Knowing & sharing (Part 2): "How Does Health Reform Impact Physicians?"

Last week, in reference to my prior post of Doctors for America's "one page handout for your patients explaining how Health Reform will affect them," a savvy reader of DownstateCafe asked me:

"Could you find one of these for how it will affect doctors?"  

Why certainly!  DFA comes to the rescue (their name indeed sounds like a superhero's, doesn't it?), with the following earlier today in their newsletter: 

"Need an easy way to teach your colleagues and your patients about the new health reform law? Download our new resources [How Does Health Reform Impact Physicians?]. Hand them out to your colleagues at a noon time talk or print copies to keep in the office..."

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NYT: Hospitalists & Health Reform

[Read the full article here.]

New York Times, May 26, 2010

New Breed of Specialist Steps In for Family Doctor

By JANE GROSS
PHILADELPHIA — By the time Djigui Keita left the hospital for home, his follow-up appointment had been scheduled. Emergency health insurance was arranged until he could apply for public assistance. He knew about changes in his medication — his doctor had found less expensive brands at local pharmacy chains. And Mr. Keita, 35, who had passed out from dehydration, was cautioned to carry spare water bottles in the taxi he drove for a living.

The hourlong briefing the home-bound patient received here at the Hospital of the University of Pennsylvania was orchestrated by a hospitalist, a member of America’s fastest-growing medical specialty. Over a decade, this breed of physician-administrator has increasingly taken over the care of the hospitalized patient from overburdened family doctors with less and less time to make hospital rounds — or, as in Mr. Keita’s case, when there is no family doctor at all.

Because hospitalists are on top of everything that happens to a patient — from entry through treatment and discharge — they are largely credited with reducing the length of hospital stays by anywhere from 17 to 30 percent, and reducing costs by 13 to 20 percent, according to studies in The Journal of the American Medical Association. As their numbers have grown, from 800 in the 1990s to 30,000 today, medical experts have come to see hospitalists as potential leaders in the transition to the Obama administration’s health care reforms, to be phased in by 2014.

Under the new legislation, hospitals will be penalized for readmissions, medical errors and inefficient operating systems. Avoidable readmissions are the costliest mistakes for the government and the taxpayer, and they now occur for one in five patients, gobbling $17.4 billion of Medicare’s current $102.6 billion budget.

Dr. Subha Airan-Javia, Mr. Keita’s hospitalist, splits her time between clinical care and designing computer programs to contain costs and manage staff workflow. The discharge process she walked Mr. Keita and his wife through can work well, or badly, with very different results. Do it safely and the patient gets better. Do it wrong, and he’s back on the hospital doorstep — with a second set of bills.
“Where we were headed was not a mystery to anyone immersed in health care,” said P. J. Brennan, the chief medical officer for the University of Pennsylvania’s hospitals. “We were getting paid to have people in the hospital and the part of that which was waste was under the gun. These young doctors, coming into a highly dysfunctional environment, had an affinity for working on processes and redesigning systems.”...

...The most compelling argument in favor of hospitalists, who are now in 5,000 institutions, from academic giants like the Hospital of the University of Pennsylvania to small community hospitals to innovators like the Mayo and Cleveland Clinics — is that they are there all the time. Another is that they are more comfortable than their predecessors with technology and cost-cutting decision-making. One day in April, Dr. Airan-Javia was in and out of the rooms of a dozen patients, toggling between clinical work and designing a computer system for the safe handoff of patients between residents whose hours are now limited by law.

Bad discharges generally result from hurried instructions to patients and families and little thought to where they are headed. One such situation was the centerpiece of a class taught for doctors at Mount Sinai Medical Center in New York. The patient, an elderly woman in the hospital for scoliosis, a spinal condition, was discharged by a hospitalist on a Friday night, with a prescription for a narcotic pain reliever that her pharmacy, as it turned out, did not stock. No one explained how her new medication differed from the old, or gave her a contact number for help. Without medication, by Tuesday, her ankles swollen and her breathing irregular, the woman was back in the hospital.

In 2008, the hospitalists’ organization decided to invent better discharge systems rather than respond defensively to criticism, not unlike the simple operating room checklist, made famous by the physician and author Atul Gawande, which reduced accidents and deaths.

In 65 participating hospitals around the country, the Society of Hospital Medicine identifies patients at high risk for readmission, provides staff mentoring, and designs user-friendly discharge forms listing follow-up appointments, potential signs of trouble and phone numbers for the hospital team.  Peer-reviewed research on the reforms in the system is expected in a year or two.

Even experts who were initially skeptical agree that the hospitalists’ skill set is timely. They are young and thus not entrenched in the current order. They enjoy working in teams, when older doctors tend to be hierarchical. And, like Dr. Airan-Javia, who has a 16-month-old baby, they appreciate the regular hours and a paycheck of, say, $190,000 — higher by $30,000 than community-based peers.

