The DJP Update

DJP Update 3-15-2010 Shell games and the health bill; PAC donations of “health professionals” by organization; President Obama’s speech today in Strongsville, Ohio

ITEM ONE: Shell games and the health bill

Yes, the “reconciliation bill” released last night is a shell. Sort of a place-holder. The final version has not been posted. Yet we are told the bill must be rushed through this week! And now the deals begin. Remember the old movies and the “shell game”? Guess where the pea is. But slight-of-hand gives the win to the dealer of the shells. Hard to get rid of that memory as one watches the drama unfolding in D.C. But be VERY CAREFUL reading what is in the “shell” as some of those items may remain. Instead of trust but verify, one should consider: don’t trust promises, verify every item in the bill to be voted, assuming it does get a true vote rather than the “Slaughter Solution” which would bypass a vote on the actual bill. Watch for the deals and the failure to remove some of the shocking deals placed in the Senate bill. Be on the lookout for replacement of the Brooklyn Bridge, adding to Mount Rushmore National Memorial in South Dakota, and on and on. But I jest. I certainly hope so. But be on the lookout for retention of the Senate special favors. I do predict the SGR will not get a permanent fix. I can hear it now, “It just couldn’t be done at this time, Doctor. Keep donating to our party and we will continue to work on it. And get some knee-pads when you come to pay homage to the power-brokers in Washington, DC. That helps when you genuflect. We have the power and we command loyalty and a show of obedience.”

Speaking of donations, that will be in Item Two.

Meanwhile, check out this Weblink to the Washington Post: http://www.washingtonpost.com/wp-dyn/content/article/2010/03/14/AR2010031401388.html?wpisrc=nl_pmopinions

It gives the opinion of Paul Ryan of Wisconsin, the ranking Republican on the House Budget Committee. He gives his criticism of the current bill and the reconciliation game, offers alternatives, Patients’ Choice Act, as well as his own plan, “A Roadmap for America’s Future, and then ends with this:

“If this debate had actually been about health care, we could have worked together to get a grip on costs, make quality care more accessible, address exclusions for preexisting conditions and realign the incentives of insurance companies with those of patients and doctors. Yet this process — including its embarrassing conclusion — demonstrates that the debate has never been about health-care policy but, instead, paternalistic ideology.

“Should the Democrats’ health-care train wreck make it to the president’s desk, it will be a pyrrhic victory, and its devastating consequences will take their toll on our health-care system, our budget and our economy.”

———

ITEM TWO: PAC donations of “health professionals” by organization as reported on page 34 of January 11, 2010 issue of Modern Healthcare. Twenty organizations are listed. The info comes from the Federal Election Commission on July 17, 2009 for Jan. 1, 2007 to Dec. 31, 2008.

Check it out. Here are a few examples. The #1 donor is the American Dental Association ($1,923,390). Note that the dentists are not covered under most of the onerous government provisions physicians are. 55% of donations went to Democrats. #2 is the American Medical Association ($1,464,450) and 56% went to Democrats. The American College of Cardiology is listed as #13 and gave $678,416 of which 59% went to Democrats. Note the “limited-license” folks:

American Podiatric Medical Association gave $658,500 and 72% went to Democrats. The American Nurses Association gave $562,466 and 86% went to Democrats. Interesting, for sure. Does any of this increase the interest in “scope of practice” issues when these groups go to Washington? Does the proposed new legislation increase the power of these groups? You decide.

What the article doesn’t mention is the donations from the trial lawyers as they are not health professionals. I don’t have the time to do the research and compare apples to apples but if you have nothing to do, you can research it yourself. A quick look on the Federal Election Commission Website ( /www.fec.gov ) shows, for a different period, the following for the new name of ATLA “American Association for Justice” PAC: $3,252,346 distributed for the 2009-2010 cycle. See http://query.nictusa.com/cgi-bin/cancomsrs/ But to be fair, research the same dates. As for cash on hand, see this link http://www.fec.gov/press/press2009/20090415PAC/documents/27top50tradecash2008.pdf and note AAJ is #5 and AMA is #23 as of Dec 31, 2008.

Enough of this diversion.

——–

ITEM THREE: President Obama’s speech today in Strongsville, Ohio

President Obama, as usual, made effective use of the rhetorical device “Anaphora”, the repetition of a word or phrase at the beginning of a series in his speech today in Ohio. See Page 89 of the Communication chapter in my book, “On Leadership…” for other examples of anaphora used by President Ronald Reagan and Winston Churchill. Churchill example: “We shall fight on the beaches, we shall fight in the fields, …”. President Obama does anaphora well. President Obama today also said, “We need courage!” “This is not about elections.” “…waiting for us to lead!” “Do what’s right!” “I don’t know about the politics.”

I certainly agree with the statements of ” We need courage”; I certainly agree with “Do what’s right!” I certainly agree that Congress and the President should do what is in the best interest of the patients and the USA. What I don’t agree with is the current bill that Congress is trying to pass. So we can all be for covering the uninsured. We can all be for putting the patient in charge. We all can be for reducing the cost of medical care. But we must examine the bill to see if it does that or merely makes the situation worse and leads to fiscal disaster and loss of access to care. So words are great but one must have the proper policy to make those words come true and get to the destination stated by the words. You can’t get to the French Quarter in New Orleans by swimming across Lake Pontchartrain to the North Shore. Wrong direction!

Let every organization interested in this health system reform debate reflect on “Courage” and “Do what’s right!”. And forget the politics and seats at tables. Do the right thing and no one can criticize you for whatever happens if you stay true to the policy and principles of the organization. And there comes a time when someone in an organization has to speak up and not fall prey to “groupspeak” or “true believer” status. Emulate Dr. John Snow of London in the Cholera epidemic and follow the facts no matter what the “leaders” say you must do. That is how progress is made and lives saved. The Nation waits. The Nation watches. This is the final play in this drama. May each and everyone sleep well at night knowing they entered the arena, they fought the good fight, and at the end they were unbowed.

On Thursday through Saturday, Robin and I attend a meeting, the International Conference on World War II, March 18-20, at the National World War II Museum in New Orleans, http://www.ddaymuseum.org/

We are inspired always when we attend seminars there. Men and women who had the courage to fight and die for liberty and freedom in the Second World War. Lots of sacrifices made then. We all should keep in mind that courage. I also will start back with interviews tomorrow and hope that all doctors can speak out, do interviews, and reach out to the Representatives in Congress. Don’t let the folks in Congress said, “If only you had contacted me.”

Oh, yes, don’t forget to drop the AMA Board a note about your views. Easy to reach them. As I have stated in previous emails, put first name period last name AT ama-assn.org

Examples:

President: James.Rohack@ama-assn.org

Chair: Rebecca.Patchin@ama-assn.org

You can get the list of all on the Board at AMA Website. Go to: http://www.ama-assn.org/ama/pub/about-ama/our-people/board-trustees/our-members.shtml

Effective two-way communication is essential for leadership. Remember, this is the week!

