I was seeing patients during the actual speech, so I had to rely on the transcript.
The points that interested me the most were any language pertaining to malpractice, addressing the AMA’s recent concerns about the public plan option, and reforming the physician payment system.
I think he did pretty well.
Regarding the physician payment system, he again addressed McAllen, Texas, which is fast becoming the symbol of what’s wrong with American health care. Not sure the city is comfortable with that notoriety.
Here’s what Obama said:
That starts with reforming the way we compensate our doctors and hospitals. We need to bundle payments so you aren’t paid for every single treatment you offer a patient with a chronic condition like diabetes, but instead are paid for how you treat the overall disease. We need to create incentives for physicians to team up – because we know that when that happens, it results in a healthier patient. We need to give doctors bonuses for good health outcomes – so that we are not promoting just more treatment, but better care.And we need to rethink the cost of a medical education, and do more to reward medical students who choose a career as a primary care physicians and who choose to work in underserved areas instead of a more lucrative path. That’s why we are making a substantial investment in the National Health Service Corps that will make medical training more affordable for primary care doctors and nurse practitioners so they aren’t drowning in debt when they enter the workforce.
Standard policy-speak about bundling payments. But, unlike the majority health policy columnists and editorials in The New York Times, he goes out of his way to blame the system, not doctors. Obviously, this is because the President is addressing the AMA, but the way to court doctors is not to wholly blame them for the health system’s ills.
Regarding primary care, the idea of simply investing more in the National Health Service Corps is grossly inadequate. First off, any improvement in primary care numbers will be seen in 5 to 10 years minimum, and second, primary care doctors are needed everywhere, not just in underserved areas.
I like that he addressed the cost of medical education, but doing something about it is another matter entirely.
Here’s what Obama said about malpractice:
I recognize that it will be hard to make some of these changes if doctors feel like they are constantly looking over their shoulder for fear of lawsuits. Some doctors may feel the need to order more tests and treatments to avoid being legally vulnerable. That’s a real issue. And while I’m not advocating caps on malpractice awards which I believe can be unfair to people who’ve been wrongfully harmed, I do think we need to explore a range of ideas about how to put patient safety first, let doctors focus on practicing medicine, and encourage broader use of evidence-based guidelines. That’s how we can scale back the excessive defensive medicine reinforcing our current system of more treatment rather than better care.
These changes need to go hand-in-hand with other reforms.
Probably the best we could have expected. He acknowledged that malpractice reform needs to go hand in hand with health reform, and admitted that defensive medicine is indeed a factor in medical decision making today. I agree that malpractice caps are a non-starter, and like single-payer, hope that cap supporters realize that it’s a political impossibility.
I hope that this could be the start of a more constructive dialogue where doctors are offered liability protection if they adhere to evidence-based guidelines. Under the current political environment, that is probably the best scenario that doctors can hope for. And, to be honest, I think it’s a reasonable compromise.
And finally, here’s what he said about the public plan option:
Now, I know there’s some concern about a public option. In particular, I understand that you are concerned that today’s Medicare rates will be applied broadly in a way that means our cost savings are coming off your backs. These are legitimate concerns, but ones, I believe, that can be overcome. As I stated earlier, the reforms we propose are to reward best practices, focus on patient care, not the current piece-work reimbursement. What we seek is more stability and a health care system on a sound financial footing. And these reforms need to take place regardless of what happens with a public option. With reform, we will ensure that you are being reimbursed in a thoughtful way tied to patient outcomes instead of relying on yearly negotiations about the Sustainable Growth Rate formula that’s based on politics and the state of the federal budget in any given year. The alternative is a world where health care costs grow at an unsustainable rate, threatening your reimbursements and the stability of our health care system.
What are not legitimate concerns are those being put forward claiming a public option is somehow a Trojan horse for a single-payer system. I’ll be honest. There are countries where a single-payer system may be working. But I believe – and I’ve even taken some flak from members of my own party for this belief – that it is important for us to build on our traditions here in the United States. So, when you hear the naysayers claim that I’m trying to bring about government-run health care, know this – they are not telling the truth.
Good to see him address this important physician concern, namely, a public plan option using Medicare rates, and using this approach as a “back door” to a single-payer system. It’s clear that he’ll use the repeal of the SGR formula as a bargaining chip, perhaps to get the AMA’s support of a “weak” public plan.
Right now, there are no details of what a plan would look like, so I can’t really give an informed opinion on it. A plan that coerces doctors to take it on condition of accepting Medicare, or one that pays doctors less than 130 to 150 percent of Medicare rates, are the only deal-breakers, in my view. The AMA is clearly shooting for the moon when they say they were “opposed” to the public plan, and I think both sides will eventually settle on a “weak” version, meaning, it will remain but not at a marked competitive advantage with private insurers. I can live with that.
