The DJP Update

This DJP Update goes to 2309 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” in subject line.

Comments Off

DJP Update 9-30-2010 WSJ Lead Editorial 9-30-2010 re: The Repeal Pledge and the Independent Women’s Forum; Lagniappe

Sep 30

Posted by Dr. Donald Palmisano in DJP Updates

DJP Update 9-30-2010 WSJ Lead Editorial 9-30-2010 re: The Repeal Pledge and the Independent Women’s Forum; Lagniappe

DJP Comment: The November elections will be an exciting time for America. Try to get some rest that day and stay up late for the final returns. Americans are getting more and more frustrated with the happenings in Washington, DC. And that frustration is felt by citizens of all political parties. The apathy of many voters in the past is turning to activism.

Here is one example of citizens offering an alternative to grousing around the coffee pot. This is a good way to give politicians their moment of truth: Action, not words of platitude.

—–

The Wall Street Journal, September 30, 2010

The Repeal Pledge

Holding politicians to their promise to replace ObamaCare.

http://online.wsj.com/article/SB10001424052748704116004575522381254724778.html

Republicans are promising to “repeal and replace” ObamaCare, and more than a few Democrats seem to be running on—or at least from—the same issue. And it’s a good campaign platform given the rising unpopularity and toxic side effects of one of the worst pieces of legislation Congress has ever passed.

But with a few notable exceptions, the wider GOP doesn’t seem to comprehend how difficult it will be to pursue this agenda in practice, even if the party does return to the majority in the House and Senate. Which is why we want to underscore a new campaign to ensure that “repeal and replace” is something more than a political slogan.

The “repeal pledge” is a project modeled after the famous taxpayer-protection pledge of Americans for Tax Reform, under which incumbents and candidates make a public promise to vote against tax increases. The tax pledge debuted in 1986 with the endorsement of Ronald Reagan and has helped to steel opposition to antigrowth policies. The repeal pledge aims to do the same for ObamaCare.

Efforts like these can be gimmicks, though when well done they educate the public and encourage politicians to commit to specific policy goals while drawing bright-line contrasts with their opponents. Pledges also help define electoral mandates. The 2010 campaign is already a referendum on the Obama Presidency, but if the repeal pledge gains currency it would allow voters to remonstrate this bill in particular and add momentum to the “repeal and replace” movement.

Launched a week ago by the nonprofit outfits Independent Women’s Voice and American Majority Action, the repeal pledge has been signed so far by 43 Republicans. Its sponsors are about to name a board of outside policy experts to evaluate all votes and let the public track how Members shake out on health care. The pledge applies beyond repeal per se to interim steps like discharge petitions to allow certain up-or-down votes in Congress on partial repeal, stripping funding from some ObamaCare subsidy or enforcement programs, and repealing certain regulations.

Dismembering ObamaCare limb by limb is probably the best, and perhaps the only, political strategy for at least the next two years. Meanwhile, many Republicans may figure that the path of least political resistance will be to hold a symbolic vote on repeal and claim victory, even if it is filibustered in the Senate or vetoed by President Obama. Republicans are also notoriously fractious on health policy and will need outside pressure if they ever do get around to the “replace” part.

The hard political slog ahead could use an accountability tool like the repeal pledge. Realistically, the health-care bill won’t be unwound as long as Mr. Obama is in office, so the Republican goal should be to do some modest good in the meantime and keep the issue a running controversy through 2012 and beyond. Democrats are determined to defend every part of ObamaCare no matter how destructive—witness their recent safe-harbor for the 1099 business reporting mandate—and they’re banking on Republican inertia.

Republicans should recognize the opportunity they’ve been handed. According to this week’s Wall Street Journal-NBC News poll, 40% of the public strongly supports repeal, and another 11% is generally in favor. CNN also found this week that 47% believes “Congress should repeal most of the major provisions in that bill and replace them with a completely different set of proposals,” a view that has held steady since Democrats passed the bill in March.

The larger GOP opportunity is to pursue genuine health-care reform now that the public has so decisively rejected the entitlement model that Democrats have favored for several political generations. That begins with unraveling ObamaCare, and we hope the repeal pledge will help the cause.

—-

Here is the link to The Repeal Pledge http://www.TheRepealPledge.com/

and the incumbent version of the pledge is at: http://www.TheRepealPledge.com/the-repeal-pledge-incumbent-version/

Here is one of the advocates of this pledge: the Independent Women’s Forum (IWF). The Website is: http://www.iwf.org/

——

Lagniappe: Gave a speech today with President of Louisiana State Medical Society, Dr. Pat Breaux, to the first and second year students at LSU Medical School. Lots of fun.

Some recent tweets at www.twitter.com/DJPNEWS

DJPNEWS

Politicians: moment of truth; See #TheRepealPledge http://tinyurl.com/37phs7a & #WSJ editorial http://tinyurl.com/256qllg #hcr 2 minutes ago via web

Interesting analysis RT @nprpolitics #Republicans Improve Chances For Senate Control http://n.pr/bbBv8o #politics#tcot #dems8:18 PM Sep 28th via Echofon
+ sales if ext HD via USB RT @macTweeter Analyst: Apple Planning Thinner iPad with Camera, Mini USBhttp://bit.ly/a8XzG9 #apple #iPad 10:15 AM Sep 28th via Echofon
What! RT @macTweeter Senior Advisor Plays Pac Man on his iPad during White House Meetings http://bit.ly/bSTTv6 #politics #tcot 9:35 PM Sep 27th via Echofon

Stay well,

Donald

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

This DJP Update goes to 2309 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” in subject line.

Comments Off

http://www.nytimes.com/2010/09/24/opinion/24brooks.html?_r=1

DJP Update 9-27-2010 Congratulations to Philip Howard again; his latest writings bring dissent from trial lawyers

Sep 27

Posted by Dr. Donald Palmisano in DJP Updates

DJP Update 9-27-2010 Congratulations to Philip Howard again; his latest writings bring dissent from trial lawyers

DJP Comment: I will include Dave Brooks article praising Philip Howard plus Philip Howard’s article in The Daily Beast and then the tweet and link from trial lawyers giving their criticism of Philip Howard and the Brooks article.

Also, you can read more about Philip Howard and Common Good at: http://commongood.org/

Philip Howard of Common Good writes that “David Brooks devotes his New York Times column today to the need to restore responsibility in America, highlighting our ideas and calling it ‘the crucial theme of the moment.'”

The New York Times

September 23, 2010

The Responsibility Deficit

By DAVID BROOKS

One of the oddities of the current moment is that the country wants a radical change in government but not a radical change in policy.