Dr. Airan-Javia says she made an inspired career choice. Forty percent of her time is spent on the floor, treating diseases and helping patients and families though complex life events, like deciding when it is time to suspend medical care and let life end. Sixty percent of the time she is designing systems to improve workflow and advising the hospital’s chief medical officer. At meetings with her fellow hospitalists, phrases seldom spoken by most doctors, like “cost-effective delivery of care,” and “preventable adverse events,” flow off everyone’s tongue: The language of health care reform.

“The tools have never been better,” she said, “for finally getting all of this right."

[Read the full article here.]

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Knowing & sharing: "How Does Health Reform Affect You?"

This week, Doctors for America, a non-profit organization of physicians and medical students who advocate for changes in the health care system to ensure affordable access to quality care for all, says:

"Need a one page handout for your patients explaining how Health Reform will affect them? Look no further. Keep copies of the handout in the reception area, or print off a copy if someone asks you about reform during a visit."

Check it out...

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VIDEO: "Washington Post Event: Health Reform And Its Implications"

On May 11th, "Washington Post staff writers, David Hilzenrath, Amy Goldstein, Ceci Connolly, Alec MacGillis and David Brown discuss the new health care law and its implications. The event was moderated by the Kaiser Family Foundation's Jackie Judd."

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Center for American Progress: "How Health Reform Really Works"

Health Care Reform Bill has become Law.  It's a big change--or as a certain VP said on live TV, "...this is a big f*cking deal."

With that expletive magnitude of a change, you'd be the exception if you weren't at least a little confused about all of its many components.

Below's a great succinct, clear video (w/ animation!) laying out the new land.  On the other hand, there's plenty of misinformation out there these days, even talk of fear-mongerers trying to get the health reform law repealed--so help spread the word now on what Reform really means for us!

In addition to the Center for American Progress's video below, Organizing for America also has a series of brief videos on "Benefits of Reform," tailored to your own state, etc., on this webpage.

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NY Times: "New Health Initiatives Put Spotlight on Prevention"

New Health Initiatives Put Spotlight on Prevention
By ROBERT PEAR
Published: April 4, 2010

(To read full article, click here.)

WASHINGTON — Amid all the rancor leading up to passage of the new health care law, Congress with little fanfare approved a set of wide-ranging public initiatives to prevent disease and encourage healthy behavior.

...Under the law, chain restaurants will have to provide nutrition information on their menus. Employers must provide “reasonable break time” for nursing mothers.

Health insurance companies will soon have to cover all recommended screenings, preventive care and vaccines, without charging co-payments or deductibles.

Medicare beneficiaries will get free annual physicals. Medicaid will cover drugs and counseling to help pregnant women stop smoking. And a new federal trust fund will pay for more bicycle paths, playgrounds, sidewalks and hiking trails.

...“When people have insurance,” Dr. Seffrin said, “they are much more likely to receive screenings and treatment. And they are more likely to seek screenings when they do not have to pay co-payments or deductibles.” As a result of such screenings, he added, cancers are more likely to be detected at an early stage, when they are treatable.

Under the law, insurers must provide coverage for all services recommended by an independent panel of experts, the United States Preventive Services Task Force, and cannot impose “any cost-sharing requirements.”

In addition, each Medicare beneficiary will be entitled to an “annual wellness visit,” in which a doctor can assess the patient’s condition, check for signs of Alzheimer’s disease and draw up a “personalized prevention plan” with a screening schedule for the next five or 10 years.

Senator Tom Harkin, Democrat of Iowa and chairman of the Senate health committee, said: “We don’t have a health care system in America. We have a sick care system. If you get sick, you get care. But precious little is spent to keep people healthy in the first place.”

Kathleen Sebelius, the secretary of health and human services, said the measures, taken together, had immense potential to “save lives and to save money.”

...The new law also allows employers to give stronger incentives to employees who participate in programs to lose weight, stop smoking or improve their health in other ways.
Employers can offer rewards equal to 30 percent of the cost of coverage — up from 20 percent under prior law — to employees who participate in such programs.

“This is exciting,” said Helen Darling, president of the National Business Group on Health, which represents 300 large employers. “It puts the emphasis on health improvement, not just paying for illness and injuries.”...

(To read full article, click here.)

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Call/write your Congressperson now!--Healthcare Reform vote in a few hours...

1min now! Crunch time! Call your Representative & Senators:
Easy steps through Doctors for America here; or, if you're not a physician/medical student, also easy to find steps to call your Representative here.  Also, SPREAD THE WORD.

Here's a quick animation (just ignore the bad repititious music...) that very effectively illustrates why we are in dire need of this health reform, & what this reform will do: 


At the speech on Friday at George Mason University, this 1-year old voice urging for health care reform--which has so often been meek, confused, and convoluted--seems to have finally matured, and found its clear intelligent populist voice.  See for yourself:


If you've still got interest/energy, and want to see how it went down tonight at a House of Representatives meeting with President Obama, see below.   Washington Post media columnist Howard Kurtz described Obama's address as "the most emotional speech I've ever seen him give."