So, in the end, I thought the President did a pretty good job. Especially with his malpractice language, acknowledgment of the practice of defensive medicine, and the fact that he’s aware that doctors are concerned about the how “our cost savings are coming off your backs.”
Will it make a difference? We’ll see. But I can say that the speech could have been a lot more antagonistic to physicians than it actually was.
Related posts:
- Will doctors get a pay cut under a public health option?
- Reflections from the AMA: President Obama’s Speech
- How President Obama can fix health care immediately
- Convincing doctors to accept a public health care plan option
- 10 President Obama posts you may have missed
- The Obama health care summit, and did the President offer any clues to the upcoming health reform effort?
- Should a public plan option be part of any health reform initiative?
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Physicians are trained to seek out the truth. We are obligated to be honest with patients. Attorneys have a different mission. They are not seeking truth. They are trained and paid to defend their clients’ interests, which often conflict with the truth. I believe that our mission is the more noble. I would not want to be in an occupation where I could be attacking an innocent person’s reputation and resources, even if the process is legal, in order to serve someone else’s interest.. Those who defend the current tort system are generally contaminated with self-interest. This is much less true for physicians, most of whom readily admit that our health care system is deeply wounded and needs to be reformed. http://www.MDWhistleblower.blogspot.com
MasonMcD,
Good point there are many MDs (I am not one) that help many just like other citizens. My wife donated her time working on the EMR at Volunteers I Medicine.
I once was a part owner in a wine business and I tried to help a divorced mother of two to quite smoking by offering here $1/hr raise to quite. She refused. She also did not want to contribute $50 per month for our Health plan. The state paid for her health because of her child. She did have plenty of tats, newest cellphone, and nails but could not pay part of her health care.
I hope that the government forces everyone to contribute to their health care cost.
Jeff Brandt
motionPHR for the iPhone
myMedBox for Android
“We are obligated to be honest with patients.”
And yet, when you make a mistake, you clam up and your insurers do the same. So apparently that obligation is put aside quite easily.
“I would not want to be in an occupation where I could be attacking an innocent person’s reputation and resources, even if the process is legal, in order to serve someone else’s interest.”
Of course, that assumes the other side is always innocent, doesn’t it? Both sides usually believe they are the virtuous one. The system’s job is to determine who is right, as best it can. For some reason, physicians struggle with the concept that theirs is not the only view of a situation.
“Those who defend the current tort system are generally contaminated with self-interest.”
As are those who attack it.
““Those who defend the current tort system are generally contaminated with self-interest.”
Incidentally, one of the major funders behind the tort “reform” movement are the tobacco companies, which seeded many of these state tort reform associations via their chief law firm, Covington & Burling. You can confirm this at any of the websites that published all the tobacco docs. Interestingly, one of the partners at that firm, which has a bunch of Fortune 500 clients and functions also as a lobbying firm, is Philip K. Howard, the head of Common Good, which is pushing backdoor caps via health courts.
So tell me, who exactly is contaminated with self interest?
Matt- Your ignorance abounds. If you practiced medicine you would know better. It does not matter if a case goes to trial. The minute I am named, for the rest of my life I have to divulge and explain to any hospital I seek privileges from, or to a prospective employer the entire situation behind it. In some cases a job opportunity is lost because either the group or hospital is so skittish, they don’t want any risk. this is because hospitals are now getting hit if a physician gets sued fro malpractice because they gave that physician privileges. They are becoming partially responsible.
By the way, how do you know anything about my legal knowledge. The fact is I have studied the law intensely, especially with regards to med mal. I am well versed on case histories involving John Edwards and other cerebral palsy cases. Most were won not based on evidence of negligence, but sympathetic juries who saw a family with years of medical bills and costs that they could not afford. That has nothing to do with negligence.
Maybe you should familiarize yourself with what is legally necessary to prove malpractice.
How is what Obama said about Med Mal any different from what Bush said? And how are we to believe Obama will succeed in Med Mal reform where Bush failed?
” In some cases a job opportunity is lost because either the group or hospital is so skittish, they don’t want any risk. ”
How many doctors, simply because they were named in a lawsuit, have lost a job as a result? As a percentage? Or is this another one of your “because I say so” claims? Given that physicians are getting jobs even after multiple judgments, it seems that there is still a market for their services. In my state, a physician went to the federal pen for child porn, and has gotten jobs paying well over $100K in several places since. So I look forward to your stats!
“I am well versed on case histories involving John Edwards and other cerebral palsy cases.”