On the one hand, voters are completely disgusted with Washington. On the other hand, they have not changed their fundamental views on the issues. There has been some shift to the right over the past two years, but the policy landscape looks mostly the way it did over the last few decades. We’re still a closely divided nation; it’s just that we’re angrier about it.

The result is that over the next two years we’ll probably see gridlock on stilts. The energized Republicans will try to reduce the size of government, but they won’t be able to get their bills past President Obama. The surviving Democrats will try to expand government programs, but they will run smack into a closely divided Senate and possibly a Republican-controlled House.

Unable to do anything in the short term, both parties will devote their energies to nothing but campaign gestures for 2012. The rhetoric will fly. Childishness will mount. Public nausea will hit an all-time high.

Somewhere in the country, though, there is a politician who is going to try to lead us out of this logjam. Whoever that person is, I hope he or she is listening carefully to what the public is saying. Because when you listen carefully, you notice the public anger doesn’t quite match the political class anger. The political class is angry about ideological things: bloated government or the predatory rich. The public seems to be angry about values.

The heart of any moral system is the connection between action and consequences. Today’s public anger rises from the belief that this connection has been severed in one realm after another.

Financiers send the world into recession and don’t seem to suffer. Neighbors take on huge mortgages and then just walk away when they go underwater. Washington politicians avoid living within their means. Federal agencies fail and get rewarded with more responsibilities.

What the country is really looking for is a restoration of responsibility. If some smart leader is going to help us get out of ideological gridlock, that leader will reframe politics around this end.

Philip K. Howard has thought hard about the decay of responsibility and what can be done to reverse it. In a series of books ranging from “The Death of Common Sense” to “Life Without Lawyers,” Howard has detailed the ways our political and legal systems undermine personal responsibility.

Over the past several decades, he argues, a thicket of spending obligations, rules and regulations has arisen, which limits individual discretion, narrows room for maneuver and makes it harder to assign responsibility.

Presidents find that more and more of their budgets are precommitted to entitlement spending. Cabinet secretaries find that their agenda can’t really be enacted because 100 million words of existing federal rules and statutes prevent innovation this way and that. Even when a new law is passed, it’s very hard to tell who is responsible for executing it because there is a profusion of agencies and bureaucratic levels all with some share of the pie.

These things weaken individual initiative, discretion and responsibility. But the decay expands well beyond Washington. Teachers don’t really control their classrooms. They have to obey a steady stream of mandates that govern everything from how they treat an unruly child to the way they teach. Doctors don’t really control their practices but must be wary of a capricious malpractice system that could strike at any moment. Local government officials don’t really govern their towns. Their room for maneuver is sharply constrained by federal mandates and by the steady stream of lawsuits that push them in ways defying common sense.

What’s needed, Howard argues, is a great streamlining. He’s not calling for deregulation. It’s about giving teachers, doctors and officials the power to actually make decisions and then holding them accountable. Some of their choices will be wrong, Howard acknowledges, but it is better to live in an imperfect world of individual responsibility than it is to live within a dehumanizing legal thicket that seeks to eliminate risk through a tangle of micromanaging statutes.

Howard proposes expanding specialized health courts, which would be more predictable than the malpractice system. He would lift controls on teachers and civil servants — giving them more freedom but then ending tenure and holding them accountable. He would create commissions to eliminate obsolete laws. He would expand judges’ discretion and end mandatory sentencing.

Howard’s agenda raises some thorny issues. But he has seized the crucial theme of the moment. If bad government undermines responsibility then it should be restructured. And he’s offering one tool a creative politician could use to break through the logjam and help us avoid a truly awful few years.

http://www.nytimes.com/2010/09/24/opinion/24brooks.html?_r=1

————-

DJP Comment: Trial lawyers, with new name of American Association for Justice (formerly known as the Association of Trial Layers of America (ATLA trademark), did the tweet below under the Twitter name of JusticeDotOrg

www.twitter.com/JusticeDotOrg

The tweet:

David Brooks NYT op-ed: Philip Howard is the answer to restoring responsibility. Except he’s the exact opposite of that. http://ow.ly/2JwLK

————–

DJP comment: another attack on the person rather than dealing with the issues. Also, when will America deal with the contingency fee that results in so many suits without merit?

—–

Here is more from Philip Howard in The Daily Beast. Philip Howard gives his five proposals for reviving America and our can-do spirit.

http://www.thedailybeast.com/blogs-and-stories/2010-09-26/philip-k-howard-manifesto-for-a-new-politics

The Daily Beast

September 26, 2010 | 10:56pm

Manifesto for a New Politics

by Philip K. Howard

Hailed by David Brooks for seizing “the crucial theme of the moment,” lawyer and author Philip K. Howard proposes five ways to liberate America, streamline government, and revive our can-do spirit.

Government is broken. It spends money we don’t have, takes no responsibility for the future, and suffocates daily freedoms under a thickening blanket of unnecessary bureaucracy and litigation.

Both the Democratic and Republican parties are to blame. Instead of appealing to our better nature, they promise short-term self-interest of continued entitlements or lower taxes. Instead of leadership for a responsible society, they attack each other with partisan half-truths, oblivious to the critical need to change course.

Changing leaders is not enough. Decades of accumulated law and bureaucracy have made it impossible for anyone to use common sense. New leaders come to Washington and immediately get stuck in the bureaucratic goo.

Government needs to be cleaned out. Government has a vital role in a crowded society, as a steward of common resources and public services. But it cannot deal effectively with the important challenges of today—whether to contain runaway entitlements or to create clean energy—when resources are committed to goals of past decades. Accumulated law has become a fortress for the status quo. Unnecessary law and bureaucracy also act as a heavy weight on society, making it hard for teachers, doctors, and other citizens to pursue their dreams. Many Americans no longer feel they can make a difference.

Government will never fix itself. Washington and state capitals have become disconnected from the public they serve, focused on partisan tug-of-wars instead of on the vital needs of society.

Change can only come from outside pressure. Americans must come together to demand a new approach to governing.

The core principle for change is this: individual responsibility. At every level of society, individuals must be free to take responsibility. This requires streamlining government and law to allow people to use their judgment to meet public goals. Individual responsibility is the key to all accomplishment. It is also the key to accountability. Who is responsible for the failures in government? No one, because government has become a bureaucratic swamp. Where are new leaders? Leadership is basically illegal in a legal thicket.

