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Medical Bankruptcy
Medicare is bankrupt in 2017. The USA,
deep in debt and short of doctors, must import them now. These doctors will probably adapt to such items as the government's stted
commitment to 'Budget Neutrality' without difficulty. Nonethless, such a provision is a pay cut. The proportion
of doctors from other countries is estimated to be ~25% of new doctors. Expect
that proportion to rise because, as the letter below suggests, the doctor-shortage just got worse:
Dear Dr. Butler,
After
months of negotiations with his Senate colleagues on a comprehensive health care reform package, Senator Max Baucus (D-MT),
Chairman of the Senate Finance Committee, released the "America's Healthy Future Act of 2009" earlier today. Senator Baucus
is still negotiating with Senators and we expect that we will see changes to the bill before the Finance Committee considers
or marks-up the legislation beginning on Tuesday, September 22, 2009.
College staff is currently reading and analyzing
the details of the legislation. There are several provisions of interest to surgery, which include:
- Medicare Physician Payments: The bill does not permanently
reform the SGR (unlike the House bill, HR 3200). It does replace a scheduled 22 percent Medicare payment cut in 2010 with
a 0.5 percent increase. In 2011, Medicare payments would be cut between 25 and 30 percent.
- Budget Neutrality: Starting in 2011, the bill
provides 10 percent bonus payments for primary care physicians and for general surgeons in health professional shortage areas.
Half of these bonus payments would be offset through payment reductions to other physicians, including surgeons (the House
bill did not cut other physicians to pay for the bonus payments).
- Medicare Commission: The bill includes a commission comprising
15 members appointed by the President that would be tasked with making proposals to Congress aimed at extending the solvency
of Medicare, slowing Medicare cost-growth, and improving the quality of care to beneficiaries (the House bill does not include
the creation of a commission).
- Physician Quality Reporting Initiative (PQRI): The bill
would extend the current program and would expand incentive payments to include eligible professionals who participate in
a qualified Maintenance of Certification (MOC) program and competed a qualified MOC practice assessment. The bill also requires
CMS to establish timely feedback to participants and establishes an appeals process. Starting in 2011, participation in the
PQRI would become mandatory. Physicians who do not successfully participate would be penalized in their Medicare reimbursement
levels in the following year (the House bill does not make PQRI mandatory).
Tomorrow and Friday, the College's Health Policy
and Advisory Group (HPAG) will be meeting in Washington, D.C. to discuss the "America's Healthy Future Act of 2009" and decide
what comments the College will offer and what position the College may take on this legislation. The College leadership and
the HPAG will carefully consider the bill's provisions in light of College concerns and priorities, and its potential affect
on patient access to surgical care.
Sincerely,
L.D. Britt, M.D., FACS, Chair of the ACS Board of Regents
John
Cameron, M.D., FACS, President of the American College of Surgeons
Andrew Warshaw, M.D., FACS, Chair of the ACS Health
Policy and Advocacy Group
Christian Shalgian, ACS Director, Division of Advocacy and Health Policy
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Working conditions in primary care: physician reactions and care quality.
Linzer M; Manwell LB; Williams ES; Bobula JA; Brown RL; Varkey AB; Man B;
McMurray JE; Maguire A; Horner-Ibler B; Schwartz MD;
University of Wisconsin School of Medicine
and Public Health, and Medical College of Wisconsin, Madison, Wisconsin 53705, USA. mxl@medicine.wisc.edu
BACKGROUND: Adverse primary care work conditions could lead to a reduction in the primary care workforce and
lower-quality patient care. OBJECTIVE: To assess the relationship among adverse primary care work conditions, adverse physician
reactions (stress, burnout, and intent to leave), and patient care. DESIGN: Cross-sectional analysis. SETTING: 119 ambulatory
clinics in New York, New York, and in the upper Midwest. PARTICIPANTS: 422 family practitioners and general internists and
1795 of their adult patients with diabetes, hypertension, or heart failure. MEASUREMENTS: Physician perception of clinic workflow
(time pressure and pace), work control, and organizational culture (assessed survey); physician satisfaction, stress, burnout,
and intent to leave practice (assessed by survey); and health care quality and errors (assessed by chart audits). RESULTS:
More than one half of the physicians (53.1%) reported time pressure during office visits, 48.1% said their work pace was chaotic,
78.4% noted low control over their work, and 26.5% reported burnout. Adverse workflow (time pressure and chaotic environments),
low work control, and unfavorable organizational culture were strongly associated with low physician satisfaction, high stress,
burnout, and intent to leave. Some work conditions were associated with lower quality and more errors, but findings were inconsistent
across work conditions and diagnoses. No association was found between adverse physician reactions, such as stress and burnout,
and care quality or errors. LIMITATION: The analyses were cross-sectional, the measures were self-reported, and the sample
contained an average of 4 patients per physician. CONCLUSION: Adverse work conditions are associated with adverse physician
reactions, but no consistent associations were found between adverse work conditions and the quality of patient care, and
no associations were seen between adverse physician reactions and the quality of patient care.
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Dr. Melvin Stern, Maryland pediatrician: 30% of the private medical insurance premium is spent on administration.
Dr. Linda Peeno:
1. Companies attempt to co-opt physicianis;
2. Has testified in 150 cases.
Mr. Wendell Potter, formerly of Cigna:
1.
The Health Care Quality Improvement Act of
1986 permits any hospital board to ignore due process as stated in the Constitution; the United
States Supreme Court has twice refused to rule in this matter (SHALLER, POLINER). Without due process, medical
practice is unsafe for patient and doctor. Doctors can lose their career-investment before paying
back their career-loans: The risk of choosing MD over JD or MBA is too great. The
doctor-shortage is predicted to reach 200,000 by 2020.
"Our
government is the potent, the omnipresent teacher. For good or for ill, it teaches the whole people by its example. Crime
is contagious. If the government becomes a law-breaker, it breeds contempt for law; it invites every man to become a law unto
himself; it invites anarchy." Louis Brandeis, United
States Supreme Court
"The failure to change
and improve the current system will continue to result in the loss of qualified and skilled physicians from their profession
due to others who maliciously pervert the current peer review process for their own selfish motives." Hall
"Physicians who are entrusted with the care of their patients can see their professional careers destroyed if
they dare to challenge a hospital's practices. When a 'whistleblowing' physician is retaliated against, it threatens
not only the physician's livelihood, but the care of all patients. This ... affects every patient and potential patient in America." Alan Dershowitz, Harvard
Law School
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