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 2223 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 3-14-2010 House vote count Senate health bill – still short & full press on to get more votes; Meanwhile AMA…; Patient Privacy in GB; LAGNIAPPE

Let’s do AMA first. Meanwhile AMA…

AMA responds in writing to individual doctors as well as the Coalition of State Medical and National Specialty Societies who urge in writing with good arguments that AMA openly oppose the Senate bill and encourage the House not to vote for it. AMA refuses to do so stating, in writing, to those letter writers that AMA is studying and negotiating. Well, let me not summarize AMA’s position. Read the letter yourself from AMA Board Chair:

I have received your letter that urges the AMA to immediately and publicly announce opposition to passage of the Patient Protection and Affordable Care Act (H.R. 3590) by the House of Representatives without waiting to analyze legislative language in a reconciliation bill that will alter provisions in the Senate bill.

The views expressed in the attached sign on letter have been respectfully and thoroughly considered by the AMA leadership.

The AMA continues to be engaged in active discussions with the Administration and Congressional leaders on modifications of the Independent Payment Advisory Board as it applies to physician. These efforts go well beyond sending letters staking out a position and involve potential provisions in the reconciliation bill that would benefit physicians and their patients. Issuing a letter of opposition prior to the conclusion of current discussions on the IPAB provisions would foreclose the ability to secure significant policy changes.

The reconciliation legislation will alter the Senate passed bill in a number of ways. With House floor votes on a reconciliation bill not expected before March 19 (and possibly later) there is still time and opportunity for the AMA to forcefully register its views on the final health system reform package. We believe the proper course is to defer a decision on whether to urge Congress to oppose or support passage of the final bill until it is apparent that we are no longer able to secure important modifications and after we have analyzed the legislative language for the reconciliation bill.

Over the next several days the AMA will provide a steady stream of communications on critical decisions with far-reaching consequences for physicians, patients and the nation.

Sincerely

Rebecca J Patchin, MD

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DJP Comment: Individual doctors, after careful consideration, have respectfully responded to the letter of the AMA and pointed out that the “Independent Payment Advisory Board” is just one of many onerous provisions in the Senate bill. Even if that item was removed, the bill still is a disaster. As one doctor active in AMA said to the Board, “Why do we think we can negotiate something in the reconciliation bill when we were unable to negotiate anything of significance in the original bill?” He also pointed out there already is a 36% loss of AMA membership in his state! He added “Do you not see the benefits of defeating bad legislation and starting over?”

Another doctor, prominent in his specialty leadership and active in the AMA House of Delegates also wrote the AMA Board and pointed out at least 16 onerous provisions in the Senate bill and specifically listed 16 of them. He urged the board to “immediately reject HR 3590.”

Congratulations to these individual doctors and to the Coalition of State Medical and National Specialty Societies for having the courage and leadership to speak out and try to save AMA from continuing a losing approach to health system reform.

No phone conferences with the House of Delegates sometime in the future can justify continuing this position of AMA. Many will think the phone conference will be used as “cover”. AMA policy is clear. Implement it now and that means opposing this Senate bill. Future students of AMA history will not give AMA the benefit of “Too little, too late.” The criticism will be harsher and AMA will become a non-player in the politics of Medicine. And what percent of dues-paying members will AMA have at that time? For the pilots among you, this is a “flat-spin” down to a crash! (Flat Spin. “A spin in which the tail of the aeroplane drops and the machine rotates in an almost horizontal plane. Recovery from a flat spin is difficult and sometimes impossible.”)

NOW CONGRESS and VOTES

DJP Comment about Congress: The vote count varies from hour to hour depending on who is speaking with you. At the moment, I believe it is about 5 votes short for passage of the Senate bill in the House. But to believe that, you have to assume that what someone is telling you at this moment will be the position taken at the vote. All sorts of additions and promises can influence votes as we have witnessed in the Senate deals. Be confident that the vote in the House will take place without delay the moment the majority vote is obtained, if it is obtained. That could be in the next few days and the “reconciliation vote” could be an express train that passes AMA up as AMA waits at the station! AMA opposing the bill immediately could alter the history of this bill and give cover to those Democrats who are looking for an excuse to vote against it! But I keep repeating myself. Sorry for rehashing old news!

The latest idea floated is the alleged “Slaughter Solution”. See last article excerpt below.

——-

Excerpt from WSJ online: http://online.wsj.com/article/SB10001424052748703457104575121604005269006.html?mod=WSJ_hpp_MIDDLTopStories

By GARY FIELDS and DARRELL A. HUGHES

WASHINGTON—White House adviser David Axelrod conceded that efforts to secure enough support to pass the party’s health-care bill was proving “a struggle,” but voiced confidence that Democrats would ultimately get enough votes.

Mr. Axelrod was one of several Obama administration and Democrat leaders who took to the airwaves on Sunday to talk about the health-care overhaul, as the Democrats’ push to pass one of President Barack Obama’s signature initiatives enters what could be a final stage.

Asked on CNN’s “State of the Union” whether he thought Democrats had the votes to pass the bill, Mr. Axelrod said: “I think we will have the votes to pass this. Obviously this is a struggle.”

House Minority Leader John Boehner (R., Ohio), appearing on the same show, was less sanguine. If House Speaker Nancy Pelosi (D., Calif.) “had [the] 216 votes [needed to pass the legislation in the House], the bill would be long gone,” he said.

——–

EXCERPT from Reuters: http://www.reuters.com/article/idUSN1414766520100314

White House confident of House approval this week

(Adds Gibbs, Boehner quotes, details)

By John Whitesides

WASHINGTON, March 14 (Reuters) – White House officials on Sunday confidently predicted quick final passage of healthcare reform but a top Democratic vote-counter said the party still needs to line up more support in the House of Representatives.

With President Barack Obama’s sweeping healthcare overhaul headed for a final House vote this week, House Democratic Whip James Clyburn said Democrats were short for now of the 216 votes needed but he was confident they could find them.

“We don’t have them as of this morning, but we’ve been working this thing all weekend, we’ll be working it going into the week, I’m also very confident that we’ll get this done,” Clyburn, the No. 3 House Democrat who is entrusted with lining up the party’s votes, said on NBC’s “Meet the Press.” …..

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EXCERPT about “Slaughter Solution” to Senate bill in House from info at Washington Examiner quoting National Journal’s Congress Daily

House Democrats looking at ‘Slaughter Solution’ to pass Obamacare without a vote on Senate bill UPDATED!

By: Mark Tapscott

Editorial Page Editor

03/10/10 4:17 PM EST

Read more at the Washington Examiner: http://www.washingtonexaminer.com/opinion/blogs/beltway-confidential/House-Democrats-looking-at-Slaughter-Solution-to-pass-Obamacare-without-a-vote-on-Senate-bill-87267402.html#ixzz0iC692IsI

Would House Speaker Nancy Pelosi and her fellow House Democratic leaders try to cram the Senate version of Obamacare through the House without actually having a recorded vote on the bill?

