Reporter explains series on insurance companies vs. physicians and patients

Reporter explains Toledo Blade series on how insurance companies compromise physician's ability to deliver care.

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Patients suffer as care, coverage limits collide

‘Most doctors don’t start people on medications because they like to start medicines,’ says Dr. Jack Brunner, a Toledo endocrinologist. ‘They have specific reasons and goals for the patient.’

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The Toledo Blade's investigative team set out to examine whether patients are getting the care their doctors ordered. No doctor or practice manager will be surprised. Take this series of articles to your local newspaper and show them how to tell the story about current health care.

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A nationwide survey of doctors by the Toledo Blade shows they increasingly feel that insurance companies erode the doctor-patient relationship and often prevent patients from getting necessary care by second guessing doctors' decisions.

The rising costs of health care procedures has led insurers to constrain treatment options available to doctors in an attempt to hold costs down, according to the majority of doctors surveyed. Doctors said the motive is a drive for profits, while the insurers said it's necessary to hold down the costs for businesses that usually pay the majority of health care premiums.

### link to Toledo Blade below

Article 1:

http://www.toledoblade.com/apps/pbcs.dll/article?AID=/20080824/NEWS32/106232155/-1/ARCHIVES30

Article 2:

http://www.toledoblade.com/apps/pbcs.dll/article?AID=/20080825/NEWS32/106231964/-1/ARCHIVES30

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Dollars and cents of health care

One of the challenges to everyone in health care is to explain the dollars and cents. But most physicians, hospitals, nursing homes and other providers hold to the traditional view that their books, operating expenses, etc., are proprietary.

Which means nobody understands because nobody effectively explains.

A powerful exception is a story in the Nantucket Independent newspaper.

http://www.nantucketindependent.com/news/2008/0820/front_page/003.html

This story explains how a publicly funded nursing home is going broke. Because it's owned by a municipality, the books are open. This story makes a compelling case for better reimbursement.

This is the way to tell the story and win a better system.

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More health care professionals running for office?

Not sure, but I get a sense that a lot of physicians and other health care professionals are running for political office. Probably because they see and feel the pain.

One of the most interesting is Judy Baker, who is mounting a strong campaign as a Democrat in a usually Republican district, Missouri 9th.
She is trained as a practice manager.

From her campaign site: She joined MU’s University Physicians practice plan, first serving as director of operations at Capital Region Medical Group in Jefferson City during the University’s management of the facility and then as interim executive director of the entire practice plan until 2002. She left the University at that time and found her own consulting firm, now Cura Advantage. In addition to operating her business, she has served as part-time administrative director for ACTS International, a not-for-profit, humanitarian organization dedicated to building partnerships that benefit the country of Georgia, and as an adjunct professor teaching managerial economics at Columbia College.

She served in the MO House for three years. Her campaign has been added to the Democratic Party's Red To Blue effort, which means she has raised enough money and support to possibly win.

The 9th District stretches from the Iowa state line to the Lake of the Ozarks and from Columbia to the western fringe of the St. Louis area.

Her site:

http://judybakerforcongress.com

OP-ed pieces: very effective, if...

Here's an excerpt from an excellent op-ed (opposite the editorial page) article in Long Island Newsday by a hospice volunteer. The full article is personal, detailed and local, full of restrained and powerful emotion.

"I know from my own and others' experience that hospice is an important option for a terminally ill patient and his or her family to be able to choose...

"But this choice is being threatened by the Bush administration, which, as a cost-cutting measure, plans to reduce Medicare reimbursement rates to hospices so severely that some may be forced out of business and others to reduce their services..."
BY JEAN BARBER

Full text of article:
http://www.newsday.com/news/opinion/ny-opbar315782876jul31,0,6538603.story

Just as with letters to the editor (see below), the writer, and as many others as you can muster, need to send a copy to senators and representatives you can vote for and request action and request a response. Fax works best and it's important to call and make sure someone got it. That demonstrates you are serious. Anything less gives elected officials and their staff permission to do nothing.

Remember, your goal with PR techniques like this is to get action from members of Congress. If that doesn't happen, it doesn't matter how many people read and agree with you.

Doctors using letters to editor - very effective, if...

