Green Medicine?

Thought this was interesting. The concept of health care professionals practicing as environmentally safe as possible doesn't seem like that profound of a concept. After all, we should be promoting "health" any way we can. It seems that responsible doctors and business people have begun a transforming movement in the industry.

Check out this ARTICLE.

PNHP: Healthy Americans Act is the "Wrong Model"

Well, it comes as no surprise that not everyone would agree on this broad reform proposition. The PNHP has posted an article extremely critical of the Healthy Americans Act. It states that: "the bill depends on the 'mandate' model of private insurance." This is truly a core issue in health care reform, mandating insurance. Through a social lens, a mandate whether private or for a federal plan, resembles how we deal with car insurance. If you drive a car you MUST purchase insurance, however there are differences in this scenario since your personal health does not have as direct affects on those around you (unlike running over a pedestrian in your hummer.) Mandating people to purchase private health insurance is tricky. The issue of compliance and enforcement is an obvious talking point for the critics. A national health plan provides a mandate, but a mandate for government to cover all individuals. As we know there is strong conservative opposition to government fitting the bill for everyone's healthcare. They believe that centralizing and growing the so-called beauracracy limits an efficiently run health care system. So this issue is of primary concern when trying to reform the system. It seems the idea of this bill is to pull away from employer based insurance but to stay in a private market for insurances to compete for this new pool of health care consumers.

The bill also provides a framework of 3 risk pools and government subsidies are to support the lowest (medicaid) of them. It assumes that the problem with medicaid is not that the program is not comprehensive, just that it is underfunded, it underreimburses providers and therefore is limited in where it is accepted. Further subsidies would be provided to those plans so as to increase where medicaid and the like would be accepted. This seems like a simple thing to write in a bill, but not easy to execute in reality. The idea however, is a concrete solution to the lack of acceptance of medicaid.

The article in PNHP went on to attack two more principles of the act:
"healthy behavior to promote personal responsibility by giving premium discounts for controlling your blood pressure or diabetes (hard to imagine the kind of gaming that occurs here), and the Republican favorite - market forces, based on transparency in prices and quality and individuals presumably shopping around for cheaper and better care."

Most people probably agree that our health care system should include some kind of incentives for personal responsiblity. That concept is not foreign even to socialized medical systems like the German system. Here is an example of some German social security code regarding health care personal responsibility:

• Services must only be used insofar as necessary
  
• Copayments are to be requested where treatment is required as a result of a criminal activity, deliberate self harm, or a "non-medically indicated measure such as cosmetic surgery, a tattoo, or a piercing"
  
• Financial incentives are to be provided to those taking part in preventive measures, screening, and check-up programmes, those taking part in managed care programmes, or those who do not use general practitioner or hospital services over prescribed periods
  
• Threshold for copayments of chronically ill and cancer patients are to depend on their compliance with screening and treatment regimens

How these incentives are provided fairly and uniformly is a burden for any piece of legislation and this act shows its vulnerability on the issue.

As for the issue of market forces, it has plenty of arguments on both sides. In our system dominated by employer based health insurance, the competition my be limited by the big players purchasing the plans. Competition may not be acting to fully improve the health care provided and the efficiency with which it is run. For instance, costs of insurance company infrastructure have been estimated as enormous percentages of the entire healthcare spending in this country, noone can argue that that is efficent. The insurance companies themselves also rake in huge profits and are really the biggest winners in the system, wheras physicians and other providers struggle to get their share. Also, if the market was maximizing efficiency then our system should prove to be a better medical system than a universal coverage system, but we lag behind many nations' in a plethora of statistical data measuring the effectiveness of our healthcare. The opposing argument is that we cannot write of the market in health care. If the system was weaned off employer based insurance, it could be possible that a higher level of competition would arise from the huge pool of independent consumers looking for private plans. This could lower prices and improve the efficiency of our system. There is obviously something wrong with the way the current insurance/market system is set up. If we are to maintain the private system that we have, it has to be changed so as to encourage improvement.

Regardless, the debate is healthy and going strong. At least if nothing else, we seem to be making something happen. Party players are coming together and working on compromise which is when the country tends to actually move forward. The next blog will continue with this discussion.

Health Reform On Its Way?

The most recent legislation with any hope of being passed is a bipartisan supported bill called the "Healthy Americans Act." Click here for a PDF download. Anyone with a future in medicine should be paying very close attention to the progress of this bill. Although it will likely change once a president is elected, the meat of the bill could remain. Whether this will actually come through is another story. As the battle goes with reforming healthcare in this country, it is not so easy. So let's examine what a co-author of the bill says it will do. The next blog I will go into more of the debate and look at other perspectives of this bill.

These are the main concepts of the bill from Senator Bob Bennet's website:

The Basic Principles of the Healthy Americans Act

1. CHOICE – Gives Americans choice in what type of coverage best suits their individual and family’s needs and a choice in where they receive health care services.
2. PORTABILITY – Because the individual will now own their health policy, insurance becomes portable from job to job and individuals will no longer feel tied to their job because of health benefits.
3. TAX REFORM – Breaks the link between employment and insurance, giving employees instead of employers the tax benefit, which will strengthen incentives to shop for lower cost plans, as well as improve health care quality.
4. HEALTHY BEHAVIOR – Promotes personal responsibility and preventative medicine by creating incentives for individuals to engage in healthy behavior.
5. MARKET FORCES – Provides for patient-driven health care through market forces by allowing more transparency and competition, thereby forcing insurance companies to compete on price, benefits, and quality.

