The New Rules of Engagement Part I: A Call to Action July 14, 2010
Posted by Amit J. Shanker, MD, FHRS, FACC in Health Policy.Tags: Healthcare reform, Medicare
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When Medicare was enacted in 1965, it promised not to interfere in the practice of medicine:
“Nothing in this title shall be construed to authorize any federal officer or employee to exercise any supervision or control over the practice of medicine, or the manner in which medical services are provided, or over the selection, tenure, or compensation of any officer, or employee, or any institution, agency or person providing health care services….” Section 1801, Medicare Act, 1965
Unfortunately, times have changed…
“The [British] NHS [National Health System] is one of the great human health care endeavors on Earth. It can be an example for the whole world — an example, I must say, that the United States needs now more than most other countries do.”
The following was a direct quote from a speech on file given to the Senate Finance Committee by Dr. Donald Berwick, the newly appointed Administrator of the Centers for Medicare and Medicaid Services (CMS). In that same spirit of pushing HR 3590 through alternative means, the administration appointed Dr. Berwick while congress was away for the Independence Day recess. Last month 56 House Republicans wrote to the President requesting that he withdraw the nomination, citing Berwick’s support for, and work with the British National Health Service, which solely uses comparative effectiveness research as a cornerstone in determining healthcare delivery. When asked about Berwick’s appointment, Democratic senator Max Baucus responded, “Senate confirmation of presidential appointees is an essential process prescribed by the Constitution that serves as a check on executive power and protects Montanans and all Americans by ensuring that crucial questions are asked of the nominee — and answered.”
With regards to health care policy, the administration has demonstrated a seemingly inexhaustible capacity for self-harm putting agenda before due, transparent process. Any fair person under plausible assumptions would have to acknowledge that a line has been drawn in the sand, and the agenda clear.
Past efforts with soft power/diplomacy have been ostensibly ineffective. Months after delivering its endorsement of HR 3590, the American Medical Association (AMA) has found itself with fewer friends on Capitol Hill and more physicians questioning its lobbying savvy. This year alone, the AMA spent $6.2 million on lobbying for the “Doc Fix” failure.
These times call for new rules of engagement predicated on a siege mentality that espouses self-sustaining policies, rather than short-term fixes: A pre-emptive doctrine. This must include an aggressive stance with other third-party payors. Moreover, some unpalatable options may have to be considered in order to preserve our clinical autonomy as physicians. These efforts may have to be closely coordinated with organizations such as the Alliance of Specialty Medicine and local state medical societies.
Available options will be detailed in the next installment, The New Rules of Engagement Part II: Tennis Anyone?
What are your thoughts?
Heart Rhythm Society
Laurie Racenet, RN, MSN, ANP
Michael Giudici, MD, FACC, FACP, FHRS
Heather M. Ross, DNP, ANP-BC, CCDS, CEPS, FHRS
Anne Dubin, MD, FHRS
John D. Day, MD, FHRS
Andrea M. Russo, MD, FACC, FHRS
Joshua M. Cooper, MD, FACC
Amit J. Shanker, MD, FHRS, FACC
Bruce Stambler, MD
David Wiggins, RN, BS BME, CEPS
Fred M. Kusumoto, MD, FHRS
Leonard Ganz, MD, FHRS
christinechiuman
Craig Delaughter, MD, PhD
Ariana Del Negro, Heart Rhythm 2010 Quality
Peng-Sheng Chen, MD, FHRS
MSKremers MD,FHRS
Ann C. Garlitski, MD, FACC, FHRS
Alan Cheng, MD, FHRS
Ulrika Birgersdotter-Green, MD
Christopher Clyne, MD, FHRS
Kathleen Blake, MD, MPH, FHRS
David Scher, MD, FHRS
Sanjay Deshpande, MD, FHRS
I’m withdrawing from this site. I hope my own electrophysiologists, three and counting, aren’t as right wing and Republican as these posts suggest.
Dr Smith, I appreciate your feedback and sympathize with your concerns. Fortunately, we live in a country where we are all entitled to express our point of view. I wish you and your practice the best in these increasingly difficult times.
I agree with Dr. Smith that this post seems inappropriate in context. Obviously, the author has a right to any viewpoint whatsoever. However, this entry would be more appropriate on a personal blog. If this website is becoming a “letters to the editor” blog rather than a professional resource, the website should at least invite opposing viewpoints on such a topic. I’m disappointed.
Dr Bederer,
Thank you for your feedback. As a member of HRS’ Government Regulatory Affairs and Reimbursement Subcommittee, I can only relay my experience based on issues (which are dealt on a daily basis) surrounding third-party payors and CMS. These editorials serve to stimulate discussion and thought, which is why we have requested constructive feedback. A healthy exchange of ideas will be essential in helping HRS formulate an effective set of policies. Thank you again for your input. Amit
Dr. Berwick’s views on health care policy are appropriate for scrutiny in this column. The recess appointment of a controversial figure to head a major department of government that influences health care in the USA is a serious concern. The new head of CMS has widely reported views that favor a “socialized” approach to health care and redistribution of heath care resources in the population. Editorials in major national publications have documented this approach. Medical specialists can be concerned about policies that may emanate from such an appointee and open and candid discussion fosters awareness of potential changes in direction of health care policy.It is appropriate for readers to become knowledgeable about major events in health care policy. Responses to such events are useful in debating the best approach and next steps for those who are involved or impacted by them. As a former leader of health care policy in cardiology and EP, this debate appears to me have only just begun. I expect much greater discussion in the weeks and months ahead.
I would consider myself to be a Republican, but the issues here are much broader than the political parties. I just wish the appointees and our elected representatives really had the industry and patient’s best interest as their major concern. HR 3590 is being partially funded by cuts in Medicare reimbursement rates. The result is many doctors will not take Medicare patients. The reduction in reimbursement rates is a growing concern with doctors and states. Instead of increasing medical coverage to individuals, it will only reduce the medical coverage and the availability of doctors to treat the patients. The respondents here that get on their political horse first rather than looking at the issues as they would a business decision in their own medical practice, should refrain from comment.
David Sadler
Individual and Group Medical Insurance Sales