Five changes are essential to create a responsive government and to revive America’s can-do spirit:

1. Clean out the stables of government. Democracy is not supposed to be a one-way valve, always piling new law on top of old laws. In each area of government, appoint respected citizens and experts to make proposals to clean out unnecessary entitlements, mandates, and regulations. Going forward, laws and regulations should expire periodically under sunset laws. Government must make choices for the future, not stay mired in choices of the past.

2. Radically simplify law. Laws must be understandable to be effective. Write laws to set public goals and general principles. Leave implementation to designated officials, with clear lines of accountability. The Constitution is 16 pages long. No statute should be over 50 pages.

3. Push responsibility down to local organizations. Give back to Americans the freedom to make a difference—without unnecessary interference of centralized bureaucracy, especially in schools and other social services. Let public schools operate with the same freedoms as charter schools. Hold people accountable for results, not bureaucratic compliance.

4. Restore boundaries to lawsuits. Fear of lawsuits has poisoned human interaction in most areas of society, especially health care and schools. Law should set outer boundaries of required conduct, not interfere in everyday disagreements. This requires judges and legislatures to define reasonable social norms as a matter of law. Create special health courts to provide a foundation of reliability and trust, essential to making health care safe and affordable.

5. Revive accountability for public employees. Individual accountability is a critical component of a functioning democracy. Overhaul civil service and teacher tenure: Public servants should have more freedom to take responsibility, and they must be accountable for their choices. Make government transparent; sunlight is the best disinfectant.

There’s nothing wrong with America that can’t be fixed—if Americans are free to use their common sense. But the legal swamp of modern government won’t let us roll up our sleeves and make needed choices. That’s why Americans must come together and force a basic overhaul of America’s governing structures. Our freedom, and our children’s future, depend upon it.

Philip K. Howard, a lawyer, is the author of Life Without Lawyers: Liberating Americans From Too Much Law, just released by W.W. Norton, and the bestselling The Death of Common Sense. He is chairman of Common Good and advises leaders of both parties on legal and regulatory reform.

———–

Stay well,

Donald

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

This DJP Update goes to 2308 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” in subject line.

Comments Off

http://www.businesswire.com/news/home/20100921006484/en

DJP Update 9-21-2010 Early consequences of PPACA* not good! Each of us needs to get involved to save Medicine; Lagniappe: Medal of Honor

Sep 21

Posted by Dr. Donald Palmisano in DJP Updates

DJP Update 9-21-2010 Early consequences of PPACA* not good! Each of us needs to get involved to save Medicine; Lagniappe: Medal of Honor

Here is my continued attempt to get the message out about the need to put the patient in control with the doctor as trusted advisor. Additional AMA presidents, Dr. Johnson, Dr. Plested, and more, have emphasized government control is not the answer. AMA policy says the same! As I mentioned before, my first testimony on these issues to Congress was in 1976. My message has not changed. But government is encroaching more and more into the practice of Medicine to the detriment of patients and physicians. So I will use the avenues available to get the message out. I hope you will do the same. I know AMA is working on getting the private contracting & balance-billing resolution into Congressional language as mandated by the House of Delegates but the time is now to get it to the public and Congress. The game will be over if we study and study without dramatic action that is well publicized. And challenge Congress to sign on BEFORE the November elections. Don’t let folks in Congress give you empty rhetoric.

The clock is ticking. Medicine’s fate is up to us. Act now! See press release below. Determine how YOU can make a difference in the debate.

See my latest comments below in press release.

*The “Patient Protection and Affordable Care Act” (P.L. 111-148) was enacted on March 23, 2010 and amended shortly thereafter by the “Health Care and Education Reconciliation Act of 2010” (P.L. 111-152) as enacted on March 30, 2010.

This is “PPACA”

———

—–

September 21, 2010 10:39 AM Eastern Daylight Time

Patients’ Group Concerned Over Increasing Health Care Costs

Despite initial promises, study shows that health care costs will increase under health care reform law

WASHINGTON–(BUSINESS WIRE)–Coalition to Protect Patients Rights (CPPR) spokesman Donald J. Palmisano, MD, expressed concern this week over the recently passed health care bill’s flaws after new survey results indicated that overall health care costs actually will increase following the bill’s passage.

“by enabling unelected bureaucrats to make sweeping additional cuts to the Medicare program every year without Congressional approval. And the failure to restore liberty to patients and physicians to negotiate fees for the care needed continues to decrease access to care for patients in their hour of need.”

“It’s not surprising to those of us who paid attention to the legislative process that a new government analysis would show health care costs are going to be higher under the reform bill than they would have been without passage of the law,” Dr. Palmisano said. “What I’m most concerned about, however, is that these increased costs will add to the difficulty of patients getting the care they so desperately need. We need less government and more care in our health care system.”

“In addition to failing to rein in health care spending, the health bill’s cuts to the Medicare program’s funding will impede the ability of American patients to get the care they need,” Dr. Palmisano said.

Dr. Palmisano also addressed the planned creation of the Independent Payment Advisory Board which is tasked with cutting Medicare spending, saying it would adversely affect patient access to care “by enabling unelected bureaucrats to make sweeping additional cuts to the Medicare program every year without Congressional approval. And the failure to restore liberty to patients and physicians to negotiate fees for the care needed continues to decrease access to care for patients in their hour of need.”

Adding to the frustration regarding the bill, a Harvard study on medical liability costs in the United States, which the bill did not address, put the price of the current medical malpractice system at over $55 billion a year.

Said Palmisano on the subject: “The amount of money spent by doctors defending themselves from medical malpractice lawsuits in the flawed system is an unnecessary waste of money. Reflecting the meritless nature of many lawsuits, 82% of the cases are closed without payment to claimant and the doctor wins at trial 87% of the time. These billions could instead be used to provide patients with better health care or to reduce overall costs.”

The Coalition to Protect Patients Rights worked hard to achieve patient-centered health care reform during the course of the health care debate, staunchly opposing the Patient Protection and Affordable Care Act due to its failure to protect patients’ rights.

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, health care providers, advocacy groups, and concerned citizens who are dedicated to the implementation of patient-centered health care reform that will improve patient care. For more information, visit the Coalition to Protect Patients’ Rights website at www.protectpatientsrights.org. Also, check out CPPR’s Facebook account here, and its Twitter feed at PatientsNOW.