Hello Health: Dr. Parkinson Launches in Williamsburg

The MSBA's first speaker was Dr. Jay Parkinson back in April. His patience has paid off as he is finally launching the "storefront" of Hello Health in Williamsburg, Brooklyn. The hip "Racked" blog published a recent post about the new Brooklyn doctor's office - or "hub" as Parkinson would prefer. We would like to congratulate the launch and wish Dr. Parkinson and his associates good luck.

Did the Industry FINALLY Wake Up??

Short term gains, quarterly stock price increases, quick fixes: for years these have been the key reasons for the American health care system downfall. Insurance companies try to please their stockholders, they have consistently achieved this by fighting tooth and nail to pay hospitals and doctors for services rendered. This lowers the quality of our medical care and turns doctors into assembly lines. Our system is essentially a "sick-care" system that offers zero incentive to be a so-called "good doctor." The insurance companies themselves are nurturing their own demise. By avoiding the costs of controlling chronic disease and prevention now, down the road when those diseases manifest themselves it will surely cost exponentially more. Have the insurance companies finally seen the fate they have created for themselves?
Someone with any business knowledge may have finally consulted with the companies and reminded them about investing for FUTURE gain. New plans springing up from Phili to North Carolina have been testing the concept of PAYING PRIMARY CARE DOCTORS MORE, and focusing on prevention and chronic disease management in order to save on more expensive treatment and consults down the road. The New York Times describes these insurance company-backed experiments in their article HERE. To me it seems like some foresight and common sense is finally seeping into these greedy insurance conglomerates. Maybe our "Sick care" can become "health care." If we manage our sickest patients efficiently, focus on prevention, pay primary doctors fairly for what they should be doing (promoting wellness and providing support to their patients) than we ALL benefit.

SHOULD DOCTORS BE RATED?

I have been having many discussions with people about the future of medicine lately. A topic, often controversial, that continues to come up is that of rating systems for doctors. As the costs of medicine rise both on the individual and the system, and patient satisfaction across the board is declining, the debate is not only legitimate but I believe absolutely necessary.

Essentially at the core of the debate is the question of whether medicine should be treated like any other consumer service or product. If I am interested in a digital camera, I can search the Canon Powershot S5 on BIZRATE.com and see that a reviewer gave it 5/5 on battery life, features, and picture quality. After a lengthy joy-filled approval of the camera, the reviewer states his grievance: "Although the battery life is really good, I wish it would tell me a little sooner that the batteries are going dead." I can see this same sort of set up for a doctor-rating site: John Doe wants a new primary care doctor, so he checks out the rating site and finds a 9.6 overall rating and reads that the doctor is great at coordinating his prescriptions so that the cost to the patient is the lowest! He is satisfied and is just about to schedule an appointment, when he reads that one patient complained that during a pelvic exam the doctor left the room to answer a page and left the door wide open with her in the stirrups. Uh-oh, maybe this is not the type of doctor John was looking for.... NEXT. Do patients (consumers) have the right to be able to check out a reliable source for physician ratings like this? Many believe so. Some, however, are staunchly fighting what they believe is a slippery slope to bargain, untrustworthy, doctor-shopping.

I do not have the perfect answer to this debate, nor does anyone right now. What I do know is that whether we like it or not, doctor-rating is coming. All the way back in October, the WSJ Health Blog wrote about Zagat's new system for patients of particular health plans to rate their experience with their doctor.

As a future doctor, I know medicine will change drastically by the time I am practicing. The rising concept of patient-consumer education, choice, and freedom will not simply vanish because of the uncompromising resistance of lobby groups. There are endless issues and challenges that we will need to approach clear-minded, and logically. That thought brings me back to the reason that we founded the MSBA, to empower ourselves as future doctors with knowledge of important issues related to the business of practicing medicine.

SPEAKER #2: Dr. Richard Handelsman

MSBA had the privilege of hosting another innovative speaker yesterday, Dr. Richard Handelsman. As part of the MDVIP network (www.mdvip.com), he has challenged the bureaucracy of managed care through his internal medicine practice.
Instead of treating patients in the assembly line fashion which is dictated by managed care, he treats his patients with the time and attention they deserve from their physician. He is able to do this by charging a $1500 flat annual fee per patient and treating a smaller patient population of approximately 450 people. He also bills the patient's insurance company as an out of network provider.
As a result, he can treat his patients and address their specific needs, rather than treat the disease with a quick diagnosis. Dr. Handelsman now has the time to make house calls, personally consult with the specialists he refers to, do an hour and a half extensive history and physical, advise his patients on nutrition, excercise, and lifestyle, and much more. His patients are very satisfied with his service and according to Dr. Handelsman neither he nor his patients would ever go back to the way he used to practice. This is just one of the innovative ways we can practice medicine without the burden of managed care.