Not only is the answer yes, they would, they have figured out a way to do it, according to National Journal’s Congress Daily:

“House Rules Chairwoman Louise Slaughter is prepping to help usher the healthcare overhaul through the House and potentially avoid a direct vote on the Senate overhaul bill, the chairwoman said Tuesday.

“Slaughter is weighing preparing a rule that would consider the Senate bill passed once the House approves a corrections bill that would make changes to the Senate version.

“Slaughter has not taken the plan to Speaker Pelosi as Democrats await CBO scores on the corrections bill. ‘Once the CBO gives us the score, we’ll spring right on it,’ she said.”

Each bill that comes before the House for a vote on final passage must be given a rule that determines things like whether the minority would be able to offer amendments to it from the floor.

In the Slaughter Solution, the rule would declare that the House “deems” the Senate version of Obamacare to have been passed by the House. House members would still have to vote on whether to accept the rule, but they would then be able to say they only voted for a rule, not for the bill itself.

Would that rationale fly with the public? Is it logical? Of course not. ……….

————————

DJP comment: And remember that the folks in the House of Representatives will be voting on the Senate bill without knowing the exact wording in the so call “reconciliation bill”. A word here, a word there, and suddenly the bill has a new meaning. What a mess! No wonder Congress has such a low favorable rating. “Voter unhappiness with Congress has reached the highest level ever recorded by Rasmussen Reports as 71% now say the legislature is doing a poor job.” http://www.rasmussenreports.com/public_content/politics/mood_of_america/congressional_performance

—————

Patient Privacy in Great Britain: this just in. Here is an excerpt. Go to link for full article. A lesson for USA?

http://www.timesonline.co.uk/tol/life_and_style/health/article7061017.ece

From The Sunday Times

March 14, 2010

Briefing: NHS database

Doctors have accused the government of entering the personal medical records of NHS patients into a central system without their consent

Breakneck speed

NHS accused of ignoring patients’ right to opt out

The confidential medical records of patients are being placed on a new National Health Service database without their consent, it emerged last week. The British Medical Association (BMA) accused the government of rushing the project through “at breakneck speed”, uploading patients’ details before they have had a chance to object. It comes amid fears that information will be targeted by hackers, and follows allegations that the government is hurrying to finish the project before the Conservatives can cancel it, as they have promised. In a letter to ministers published last week, Hamish Meldrum, the BMA chairman, urged the government to suspend the scheme, which he said risked damaging patients’ relationship with their doctors.

…..

In April 2007 a report by the House of Commons public accounts committee concluded: “This is the biggest IT project in the world — and it is turning into the biggest disaster.” Last October, it was revealed that more than 14,000 people were being forced to wait at least six months for hospital treatment or tests because staff at Barts and the London NHS Trust, one of the first health authorities to upgrade to the system, had lost track of patients when the computerised records were introduced.

Security fears

Doubts over government’s ability to look after data

Since HM Revenue & Customs lost computer disks containing the details of 25m child benefit recipients in 2007, the government’s appetite for retaining personal data and questions over its ability to guard it have come increasingly under the spotlight. …….

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LAGNIAPPE:

“Ozymandias”, the 1918 sonnett of Percy Bysshe Shelley, is writing that I reflect on during this Congressional battle. As one commentator said, the poem reflects “Pride before the Fall”.

Think of the “spin” about the Senate bill; think about the math used to promote it; think about the view that the bill will not solve the problems it purports to fix; think about the arrogance that the Public doesn’t understand how more government control will help. What is the problem with starting over with specific changes that truly would benefit patients and keep doctors in practice? No rational reason is given for not starting over. Health system reform doesn’t need 2700 pages of law that the majority of the public is against. Reform can be done in 40 pages or less. Significant events occurred with less words: think Declaration of Independence; think U.S. Constitution and the Bill of Rights portion of the Constitution. Passing a bill with disaster in the details may give rise to a celebration for those in power at the moment but the long-term consequences will not make an addition on their CV that history will praise.

Ozymandias

BY PERCY BYSSHE SHELLEY

I met a traveller from an antique land,

Who said—“Two vast and trunkless legs of stone

Stand in the desert. . . . Near them, on the sand,

Half sunk a shattered visage lies, whose frown,

And wrinkled lip, and sneer of cold command,

Tell that its sculptor well those passions read

Which yet survive, stamped on these lifeless things,

The hand that mocked them, and the heart that fed;

And on the pedestal, these words appear:

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.”

http://www.poetryfoundation.org/archive/poem.html?id=175903

———

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.

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 2223 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 3-12-2010 AMA HSR Bulletin; Coalition of State Medical & National Specialty Societies letter to Congress; Lagniappe

Lots going on in Congress! We certainly do live in interesting times!

Meanwhile, here is some information from two sources. First, AMA’s Health System Reform Bulletin in part.

———

From: health.system.reform.bulletin@enews.ama-assn.org

Subject: Timeline announced for health system reform legislation

Date: March 12, 2010 5:23:58 PM CST

March 12, 2010

Here’s your regular update on efforts by the American Medical Association (AMA) to work with lawmakers in reforming the nation’s health care system in a way that provides quality, affordable health care for all.

Speaker Pelosi announces timeline for reform legislation

House Speaker Nancy Pelosi informed House Democrats today that there are plans to hold a House floor vote on health system reform in the coming week, and said that members should be prepared to stay in session through next weekend and into the following week, if necessary. The House Budget Committee is scheduled to start the process on Monday, March 15, with a mark-up of the reconciliation bill scheduled to begin at 3 p.m. and conclude at midnight.

Legislative language for the reconciliation bill, which will contain amendments to the Senate-passed health system reform legislation as well as a college student aid package, has not yet been circulated. It has been widely reported that at least two provisions designed to obtain key Senate votes will be eliminated by the reconciliation bill and that the tax on high-cost health plans will be modified to apply only to individuals with incomes of more than $250,000.

Currently, the House plans to hold a single floor vote that will include the reconciliation provisions and the health reform bill passed by the Senate on Christmas Eve. After House passage, the original Senate bill will be sent to President Obama for signature and the reconciliation bill will be sent to the Senate for passage. Details on the reconciliation bill are expected to be released by the administration and House leadership on or before Monday.

At press time, the reconciliation legislative language had yet to be finalized. The AMA continues to be involved in ongoing discussions with administration officials and congressional leaders regarding necessary changes in the Independent Payment Advisory Board provisions that apply to physicians.

————

Now the second source. Meanwhile, here is the letter sent to Congress from the Coalition of State Medical and National Specialty Societies:

Go to: http://www.donaldpalmisano.com/html/djp_update/coalition_djp.pdf

or you can access it from the tweet I sent out:

http://twitter.com/djpNEWS

85,000 doctors oppose #hcr #Senate bill – 3-10-2010 letter to Congress http://tinyurl.com/y9dx5we

———————

Excerpt from letter’s introduction:

———

The undersigned state and national specialty medical societies — representing more than 85,000 physicians and the millions of patients they serve — are writing to oppose passage of the “Patient Protection and Affordable Care Act” (H.R. 3590) by the House of Representatives.

