compared with the copayments in effect on March 23, 2010, grandfathered plans will be able to increase those co-pays by no more than the greater of $5 (adjusted annually for medical inflation) or a percentage equal to medical inflation plus 15 percentage points. For example, if a plan raises its copayment from $30 to $50 over the next 2 years, it will lose its grandfathered status. Cannot Significantly Raise Deductibles. Many plans require patients to pay the first bills they receive each year (for example, the first $500, $1,000, or $1,500 a year). Compared with the deductible required as of March 23, 2010, grandfathered plans can only increase these deductibles by a percentage equal to medical inflation plus 15 percentage points. In recent years, medical costs have risen an average of 4-to-5% so this formula would allow deductibles to go up, for example, by 19-20% between 2010 and 2011, or by 23-25% between 2010 and 2012. For a family with a $1,000 annual deductible, this would mean if they had a hike of $190 or $200 from 2010 to 2011, their plan could then increase the deductible again by another $50 the following year. Cannot Significantly Lower Employer Contributions. Many employers pay a portion of their employees’ premium for insurance and this is usually deducted from their paychecks. Grandfathered plans cannot decrease the percent of premiums the employer pays by more than 5 percentage points (for example, decrease their own share and increase the workers’ share of premium from 15% to 25%). Cannot Add or Tighten an Annual Limit on What the Insurer Pays. Some insurers cap the amount that they will pay for covered services each year. If they want to retain their status as grandfathered plans, plans cannot tighten any annual dollar limit in place as of March 23, 2010. Moreover, plans that do not have an annual dollar limit cannot add a new one unless they are replacing a lifetime dollar limit with an annual dollar limit that is at least as high as the lifetime limit (which is more protective of high-cost enrollees). Cannot Change Insurance Companies. If an employer decides to buy insurance for its workers from a different insurance company, this new insurer will not be considered a grandfathered plan. This does not apply when employers that provide their own insurance to their workers switch plan administrators or to collective bargaining agreements. ———- ITEM TWO: An alert from AMA eVoice® Alert June 21, 2010 How will you get paid for your Medicare claims? You may have received conflicting reports about how Medicare claims for services provided on or after June 1, 2010, will be processed since Congress failed to send legislation to President Obama in time to avert implementation of the scheduled 21 percent payment cut. The AMA checked again today with senior officials at the Centers for Medicare and Medicaid Services, and physician claims submitted for services provided in June are in fact being processed under the reduced payment rate on a rolling, first in/first out basis. In other words, claims submitted earliest are now being paid at the reduced rate, while newer claims will continue to be held for a 10-day period until the president is able to sign legislation into law. The AMA still anticipates that whatever legislation is passed will apply retroactively to all services provided since June 1, and that claims that have already been processed will be adjusted automatically without physicians having to resubmit them. The AMA expects Congress to resolve the issue before the end of the week and will keep you updated on new developments. ———— DJP COMMENT: I had a dream that AMA advocated in the press for AMA policy of private contracting and balance-billing without penalty and ran large ads nationwide. But, alas, it was a dream! Help turn the AMA House of Delegates policy into reality. Write AMA and tell AMA to get moving on this issue. LAGNIAPPE: Just did a tweet about this new IPhone software for IPhone 4 that will work with some of the current models of IPhone: IPhone iOS 4 Software Update now available http://bit.ly/12tj1X & works with 3GS & 3G Stay well, Donald P.S. Stop by http://twitter.com/djpNEWS and sign up for DJPNEWS to get tweet alerts that may not make it into DJP Updates. Twitter is free and takes minutes to join. Put email in and pick password. Great source of breaking news and you don’t flood your email with it. You can get free app for BlackBerry or IPhone etc and you check on tweets when you want. Also, recent selected DJP Updates can be found at: http://www.donaldpalmisano.com/html/djp_update/ Donald J. Palmisano, MD, JD Intrepid Resources® / The Medical Risk Manager Company 5000 West Esplanade Ave., #432 Metairie, Louisiana USA 70006 504-455-5895 office 504-455-9392 fax DJP@donaldpalmisano.com www.donaldpalmisano.com www.onleadership.us This DJP Update goes to 2260 leaders in Medicine representing all of the State Medical Associations and over 100 Specialty Societies plus some other friends. You can share it with your members and it has the potential to reach 800,000 physicians. To join the list, send me an email stating “Join DJP Update” To get off the list, state “Remove DJP Update”. Best to put in Subject line so I can do immediately.