Please pass along to the President that healthcare reform does indeed start in the community. Tobacco and teens is big but how difficult can it be to ban sodas, and highly processed "foods" in our school systems?

BRAVO! I would only add to that pitch to demand patient accountability for their own health status. Preventative care must become a standard of care that patients embrace much like they embrace caring for their cars.

BRAVO!! I wonder, as the president admires "The Clinic", if anyone will point out that there is a $400.00 surcharge for "facilities" charged to each patient for every physician they see. The charge is not reimbursed by insurance. Yessiree..ya gotta admire "The Clinic" when it comes to health care reform.

I could not agree more with the previous 2 comments. We as a nation can not continue to gorge ourselves and remain sedentary and then expect the system to fix all our problems with prescriptions and procedures.  We need to be responsible for our actions.

Good one! Surcharge for "facilities". $400.00 FOR EACH PHYSICIAN???  Per Admission?  What a racket.

I agree. A lot of our health issues are related to unhealthy lifestyles. We go to the doctor with painful knee and the doctor writes a prescription and maybe injects with cortisone instead of saying ..LOSE WEIGHT AND YOUR KNEES WILL STOP HURTING! My patients average 16 medications a day. Yes, I said AVERAGE 16 a day. Many could be eliminated by losing weight and stop smoking. The American taxpayer should not have to pay for the unhealthy decisions of our neighbors. We need a strong prevention program first and foremost.

I agree with all of the comments thus far, especially the ones regarding personal responsibility for ones own health.  Prevention IS the key to health and to the control in healthcare spending, but this is accomplished by each and every US citizen acting on the responsibility to practice it.  Being able to afford and to pay for this service, however, is where the government comes in.

I'm concerned that with all of the political rhetoric regarding healthcare reform, that Americans will "assume" that the government will take care of them once this reform bill is signed; the same mindset of those considering social security and Medicare as a retirement plan.  Until we have programs in place that almost force personal responsibility and show that they actually work to decrease the costs of reactive verses proactive health care delivery, the ball is in the government's court with the control lying in reimbursement decisions.

I agree with the president that we cannot continue with the status quo and that the quality of the care that we "purchase" from our health care providers should be considered.  There are a number of quality initiatives in place for hospitals and physicians whereby they must report results of objectives measures. Mr. Obama briefly mentioned the pay for performance program by Medicare that is very close to being enacted, and once it is, poor care quality (as determined by the measures results) will not be reimbursed by Medicare.  This is definitely NOT the status quo, but it's only a part of the puzzle. 

I thought he did a nice job last night.  

My sediments exactly; people balance their check book to the penny; always service their car on time but don't know their cholesterol or b/p numbers.  Why wait to have a heart attack or stroke which is preventive with lifestyle changes?  Same concept applies to waiting til that tire with the buldge blows out on the highway going 65!

The only thing Obama did last night that was a "nice job" was illustrating his ignorance about healthcare. Unfortunately, front-line docs are having no say in the direction we are going and his perspective of them is just a bunch of people who order tests and procedures based on how much money they can grab rather than crediting them with providing the best healthcare in the world - which he NEVER states. Nobody from the USA ever goes to Canada and the UK and all those other Meccas of Medicne Obama and his gang adores. 

AMEN Sister!  I too listened, then started reading this 1070 page reform act.  What a bunch of mularky!!!!!  If you think that the OPPS proposed rule was bad at taking away reimbusements for your practice testing, just wait!!!!!!

Melissa, if all of us medical/nursing people don't get on the phone and call our reps and senators while they are on their "so-deserved because they work so hard" August break and tell them that the AMA does NOT represent us, and that we do indeed provide superior care right now, use that silly ARRA stim money to fund the so-called uninsured people instead of trying to spend more non-money we don't have on already proven non-answers, we'll just revolt and start our own reform from the bottom up.

This has NOTHING to do with the thread on the OPPS proposal.  This has everything to do with QUALITY CARE that is already being given and the ruling governments penchant to SCRUTINIZE everything we do instead of going after the problem offenders: LAWSUITS AND TORTES!!!!!