Contacts

Coalition to Protect Patients Rights (CPPR)
(703) 405-9407
media@protectpatientsrights.org

Permalink: http://www.businesswire.com/news/home/20100921006484/en/Patients%E2%80%99-Group-Concerned-Increasing-Health-Care-Costs

—–

LAGNIAPPE: Tweet of today at www.twitter.com/DJPNEWS regarding Medal of Honor

——-

Prez #Obama presented Posthumous #MedalofHonor to sons hero Chief Master Sgt. R. L.#Etchberger – died in Laos 42 yr ago; A moving tribute

—–

If you missed the ceremony today on TV, try to catch it on the news. President Obama said, in part, “Never too late to pay tribute to Vietnam Veterans”. Chief Master Sgt. Etchberger’s heroic sacrifice has been kept secret for many years. He save the lives of his fellow soldiers. A moving ceremony. The President also stated how inappropriate it was that returning veterans from Vietnam were treated with disrespect by some. The President mentioned that Chief Master Sgt. Etchberger spent time at Barksdale AFB in Sheveport, Louisiana. Yes, Freedom is not Free.

Here is an excerpt from one news report: http://www.star-telegram.com/2010/09/21/2484486/obama-awards-posthumous-medal.html

A native of Hamburg, Pa., Etchberger was an electronics expert without formal combat training in March 1968 when he single-handedly kept the North Vietnamese enemy at bay while helping evacuate wounded comrades from their radar station on a remote Laotian mountain after coming under attack.

The next morning, Etchberger managed to get three wounded comrades into rescue slings and on their way to safety. But Etchberger was fatally wounded after enemy ground fire struck the helicopter attempting to lift him to safety.

——

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

This DJP Update goes to 2294 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” in subject line.

Comments Off

DJP Update 9-20-2010 2nd update: If last DJP Update today depressed you, here is a Saints suspense thriller to cheer you up!

Sep 20

Posted by Dr. Donald Palmisano in DJP Updates

DJP Update 9-20-2010 2nd update: If last DJP Update today depressed you, here is a Saints suspense thriller to cheer you up!

Take a break from the stress and relax with some activity you enjoy. Clears the mind of problems and new ideas emerge later. The Saints give inspiration to a city devastated by past politicians, Hurricane Katrina, and other maladies. We can learn from them about not giving up and give inspiration to those who volunteer to fix the mess politicians are bringing to Medicine. Let not Medicine be destroyed on our watch.

Hope you enjoy the tweets! 49ers played well against the World Champs!

www.twitter.com/DJPNEWS

Tweets during New Orleans Saints – San Francisco 49ers game

———–

The World Champion New Orleans #Saints vs San Francisco#49ers tonight 7:30 p.m. Central – Who dat! #NOLA #football about 4 hours ago via webThe world champs, New Orleans #Saints, lead San Francisco#49ers 9-7 at half. #NOLA #football about 2 hours ago via EchofonThe #Saints got behind but just scored and now lead #49ers16-14 with less than 2 min left in 3rd quarter. #NOLA #football about 1 hour ago via EchofonReggie #Bush is showing how good he is; just did 47-yard punt return! Go #Reggie! Go #Saints! #NOLA about 1 hour ago via EchofonField goal by #Saints #Hartley and they now lead #49ers 19-14. #NOLA #football about 1 hour ago via EchofonFor #49ers Frank #Gore is terrific; but 49ers giving up too many turnovers. #Saints Drew #Brees cool under pressure & great leadership.about 1 hour ago via Echofon #Saints Reggie #Bush hurt & off field. Sad! But #49ers just fumbled on punt return and Saints recovered on 49ers 15-yard line! #NOLA 41 minutes ago via Echofon22-14 after #Saints kick field goal. #49ers have ball with 2 min left to catch Saints. #NOLA #football 31 minutes ago via Echofon #49ers QB Alex #Smith on the move! #Gore scores for 49ers! 22-20. 49ers try 2 points but fail! Challenge success. Tie & 1:16 left.19 minutes ago via Echofon20 sec left. Saints Brees to Coltston pass good & now on 20, then 14. Two sec left. Field goal #Hartley good! #Saints win 25-22! Champs!11 minutes ago via EchofonIn last tweet, typo: #SaintsMarques Colston is correct spelling. Sorry. Great catch. Excited about #Saints win over 49ers!! #NOLA 5 minutes ago via Echofon

———–

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 2294 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” in subject line.

Comments Off

DJP Update 9-20-1010 Federal Government’s New Tools for Medicare Fraud

Sep 20

Posted by Dr. Donald Palmisano in DJP Updates

Fraud: Certainly fraud needs to be eliminated!

The bad folks need to be caught and punished. But what happens to the doctor incorrectly accused? Who pays his or her defense costs? What happens to the doctor’s practice during an accusation under the new expanded contingency fee hunt by contractors in the RAC (Recovery Audit Contractor) audits? During the “negotiations” in Congress who represented the innocent doctors and what was said? Have we moved to a “guilty” unless proven innocent? Are we no longer innocent unless proven guilty? Remember, the accusations bring the threat of huge penalties and jail time!

No need to wonder why the doctors coming out of medical school today don’t think private practice is viable with billing complexity, broken medical liability system, electronic health records with patient privacy concerns and billing being fed to government computers, the increased overhead and price-fixing by government for services rendered, the massive regulatory burdens, and on and on. Easier to go and work fixed hours for a large group or a hospital if such a job can be found. Let someone else worry about all of that and just try to practice ethical science-based Medicine as best one can. Sad that the choices are diminishing each year.

And now a few links and excerpts:

https://www.cms.gov/RAC/03_RecentUpdates.asp

Excerpts:

01/29/10: CMS Expands FY 2010 RAC ADR limits to all Institutional Providers. Click the link below to review the additional documentation limits for fiscal year 2010. The limits announced in December 2009 applied only to requests for DRG validation purposes; the same methodology will now be used for reviews of all institutional claim types. CMS will post the limits for physicians, non-physicians practitioners and DMEPOS suppliers at a later date.

10/10/08: CMS Announces RAC Contingency Fee Percentages. The RACs are paid a contingency fee; that is, the RACs receive payment based on the amount of the improper payments they correct for both overpayments and underpayments. Each RAC’s contingency fee is established during contract negotiations with CMS and, as such, the contingency fee varies for each RAC. Click the link below to view the RAC contingency fees.

https://www.fbo.gov/index?s=opportunity&mode=form&id=5c8c7d4b00249ba579d4d77d64bd0aea&tab=core&_cview=1&cck=1&au=&ck=

http://www.usatoday.com/news/washington/2010-09-20-medicare-new-rules_N.htm

Feds gain power over billions in Medicare fraud

By Alison Young, USA TODAY September 20, 2010

A couple of excerpts:

-Suspending payments to a provider as soon as there’s been a “credible allegation” of fraud that merits further investigation, including tips from consumers.

