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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To defend against malpractice suits, one speaker at the recent MGMA-ACMPE annual conference in San Antonio recommended, practices must maintain constant vigilance of their health information technology systems. Another speaker said lawsuits can be avoided by showing patients courtesy and respect.
They are probably both right, though the second speaker's message was more inspiring.
Ronald Sterling, an electronic health-record consultant based in Silver Spring, Md., gave a presentation titled "Malpractice Discovery in the Age of EHR" and warned his audience that he was about to address a "depressing" subject.
Sterling said the good news was that mitigation efforts in the area of malpractice discovery could best be described as "good housekeeping," and he warned against "ceding clinical control to the techno geeks."
Sterling sprinkled his talk with horror stories such as the pediatric practice whose patient immunization records were not transferred into the EHR, and his main message seemed to be: Test systems; verify data; train staff; and document what you did.
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It's not uncommon these days for newly elected physician association leaders to hop on the social-media bandwagon, but the American Academy of Family Physicians' new president-elect, Dr. Reid Blackwelder—a.k.a. @blackweldermd—is an old pro.
Blackwelder has sent 3,429 tweets to 690 followers since joining Twitter in May 2011, but he has been on Facebook a lot longer. First elected to the AAFP board in 2009, Blackwelder is the director of the medical student educational division within the James H. Quillen College of Medicine's family medicine department at East Tennessee State University in Johnson City, Tenn. He first joined Facebook as a way of connecting with his students.
The 2004-2005 president of the Tennessee Academy of Family Physicians, Blackwelder said he stepped up his Facebook activity as he became more involved with the state and national academy chapters. Now he cross-posts everything on both Facebook and Twitter.
Blackwelder said he discovered live-tweeting while attending a meeting and seeing the AAFP's medical resident representative, Dr. Kevin Bernstein (@BernieMD31), pecking away at a keyboard. He learned that Bernstein was "taking notes in Tweet form" for the benefit of a colleague who couldn't attend that session and wanted to find out what happened.
Except for live-tweeting from an event, Blackwelder said he usually keeps to three to five tweets a day: an opening inspirational tweet, around three educational or informational tweets with links to source material, and an evening "thought for the day to allow people to wind down." The tweets are buffered so they're sent out several hours apart, which allows him to "maintain a presence" even while he's seeing patients, teaching or tending to AAFP matters.
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Without hesitation, Dr. Allan Korn, the Blue Cross and Blue Shield Association's chief medical officer and senior vice president for clinical affairs, declared that the patient-centered medical home has the potential to transform the U.S. healthcare system.
"The things you want going up are going up, and the things you want going down are going down," said Korn in an interview following his appearance Monday on a panel assessing the state of the healthcare industry presented in San Antonio at the MGMA-ACMPE's annual conference. "There's no question that the medical home is working, and that's what's gratifying to me."
While speaking on the panel, Korn said he thinks steps could be taken to improve the patient-centeredness of the medical-home practice model. Still, he said later, medical homes—which use information technology to coordinate care and track the treatment of patients who have chronic diseases—have led to double-digit declines in patients' exposure to radiation from diagnostic tests, in "ambulatory-sensitive" hospital admissions, and in unnecessary and costly healthcare episodes.
They have also boosted physician satisfaction.
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As evidenced by library shelves stacked with medical journals, the science of medicine can be measured in countless ways, but Dr. Richard Levin, the new president and CEO of the Arnold P. Gold Foundation, believes the art of medicine—or at least its effects—can be measured as well.
I spoke with Levin recently during the Gold Humanism Honor Society's fifth biennial conference and 10th anniversary celebration, held in Rosemont, Ill. He told me about the foundation's roots and its work creating an institute for research on humanism in medicine that will be dedicated to studying the role of compassion, altruism and respect in healthcare.