Two letters to the editor make good points in the Baltimore sun July 31:

"If Medicare altered its reimbursement system by rewarding preventive care and giving a smaller financial incentive to tests and procedures, not only would the cost of health care drop without any decline in quality but the altered financial incentives might prompt more medical students to pursue primary care fields."
Dr. Andy Lazris

"Under (the current) system, excess blood tests, EKGs, X-rays, CT scans, MRIs, etc., will be ordered with increasing frequency, no matter what else happens."
Dr. Edmund J. MacLaughlin
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This is an effective tactic to get out your message, but you need to make sure the letters are read by appropriate elected officials. I recommend you cut out the newspaper masthead (that gives the name and date), put it with your letter, copy it, then fax to your representative and senator with a cover letter to them. Call to make sure it got there and -- most important -- ask for action.

Otherwise they may never see it and they will not respond.

Full text of letters at

http://www.baltimoresun.com/news/opinion/letters/bal-ed.le.medicare31jul31,0,1240881.story

Physicians and their associations shift money to Democrats

Insightful look at the politics of medicine from Patrick O'Connor at Politico:

Congressional Republicans are trying to mend an ailing relationship with their once-loyal allies in the medical community after opposing legislation to block an annual pay cut for doctors under Medicare.
In the House, Republican Whip Roy Blunt of Missouri convened a private meeting last week with a handful of top lobbyists for the medical community to make amends after the contentious vote, according to people familiar with that session...

In the run-up to the 2006 midterm elections, doctors and the groups that represent them gave 62 percent of their combined $52.4 million war chest to Republicans, compared with 37 percent to Democrats, according to the Center for Responsive Politics. That breakdown mirrors previous cycles since Bush entered the White House.
But since 2006, doctors and related groups have given Democrats 53 percent of their combined $53 million in campaign contributions, according to the watchdog group.
The switch is even more stark for the AMA.
In the run-up to the 2006 election, the AMA’s political action committee gave Republicans 70 percent of its campaign cash, according to the Center for Responsive Politics. In 2004, the AMA’s PAC contributed 80 percent of its total donations to Republican lawmakers and candidates.
Since 2006, that PAC has directed 53 percent of its contributions to Democrats.

The complete commentary at:

http://www.politico.com/news/stories/0708/12124.html

What it takes to fix Medicare Medicaid reimbursement

Here's an interview with a lobbyist for California Medical Association that explains how powerful -- and easy -- it is for physicians to contact politicians. The first thing he says gives you an indication of why such issues as Medicare and Medicaid reimbursement don't always go the way physicians would like.

Sensible editorial about Medicare reimbursement

Atlanta Journal Constitution gets it right. Here's an excerpt:

The most reasonable approach would be to bundle payments to doctors, or groups of doctors, who care for patients with chronic conditions such as diabetes and congestive heart failure. The healthier the doctors keep their patients, the lower the cost to taxpayers and the higher the reimbursement rate.

Instead, Medicare still pays doctors for more than 7,000 "units of service" — ordering tests, changing medications, requiring more frequent visits from patients — all of which are billed separately. With few exceptions, there is no financial incentive for physicians to keep their per-patient cost under control.

Use this url for the full editorial

http://www.ajc.com/opinion/content/opinion/stories/2008/07/25/medicared_0727.html

Another good shot in the Medicare war

Dr. Robert A. Thompson, President, North Dakota Medical Association
wrote a great letter that is published in The Dickenson Press. Note how it is localized and relevant to the newspaper's readers.

This can now be reproduced and sent to elected officials and others. No doubt most of them will get it from their clipping service and by sending it in from multiple sources you reinforce the message. Politicians pay careful attention to what their voters pay attention to. While letters to the editor are not read as much as the sports pages, the people who read them are opinion leaders.

This is a time-tested, effective, cheap and easy technique to influence elected officials.

http://www.thedickinsonpress.com/articles/index.cfm?id=16323&section=Opinion

Excellent newspaper coverage of Medicare problems

The Nashville Tennessean just featured a two-part series about how physicians are limiting the number of new Medicare beneficiaries they will treat and how some are charging concierge fees to accept new beneficiaries.

This is a model you might be able to suggest to your local news media and offer to find people to flesh out the story.

Part 1 Medicare cuts take toll on patients, doctors

http://www.tennessean.com/apps/pbcs.dll/article?AID=2008807200408

Part 2 Want to keep your doctor? Pony up $1,500

http://www.tennessean.com/apps/pbcs.dll/article?AID=2008807210342