-•Rating all types of medical providers by their risk for engaging in fraud. Those at highest risk would undergo fingerprinting and criminal background checks.

———–

———–

And don’t forget the myriad of previous laws & regulations including “Fraud Alerts” of yesteryear.

Watch out for co-pay forgiveness! See enlarged and bold highlighting below.

http://oig.hhs.gov/fraud/docs/alertsandbulletins/121994.html

EXCERPT:

[Federal Register: December 19, 1994] ----------------------------------------------------------------------- DEPARTMENT OF HEALTH AND HUMAN SERVICES Publication of OIG Special Fraud Alerts AGENCY: Office of Inspector General, HHS. ACTION: Notice.

Why Is it Illegal for “Charged-Based” Providers, Practitioners and Suppliers to Routinely Waive Medicare Copayment and Deductibles? Routine waiver of deductibles and copayments by charge-based providers, practitioners or suppliers is unlawful because it results in (1) false claims, (2) violations of the anti-kickback statute, and (3) excessive utilization of items and services paid for by Medicare. A “charge-based” provider, practitioner or supplier is one who is paid by Medicare on the basis of the “reasonable charge” for the item or service provided. 42 U.S.C. 1395u(b)(3); 42 CFR 405.501. Medicare typically pays 80 percent of the reasonable charge. 42 U.S.C. 1395l(a)(1). The criteria for determining what charges are reasonable are contained in regulations, and include an examination of (1) the actual charge for the item or service, (2) the customary charge for the item or service, (3) the prevailing charge in the same locality for similar items or services. The Medicare reasonable charge cannot exceed the actual charge for the item or service, and may generally not exceed the customary charge or the highest prevailing charge for the item or service. In some cases, the provider, practitioner or supplier will be paid the lesser of his [or her] actual charge or an amount established by a fee schedule. A provider, practitioner or supplier who routinely waives Medicare copayments or deductibles is misstating its actual charge. For example, if a supplier claims that its charge for a piece of equipment is $100, but routinely waives the copayment, the actual charge is $80. Medicare should be paying 80 percent of $80 (or $64), rather than 80 percent of $100 (or $80). As a result of the supplier’s misrepresentation, the Medicare program is paying $16 more than it should for this item.

(emphasis added) In certain cases, a provider, practitioner or supplier who routinely waives Medicare copayments or deductibles also could be held liable under the Medicare and Medicaid anti-kickback statute. 42 U.S.C. 1320a-7b(b). The statute makes it illegal to offer, pay, solicit or receive anything of value as an inducement to generate business payable by Medicare or Medicaid. When providers, practitioners or suppliers forgive financial obligations for reasons other than genuine financial hardship of the particular patient, they may be unlawfully inducing that patient to purchase items or services from them. At first glance, it may appear that routine waiver of copayments and deductibles helps Medicare beneficiaries. By waiving Medicare copayments and deductibles, the provider of services may claim that the beneficiary incurs no costs. In fact, this is not true. Studies have shown that if patients are required to pay even a small portion of their care, they will be better health care consumers, and select items or services because they are medically needed, rather than simply because they are free. Ultimately, if Medicare pays more for an item or service than it should, or if it pays for unnecessary items or services, there are less Medicare funds available to pay for truly needed services. One important exception to the prohibition against waiving copayments and deductibles is that providers, practitioners or suppliers may forgive the copayment in consideration of a particular patient’s financial hardship. This hardship exception, however, must not be used routinely; it should be used occasionally to address the special financial needs of a particular patient. Except in such special cases, a good faith effort to collect deductibles and copayments must be made. Otherwise, claims submitted to Medicare mat violate the statutes discussed above and other provisions of the law.

——

Read more about Fed Gov efforts at:

http://www.stopmedicarefraud.gov/

and read Fed Gov summary of “new tools”

http://www.healthreform.gov/affordablecareact_summary.html

——

And read American Bar Association article giving some definitions of the various RAC programs:

http://www.abanet.org/health/esource/Volume6/SE2/Wachler.html

The Patient Protection and Affordable Care Act (PPACA)¹ calls for significant expansion of the Recovery Audit Contractor (RAC) program by the end of 2010.

—-

Be good! Be careful! The older doctors remember the days when patients paid the doctor directly. If the patient couldn’t afford the fee, the doctor and the patient worked it out to the patient’s satisfaction. And if the doctor said to forget the fee, no crime was committed.

—–

A few recent tweets from www.twitter.com/DJPNEWS

RT @Heritage The economic toll of the Obama #tax hikes will NOT just hit the wealthy. Here’s a MUST-READ Morning Bell:http://herit.ag/OtJ about 7 hours ago via Echofon

Why? Because #PPACA disaster in details RT @RasmussenPoll61% Favor Repeal of Health Care Law…http://tinyurl.com/RR2070 #hcr about 8 hours ago via Echofon

Movie “The Town” a roller-coaster thriller. Casting & acting superb.1:12 PM Sep 19th via Echofon

Dr’s books good! RT @tessgerritsen Some tidbits about the REAL Boston PD detective advising TNT’s ‘Rizzoli & Isles’ http://patch.com/A-6mg 12:26 PM Sep 19th via Echofon

The well is dead! The well is dead! #AP. #BP Gulf disaster leak permanently sealed. Chap one over. Now recovery! R.I.P. Workers who died12:06 PM Sep 19th via Echofon

Reread book 1984 & reflect how some try to distort reality RT @RasmussenPoll One nation under revolt…http://tinyurl.com/RR2048 11:27 AM Sep 17th via Echofon

——-

Stay well! And get more folks to join DJP Update and www.twitter.com/DJPNEWS A new Twitter is on the way. Twitter will offer more content with tweets. GET A PREVIEW AT http://twitter.com/newtwitter

We have a short time to get the message out before the upcoming Congressional session and the NOVEMBER Elections! The more we communicate, the greater is the chance we can get meaningful health system reform including medical liability reform. The current system is collapsing because of wrong policies out of Washington, DC. Better to fix the problem then have a complete collapse. Communicate & Act! Remember “Facts don’t cease to exist because they are ignored”. PPACA is a disaster.

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 2294 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” in subject line.