The changes that were recently proposed by President Obama do not address our many concern with this legislation, and we therefore urge you to draft a more patient-centered bill that will reform the country’s flawed system for financing healthcare, while preserving the best healthcare in the world. While we agree that the status quo is unacceptable, shifting so much control over medical decisions to the federal government is not justified and is not in our patients’ best interest. We are therefore united in our resolve to achieve health system reform that empowers patients and preserves the practice of medicine — without creating a huge government bureaucracy.

There are a number of problems associated with H.R. 3590 as passed by the Senate in December, including: …….

(MORE EXCERPTS)

-undermines the patient-physician relationship and empowers the federal government with even greater authority….

-The bill is unsustainable from a financial standpoint.

-Largely unchecked by Congress or the courts, the federal government would have unprecedented authority to change the Medicare program through the new Independent Payment Advisory Board and the new Center for Medicare & Medicaid Innovation. Specifically, these entities could arbitrarily reduce payments to physicians for valuable, life-saving care for elderly patients — …….

-The bill is devoid of proven medical liability reform measures that have been shown to reduce costs in demonstrable ways.

Our concerns about this legislation also extend to what is not in the bill. Two important issues

include:

-The right to privately contract is a touchstone of American freedom and liberty.

-For healthcare reform to be successful, Medicare’s Sustainable Growth Rate (SGR) must be permanently repealed — something the Senate bill fails to do.

We are at a critical moment in history. America’s physicians deliver the best medical care in the world, yet the systems that have been developed to finance the delivery of that care to patients have failed. With congressional action upon us, we are at a crossroads. One path accepts as “necessary” a substantial increase in federal government control over how medical care is delivered and financed. We believe the better path is one that allows patients and physicians to take a more direct role in their healthcare decisions. By encouraging patients to own their health insurance policies and by allowing them to freely exercise their right to privately contract with the physician of their choice, healthcare decisions will be made by patients and physicians and not by the government or other third party payers.

—————

DJP Comment: Please read the entire letter at the link above.

Note the organizations signing the Coalition letter plus the three former presidents of AMA who are associate members of this Coalition. Only organizations that sit in the AMA House of Delegates can be full voting members in this Coalition. Consider having your organization join. Contact David Cook at Medical Association of Georgia: DCook@mag.org

Medical Association of the State of Alabama

Medical Society of Delaware

Medical Society of the District of Columbia

Florida Medical Association

Medical Association of Georgia

Kansas Medical Society

Louisiana State Medical Society

Missouri State Medical Association

Medical Society of New Jersey

South Carolina Medical Association

American Academy of Facial Plastic and Reconstructive Surgery

American Association of Neurological Surgeons

American Society of Breast Surgeons

American Society of General Surgeons

Congress of Neurological Surgeons

Daniel H. Johnson, Jr., MD

AMA President 1996-1997

Donald J. Palmisano, MD, JD, FACS

AMA President 2003-2004

William G. Plested, III, MD, FACS

AMA President 2006-2007

————

DJP Comment: This letter to Congress by the Coalition of State Medical & National Specialty Societies is not sent on behalf of insurance companies, lawyers, drug companies, or any other people opposed to health system reform. These organizations and individuals in the Coalition of State Medical & National Specialty Societies want health system reform done properly and they helped pass AMA policy that binds AMA. In fact, you know most of them. The message in this Coalition letter is AMA policy. Wouldn’t it be great if AMA sent such a letter! Clock continues to tick. We watch, we wait.

Spread the word to defeat the current bills being pushed through Congress. And keep reviewing the poem “If” by Kipling when people attack you personally, allege sinister motives, and refuse to deal with the facts. Remember, Santa Claus is not going to supply the funding for this disaster bill. Nor is Santa Claus going to restore your liberty to privately contract with patients without penalty. Congress will not go to a indemnity payment and allow private contracting. That would mean doctors would not have any need to beg each year about the inadequate payment by government. That would mean the folks in Congress would lose power over doctors! And it might affect their political contributions. Reality is what is written in the bill and not some fanciful dream of what it might mean or could be. Reality exists. Organized Medicine needs to stop being treated like a puppet! And it is easy to do. Just say no to the bill and state what is needed to put the patients in control with the doctor as trusted advisor. Let patients have money at risk when they make medical choices. Let information flow easily to patients so they can make those choices wisely.

Never forget that the individuals in Congress and the administration are not going to have the skills to save the life of a patient in the ER, drain the blood clot pressing on the brain of a child who was hit by a car while chasing his basketball that went into the street, help a woman deliver a baby that has the shoulder stuck in the pelvis, and the myriad of other caring events every day in the life of physicians in this great Land of Liberty. The current situation exists only because of the sanction of the victim. In this case, the doctors and patients are the victims. End the political games and let statesmanship enter the negotiations. Get rid of fear!

Lagniappe: I will be interviewed sometime between 8:00 a.m. and 9:00 a.m. Central, tomorrow Saturday, most likely around 8:30 a.m. for about 20 minutes. The radio station is WGSO 990 AM in New Orleans and the show is “Baldy and the Blond” (Tom Kowitz and Michele Gaudin) You probably can get it on the Web if you wish to listen live. WunderRadio App on the IPhone will pick up all Internet connected radio statiions regardless where you live or you can listen via computer and Web. Go to: http://www.nola.com/wgso/ or the livefeed at: http://wgso.com/?page_id=129

The podcast most likely will be at: http://wgso.com/?cat=24

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.

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 2221 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 3-11-2010 Senate Parliamentarian “kills an option for moving health bill”; more about the quest for votes; Meanwhile AMA plans phone conf sometime in future

ITEM ONE: Senate Parliamentarian…

ITEM TWO: More about quest for votes

ITEM THREE: AMA plans “potential” phone conference… (and a few words from Senate Harkin about “SGR” and perhaps a fix “a few years away.”

ITEM ONE: Senate Parliamentarian states Senate bill must be passed and signed by President before Senate can act on a companion reconciliation bill.

DJP comment. If these media reports are correct, then the only way the Senate Majority can get around this is to have the U.S. Vice-President overrule the Parliamentarian OR fire the Parliamentarian and get one with a different view. Either would be a media disaster!

http://www.rollcall.com/news/44110-1.html

Ruling Kills an Option for Moving Health Bill

By David M. Drucker

Roll Call Staff

March 11, 2010, 2:30 p.m.

The Senate Parliamentarian has ruled that President Barack Obama must sign Congress’ original health care reform bill before the Senate can act on a companion reconciliation package, senior GOP sources said Thursday.

The Senate Parliamentarian’s Office was responding to questions posed by the Republican leadership. The answers were provided verbally, sources said.