Excellent. What were the names of the parties, case numbers and counties they were heard in of the cases you got copies of the evidence and transcripts in? Perhaps we can discuss them in more detail if we both know which ones.
“Maybe you should familiarize yourself with what is legally necessary to prove malpractice.”
I actually do know, but apparently you think it’s just a sad story. What are the elements required to prove a malpractice claim, in your opinion?
To suggest that the medical community is contaminated with sefl-interest is absurd. Nearly every lawyer I know, as well as their professional societies, believe that the current tort system works well and should be maintained. The rest of the country disagrees with them. In contrast, nearly every physician I know, and all of our professional societies, admit that our health care system is wounded and needs repair. The rest of the country agrees with us. While a partisan ideologue could parse my words and search for exception, I believe that most reasonable readers would make the proper judgment. My own blog, http://www.MDWhistlelblower.blogspot.com, offers many criticisms of the medical profession. Perhaps, this means that I am contaminated with the public interest.
Now that we agree that the uninsured have access to quality health care, we can also agree that we need to devise (from the funds that are used for the ER visits) clinics that operate next to the ERs or other fix. This does not require a total destruction to the current system, nor does it require a single payer system.
The U.S. is hands down the best, state-of-the-art health care system. I see no reason to change that. Improve, perhaps. Improvement is done piece-by-piece and precept-upon-precept.
“To suggest that the medical community is contaminated with sefl-interest is absurd.”
Why? You mean the medical community DOESN’T support tort reform to save some money on their liability insurance? Really? How do you even type that without smiling?
“In contrast, nearly every physician I know, and all of our professional societies, admit that our health care system is wounded and needs repair.”
Yeah, in the sense that you think you ought to be paid more. Read your blogs. The vast majority of complaints center around tort reform and reimbursement rates, and constant threats that if the public doesn’t pay you more or give you immunity you will disappear!
“The rest of the country agrees with us.”
You should be careful making claims about what the rest of the country thinks and using that to justify your position. It might turn out that the rest of the country thinks single payer will be the cure for what ails healthcare. Does that make them right?
You can prattle on about your love of the public all you want, but when a member of that public is injured by a physicians’ malpractice, you’re nowhere to be found for help.
Personal injury lawyers are like mortgage loan originators in the ’90s…there is only vast financial incentive to create business, and no meaningful deterrent for misrepresenting facts on application for business.
Can anybody name a single successful(that is, having recovered a damage award of cost breakeven) ‘malicious prosecution’ or ‘abuse of process’ lawsuit by a doc against a lawyer?
Can anybody cite case law of legal malpractice which awarded monetary compensation for pain and suffering or loss of consortium?
Doctors need to make public aware of the bizarre protections attorneys enjoy, in that there is no practical recourse available to victims of their professional malfeasance.
As far as your pejorative and inaccurate comment on physician blogs, my own blog doesn’t seem to fit into your skewed categorization. Yes, I support the medical profession, but I also criticize it for its excesses.
Did you notice that the New York Times reported this morning that a whopping 44% of the country approve of Obama’s health care plan? So, it doesn’t seem that ” rest of the country thinks single payer will be the cure for what ails healthcare”, as you suggest.
The vindictive tone of your corresponsdences detract from whatever legitimate points might exist underneath.
http://www.MDWhistleblower.blogspot.com
The legal realities of medicine are not pretty. For example: most radiologists will no longer read mammograms. Mammograms are not a good tool for finding breast cancers and any attorney can find one in retrospect on a mammogram. However the good tools available are not reimbursed for routine screening by insurance or medicare (digital mammograms and breast MRI).
Why are judges immune from civil malpractice suits? How is it different, when a judge’s professional opinion is overturned on appeal, from a doctor’s opinion being ‘overturned’ by a hired expert witness?
“my own blog doesn’t seem to fit into your skewed categorization. ”
My comment is not inaccurate, but it is a generalization. I have not read yours, so if it does not apply to yours, then please disregard.
“So, it doesn’t seem that ” rest of the country thinks single payer will be the cure for what ails healthcare”, as you suggest.”
Perhaps not, but if the number were 51%, would that change the merits? That’s my point – simply because the majority thinks something does not make it a good idea.
“The vindictive tone of your corresponsdences detract from whatever legitimate points might exist underneath.”
I am simply responding in kind. When you accuse others of acting not based on principle or any actual legitimate position, but solely out of financial self interest, what reaction do you expect? If you want a respectful tone, I am glad to offer it.
“However the good tools available are not reimbursed for routine screening by insurance or medicare (digital mammograms and breast MRI).”
It would seem, then, that physicians would get together and push for reimbursement for these things when they sign those contracts with the insurers, or direct their lobbyists in Congress with regard to Medicare. That is not a legal reality, it’s a medical reality.
