Heartfelt with Dr Melissa Walton-ShirleyView all posts »
Dead subspecialists walking--Enough with the reprieves, already!Jan 4, 2013 08:24 EST
It's really getting to be habit, you know—this end-of-year pilgrimage that subspecialists make down the long hall. We begin our final ambulation with the booming announcement decried by a few anxious hangmen politicians, "Dead subspecialists walking!" We are shackled Django-like from about mid-December while politicians haggle for the best deal possible until they shut down for a few hours of Christian holiday merriment. Washington awakens just before the dawn of the New Year to reactivate our march toward our final destination. Other physicians clang their cups on their bars as we pass by, keenly aware that at any moment their number may also come up. We walk hoping upon hope that a miraculous reprieve from the looming employee-salary, benefit-busting, private-practice-gutting plan for a 20-something percent cut in Medicare reimbursement might disappear. Several times now, we've won that welcome reprieve from Congress, but one of these days, we'll be strapped into the big chair and asked if we have any final words, then the gas will come pouring into the world of subspecialists. Our crime? Simply desiring to continue to deliver good care to our communities from our well-established offices. This time, though, the big machines of medicine didn't get that reprieve, as hospitals suffered a massive reduction in reimbursement, and our friends who are those Rubik's cubes of relative value units (RVUs) didn't get the governor's call either.
What exactly do politicians hope to gain by the mass execution of American subspecialists? Reducing Medicare reimbursement is akin to removing a corner piece from a massive house of care delivery cards? As we walk toward our public execution, we carry our patients on our backs, patients who already have difficulty accessing outpatient services and who cannot afford their medications. Politicians don't understand or seem to care enough that families of our employees who depend upon us for their livelihoods and healthcare coverage dangle precariously at our side. The greater question is this: Why excise a metastatic cancer from the surface of a damaged and broken system and do nothing to stop the terminal processes that drive it?
Reductions in Medicare reimbursement are a lazy and uninformed legislator's ineffective and very temporary way out. There are tons of opportunities for savings that would be immediate and broad sweeping if we just implemented a few solid changes early this year:
- President Obama—Declare war today on smoking in our nation. The carnage from first- and secondhand smoke exposure is one of the oldest Benghazi stories in the US, although it's not a cover-up—it's malignant neglect. Listen closely—can you not hear our continuing cries for help? Driving legislation state by state would result in massive reductions in heart-attack occurrence and visits to emergency departments for asthma, COPD, and bronchitis therapies within just six months of implementation. The rising cost of healthcare in the US is unsustainable. The long-term benefits of these legislative changes would be immeasurable and immediate.
- Provide tax incentives to hospitals that implement programs that reduce medical errors and hospital-acquired infection. It's entirely possible to increase transparency and promote mediation instead of litigation. According to Dr Roger Stark of the Washington Policy Center, in 2011 "the country spent $2.4 trillion, or nearly 18% of our gross domestic product (GDP), on healthcare." Frivolous lawsuits against doctors and hospitals contribute significantly to these rising costs and by some estimates are responsible for up to 10% of the cost of healthcare. Fifty-four cents of every dollar awarded goes to the litigation process. I know most men don't like to talk on the phone but First Lady Michelle, please ask the president to be bold and pick up the phone! Tell him to call the University of Michigan and ask for Richard Boothman. He can tell him everything he needs to know about this monstrous issue that does have a fairly easy, straightforward solution. Make your man be the first man in public office to change the world of US patients and practitioners forever—and you don't even have to breathe the words "tort reform."
- Start rolling the wagon wheel of prevention. The hub of that most important wheel is the massively expensive DRG known as heart failure. The spokes are hypertension, diabetes, obesity, sedentary lifestyle, poor diet, and smoking, all of which drive coronary heart disease, diastolic dysfunction, systolic dysfunction, obstructive sleep apnea, atrial fibrillation, and stroke. Incentives to improve access to simple blood-pressure checks in places where US citizens congregate are one simple step—put them in grocery stores, beauty salons, and barber shops. Asking schools to restructure their health programs by teaching our kids the difference between a carb and a fat and how to read labels for sodium content are key. Making phys-ed programs a daily mandatory activity is also essential as the ultimate prevention measure. Incentivizing with tax breaks to large US employers for not only providing access to dietary and exercise programs but implementing the actual utilization of these services will work!
- Instead of penalizing hospitals with 30-day readmit issues, incentivize them to provide adequate follow-up. Fellow blogger Dr Ileana Pina from Montefiore Medical center's brown-bag clinic is a great place to start. Other studies with nurse-driven simple phone calls following discharge have shown impact on readmit rates. Seems to me another phone call might be in order here from our legislators to those folks with proven success to push these out to their constituents state by state.
One of the most impactful movies for me as a child was the Susan Hayworth film I Want to Live. I'll never forget seeing it with my mother on our old black-and-white television that just received one or two stations. The tension was palpable every time she was forced to walk the walk toward the execution chamber, but on her final walk, the one where they picked up the phone line just to make sure the governor couldn't get through, one could see the terror in her eyes. I'll never forget her hands tensed against leather straps as a blend of sulfuric acid, distilled water, and cyanide crystals generated a cloud of smoke that encircled her head. One of these days, subspecialists will not get that much-needed reprieve, and access to decent subspecialty medical care will diminish forever in the US, an irreparable foray into the worship of mediocrity.
Next year, let's not do this again. Let's not leave everyone dangling, hoping and wondering as we sit in the glow of our festively decorated trees trying to pretend we aren't just a little bit distracted. Enough already. Start now, legislators! It's the dawn of a New Year. If we work together and avoid trying to reinvent the wheel, a reprieve this time around 2014 won't be necessary at all.