House Democratic leaders have been searching for a way to ensure that any move they make to approve the Senate-passed $871 billion health care reform bill is followed by Senate action on a reconciliation package of adjustments to the original bill. One idea is to have the House and Senate act on reconciliation prior to House action on the Senate’s original health care bill.

Information Republicans say they have received from the Senate Parliamentarian’s Office eliminates that option. House Democratic leaders last week began looking at crafting a legislative rule that would allow the House to approve the Senate health care bill, but not forward it to Obama for his signature until the Senate clears the reconciliation package.

Meanwhile, Senate Majority Leader Harry Reid (D-Nev.) moved Thursday to put Senate Republicans on the defensive over health care, sending a letter to Minority Leader Mitch McConnell (R-Ky.) in which he dared the GOP to vote against reform.

——————–

Also see article about Parliamentarian at: http://www.businessweek.com/news/2010-03-11/health-care-bill-path-complicated-by-parliamentarian-update1-.html

Excerpt:

House Democrats are seeking assurance that the reconciliation changes will become law. Lawmakers in the chamber originally sought to have the Senate act first on reconciliation; then they wanted Obama to delay signing the 10- year, $875 billion Senate bill until the changes were passed.

Jim Manley, a spokesman for Senate Majority Leader Harry Reid of Nevada, declined to comment. Illinois Senator Dick Durbin, the No. 2 Senate Democrat, said on March 9 that he understands why some House Democrats might not want to trust that the Senate will act on the reconciliation changes.

‘Right to Be Skeptical’

“The House has a right to be skeptical,” Durbin told reporters. “They have almost 300 bills they’ve passed” that are “somewhere lost in the Senate.”

The news from Senate Republicans, who are unanimously opposed to the legislation, comes on the same day that House and Senate leaders said they had reached agreement on the majority of the language in the new reconciliation bill. The leaders presented the outlines of the plan to House Democrats today.

“The decisions are made, the choice has to be made” by lawmakers, House Speaker Nancy Pelosi told reporters.

Reid today formally notified McConnell that the Democrats plan to use reconciliation. Republicans say the process would be an abuse of Senate procedures.

————–

ITEM TWO: New information about the potential votes for and against the Senate bill when it gets into the House.

Dems Look To Health Vote Without Abortion Foes

The Associated Press

Erica Werner

March 11, 2010

http://www.ajc.com/business/dems-look-to-health-363244.html

EXCERPTS:

WASHINGTON — House leaders have concluded they cannot change a divisive abortion provision in President Barack Obama’s health care bill and will try to pass the sweeping legislation without the support of ardent anti-abortion Democrats.

——

“We will finish the job,” Senate Majority Leader Harry Reid, D-Nev., wrote in a letter to his Republican counterpart describing the path ahead.

Said Sen. Tom Harkin, D-Iowa: “The stars are aligning for victory on comprehensive health reform. The end is in sight.”

——–

ITEM THREE: AMA sent out an email to delegates and alternates under the name of the Speaker and Vice-Speaker (Sent: Wed, Mar 10, 2010 5:15 pm.) Unfortunately, as a former president of AMA who has a non-voting seat in the House of Delegates with microphone privileges, I am not on the email list for this information. Fortunately, one of the delegates on the DJP Update list sent it to me. In summary, the AMA email said things are “fluid” and

“The AMA will review the legislative language for the reconciliation bill promptly when it is finalized and made available. This work could be completed as early as next week. Wehope to convene an HOD conference call after we have reviewed and analyzed the final legislative language. Please watch your email for scheduling and logistical information on the potential upcoming HOD conference call.”

—–

DJP: Meanwhile “Rome is burning” and the U.S. House will vote the MOMENT the vote count gives a majority. That could be any hour. The closed doors will open and the vote will be taken. The AMA “potential upcoming HOD conference call” will be like ordering one more test on a patient who is bleeding and needs immediate operation. The patient may die in the interim. Decision-making is critical in leadership. If AMA came out against the onerous Senate bill, the bill would not pass in the House as AMA opposition would give “cover” to those Democrats who are on the fence.

Meanwhile, the big “SGR” negotiation has another surprise, namely the statement by Senator Harkin:

Date: March 9, 2010

© Inside Washington Publishers

Julian Pecquet and Seth Freedland

Harkin Acknowledges Permanent SGR Repeal Could Be A Few Years Away

A permanent ‘doc fix’ is unlikely this year and may have to wait a “couple, three years” for the federal budget to get in order, Senate health committee Chair Tom Harkin (D-IA) said Tuesday morning. The comments come just days after the American Medical Association sent a letter to Senate leaders saying it opposes a short-term payment patch of any duration.

Answering a question during a CQ/HealthBeat conference, Harkin said Congress “should have fixed it a long time ago,” but now “with the deficit as high as it is, it’s hard to think about taking all that money and moving it up front to fix the problem. It’s much easier to dribble it out a little bit at a time, year after year. But at some point, we’re going to have to bite the bullet.”

“Now, is that going to happen this year?” Harkin said. “I don’t think so. Hopefully if we get out of our slump in the next couple, three years, start moving up, then perhaps we can make some fix in that.”

—–

DJP Comment: I predict Senator Harkin is correct. There will be no permanent fix of the SGR this year! If that is what our AMA is waiting for in the negotiations, AMA will be waiting like the Spartans at Thermopylae. But the Spartans put up such a heroic fight that history remembers them for all time. AMA can be a powerful voice and a powerful actor. Time to act. Time to operate. Medicine is in shock. Words mean something but actions define the person and the organization. And yes, if AMA policy was passed into law, the right to privately contract without penalty, we would not have to spend a minute on “SGR” or other price-fixing schemes. The issue would be between politicians and the public. How long must we tolerate these abuses!

Today was my seminar I teach at Tulane Medical School entitled “Leadership in Medicine”. A good group of young, soon to be graduate doctors. I try to give them hope that Medicine can be saved from the politicians. Their future is bright if they are allowed to use their creativity and conquer diseases that we now can only offer comfort for. Let’s give them a chance and not shackle them.

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.

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 2221 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 3-9-2010 AMA & The Final Vote in Congress on Health System Reform; Background info DJPNEWS on Twitter

ITEM ONE: AMA & The Final Vote in Congress on Health System Reform

Tick Tock, Tick Tock; Time is of the essence. The advocates in the Administration and in Congress are having closed door meetings to try and get a majority vote in the House to pass the Senate bill. The moment the necessary number of votes are in favor there will be an immediate vote. As of this moment, there are not enough votes in the House of Representatives to pass the Senate bill. But lots going on behind the scenes. Remember the revelations when the Senate bill was passed as the public read the fine print of the 2700 page disaster in the details bill that emerged. Can’t get the book “Animal Farm” out of my mind when I review the actions of Congress: some are more equal than others.

Now our AMA. AMA has been silent of late as to AMA position of the vote about to be taken in the House of Representatives. AMA was not at the last President Obama press conference on stage with the other stage doctors and I did not see a representative of AMA in the audience of white coats.