See, nobody cares whether breast tumors are efficiently found and treated, and the subtle aspects of that issue.
Society apparently values its legal practitioners more highly than its medical practitioners, as evidenced by the protections afforded its legal members and its willingness to let doctors become extinct,
But…is society aware of this? Or is it simply happening because predator lawyers are more vicious and numerous than prey physicians?
“Society apparently values its legal practitioners more highly than its medical practitioners”
Given the average salary of medical practitioners is 50% higher than legal practitioners, it would seem otherwise. Lawyers can be sued for malpractice, same as physicians.
Matt, cite a case where legal malpractice suit was awarded pain and suffering damage award
When an HMO knows your practice has enough of their patients to be a critical volume of your business, upon annual renewal they will offer you a new contract which pays significantly less than the old one. They surmise that you cannot afford to drop their plan. If you protest the answer is take it or leave it. Are you suggesting that if doctors unionized they could achieve higher reimbursements through a union negotiated contract?
Pat, society does not care about doctors. Society is letting doctors be extingushed by lawyers. Society is allowing HMOs and insurance plans and government to set rates which do not allow medical providers to break even.
Doctors (and don’t forget nurses, the new prey) can’t survive, union or no union. Maybe all docs and nurses need to move to offshore boats (International waters and civil law) or Indian Reservations (Tribal civil remedies) and operate cash-only practices.
My belief is that healthy members of society will let a point of crisis be reached before addressing inequities that fostered the crisis.
“Matt, cite a case where legal malpractice suit was awarded pain and suffering damage award”
Can’t. It would have had to go up on appeal, and I don’t follow the appeals court unless it relates to cases in my areas of practice. The only reason we know so much about physician legal issues is because they are trying to get tort reform.
And, most of those are settled, and settlements are confidential.
Matt, cite a case of meaningful sanctions against any attorney for frivolous medical malpractice litigation.
Or is it your contention that all medical malpractice charges are meritorious?
Susan, sanctions typically won’t be reported except in the state bar magazines. I don’t recall one related to med mal, but I’m in a small state and don’t read the monthly bar magazine every month.
I would never contend that all med mal suits are meritorious. Nothing involving humans is perfect.
Matt, you must recognize the disparity between treatment of alleged legal and medical professional malpractice is skewed in favor of lawyers. And with no deterrent to frivolous litigation, it has flourished like bad mortgage loan originations have.
Ultimately, anyone smart enough to get through medical school will realize that law school is faster, cheaper, and the back-end is safer and better rewarded.
Matt, you had claimed that: “Given the average salary of medical practitioners is 50% higher than legal practitioners,…”
I looked on PayScale.com to compare hourly wage rates, and found the following, which contradicts your assertion:
Median hourly wage rates for lawyers were higher than the median hourly wage rates for doctors by 100% in the category 20+ years experience, higher by over 18% in the 10-19 years experience range. Zero to 9 years wages were higher for doctors that attorneys but not 50% higher.
” And with no deterrent to frivolous litigation, it has flourished like bad mortgage loan originations have.”
Susan, I’m not sure how you define frivolous, but the vast majority of lawsuits are filed by businesses suing businesses. Tort filings are down over the last 20 years, so this explosion you’re claiming doesn’t exist.
As for the disincentives, there are clear economic disincentives for filing dog cases, especially on contingency, because you don’t get paid by the hour, plus you’re fronting all the expenses. You’d quickly go broke under that economic model.
Here’s your median compensation for physicians from the DOL:
http://www.bls.gov/oco/ocos074.htm#earnings
Here’s your median for attorneys:
http://www.bls.gov/oco/ocos053.htm#earnings
Not even close.
Setting aside the litigation issues. Cost is the driver here. The one real thing Obama is proposing is to require open architecture for EMR. Jay Rockefeller has a bill before Congress that will require open architecture and establish a medical informatics public utility (not government) to house EMR. See a demo at medicalinformaticspublicutility.com.
Doctors and hospitals will retain their independence and will be able to competet on the basis or results.
Kevin,
I agree with your comments in the recent NY Times article, http://roomfordebate.blogs.nytimes.com/2009/06/18/better-medical-care-for-less/#comment-92293, that state that physician payments need to be divorced from patient volume. I once worked in a practice that booked a patient for almost the same time slot (5 minutes apart) as I had exam rooms assigned to me. It was all to keep up the practice’s revenue as reimbursements declined. Needless to say I left that practice and now, I’m sure, deliver much better medical care at a reasonable pace. I certainly have more time to listen to the patients, and my own blood pressure is better!
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