The foundation was co-founded by Dr. Arnold Gold, a professor of clinical neurology and clinical pediatrics at Columbia University's College of Physicians and Surgeons, and his wife, Sandra, who served as president and CEO until August. Levin said Dr. Gold was motivated by seeing how "physicians, seduced by new technology, turned away from the tenets of the profession," such as Sir William Osler's words: "Listen to the patient. He is telling you the diagnosis."
"We got so caught up with the idea that technology could take us out of suffering," Levin said.
To instill professionalism, Dr. Gold initiated Columbia's white-coat ceremonies welcoming new medical students into the field of medicine. Levin said the ceremonies are now an annual ritual at 90% of U.S. medical schools—and he notes that the Golds were able to spread this practice without spending money to promote it.
"There was no endowment," he said. "They did it through sheer will and passion."
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Noting that healthcare is in the beginning of its “Decade of Transformation,” healthcare strategist Marc Sauve told attendees at the 25th annual Healthcare Facilities Symposium and Expo in Chicago that “We are going to have to rethink everything.”
“There is going to be a lot of anger, fighting and people getting mad,” said Sauve, a consultant on healthcare provider growth strategies with Gresham Smith & Partners in Nashville. Then, quoting Dr. Seuss, he said the questions are complicated, but the answers are simple—and that these answers include shared sacrifice, compromise and negotiation.
Sauve, a perennial speaker at the symposium, noted how he successfully predicted last year that Congress wouldn't come to a meaningful agreement on deficit reduction. An easy prediction, Sauve acknowledged, but he said he also correctly predicted the Patient Protection and Affordable Care Act's personal insurance mandate would be upheld by the U.S. Supreme Court and Chief Justice John Roberts would cast the deciding vote.
“Maybe we were lucky,” he said.
For this year, Sauve predicted Congress would prevent sequestration-driven budget cuts called for in last year's Budget Control Act, but only do so by “kicking it down the road for six months.” He also predicted failure for legislative attempts to overturn the ACA.
“If you're waiting for repeal, good luck,” Sauve said, though he later praised GOP vice presidential nominee Rep. Paul Ryan for proposing Medicare reform. “At least he had has some guts to put the thing on the table.”
Each year, Sauve runs down the nation's top 15 causes of death and compares U.S. healthcare statistics with other countries. He noted how homicide fell off the list last year after a 10-year run, but countered by stating how the nation's suicide rate is “going through the roof” and how deaths from accidents are on their way up because of driving and texting. But all others are way behind the first and second causes—heart disease and cancer—despite “great strides” made in the treatment of both.
Sauve cited how the World Health Organization ranks the U.S. health system 37th out of 190 countries. While U.S. infant mortality figures are improving, he said the current rate of 6.8 deaths per 1,000 live births is “still embarrassing” and that statistics indicate the high rate is poverty related.
This link continues into adulthood as high school dropouts have a 2.5 times higher death rate than students who go onto college, he said, adding that our “28% high school dropout rate is killing us.” Education is the key to getting people out of poverty and toward a healthier lifestyle, he said.
As health systems transform, Sauve said “there needs to be a physician at the head of the table,” and he criticized how hospital CEOs are all talking about how they need “physician alignment.”
“You need physician partners—just because they're employees now doesn't mean they are cooperating,” he said, adding that nurses need to be empowered as well.
Follow Andis Robeznieks on Twitter: @MHARobeznieks.
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Even with a presidential election coming up and healthcare budgets being threatened by the sequestration-driven cuts mandated by one law and the sustainable growth-rate formula cuts mandated by another, the big question on everyone's mind at the four healthcare conferences filling the convention halls of Chicago just might be, "Who's having the most fun?"
The American Health Information Management Association and the American College of Surgeons have taken over separate halves of the McCormick Place Convention Center; folks at the Healthcare Facilities Symposium and Expo are taking in Lake Michigan breezes at Navy Pier; and the American Urogynecologic Society is meeting in between at the Hilton Chicago on Michigan Avenue.