Comments Off

DJP Update 9-16-2010 A must read article by George Will of Washington Post: “Pressed Into Conformity” (“Trifle with the Gov…)

Sep 16

Posted by Dr. Donald Palmisano in DJP Updates

DJP Comment: George Will, columnist for the Washington Post has a fascinating article of September 16, 2010 below. Read and then think about what is happening to Medicine. Article is published at many sites, including the Washington Post (different title there: Trifle with the government? Just ask Jacob Maged” Most newspaper published the column with the title below). Links below. —— http://www.washingtonpost.com/wp-dyn/content/article/2010/09/15/AR2010091505090.html
http://patriotpost.us/opinion/george-will/2010/09/16/pressed-into-conformity/

http://tinyurl.com/32ndjhh or http://tinyurl.com/2b4szn8

Pressed Into Conformity

By George Will (Archive) · Thursday, September 16, 2010

JERSEY CITY, N.J. — The crime scene at 138 Griffith St. has changed in 76 years. Today it is a barber shop. In 1934, it was a tailoring and cleaning establishment owned and run by Jacob Maged, 49.

With his responsibilities as a father of four, Maged should have shunned a life of crime. Instead, he advertised his criminal activity with a placard in his shop window, promising to press men’s suits for 35 cents. This he did, even though President Franklin Roosevelt’s New Dealers, who knew an amazing number of things — his economic aides were not called a “Brains Trust” for nothing — knew that the proper price for pressing a man’s suit was 40 cents.

The National Recovery Administration was an administrative mechanism for the National Industrial Recovery Act of 1933, which envisioned regulating the economy back to health by using, among other things, codes of fair competition. The theory was that by promoting the cartelization of labor by encouraging unions, and the cartelization of industries by codes that would inhibit competition, prices would be propped up and prosperity would return.

Soon there were more than 500 NRA codes covering the manufacture of products from lightning rods to dog leashes to women’s corsets. Amity Shlaes, in “The Forgotten Man,” her history of the New Deal, reports that the NRA “generated more paper than the entire legislative output of the federal government since 1789.”

Businesses were asked to display the Blue Eagle, an emblem signifying participation in the NRA. Gen. Hugh “Iron Pants” Johnson, an admirer of Mussolini who headed the NRA, declared, “May God have mercy on the man or group of men who attempt to trifle with this bird.”

Maged trifled by his five-cent violation of New Jersey’s “tailors’ code,” written in conjunction with the NRA. On April 20, 1934, he was fined $100 — serious money when the average family income was about $1,500 — and sentenced to 30 days in jail. The New York Times reported that Maged “was only vaguely aware of the existence of a code.”

Not that such ignorance was forgivable. It is every citizen’s duty to stay up late at night, if necessary, reading the fine print about the government’s multiplying mandates.

“In court yesterday,” the Times reported, “he stood as if in a trance when sentence was pronounced. He hoped that it was a joke.” Maged was an immigrant from Poland, which in the Cold War would become familiar with the concept of “economic crimes” and the use of criminal law for the “re-education” of deviationists.

Actually, his sentence was a judicial jest. After Maged spent three days in jail, the judge canceled the rest of his sentence, remitted the fine and, according to the Times, “gave him a little lecture on the importance of cooperation as opposed to individualism.” The judge emphasized that people “should uphold the president … and General Johnson” in their struggle against — among other miscreants — “price cutters.” Then, like a feudal lord granting a dispensation to a serf, the judge promised to have Maged “measure me for a new suit.”

Maged, suitably broken to the saddle of government, removed from his shop window the placard advertising 35-cent pressings and replaced it with a Blue Eagle. “Maged,” reported the Times, “if not quite so ruggedly individualistic as formerly, was a free man once more.” So that is freedom — embracing, under coercion, a government propaganda symbol.

Today, as 76 years ago, economic recovery is much on the mind of the government, which is busy as a beaver — sending another $26 billion to public employees, proposing another $50 billion for “infrastructure” — as it orchestrates Recovery Summer to an appropriate climax. But at least today’s government is agnostic about the proper price for cleaning a suit.

In 1937, FDR asked in his inaugural address for “unimagined power” to enforce “proper subordination” of private interests to public authority. The biggest industrial collapse in American history occurred eight years after the stock market crash of 1929, and nearly five years into the New Deal, in … 1937.

Maged died here of cancer on March 31, 1939. He was 54. He remains a cautionary example of the wages of sin, understood by the progressives of his day as insubordination toward government that knowseverything. The NRA lives on, sort of, in this Milton Friedman observation: Pick at random any three letters from the alphabet, put them in any order, and you will have an acronym designating a federal agency we can do without.

—–

And here is my tweet at www.twitter.com/DJPNEWS about the article:

DJPNEWS

A must read. Gov power & price-fixing. #GeorgeFWill 9-16, #WashPost columnist. http://tinyurl.com/32ndjhh Think #hcr #liberty less than 5 seconds ago via web—— Stay well! And get more folks to join DJP Update and www.twitter.com/DJPNEWS A new Twitter is on the way. Twitter will offer more content with tweets. GET A PREVIEW AT http://twitter.com/newtwitter
We have a short time to get the message out before the upcoming Congressional session and the NOVEMBER Elections! The more we communicate, the greater is the chance we can get meaningful health system reform including medical liability reform. The current system is collapsing because of wrong policies out of Washington, DC. Better to fix the problem then have a complete collapse. Communicate & Act! Remember “Facts don’t cease to exist because they are ignored”. PPACA is a disaster. 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 2290 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” in subject line.

Comments Off

http://www.supertalk.fm/pages/5046222.php

DJP Update 9-15-2010 Quick Reflection; Media Alert: Dr. Todd Williamson on radio in morning 9-16; Chart AMA State Liability Chart; Tweets

Sep 15

Posted by Dr. Donald Palmisano in DJP Updates

DJP Update 9-15-2010 Quick Reflection; Media Alert: Dr. Todd Williamson on radio in morning 9-16; Chart AMA State Liability Chart; Tweets

ITEM ONE: Quick Reflection

As my surgical partner over the years, Dr. Jim Brown, has taught me over the years: “We are here by a thin thread; at any time it may snap!”

I have mentioned that to you in these updates over the years. I saw the thin thread almost snap on Sunday. I had just finished my third speech in Oregon on leadership and health system reform. I was a passenger in a BMW on a mountain curve when suddenly a 3/4 ton truck moving an a very high rate of speed came around the curve in the opposite direction. The driver of that truck lost control of the truck as it rocked back and forth giving me the impression it was going to flip over and hit us head on. It moved about four feet into our lane and my friend driving his BMW deftly swerved into the shoulder next to the mountain and the catastrophe was averted. The truck did not flip but it was close. At any time, disaster can strike. A lesser driver and a less nimble car and you would not have any more DJP Updates. Hug a loved one! Who knows when our threads will snap!