It is time for AMA to state to the public and send a letter to Congress that AMA opposes the Senate bill. Do a clear and unequivocal press release that states opposition. All along AMA kept saying it is working to get changes in the bills. Well, the changes did not come.

One of many examples of items AMA opposed in the Senate bill. Still in the bill!

Independent Medicare Advisory Board

AMA policy specifically opposes any provision that would empower an independent commission to mandate payment cuts for physicians, who are already subject to an expenditure target and other potential payment reductions under the Medicare physician payment system. Therefore, we oppose the Independent Medicare Advisory Board as currently designed in H.R. 3590, and we look forward to working with you on significant changes to the proposal.

( This except above from AMA: http://www.ama-assn.org/ama/pub/health-system-reform/news/december-2009/ama-comments-hr-3590.shtml )

The better fix for payment is for AMA to boldly state no price-fixing by government! Let government decide what it can pay and let doctors and patients negotiate the rest. I am tired of people saying doctors can’t be trusted!

Time to enter the arena, AMA! Reread Shakespeare’s Henry V speech on St. Crispian’s Day:

————

We few, we happy few, we band of brothers;

For he to-day that sheds his blood with me

Shall be my brother; be he ne’er so vile,

This day shall gentle his condition;

And gentlemen in England now-a-bed

Shall think themselves accurs’d they were not here,

And hold their manhoods cheap whiles any speaks

That fought with us upon Saint Crispin’s day.

————

Time for AMA to enter the field of battle. Doctors are looking for warriors to save the patient-physician relationship and the Senate bill will not decrease cost, will not increase quality, and will give a false sense of access: an insurance card that has no doctor on the other end to do the treatment. In addition, the funny math will bankrupt this Country. Let this bill fail and put forth a bill that truly addresses the current problems. Allow health insurance purchase across state lines, get real proven medical liability reform and put some penalty on those attorneys who file suits without merit, use tax credits, convert Medicaid that currently is bankrupting states into a defined contribution, allow private contracting without penalty, and more: FOLLOW SPECIFIC AMA POLICY!

It is tough trying to convince members not to quit AMA. Give us some help, AMA!

ITEM TWO: Go to http://twitter.com/djpNEWS to see recent postings on the funny math Congress is using.

Especially see: DJPNEWS: Importance of analysis! RT @bridgettwagner How government lies about cost ’savings’ | Kyle Wingfield: http://bit.ly/bo7ix7

Stay well and a special welcome to the orthopedic surgeons in New Orleans for their annual meeting! Stop by the National WWII Museum here for a powerful reminder of the cost of Liberty.

http://www.aaos.org/education/anmeet/anmeet.asp

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.

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 2209 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 3-7-2010 Critical evaluation of British National Health Service by 3 organizations (IHI, JCAHO Int. & Rand) invited by British Gov to investigate; Lessons for U.S. Congress?

Below is tweet I sent out in early hours of this day as soon as the article came out in London.

“..ugly truth National Health Service” #NHS – Congress should read this article in #Times in UK http://tinyurl.com/yhdjy4c

——–

Alternative link to National Health Service story in the United Kingdom: http://www.timesonline.co.uk/tol/news/uk/health/article7052606.ece

Here is headline and some excerpts from article by Lois Rogers in Times of London. Read the entire article.

Labour hid ugly truth about National Health Service (NHS)

(DJP comment: This article is based on 3 reports from different organizations evaluating the NHS. The reports were obtained under a Freedom of Information request. The organizations: IHI of Massachusetts, JCAHO International, and the third report, by the US-based Rand Corporation)

DAMNING reports on the state of the National Health Service, suppressed by the government, reveal how patients’ needs have been neglected.

They diagnose a blind pursuit of political and managerial targets as the root cause of a string of hospital scandals that have cost thousands of lives.

The harsh verdict on the state of the NHS, after a spending splurge under Labour between 2000 and 2008, raises worrying questions about the future quality of the health service as budgets are squeezed.

One report, based on the advice of almost 200 top managers and doctors, says hospitals ignored basic hygiene to cram in patients to meet waiting-time targets.

It says “several interviewees” cited the Maidstone and Tunbridge Wells [NHS Trust in Kent where 269 deaths during 2005-6 were caused by infection with Clostridium difficile bacteria].

“Managers crowded in patients in order to meet waiting-time targets and, in the process, lost sight of the fundamental hygiene requirements for infection prevention,” the report stated.

There were subsequent failings at health trusts in Basildon in Essex, and Mid Staffordshire. Filthy wards and nurse shortages led to up to 1,200 deaths at Stafford hospital.

Lord Darzi, the former health minister, commissioned the three reports from international consultancies to assess the progress of the NHS as it approached its 60th anniversary in 2008. They have come to light after a freedom of information request.

The first report, by the Massachusetts-based Institute for Healthcare Improvements (IHI), identified the neglect of patients as a serious obstacle to improving the NHS. “The lack of a prominent focus on patients’ interests and needs … represents a significant barrier to shifting the trajectory of quality improvement in the NHS.”

——-

Some subheadlines in the article:

A damaging rift between doctors and managers.

Pointless new structures.

A culture of fear and slavish compliance.

——-

Note that the reports by IHI of Massachusetts and JCAHO International and Rand Corporation were done at the request of the British Government.

The IHI report, whose interviewees included Lord Crisp, chief executive of the NHS between 2000 and 2006, also described a system of self-assessment where only 4% of trusts are externally inspected.

———

A similar picture emerges in the second report, by the US-based Joint Commission International. It says the “quality and integrity of [NHS] performance data is suspect”.

Dennis O’Leary, its lead author and an international expert on patient safety and improvement…

——–

A Department of Health spokesman maintained that the three reports were never intended for “wider circulation” …

———

DJP Comment: Lessons for U.S. Congress to learn?

————-

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.

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 2207 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 3-4-2010 A message from 70,000 physicians to Congress about Medicare Payment System & The Right to Privately Contract without Penalty; and a few more things!

The letter below was sent today to the U.S. House of Representatives. The same letter was addressed and sent to the Senate Majority Leader Senator Harry Reid and the Senate Minority Leader Senator Mitch McConnell plus the entire Senate.

The message in the letter is long-standing AMA policy (since 1993) and among the highest advocacy issues of AMA as voted by the policy-making body of the AMA, the House of Delegates. (Reformatting of the names and addresses for this email)

The message also respects Liberty which has been the policy of These United States of America since 1776.

Stay tuned as the health system reform debate is nearing the holiday break of Congress and the sponsors of the senate and house bills are pushing for passage of these bills with disaster in the details prior to the March 29 – April 11 recess.

The focus is on the House of Representatives at the moment and you can be certain that a vote will be taken the moment the whip count shows enough votes for passage regardless of the day or hour. Lots going on behind the scenes in Washington, DC!

Call everyone you know in the House of Representatives and tell them not to pass the Senate bill! The vote could be very close.

