Monday, March 30, 2009

White House Report on Health Reform

Today the White House issued the Forum on Health Reform Report.  It is a summary of the events of March 5, 2009, and includes the remarks of President Obama, the findings of the “breakout sessions,” and a transcript of the Town Hall session.  I won’t repeat the report here.  All 54 pages are available at www.whitehouse.gov/assets/documents/White_House_Forum_on_Health_Reform_Report.  His attendees included representatives from Congress, physician groups, the insurance industry, the hospital industry, and the private/business sector. I do applaud the president on a carefully orchestrated public display of unity on a topic that is inherently divisive.  

 

Several common themes appear in the text of the breakout sessions.  The participants stressed the need for:

 

Access

Quality

Fair Payment/Reimbursement

 

Incidentally, those are three of the Priority Objectives for 2008-2009 for the American College of Emergency Physicians.

 

Not among ACEP Priority Objectives, but also stressed by participants in President Obama’s were:

 

Cost control

Expanded (insurance) coverage

Prevention of illness/Promotion of health

 

Each group expressed urgency in the need for reform to the delivery system for health care in this country.

 

I witnessed the press event on March 5, 2009, and I read the report eagerly.  Both times I found something missing:  EMERGENCY MEDICINE.  One hundred and nineteen MILLION patients seek emergency care every year in this country, and the only words spoken about emergency medicine were these, “Now, keep in mind, we’re already paying for those folks. Every single person at home, the average family

is paying $900 per family in additional premiums because of the care that people are receiving in emergency rooms. So we’re paying for it, but it’s oftentimes hidden.”

 

Mr. President, if you’re paying for it, I’d like to know where the money is going.  One of the problems in emergency medicine is the fact that emergency physicians are required by EMTALA to provide care for all who present with an emergency condition, without regard for payment.  Emergency physicians are not paid for that care forty percent of the time.  I dare you to name another specialty that donates forty percent of their income to charity care. 

 

I do not care to come across as another doctor whining about not making enough money.  I love my specialty, I love the practice of medicine, and I would rather spend seven night shifts in an row in an emergency department than spend one day as ......[fill in any specialty here.]  However, if we are to have health reform in America, some unpleasant truths must be told.  One of those unpleasant truths is that the system for delivery of emergency care is strained to the breaking point.  If meaningful discussion of reform is to be had, emergency physicians must be included.   The U.S. population was 263 million at the last census, and 119 million people seek emergency care each year.  You do the math.....

 

 

 

Saturday, March 21, 2009

A Day at NASA


I had the pleasure of spending a day at NASA this week.   I met Dr. Joseph P. Kerwin, M.D. (Captain, MC, USN, Ret.), the first physician astronaut to serve with the National Aeronautics and Space Administration.  Dr. Kerwin has had a long and varied career.  He logged 4500 hours flight time as flight surgeon before being selected by NASA in 1965.  He served as science-pilot for the Skylab 2 (SL-2) mission, and subsequently managed the on-orbit branch of the Astronaut Office, where he coordinated astronaut activity involving rendezvous, satellite deployment and retrieval, and other Shuttle payload operations.  He later served as Director of Space and Life Sciences at the Johnson Space Center, Houston.  In that capacity he was responsible for direction and coordination of medical support to operational manned spacecraft programs, including health care and maintenance of the astronauts and their families; for direction of life services, and for managing Johnson Space Center earth sciences research, light experimentation projects, and scientific efforts in lunar and planetary research. 

 

We compared notes on our respective fields, and on the progress that has been made in medicine in the past 50 years.  Dr. Kerwin told me, “The only difference between your specialty and mine is that I made house calls.”  I guess that’s true, but I think most people would consider a house call thousands of miles away in space an adventure.  Dr. Kerwin is the co-author of “Homesteading Space:  The Skylab Story,” a compelling tale of the Skylab from the near-disastrous launch to the descent into the Indian Ocean. 

 

I had the opportunity to tour the historic Mission Control, and I admit to developing a lump in my throat at the thought of the teams who labored tirelessly and risked their personal safety to send human beings into space.  Every mission was an exercise in learning......learning the tasks necessary to live in a weightless environment, learning the mechanical skills to manage spacecraft, learning the nuances of flight.    In the early days of the space program every person had a singular focus – get a man on the moon.  Today NASA has a new program known as Constellation.  The Constellation Program is focused on carrying a new generation of explorers to the moon, and then to Mars. 

 

In these troubled days of challenges in healthcare, economic depression and worldwide warfare, there is a bright spot in the form of Orion, NASA’s first Constellation Program vehicle.  Orion is a reminder that whatever the challenges, the human spirit will continue to seek knowledge and understanding beyond what is currently known.   

