A doctor who died 12 years ago is having an influence on healthcare debates all across the country.
Some 200 bills relating to certificate-of-need laws have been introduced in state legislatures this year. According to Kara Hinkley with the National Conference of State Legislatures, the trend is toward limiting CON by repealing pieces or including moratoriums on CON requirements.
Despite this opposition to the CON process, a new study concluded that certificate of need has done what it set out to do: Control healthcare costs.
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The brave new worlds of healthcare and healthcare economics got me thinking about legendary University of Alabama football coach Paul "Bear" Bryant.
First I was assigned to write an article on voters' approval of a local ballot measure in California that capped executive pay at the public healthcare institution in Google's hometown, El Camino Hospital in Mountain View, Calif., at twice that of the state's governor.
The El Camino Hospital pays CEO Tomi Ryba a $695,000 base salary to run its 361-bed, two-campus institution, and—eight days after the election—its board approved a $137,815 performance bonus (PDF) for her.
In contrast, Gov. Jerry Brown makes almost $174,000 as the state's CEO, but the California Citizens Compensation Commission—as part of state austerity measures—has knocked that down to $165,000 starting next month.
The hospital board has authorized taking legal action to challenge the ballot measure's directive, which would reduce Ryba's salary to $330,000.
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Election Day has finally come and gone, and although it's true that the number of Democrat doctors in the U.S. House of Representatives will have tripled once the new Congress is sworn in, the statistic isn't all that significant—their numbers grew from one to three. In the Senate, Democrat docs saw no gain in ranks.
On the Republican side, there are currently 15 doctors in the House. Dr. Ron Paul of Texas ran unsuccessfully for president and didn't seek re-election to Congress, and New York ophthalmologist Dr. Nan Hayworth lost her re-election bid. Dr. Charles Boustany, a cardiovascular surgeon, won his race but faces a run-off against fellow Republican Jeff Landry on Dec. 8. No new GOP physicians were elected.
In the Senate, the only incumbent physician running, the GOP's Dr. John Barrasso, won handily with 75.9% of the vote. The only Democratic doc in a Senate race, Dr. Richard Carmona—a general surgeon and the former U.S. Surgeon General—lost his bid to win Arizona's open seat by a 50.4% to 45.2% vote to Republican Rep. Jeff Flake. Republican Senate Drs. Tom Coburn of Oklahoma and Rand Paul of Kentucky were not up for re-election.
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UPDATED 5:15 p.m.: If you can still find a telephone booth in Washington, it could probably serve as an adequate meeting room for the Democratic Congressional Physician Caucus, but that could change after the Nov. 6 election.
There are 19 physicians serving in Congress along with Dr. Donna Christensen, the nonvoting delegate representing the U.S. Virgin Islands. Christensen and Dr. James McDermott, a Washington state psychiatrist, are the only Democratic doctors in Congress—though they may soon have a lot more company. Of course, they both have to be re-elected first.
With the exception of Rep. Ron Paul, the Texas OB-GYN and erstwhile presidential candidate, all of the GOP doctors in the House are running for re-election. They are: Dan Benishek (Michigan, general surgeon); Charles Boustany (Louisiana, cardiovascular surgeon); Paul Broun (Georgia, family medicine); Larry Bucshon (Indiana, thoracic surgeon); Michael Burgess (Texas, OB-GYN); Bill Cassidy (Louisiana, gastroenterologist); Scott DesJarlais (Tennessee, family medicine); John Fleming (Louisiana, family medicine); Phil Gingrey (Georgia, OB-GYN); Andy Harris (Maryland, anesthesiologist); Nan Hayworth (New York, ophthalmologist); Joe Heck (Nevada, emergency medicine); Tom Price (Georgia, orthopedic surgeon); and Phil Roe (Tennessee, OB-GYN). Heck, by the way, is the only D.O., or doctor of osteopathy, in Congress.
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Physician Hospitals of America says that by supporting the Republican opponent of the junior senator from Montana, it's hoping to send a message to the state's senior senator, Democrat Max Baucus, that "anti-competitive healthcare" will no longer be tolerated.
The PHA, an association for physician-owned hospitals, is backing GOP Congressman Denny Rehberg over Democratic incumbent John Tester in the Senate race and is planning to host a breakfast fundraiser for him in Austin, Texas, on Sept. 22—the morning after it concludes its annual conference. The PHA also hopes to slice away at the Democrats' Senate majority helping to keep Baucus in the Senate Finance Committee chairman's seat.
In an e-mailed news release promoting the Rehberg fundraiser, the PHA says Baucus "has time and time again blocked the necessary reform needed to provide relief for physician-owned hospitals." The group has been at odds with Baucus for several years over the senator's opposition to physician-owned hospitals.
Since the PHA was unable to get rid of Section 6001 through litigation, the strategy makes sense—but doctors don't always get what they want from politicians they support.
Case in point: Jim Bunning, the Hall of Fame baseball pitcher and former GOP senator from Kentucky who was re-elected 51-49 in 2004 thanks in part to the financial support he received from physicians to defeat another physician, surgeon Daniel Mongiardo. Six years later, Bunning was filibustering to allow a 21.2% Medicare physician payment cut called for by the sustainable growth-rate reimbursement formula.
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According to two influential GOP lawmakers, doctors will not have their Medicare pay cut by around 30% in January as called for by the sustainable growth-rate reimbursement formula. However, the lawmakers differ on when the much-hated SGR will be repealed for good.