March 4, 2010

The Honorable Nancy Pelosi

Speaker

The Honorable John Boehner

Minority Leader

United States House of Representatives

Washington, DC 20515 Washington

Subject: Medicare Physician Payment System and Private Contracting

Dear Speaker Pelosi and Minority Leader Boehner:

For nearly a year, the Coalition of State Medical and National Specialty Societies, representing more than 70,000 physicians, has expressed deep concern with the country’s broken and unsustainable medical payment system. Congress’ failure to adopt a permanent solution to prevent draconian cuts in Medicare payments to physicians affirms our concerns. Clearly, the current system is not financially sustainable. To help stabilize the Medicare system and ensure that seniors have timely access to care by the physician of their choice, we urge you to repeal the Sustainable Growth Rate and replace it with a new payment system that allows patients and physicians to privately contract without penalty.

The right to privately contract is a touchstone of American freedom and liberty and all patients should have the right to choose their doctor and negotiate the fees for those services without penalty. Medicare patients should not be required to forego the value of their Medicare insurance benefit because they privately contract with the physician of their choice; nor should physicians who privately contract with Medicare patients be required to opt-out of Medicare altogether for two years. Furthermore, in some instances, under current law it is actually illegal for a physician to waive or reduce his or her fee. By allowing patients to privately contract with their physicians, patients will have access to a greater number of physicians. In addition,

Congress can obtain budget certainty by establishing payment rates and giving physicians and patients the freedom to privately contract for any difference.

In closing, we believe that empowering patients and physicians with the right to privately contract is both an optimum and sustainable solution when it comes to the Medicare funding crisis. Please contact David Cook, Executive Director of the Medical Association of Georgia (dcook@mag.org 678-303-9251), if you have questions, need additional information or would like to discuss this concept in greater detail with the members of our coalition.

Thank you for considering our request.

Sincerely,

Medical Association of the State of Alabama

Medical Society of the District of Columbia

Florida Medical Association

Medical Association of Georgia

Kansas Medical Society

Medical Society of New Jersey

South Carolina Medical Association

American Academy of Facial Plastic and Reconstructive Surgery

American Association of Neurological Surgeons

American Society of General Surgeons

Congress of Neurological Surgeons

Daniel H. Johnson, Jr., MD

AMA President 1996-1997

Donald J. Palmisano, MD, JD, FACS

AMA President 2003-2004

William G. Plested, III, MD, FACS

AMA President 2006-2007

cc: Members, United States House of Representatives

——–

A few other items you may find of interest:

— Watch Senator Blanche Lincoln’s new TV ad. She says she doesn’t answer to the Democratic Party. Interesting.

https://secure.democratsenators.org/o/40/p/wfc/dscc/senators/lincoln/donate?donate_page_KEY=6518

— Read the transcript of the exchange between Paul D. Ryan of Wisconsin, ranking Republican on the Budget Committee, and President Obama at the Health Summit

Congressman Ryan is full of facts. The CQ transcript is posted at the Washington Post.

http://www.washingtonpost.com/wp-dyn/content/article/2010/02/25/AR2010022504074.html

— Some recent tweets you may enjoy; click on the links for the articles:

http://twitter.com/djpNEWS

#TomHanks toasts #NewOrleans”…most special place on planet”#NOLA.com at#WWIIMuseum movie ThePacific http://tinyurl.com/yjc3brk

about 12 hours ago via Echofon

Via #TheSaints New Orleans Saints turn New Orleans into America’s City – NOLA.com: http://tinyurl.com/ylomebx

about 14 hours ago via Echofon

Like a Greek tragedy play RT @washingtonpost #DavidBroder: The fable of Emanuel the Great: http://bit.ly/9WvXGi #Obama

about 14 hours ago via Echofon

RT @TheEconomist #BarackObama unveils his final strategy for pushing health reform in America http://econ.st/aXVugy#economist

about 14 hours ago via Echofon

Advantage of using #Twitter for news even when you don’t post tweets #NYTimes http://tinyurl.com/ygmbtqk

3:08 PM Mar 3rd via web

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.

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 2207 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 3-2-2010 Breaking news: SGR decrease delayed one month; H.R. 4691 temporary extension act passes; now goes to President for signature

http://twitter.com/djpNEWS

DJPNEWS

#Senate delays #SGR doctor payment cut 1 month with passage H.R. 4691 via @SenateFloor http://bit.ly/a8T3illess than 5 seconds ago via web

This temporary extension act also includes SGR in Section 5

Section 5 – (of H.R. 4691) summary

Amends title XVIII (Medicare) of the Social Security Act to extend through March 31, 2010: (1) the 0% update to the conversion factor in the Medicare physican payment computation; and (2) the Medicare physical therapy services caps exceptions process.

——

Full text of Sec. 5: http://www.govtrack.us/congress/billtext.xpd?bill=h111-4691

SEC. 5. INCREASE IN THE MEDICARE PHYSICIAN PAYMENT UPDATE.

Paragraph (10) of section 1848(d) of the Social Security Act, as added by section 1011(a) of the Department of Defense Appropriations Act, 2010 (Public Law 111-118), is amended–

(1) in subparagraph (A), by striking ‘February 28, 2010’ and inserting ‘March 31, 2010’; and

(2) in subparagraph (B), by striking ‘March 1, 2010’ and inserting ‘April 1, 2010’.

Senate Floor tweet:

On Passage – Senate – H.R. 4691: Bill Passed 78-19, 3 not voting. Bipartisan support. Go to Bill Status : H.R. 46…http://bit.ly/9wsWsV

http://www.govtrack.us/congress/vote.xpd?vote=s2010-32

Senate Vote On Passage: H.R. 4691: Temporary Extension Act of 2010

Number:

Senate Vote #32 in 2010 [primary source]

Date:

Mar 2, 2010 8:56PM

Result:

Bill Passed

———–

Stay well,

Donald

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 2211 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 3-1-2010 Press release about physician payment cut of 21% Medicare and a little more

Don’t forget the liberty right of contracting with patients for any differences that government pays, a right physicians do not have now unless the physician gets out of Medicare for two years! In my view, that should be part of every medical organization’s message to Congress and the American public. Price-fixing throughout history always leads to loss of access to service or product.

Press release follows:

FOR IMMEDIATE RELEASE Contact: media@protectpatientsrights.org

March 1, 2010 (703) 405-9407

MEDICARE BEING CUT TODAY

Biggest story in healthcare isn’t the reform bill, it’s that already-below-market physician reimbursement rates are being cut 21% today

WASHINGTON, DC – Due to Congressional inaction, Medicare’s reimbursement rates to doctors for their care of our nation’s elderly population will be cut a staggering 21 percent today. This is a result of an unwillingness or inability – pick your poison – to permanently secure the Medicare payment formula system or to even temporarily extend the patchwork fix already in place (the Sustainable Growth Rate formula or SGR). The Coalition to Protect Patients’ Rights supports a strong Medicare and a fair formula that will provide physicians with the resources they need to treat America’s seniors and also allow patients and physicians to negotiate any differences in cost to ensure patients get the care they need.