One more thing about the joy of travel. I have 2 IDs with me when traveling. One is my driver’s license and the other is a non-driver Louisiana ID card available to non-drivers and any driver who requests a second ID. The non-driver card states permanent and for life. I carry both in event I lose an ID on my travels. That happened to me when I was on marathon travel with AMA.

When going through security at New Orleans airport I experienced a “first” in ID questions. I showed the lifetime ID and the person looked at the card and then at me and said it was not acceptable. I was told I would have to show another one. I asked why. She said the lifetime one did not have an expiration date. Hmmm. My first thought was to say that I did not know the date of my death! But considering some other experiences at these security checks, I pulled out my drivers license and smiled. Joy of travel!

ITEM TWO: Dr. Todd Williamson on radio in morning 9-16

THE GALLO SHOW
Weekdays 6am-9am

“The morning buzz starts with The Gallo Show on SuperTalk Mississippi. Get your morning started right with news and information from the movers, shakers, and playmakers in local, state, and national politics. You never know who will stop in to keep you up to date on the latest happenings in the state. Veteran broadcaster Paul Gallo has asked the pointed questions from guest such as Karl Rove, Gov. Haley Barbour, and Rep. Gregg Harper to entertainment’s biggest names. Simply put, your morning won’t start like it should unless you have a cup of coffee with The Gallo Show.”

On the Program for Thursday, September 16, 2010…

7:05 (CENTRAL TIME) “Dr. Todd Williamson, spokesman for the Coalition of State Medical and National Specialty Societies & past president of the Medical Association of Georgia, will join us on the show. He will go into the need to empower patients and reduce the role of government and other third party payers.”

Check at Website for various stations covering the interview or listen via Internet. Great to see young leaders leading the charge!

——–

ITEM THREE: AMA 2009 State Laws Chart 1 – Liability Reforms

This document summarizes the medical liability laws in each state.

This is inside the AMA member portion of AMA Website. Put in your ID and Password and then go to:

http://www.ama-assn.org/ama1/x-ama/upload/mm/378/stlaw-cht1.pdf

Good reference material for your research and debates.

———–

RECENT TWEETS: www.Twitter.com/DJPNEWS

———-

Suicide? How? RT @BreakingNews Dead man found..LA airport restroom, his head covered in a bag & hands bound – LA Times http://lat.ms/ddLtmsabout 5 hours ago via Echofon
A step forward! RT @PatientsNOW Judge..”likely” allow..proceed..part of their lawsuit..for unconstitut #healthlaw http://politi.co/cMQL42 about 23 hours ago via Echofon
Good. If law lost, patients lose access RT @texmed Magistrate Says #Tort Reform Not Unconstit.. trib.it/9cj2BR via @TexasTribune #law 6:49 PM Sep 14th via Echofon
Power of Sec Sebelius in view RT @sonodoc99 @DJPNEWS@Mark_Levin Obamacare v The Rule of Law http://tinyurl.com/2d9gzvl 10:04 AM Sep 14th via Echofon
Rest in Peace Former Louisiana Senator Ken Hollis, a friend & neighbor & good legislator. Sincere condolences to family.3:54 PM Sep 10th via Echofon
Delightful cafe find: Salem, Oregon. Great breakfast & staff nice. Busick Court Rest. at 250 Court St NE 503-370-8107 #food 11:44 AM Sep 10th via Echofon
Dave Tarver, the talented wise EVP Louisiana State Medical Society, retiring after decades award-winning service #LSMS #LaMedSoc 8:26 AM Sep 10th via Echofon
Well written coverage of #Saints win RT @TheSaints New Orleans Saints chart new path to victory – NOLA.com http://is.gd/f3Zxw 8:04 AM Sep 10th via Echofon
Will be giving my speech in Oregon during #Saints game. Too bad for me but wonderful wife will record!5:17 PM Sep 9th via Echofon
Just landed in Portland Oregon to give speech on #Leadership& Health System Reform #hcr #docs 4:58 PM Sep 9th via Echofon
You have to like Sec of #Defense #RobertGates after reading @washingtonpost #Ignatius column http://tinyurl.com/3785d73 4:56 PM Sep 9th via Echofon
Diag imaging head injury ED & states’ med malpractice reform; more=less tests! http://tinyurl.com/2eu9x5z #medical liability10:30 PM Sep 7th via web
Visit weekly & watch #RiseOfFreedom at http://tinyurl.com/2fcysg4 #GroundZero #911#WorldTradeCenter #Freedom #liberty 7:18 PM Sep 7th via Echofon

———–

————-

Stay well! And get more folks to join DJP Update and www.twitter.com/DJPNEWS We have a short time to get the message out before the upcoming Congressional session and the NOVEMBER Elections! The more we communicate, the greater is the chance we can get meaningful health system reform including medical liability reform. The current system is collapsing because of wrong policies out of Washington, DC. Better to fix the problem then have a complete collapse. Communicate & Act! Remember “Facts don’t cease to exist because they are ignored”. PPACA is a disaster.

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

This DJP Update goes to 2290 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” in subject line.

Comments Off

DJP Update 9-7-2010 Press conferences re PPACA, Malpractice, Medicaid, & ER use

Sep 07

Posted by Dr. Donald Palmisano in Random Thoughts

DJP Update 9-7-2010 Press conferences re PPACA, Malpractice, Medicaid, & ER use

Today Health Affairs had a press conference regarding two articles in Health Affairs. I did not participate in that conference. However, my comments about two of the papers presented were requested for an article in MedPageToday. The MedPage Article by Peggy Peck is below with a Weblink.

In addition, I participated in a press conference held in Washington, DC. Other members of the panel who spoke and then answered questions from the press are listed below in this excerpt from the press release:

The American Action Forum will host a press conference on Tuesday, September 7 at 1:00PM (EDT) to discuss costly care delivery problems that went unaddressed and have worsened as a result of the healthcare reform law.

WHAT: The American Action Forum will host a press conference to discuss “Medical Liability, Medicaid, and Emergency Room Use: What Does Health Reform Mean?”

WHO:

§ Douglas Holtz-Eakin, President of the American Action Forum

§ Dr. Donald Palmisano, Clinical Professor of Surgery and former AMA President

§ Grace-Marie Turner, President of the Galen Institute

§ Jim Copland, Direct of the Manhattan Institute’s Center for Legal Policy

§ Edmund Haislmaier, Senior Research Fellow at the Heritage Foundation

———-

A podcast of this press conference will be available soon at the American Action Forum Website. I will send the link when it is available. Some great comments about statistics and what is put in numerator and denominator when calculating percentages. Very interesting. If you put all health care costs for entire system in denominator and only put a subset of individuals in the numerator, you get a lower percentage. Basic statistics!