Along with exhibit-hall receptions, the facilities symposium is hosting a mixer at the Merchandise Mart and offering a riverboat architecture tour as well as field trips to the North Park University School of Nursing simulation center and Chicago's newest healthcare facilities: the Ann & Robert H. Lurie Children's Hospital and Rush University Medical Center's new 14-story tower.
The AUGS will host exhibit-hall receptions as well as an "AUGSome" Friday night party and foundation fundraiser at the Art Institute of Chicago. The event will be capped by the AUGS Karaoke Challenge, an event I'm sure you won't want to miss.
Only AHIMA could feature an ICD-10 Refreshment Bar in its exhibit hall. But the fun doesn't stop there. Five universities are holding alumni events, and a "1920s speakeasy" party was set for the Excalibur nightclub (for you old-timers, that's the former Limelight).
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Predictably, the doctor-nurse scope-of-practice turf battle reignited after the American Academy of Family Physicians issued a report that said, essentially, nurse practitioners and other healthcare professionals play vital roles in team-based care that's provided under the patient-centered medical home practice model—but the team needs to be led by a physician.
The American Academy of Nurse Practitioners, in response, issued a statement declaring the AAFP to be "misdirected and out of step with today's environment."
The extra education physicians receive is at the heart of the debate, but Tamara Zurakowski, a practice associate professor at the University of Pennsylvania School of Nursing, said in response to the AANP's reaction: "A nuclear physicist knows a great deal more about the production of electrical energy than a licensed electrician does, but when I need the wiring in my house fixed, I don't hire a physicist."
Though it was the AAFP that fired the initial salvo—and then took the heat for doing so—it should be noted that the AAFP news release included words of support from the presidents of the American Academy of Pediatrics and the American Medical Association and the executive director of the American Osteopathic Organization.
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Although they face significant obstacles, physician hospital investors will likely succeed in the end because they have a history of doing so, a crowd of these investors was told at the Physician Hospitals of America annual conference in Austin, Texas. The opening keynote speaker, futurist Jim Carroll, first voiced the message, which was later echoed by healthcare consultant Kevin McDonough.
Carroll's general theme was nothing new, and it reminded me of Alvin Toffler's book Future Shock, which I was assigned to read in my high school sociology class more than 30 years ago. But the more he tailored his message, the more Carroll's words resonated.
"There is so much opportunity in front of you, it's staggering," Carroll said, adding that—even though the Patient Protection and Affordable Care Act restricted business opportunities for physician-owned hospitals—growth was still possible with a change in mindset and a change in business models.
McDonough, a senior manager with Dallas-based consultants VMG Health, and VMG Health manager Sarina Hickey offered some specifics. "Margins have remained remarkably stable" for physician-owned hospitals, Hickey said. She added that doctor owners have been "adept at controlling costs," and, while legal and market challenges are daunting, "survivors will emerge stronger." McDonough noted that the ACA's limits on growth may increase the value of existing physician-owned hospitals because they have been made a "limited commodity."
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Pathologists are integrated thoroughly into patient care at Cooper University Hospital, Camden, N.J., and this is by design—architectural design, that is.
The new $163.7 million Roberts Pavilion at Cooper was one of 105 entries in the 27th annual Modern Healthcare Design Awards contest. It was one of 11 winning designs, and EwingCole architects took home a Citation award for their work. What caught my attention, however, was that the architects said that special care was taken to locate the "clinical and anatomic pathology departments to enhance increased involvement of pathologists in the patient treatment stream, a fundamental shift in the role of pathology."
"We love it, it's gorgeous," said Dr. Roland Schwarting, Cooper's pathology department chairman and chief. "What I love about it is it's an integrated design.”
Schwarting explained how, typically, pathology departments and hospital laboratories are fragmented into various silos, hindering communication and collaboration. He said that on paper, it would amount to a very confusing "spaghetti diagram," with arrows pointing every which way to connect the various functions. One can still use a spaghetti diagram to illustrate the department's operation at Cooper, but "the noodles are not as long," Schwarting said.
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