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By Andis Robeznieks 
Posts tagged Physicians
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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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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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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With the recent passing of Jerry Nelson, the voice of Sesame Street's Count von Count, I'm compelled to note that the 2012 edition of Modern Healthcare's 100 Most Influential People in Healthcare list had 18 first-timers, eight 11-timers, 78 men, 22 women and 25 doctors (20 men and five women).
No doctor is on the "perennial" list of eight people who made the list all 11 years of its existence. In order of their appearance on this year's list, here are the names of the 25 physicians, followed by their titles and the number of times they've appeared on the Most Influential list: No. 3, Dr. John Kitzhaber, governor of Oregon, (1); No. 17, Dr. John Noseworthy, president and CEO, Mayo Clinic, (2); No. 20, Dr. Regina Benjamin, U.S. Surgeon General, (3); No. 21, Dr. Delos "Toby" Cosgrove, (6); No. 26, Dr. Atul Gawande, professor, Harvard Medical School, (1); No. 29, Dr. Gary Gottlieb, president and CEO, Partners HealthCare System, (6); No. 32, Dr. Carolyn Clancy, director of HHS Agency for Healthcare Research and Quality, (10); No. 34, Dr. Farzad Mostashari, national coordinator for health information technology, (2); No. 41, Dr. Gary Kaplan, chairman and CEO, Virginia Mason Medical Center, (4); Dr. Susan Turney, president and CEO, MGMA-ACMPE, (1); No. 46, Dr. Thomas Frieden, director, Centers for Disease Control and Prevention, (3); No. 50, Dr. Risa Lavizzo-Mourey, president and CEO, Robert Wood Johnson Foundation, (7); No. 51, Dr. Mark Chassin, president of the Joint Commission, (5); No. 53, Dr. Glenn Steele Jr., president and CEO, Geisinger Health System, (4); No. 58, Dr. Margaret Hamburg, Commissioner, Food and Drug Administration, (3): No. 60, Dr. Francis Collins, director, National Institutes of Health, (3); No. 63, Dr. Harvey Fineberg, president, Institute of Medicine, (4); No. 64, Dr. Eric Topol, chief academic officer, Scripps Health, (2); No. 68, Dr. Bruce Siegel, president and CEO, National Association of Public Hospitals and Health Systems, (2); No. 75, Dr. Ralph de la Torre, chairman and CEO, Steward Health Care System, (1); No. 80, Dr. Georges Benjamin, executive director, American Public Health Association, (6); No. 85, Dr. James Madara, executive vice president and CEO, American Medical Association, (1); No. 88, Dr. Richard Gilfillan, acting director, CMS Center for Medicare and Medicaid Innovation, (2); No. 94, Dr. Darrell Kirch, president and CEO, Association of American Medical Colleges, (5); and No. 97, Dr. Charles Sorenson, president and CEO, Intermountain Healthcare, (2). Congratulations one and all. Was there an influential physician you thought should have been on the 2012 list? Let me know at arobeznieks@modernhealthcare.com. Follow Andis Robeznieks on Twitter: @MHARobeznieks.
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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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Consolidation is occurring everywhere in healthcare. Without the involvement of public shareholders' or taxpayers' dollars, private companies have become very private about how much they're spending on their latest acquisition—unless the deal lands in court.
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The reader comment sections on news websites and the Twitter-sphere can be nasty places. Unfortunately, it took the untimely death of Dr. Donald Liu to demonstrate that those electronic opinionators can be used for better purposes.
Liu, 50, was the surgeon in chief at the University of Chicago's Comer Children's Hospital since 2007, and he drowned in Lake Michigan on Aug. 5 after helping save two boys who were struggling in the water.
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