MedPageNow article follows:
http://www.medpagetoday.com/PracticeManagement/Medicolegal/22051

Malpractice Adds Less than 3% to Healthcare Tab

By Peggy Peck, Executive Editor, MedPage Today
Published: September 07, 2010

Costs associated with medical malpractice added about $55.6 billion to the nation’s total healthcare costs in 2008 — roughly 2.4% of a more than $2.3-trillion tab — and most of that money went to pay for tests, procedures, and treatments associated with defensive medicine, according to an analysis by Harvard researchers.

The estimate by a research team that included Atul A. Gawande, MD, of Harvard Medical School, is considerably less than “some imaginative estimates put forth in the health reform debate, and it represents a small fraction of total healthcare spending. Yet in absolute dollars, the amount is not trivial,” they wrote.

The analysis was published online today and in the September issue of Health Affairs as part of a package of articles aimed at exploring “Physicians’ Misperception of Malpractice Lawsuits,” according to a press release issued by the journal.

A second paper by J. William Thomas, PhD, of the Cutler Institute for Health and Social Policy at the University of Southern Maine, in Portland, and colleagues, analyzed the costs of defensive medicine across 35 medical specialties and concluded that “defensive medicine practices exist and are widespread, but their impact on medical costs is small.”

So small, they wrote, that tort reform changes that would reduce medical malpractice premiums by 10% would only reduce the nation’s total medical costs by 0.120% to 0.134%.

Taken together, the papers suggest that promoting tort reform as a means to control healthcare costs is a straw man, and their conclusions run contrary to the figures cited by supporters of tort reform.

For example, Rep. Darrell Issa (R-Calif.), in an opinion column posted on Politico in the height of this year’s healthcare reform debate, wrote, “Defensive medicine — when doctors order unnecessary and usually expensive tests and procedures in order to avoid lawsuits — is a major contributor to skyrocketing healthcare costs. As much as $210 billion is spent on defensive medicine annually — equal to $700 for every U.S. man, woman and child. This helps drive up insurance premiums that are already too high for many Americans.”

And Donald J. Palmisano, MD, JD, of Metairie, La., told MedPage Today $55 billion a year is real money. In an e-mail, Palmisano, who is a former president of the American Medical Association and a well-known campaigner for tort reform, pointed out that $55 billion adds up to “over half a trillion dollars in 10 years!”

Yet even as they characterized such estimates as “imaginative,” the Harvard researchers were not unsympathetic.

Michelle M. Mello, JD, PhD, of the Harvard School of Public Health; Amitabh Chandra, PhD, of the John F. Kennedy School of Government at Harvard; Gawande; and David Studdert, LLB, ScD, of the University of Melbourne School of Law in Melbourne, Australia, pointed out that some malpractice costs “stem from meritless malpractice litigation,” which, they concede, is “particularly objectionable to healthcare providers.”

Meritless malpractice suits are so objectionable, Mello and colleagues wrote, that “the psychological and political value of addressing this grievance could be considerable.”

Mello and colleagues broke down the costs of malpractice this way:

Indemnity payments: $5.72 billion, of which $3.15 billion represents payment for economic damages, $2.4 billion for noneconomic damages, and $0.17 billion for punitive damages.
Administrative expenses: $4.13 billion, which includes $1.09 billion in fees to defense attorneys and $3.04 billion in overhead expenses. (Estimated fees to plaintiffs’ attorneys were $2 billion, but that amount is included in indemnity payments.)
Defensive medicine costs: $45.59 billion, of which $38.79 billion was estimated as the costs of hospital services and $6.80 billion as physician services.

Another $0.20 billion was added to the estimate to cover other costs, including lost physician work time — the authors estimated that physicians lose 2.7 to five working days for each malpractice suit — and the cost of “reputational and or emotional harm” to the defendant physician.

Although they didn’t find much benefit in tort reforms that put caps on noneconomic damages, Mello et al. did conclude that collateral source offsets appear to work, and, in this case, the new healthcare reform law, known as the Affordable Care Act (ACA), may be helpful to tort reform advocates.

The ACA will eventually require all individuals to obtain health insurance, and in states that have already adopted collateral source offsets — which prohibit malpractice awards from covering expenses already covered by health insurance — “greater prevalence of insurance will mean more frequent offsets, lower total indemnity payments, and less ‘double payment’ of medical expenses,” they wrote.

Thomas and colleagues, meanwhile, concluded that even if tort reform wouldn’t save much money, it doesn’t mean that Congress should back away from tort reform that would place a cap on damages and attorneys’ fees because “even this small cost [of defensive medicine] should be eliminated from the system.”

Palmisano echoed that sentiment and pointed out that Thomas et al. did not consider the implications of “negative” defensive medicine, a term that refers to the practice of physicians either leaving medicine altogether or closing practices in areas considered litigious.

“The implications for patients who can’t find a doctor in the hour of need should not be forgotten as doctors leave areas that do not have meaningful medical liability reform,” Palmisano said.

———– END OF MEDPAGENOW ARTICLE. ———–

Some of the recent tweets at www.twitter.com/DJPNEWS

Paul #Gigot & Journal Editorial Report show yesterday: critical analysis taxes, depressed economy & nailed #spin of politics #WSJ 1:04 PM Sep 5th via Echofon
Holiday #safety tips: take extra care driving in shopping centers, some don’t follow road; caution with home repairs esp ladders!12:24 PM Sep 5th via Echofon
NBC’s #Gregory #MeetThePress superb show today; many views; factual responses by #Graham (SC) #Lowey & #Cook; some others = elec #spin 12:05 PM Sep 5th via Echofon
Leadership! RT @TheSaints Drew Brees key ingredient..New Orleans Saints’ recipe for success – NOLA.com http://is.gd/eW4iX #Saints 7:28 AM Sep 5th via Echofon

———-
Lagniappe: Heading out to Oregon later this week to deliver 3 speeches there. The joy of travel!
Stay well! And get more folks to join DJP Update and www.twitter.com/DJPNEWS We have a short time to get the message out before the upcoming Congressional session and the NOVEMBER Elections! The more we communicate, the greater is the chance we can get meaningful health system reform including medical liability reform. The current system is collapsing because of wrong policies out of Washington, DC. Better to fix the problem then have a complete collapse. Communicate & Act! Remember “Facts don’t cease to exist because they are ignored”. PPACA is a disaster. 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 2290 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” in subject line.

Comments Off