Both Rep. Paul Ryan of Wisconsin, the party's presumptive vice presidential candidate, who finished No. 24 on Modern Healthcare's 2012 Most Influential People in Healthcare list, and Sen. Chuck Grassley of Iowa, No. 56 on the list, seemed certain that another temporary fix will be approved by Congress and signed by President Barack Obama before the scheduled pay cut kicks in.
"No one is going to go home to their state to tell doctors we're cutting their pay 30%," Grassley said during an interview with Modern Healthcare for the Most Influential list.
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Just in time for the Republican and Democratic presidential conventions, the American College of Physicians has released a position paper telling the people who keep saying they don't want politicians to get between patients and their doctors to stop placing themselves between patients and their doctors.
"Some recent laws and proposed legislation appear to inappropriately infringe on clinical medical practice and patient-physician relationships, crossing traditional boundaries and intruding into the realm of medical professionalism," Dr. David Bronson, president of the ACP, said in a news release.
The ACP spelled out its stance in a 12-page Statement of Principles on the Role of Governments in Regulating the Patient-Physician Relationship (PDF). The statement noted that of particular concern were laws and regulations "that require physicians to provide care not supported by evidence-based guidelines and/or not individualized to the needs of the specific patient."
Approaching the subject politely, the paper begins by stating that "it may be difficult to distinguish between mandates that interfere with clinical practice versus those that promote good public health," but it goes on to basically say that unless you have scientific evidence supporting your position, don't tell us what to say and don't tell us what to do.
And it's about time someone said it.
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Among my random observations from the recently concluded annual meeting of the American Medical Association House of Delegates was that there was at least one fewer mustache and one fewer bowtie this year.
Dr. Richard Frankenstein, former California Medical Association president, was sporting a new clean-shaven look. But when I noticed this one of us was on an escalator and the other on the stairs, so there wasn't an opportunity to inquire about the fashion statement.
Frankenstein was an unsuccessful 2010 AMA Board of Trustees candidate, and 2010 was the last year the AMA had a contested election for the office of president-elect. It should be different in 2013, as trustees Dr. Joseph Annis, an anesthesiologist from Austin, Texas and Dr. Robert Wah, chief medical officer with Computer Sciences Corp, Falls Church, Va., have already announced their candidacies for the post. Wah finished 10th on this year's Modern Physician/Modern Healthcare 50 Most Influential Physician Executives list.
One thing that happens during every annual meeting is that downtown Chicago's population of bow-tie wearers spikes noticeably. This year, however, the group by was down by at least one, as Dr. Joseph Bailey Jr., perhaps the House of Delegates' dean of Southern gentlemen, did not attend.
In an e-mail, Medical Association of Georgia spokesman Tom Kornegay said Bailey had to attend to a personal matter. Kornegay added that no one in the MAG office could determine the last time Bailey didn't attend the annual meeting.
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Reporters think they have it tough, but—during the annual American Medical Association House of Delegates meeting in Chicago—it's the AMA staff that must get the most done in very little time. And sometimes, apparently, sleep deprivation can make things can go from bad to verse.
Such was the case this week with good ol' Reference Committee C (PDF), which is tasked with processing reports and resolutions having to do with medical education—including its endless string of acronyms for continuing medical education (aka CME) offshoots. Commonly repeated terms in this year's meeting have included maintenance of certification (MOC), osteopathic continuous certification (OCC), and maintenance of licensure (MOL).
This year, the panel also addressed plenty of graduate medical education (GME) issues, such as resident work hours and resident "moonlighting" at other jobs in their off-hours (to help pay off those med school debts, you know). Every year, there are some folks who believe that med students and residents aren't learning enough about the topics that interest them, so this year there were calls to add lessons on pain, organ donation, autopsies, patient safety and more.
I could go on, but the agenda was cleverly summarized by Dr. J. Mack Worthington, professor, chair and clerkship director for the family medicine program at the University of Tennessee (Chattanooga) College of Medicine.
Worthington, who served as chairman of Reference Committee C, closed the committee's proceedings at the meeting by reading a poem written by Fred Lenhoff, one of the AMA staffers assigned to the panel.
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Being a voting member of the American Medical Association House of Delegates means being part of an exclusive club—but apparently it doesn't mean you always feel like voting.
Minutes after the Society of Cardiovascular Angiography and Interventions was admitted into the House of Delegates at the delegates' annual meeting this week in Chicago, House Speaker Dr. Andrew Gurman of Pennsylvania instructed the group's lone delegate, Dr. Joe Babb of North Carolina, to go to registration and pick up his credentials.
He was also told to sit where there was an electronic vote "clicker" waiting for him.
According to an AMA Board of Trustees report, Babb's group was founded in 1978 and has 2,185 members, 562 of whom are AMA members (25.7%). And the AMA may need to add more new member groups as its meeting goes on if Monday's lethargic-voting trend continues.
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Being a voting member of the American Medical Association House of Delegates means being part of an exclusive club—but apparently it doesn't mean you always feel like voting.
Minutes after the Society of Cardiovascular Angiography and Interventions was admitted into the House of Delegates at the delegates' annual meeting this week in Chicago, House Speaker Dr. Andrew Gurman of Pennsylvania instructed the group's lone delegate, Dr. Joe Babb of North Carolina, to go to registration and pick up his credentials.
He was also told to sit where there was an electronic vote "clicker" waiting for him.
According to an AMA Board of Trustees report, Babb's group was founded in 1978 and has 2,185 members, 562 of whom are AMA members (25.7%). And the AMA may need to add more new member groups as its meeting goes on if Monday's lethargic-voting trend continues.
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