 

Thank you, Joe. 

Friday, March 13, 2009

Too big to fail: the malpractice industry?

“I will pursue tort reform in America until every state enjoys the same success as Texas,”  announced Texas Governor Rick Perry to a group of physicians gathered in Washington D.C.  In a speech eerily reminiscent of another Texas governor, Perry detailed the successes of the tort reform movement in Texas, stating, “We need tort reform, and we need it now!”  Unsurprisingly, the group of physicians gathered for the American Medical Association’s National Advocacy Conference greeted the remarks with a standing ovation. 

 

Since the passage of Proposition 12 in September 2003, Texas has transformed from one of America’s “judicial hell-holes” into the land-of-milk-and-honey for physicians.  Neurosurgeons, obstetricians, and emergency physicians flocked to the state, seeking shelter from the litigation wars in Florida, Ohio, and Mississippi.  Malpractice insurance rates have declined by 23% overall.  There is a 2,300 case backlog for the Texas State Board of Medical Examiners, struggling to provide licensure for the litigation refugees of other states.  Seventy-two counties in sparsely populated west Texas boast physicians where there were none 5 years ago. 

 

As the debate for health care reform heats up in Washington D.C., the focus is appropriately on accessible, affordable, high-quality medical care.  Policy-makers struggle to find an economic model that will pay for the kind of care that Americans want and deserve.  Physicians make up a very small percentage of those serving as elected officials in Washington.  Perhaps that explains why lawmakers, who overwhelmingly come from another line of work, fail to see the blunt truth that is right in front of them.

 

Americans could provide the highest quality medical care to everyone in the country, conveniently and affordably, by eliminating defensive medicine. 

 

Of course, the economic cost would be borne by those involved in the litigation industry, which includes far more people than the the much maligned plaintiff attorneys.  Also securing monetary gain from the pursuit of malpractice litigation are defense attorneys, malpractice insurance companies, professional (I mean, expert) witnesses, arbitrators of all types, professional and paraprofessional case reviewers, settlement structure analysts, actuarials , courthouse personnel, and purveyors of advertising.  In fact, perhaps tort reform is not a part of health care reform discussions because the entire malpractice industry is too big to fail?

Wednesday, March 11, 2009

Congratulations, Dr. Jeff Runge


I am in Washington D.C. this week participating in the discussions about health care reform.  Last night I had the honor of being invited to participate in honoring one of emergency medicine’s own, Dr. Jeff Runge.  

 

Dr. Jeffrey W. Runge, MD, FACEP, received the Dr. Nathan Davis Award for Outstanding Government Service in a ceremony last evening.  Dr. Runge practiced emergency medicine for 25 years, and was assistant chairman of the Department of Emergency Medicine at the Carolinas Medical Center in Charlotte, North Carolina when President Bush appointed him administrator of the National Highway Safety Administration.  While there he implemented a combination of legislative and law enforcement initiatives, including the “Click It or Ticket” program.  Dr. Runge went on to serve as chief medical officer within the Department of Homeland Security (DHS), working as an advisor on medical and bioterrorism issues.  While there Dr. Runge founded the Office of Health Affairs, providing oversight of the Department’s biodefense and medical readiness programs.  Dr. Runge now acts as a consultant in the areas of disaster medicine, bioterrorism defense and homeland security technology.  

Sunday, March 08, 2009

A Message from Dr. Nicholas Jouriles, ACEP's President

It is imperative that Congress and the Obama Administration address the escalating crisis in our nation’s emergency departments.  Every American expects emergency departments to provide expert medical care when they need it.  Emergency departments are a vital part of every community - caring for critically ill or injured patients, as well as victims of epidemics, natural disasters and acts of terrorism.  Emergency physicians also care for people who have nowhere else to turn and often are the only source of medical care available at night, on weekends and on holidays.

The consequences of our nation’s economic turmoil and mounting job losses can be seen every day in emergency departments across the country, where the newly uninsured increasingly are turning for care.  Emergency departments are the health care safety net for everyone, insured and uninsured alike, and their role in America’s health care system has never been more critical.

As Congress tackles health care reform this year, it must not ignore the issues raised in the American College of Emergency Physicians’ National Report Card on the State of Emergency Medicine, which gave the nation a near-failing D- in the category of access to emergency care.

Recognizing the important role of emergency medicine and trauma care in this country and acknowledging the critical problems patients face when these services are not readily available, the "Access to Emergency Medical Services Act" was introduced in February 2009 by Reps. Bart Gordon (D-TN) and Pete Sessions (R-TX) in the U.S. House of Representatives (H.R. 1188), and Sens. Debbie Stabenow (D-MI) and Sen. Arlen Specter (R-PA) in the U.S. Senate (S. 468).