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Sex in Medicine--& a medical student's reflection

For the second consecutive year, medical students, faculty advisors, and a collaboration of a dozen student clubs at SUNY Downstate organized a series of lectures, discussions, and workshops on a topic often overlooked—and a facet often underserved—within American medicine.  In February, 2010, “Sex in Medicine Week” allowed participants and audience members to explore issues ranging from “Relationships, Sexuality, and Disability,” to sexual assault & the healthcare provider’s role, to the unique experiences of LGBT patients within a healthcare setting.  

What follows is a reflection written after attending a “Sex in Medicine Week” event. The author is a SUNY Downstate 2nd year medical student.

Conscientious Care for the Patient
By Alaina Burns

    Imagine that you and your life partner are about to board a cruise ship for a vacation with your three children when your partner suddenly suffers a massive stroke. Your partner is taken to the nearest hospital, but you are physically denied visitation rights; your partner dies eighteen hours later, and you are allowed entrance to the room only when the priest is reading the final rights.
    …Or imagine that you have been receiving care from your physician for a chronic medical condition, and one day, you happen to mention your partner. Your physician, who has been treating you for over a year, suddenly refuses to write you your next prescription.
    …Or imagine that you are a woman who has been receiving preparatory treatment for in vitro fertilization from the only in-network provider offered by your insurance plan. When, after a year, the staff at the clinic learn about your partner, they subsequently refuse to continue treatment.
    These cases might seem unbelievable, but they are all true; and they all took place in recent years, right here in the United States: in Miami, Washington state and California, respectively.  Welcome to the difficult reality faced by many lesbian, gay, bisexual and transgender (LGBT) patients who try to navigate the American healthcare system.
   Doctor’s offices and hospitals are often vulnerable spaces for all patients, but they can be particularly unpleasant for people who identify as LGBT. As part of SUNY Downstate’s 2010 “Sex in Medicine Week,” Dr. Maile O’Hara gave a talk, entitled, “Being a Good Doctor for ALL of Your Patients: Specific Needs of Lesbian, Gay, Bisexual, and Transgender Patients,”* in which she spoke about what medical professionals can do to provide more sensitive care for LGBT patients. Dr. O’Hara, a clinical psychologist at the Bellevue/NYU Program for Survivors of Torture, has worked extensively with the LGBT population.
    Among Dr. O’Hara’s recommendations for healthcare practitioners are these:

• Treat your patients who are LGBT with the same respect with which you treat all patients.
• Recognize that many LGBT people have had negative experiences with the health care system in the past.
• Ensure that your office has a nondiscrimination policy and that decorations and selections of items such as magazines and pamphlets are inclusive of the LGBT community.
• Treat the partners of LGBT patients as you would spouses, even if they are not legally married.

    In an era when most people can rest assured knowing that their civil rights are guaranteed, LGBT individuals, on the other hand, are made aware that discrimination can still lurk in the most unexpected of places. No national anti-discrimination law exists that protects lesbian, gay and transgender people, and among states, only twenty-one and the District of Columbia currently protect individuals from discrimination based on sexual orientation.
    Visiting the doctor, for any person, can often be stressful and scary for various reasons.  But for LGBT people, in an unwelcoming healthcare setting, the experience can be doubly terrifying. Educating yourself and being aware of the unique issues faced by people who are LGBT is the first step in providing conscientious care for all of your patients.

*To view the slides presented during Dr. Maile O’Hara’s talk, given at SUNY Downstate on February 25, 2010, please click on the “LGBT Q&A” link on the top left margin of this page.

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Health Professionals March for Reform, March 22

WHAT: A march on Washington for health reform
WHEN: Monday, March 22, 2010, 11am
WHO: Hundreds of health professionals (doctors, nurses, and more) from across the country
WHY: Our patients need it, our communities need it, our country needs it. A sea of white coats and scrubs on Pennsylvania Ave will give Congress a strong message – we must pass health reform now.
MORE INFO: www.healthmarch.org

Who Are We?

We are health professionals — doctors, nurses, dentists, pharmacists, physicians assistants, and friends of health professionals.

We come from all over the country and one thing unites us: each of us has been touched by the patients we see and the struggles they have faced in our current health care system. This is why we are marching together to fight for the health care reform that we can and must achieve as a nation.
Do we agree on every single aspect of health reform? Of course not. Do we agree that moving forward with health reform will lay the foundation to a better health care system for our patients and for America? Absolutely!

Our patients need better access to care, a regulated insurance industry, improved quality and lower costs. Health professionals know that health reform for our patients and for America is not optional.

That's why we are marching on Washington DC on March 22 — to make sure Congress hears us and gets the job done.

We know. We care. Reform can't wait.

See you on March 22,

 For more details visit www.healthmarch.org.

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Help to spread the Healthcare Reform Facts now!

Help to get the word out on why this healthcare reform is crucial, by printing & posting up fact sheets like this one:

Or, you can also go to that Organizing for America webpage to share many healthcare reform facts via Facebook, Twitter, or email.

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