Former president of the American Medical Association and current spokesman for the Coalition to Protect Patients’ Rights, Dr. Donald Palmisano, made the following statement on the Medicare payment cuts:

“What are physicians to do? What are senior citizens to do?

“As Congress debates, seniors are at peril of losing the medical care they desperately need. Doctors are already providing care to the nation’s seniors at a reduced rate, but this latest cut makes treating those on Medicare financially impossible for doctors, nurses, and hospitals.

“And a one-time patch isn’t going to fix the problem for long. Although more than 40 million Americans rely on Medicare for their well-being and as enrollment is expected to explode as baby-boomers age and retire, Congress has recently proposed gutting Medicare – to the tune of $500 billion. There’s no way Medicare can be cut and still provide the medical service our most vulnerable populations need. Congress must fund Medicare so that it becomes solvent, pays physicians for the work and treatments they provide, and give seniors the peace of mind they deserve.

“Unfortunately, when medicine is subject to the limits of government-control and price-fixing, patients suffer. This isn’t just the case for Medicare, but also for Medicaid, or any other government controlled healthcare system – no matter what it’s called. Congress must do what it can to empower patients and physicians in healthcare, while limiting the role of bureaucrats.”

Dr. Palmisano is also available for interviews from New Orleans, LA, today. Please contact CPPR for more information (703) 405-9407.

About the Coalition to Protect Patients’ Rights

The Coalition to Protect Patients Rights is a non-partisan, grassroots coalition made up of over 10,000 doctors, healthcare providers, advocacy groups, and concerned citizens who are dedicated to the implementation of patient-centered healthcare reform that will improve patient care. For more information, visit the Coalition to Protect Patients’ Rights website at www.protectpatientsrights.org.

###

—————-

Meanwhile, others talk of the “the growing market power of hospitals and physicians to negotiate higher payment rates-”

DJP: The overwhelming majority of physicians have no market power!

The context of the market power of physicians comes from this article:

—————

http://content.healthaffairs.org/cgi/content/abstract/hlthaff.2009.0715

While the high cost of private health insurance has drawn plenty of attention in the health reform debate, an underlying driver of higher insurance premiums–the growing market power of hospitals and physicians to negotiate higher payment rates–has gone largely unexamined, according to a Center for Studying Health System Change (HSC) study published online Feb. 25 by Health Affairs.

Funded by the California HealthCare Foundation, the study examines the growing market power of many California hospitals and physicians, finding that providers are using various strategies, such as tighter alignment of hospitals and physician groups, to negotiate significantly higher payment rates from private insurers. The authors point out that California offers a cautionary tale for reform proposals that encourage hospitals and physicians to form tighter relationships through accountable care organizations.

“Health insurers have been squarely in the crosshairs and blamed for the high cost of private insurance, while the role of growing hospital and physician market power has escaped scrutiny,” said HSC Senior Consulting Researcher Robert A. Berenson of the Urban Institute, a coauthor of the study with HSC President Paul B. Ginsburg and Nicole Kemper, a former HSC research analyst.

—————–

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.

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 2211 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 2-26-2010 Gov Price-Fixing: the end result

Quick update as boarding plane at plane change in Phoenix.

See AMA press release below.

The 21% fee cut for physicians for Medicare and Tricare takes place March 1.

Yet Congress departs!

Why would anyone want government more involved in the health system?

With the price-fixing and FORBIDDING of private contracting without penalty, it is the patients who will suffer!

Does Congess really care?

Every senior in America should loudly protest. And we all know the families of our brave military do not need any more stress with the Tricare coverage.

Shame on Congress. Why was this crisis not discussed at the Summit?

So much for Organized Medicine’s negotiating approach over this past year and “seat at the table”.

Time for a new game plan. Time for return to Liberty!

Stay well. Have to board plane.

Donald

Begin forwarded message:

From: HOD Advocacy Update <hod.advocacy.update@enews.ama-assn.org>

Date: February 26, 2010 11:27:53 AM MST

To: djp@donaldpalmisano.com

Subject: FW: AMA News: Senate Inaction on Medicare Hurts Seniors, Military and Boomers; Drastic 21% cut on March 1

Reply-To: terri.marchiori@ama-assn.org

The AMA press release on the Senate in action…

FOR IMMEDIATE RELEASE February 26, 2010

SENATE INACTION ON MEDICARE HURTS SENIORS, MILITARY AND BOOMERS

Drastic 21 percent Medicare physician payment cut will take place on Monday, March 1

WASHINGTON, D.C. – A Medicare meltdown now seems certain, as the U.S. Senate has left early for the weekend, abandoning seniors, military families and baby boomers. The Senate failed to repeal the Medicare physician payment formula that will cause a drastic 21 percent payment cut to physicians who care for Medicare and TRICARE patients. On Monday, the 21 percent cut goes into effect, forcing many physicians to limit the number of Medicare and TRICARE patients they see in order to keep their practice doors open.

“Our message to the U.S. Senate is stop playing games with Medicare patients and the physicians who care for them,” said AMA President J. James Rohack, M.D. “It is shocking that the Senate would abandon our most vulnerable patients, making them the collateral damage of their procedural games.”

Already, about one in four Medicare patients seeking a primary care physician is having trouble finding one, according to MedPAC, Congress’ advisory body on Medicare. Physicians have told AMA that steep Medicare cuts will force them to limit the number of Medicare patients they treat. A new 2010 survey of neurosurgeons found that about 60 percent are already reducing the number of Medicare patients in their practices, and cuts will force nearly 40 percent to decrease the number of new Medicare patients they see. More than 18 percent of neurosurgeons will no longer take new Medicare patients.

“The Senate had more than a year to repeal the formula and ensure the security and stability of Medicare and TRICARE, but that opportunity has been squandered,” Dr. Rohack said. “This drastic cut will hurt our senior, disabled and military patients, as well as baby boomers who start entering the Medicare program next year.”

“Last November, the U.S. House passed legislation (H.R. 3961) that would repeal the broken formula and better update payments to reflect the increasing cost of care,” Dr. Rohack said. “AARP and the Military Officers Association of America (MOAA) have joined with the AMA in calling on the Senate to act, but the Senate has turned its back on America’s seniors, military families and baby boomers.”

###

Contact:

Brenda Craine, Director, AMA Media Relations

202-789-7447

Follow AMA on Twitter at https://twitter.com/AmerMedicalAssn

About the American Medical Association

The American Medical Association helps doctors help patients by uniting physicians nationwide to work on the most important professional and public health issues. Working together, the AMA’s quarter of a million physician and medical student members are playing an active role in shaping the future of medicine. For more information on the AMA, please visit www.ama-assn.org

Brenda Craine

Director, Media Relations

25 Massachusetts Avenue, NW

Suite 600

Washington, DC 20001-7400

P: (202) 789-7447

F: (202) 789-7472

brenda.craine@ama-assn.org

AMA news on Twitter at: https://twitter.com/AmerMedicalAssn

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 2210 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.