I too wish Billy Mays was still here to hawk PROPER healthcare reform that we have talked about ad nauseum here.  The shock facotr alone might smack some sense into our ELECTED officials (as the president kept reminding us last night--HE IS the president). 

PRESIDENT OBAMA:  WAKE UP AND SMELL THE COFFEE!!!!!!  You should READ what you are demanding to be passed----do you really want to maintain a registry of every class 2 and 3 medical device that has ever been used by a patient as is claimed on pages 1000-1009 of this bill?  For what purpose?  Is it going to matter to a dr in NY what a dr wants to do for his 85 y/o pt in MO?  Especially if that 85 y/o is still planting his fields and providing food for the country?  Whose heart may need a bit of coaching on occasion to beat properly so he can still be a productive member of our society???!!!!!  Or do you REALLY want socialism here, where some beaurocrat decides who can have which pacemaker when?  Are the drs going to be told--sorry, this patient is too old? 

Why is a totally different system ok for the elected officials but not for the rest of the US of A that elected you?  (right now I don't have that page on top of my head, sorry, but I did download the entire bill and am reading it page by page).  Why don't you recommend that we ALL have the same access to the care we are paying for YOU to have?  Sen. Kennedy gets excellent care, why can't the farmer in MO get the same care he is paying for the Senator to have?

I promised myself I was not going to get political on this forum.  But I can't fulfill that promise.  This farce that is being ramrodded through and down our throats needs to be stopped NOW.  To "blankety-blank" with the AMA endorsement and the Cleveland Clinic endorsement.  The sooner lobbyists and lawyers quit dictating what the rest of the country has to do and have, the better!  I want my docs to have the TIME to TREAT their patients, not LOOK UP TO SEE WHAT SOMEONE SAYS THEY CAN DO!  Managed care has done that for 20 years, and all it has done has created a nightmare of paperwork, enormous overhead for physicians (gone are the days your 'nurse" was your receptionist, where you may have had 2 people in your office, one to answer phones and one to do your vitals, take the x-ray, draw the blood if you had a machine to do simple analyses, and pour the pills from your little pharmacy area, which you the doc really never went in to check, because there was TRUST that your "nurse" could read and count and type out instructions).  Now you have to have 5 or 6 people in your office to deal with referals, different insurance requirements, billing, phones, EMR's, etc.  And now the GOVERNMENT wants to add to this AND DECREASE REIMBURSEMENT too!  Absolutely ridiculous!!!!!!!!!!

OK, I'm done.

Becky

Well, back in the day of indemnity health insurance, the docs and patients just told the insurance company to pay, pay, pay...with no say. In came managed care and the pendulum swung way to the other side...so now ball is in insurance companies' court. In either case, private entities got greedy and didn't police themselves. So now what do you expect but to have the government step in and regulate?

I agree with Melissa on points 2 & 3 but she misses the point on #1.

While CHF is killing many, the answer is not more cath labs. The answer (did you see BARI-2D?) is coordinated simultaneous control of BP, Lipids, and glucose in advance of the acute event or in the ER with the presenting event. At our diabetes clinic we control over 80% of 2000 AODM with Benazepril, Ziac and Spironolactone (1/2 tab) for $8.33/month at WalMa**, KMa** or Targ**, Lipids with Simva 80mg 1/2 tab ($2.50/month at KM***) and Omega 3 supplements, Metformin and ASA. Others need more. Platitudes about diet and changing how large cola and fast food places can be forced to change are not legal realities. What we need is true preventative proactive care based on data, and payments to PCP made appropriate, to cause the best and brightest to choose clinical diabetes care and vascular dz prevention, not Intervention.

Hey Susan--in Canada, way back in the 90s, cigarettes cost $8.00/pack! Now THERE'S rationing for you! Also back then, a package of mindless chewy TV-watching garbage cookies, cost--Ta-DA! $5,00 for a pack of 12! God only knows how much, here in 2008, this garbage costs in Canada!

That's how 'preventive care' is performed in Canada.  Helluva system, I must say! Only the 'idle rich' can afford to get emphysema, etc...and/or diabetes!

That only happened once Canada went single-payer. THAT'S how the Canadians, took care of that little 'prevention' problem!

 

My website " Myhealthindependence.com" has a health checklist of about 20 iems.

Each topic includes  the following: Medical Condition, Suggested Solution . US Guidelines, Statistics and Risk Reduction  Data.

There is a section on Health Care costs and savings that could be achieved with better adherence to US Guidelines to achieve better  outcomes.

All of this information has been referenced with links to several other reputable sites and articles.

I am using this for  educating my patients and medical colleagues with positive results.

However the overhead for my practice is exorbitant. I hope I will be able to continue  this. Practicing medicine  and achievig good outcomes is my passion and I have published outcome data in 2007 in Diabetes Research and Clinical Practice . I have also presented that at the American Diabetes Association meeting in 2006.

I would appreciate any comments and feedback regarding this website.

I wonder if the President and his health care team would review this and help all of us implement the checklist. The cost savings from this Preventive Care Model may actually pay for health care reform in a deficit neutral fashion.

Eagerly waiting for comments.

Swarna Varma MD

 

I agree with you 100%. What have politicians ever done for American health care in the last 30 years? We have more government oversight than we can handle and it costs more because of it. The Home Care sector is getting killed at every turn. Head hunters are now being hired to cut costs. What they find in "savings" they get to keep some of it. The Home Care has to go thru the expense of appealing the decisions to get what is rightfully theirs. I also agree that we all should have Senator Kennedy's coverage. We should all have their retirement plan too. I am tired of being ripped off by politicians. President Obama needs an education in health care before he decides anything.I am very disappointed in him.

Thanks to all of you for your passionate commentary!!! You are welcome to keep it coming!

Dr. Mike, I hear your logic, but I think you missed mine.  I'm not advocating for more caths for elective situations. I'm advocating the taking of our current infrasctructure and honing it to our best capabilities for AMI care.  Unless you are one getting up at night to take those patients to the cath lab, you might not have a feel for just how many times that happens every night in America.  With regard to elective PCI,  The risks and benefits need to be carefully weighed there with such considerations as size of reversible defect, symptoms, tolerability of medications, etc.  I'm all for your medical management and prevention/screening strategies.  But we need cash flow NOW in order to make prevention and detection and focus in this country.  It will take time to generate revenue to do what you wish to do.  If the President will just tackle the three issues I mentioned, the revenue will start to flow in just under 3 months (based on studies from 2nd hand smoke exposure, the logic from tort reform and the certainity that better AMI therapy will yield higher EF's and lower mortality, a dramatic savings in wasted transport costs, readmit costs and length of stay).

By implementing just the three strategies, especially #1 which focuses on the fact that we have patients with MI's in ambulances  driving past cath lab capable hospitals screaming toward a hospital that has "surgery on site" for no good reason, we can mine the gold that rightly belongs to sick patients and prevention.  We have a hospital in  the state of Ky. that was ene of the first to sign up for "mission life line", but when it comes to "throwing out the life "for the rest of the state, they have selfishly attempted to block every effort, claiming a potential loss in revenue for their PCI program, when it fact, less congestive heart failure and more timely AMI care will find revenue for everyone. 

I stand firm in my recommendation that we need better and more timely AMI care in a population of which 1/3 cannot be and will not be helped with lytic therapy.  Any resistance to such progress should be viewed with suspicion or the certainty that this issue is not fully understood.  Dr. Mike, I don't think you are one of them, I think you misunderstood what I was advocating.  I'll bet you are one of the "good guys"!

Melissa

 

 

Nurseforever, can you provide a source for validating your assertion re the CC facilities charge of $400, please? I have several editorialists with whom I corrsepond who will have that as their first question when I pass this along. Having my late wife run up a bill in excess of $1mil at CC 8 years ago, I would never have noted the facilities charge had an itemized bill been provided me. While things might be better there today in their billing office, their billing was so screwed up then that they were unable to provide the requested itemization of charges and receipts covering my wife's 6 1/2 mo stay. I have no interest in this info for this long ago event, but do think this charge should be widely publicized if CC is to be held up as the cost-effective paradigm for medical practice for America. There were definite problems with their collaborative model then. Perhaps they've improved it in the interim.