Announcement of New Book

February 2. 2013 – My new book,  The Physicians Foundation – A New Voice for Physicians,  is now available.  It is 250 pages and sells for $19.95.  You may order it at 1-203-245-3959 (ask for Bronwen) or at rjjulia@ondemandbooks.com.

The Physicians Foundation is an important non-profit organization.  The P.F.  represents over 500,000 practicing U.S. physicians in state and country medical societies.  It conducts research studies, does national surveys of  hundreds of thousands of physicians (the last survey involved 630,000 physicians), publishes white papers,  and issues millions of dollars of grants to physician organizations to improve care. 

The P.F. is vitally  important because it reflects the true views of physicians – what they think of health reform,  how they are likely to react in 2014 when Obamacare provisions and regulations hit, and where they believe they will fit into the reform picture in the next 3 to 5 years. These are the physicians who will provide the bulk of care required when 30 million to 35 million  Medicaid patients enter the system and 78 million baby boomers become Medicare eligible at the rate of 10,000 each day.

If you feel so inclined, please spread the word about the new book and the new voice for physicians to your friends, associates, audiences, and organizations to which you belong.

What follows is the front part of the new book,  its table of contents, and a medinnovation blog post I wrote yesterday on the implications of the new book._______
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Cover Page (The cover will be designed in the form of a computer tablet to emphasize the importance of information technologies in this hyperconnected era of computer connectivity)

New Voice of Health Reform:

The 3 R's - Rhyme, Rhetoric, and Reality

Book Number Two

The Physicians Foundation-A New Voice for Physicians

Second of a Series of Books on Health Reform

Richard L. Reece, MD
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Dedication Page

Dedication: To Tim Norbeck, Lou Goodman, and Walker Ray who mobilized the doctors and helped found the Physicians Foundation, and to Phillip Miller of Merritt Hawkins, who helped articulate and define doctors dilemmas under Obamacare

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Quotation Page

Draw your chair up close to the edge of the precipice and I’ll tell you a story.

Francis Scott Fitzgerald (1896-1940),  The Great Gatsby (1925)

Books by Richard L. Reece, MD

A Collection Editorials from Minnesota Medicine: 1975-1982 (1983)And Who Shall Care for the Sick? The Corporate Transformation of Medicine in Minnesota (1988)

A Managed Care Memoir: A Physician’s Whistle-Stop Journey, 1988-2003 (2004)

Hello Health-Care Consumer: The Transformation of the Patient-Doctor-Hospital-Health Plan Relationship (2004)

Voices of Health Reform – Interviews with Health Care Stakeholders at Work (2005)

Sailing the Seven “C’s” of Hospital-Physician Relationships: Competence, Convenience, Clarity, Continuity, Control, Cash, and Competition, with James A. Hawkins (2006)

Innovation-Driven Health Care: 34 Concepts for Transformation (2007)

Navigating the Maze of Health Coverage and Access: A Quick Guide for Physicians (2008)

Obama, Doctors, and Health Reform: A Doctor Assesses the Odds for Success (2009)

The Pros and Cons of Accountable Care Organizations (2011)

The Health Reform Maze: A Blueprint for Physician Practices(2011)

The New Voice of Health Reform: The 3 R’s -  Rhyme, Rhetoric & Reality. Book One: Physicians, Parodies & Poems (2012)

The New Voice of Health Reform: The 3 R’s – Rhyme, Rhetoric & Reality. Book Two: The Physicians Foundation- A New Voice for Physicians

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Foreword:

This is the second of a series of books on health reform. These books are based on blog posts I have written over the last 5 years in my Medinnovation blog. The first book was Physicians, Parodies & Poems.

This series of books will consist of revised daily posts or fragments of those posts.

The first book contains poems that appeared as posts, at the beginning or the tail end of posts.

The other books that will follow will include posts on these subjects, not necessarily in this order:

 American Culture and Physician Culture

 Obamacare

 Medicare and Medicaid

 Patient-centered care

 Surveys of U.S. physicians

 Primary care and specialty care

 Book reviews on health reform

 Accountable Care Organizations

 Medical innovation

 Electronic Records and Information Technologies

 Malpractice and tort reform

Richard L. Reece, MD

January 26, 2013

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Introduction

The Physicians Foundation – A New Voice of Physicians

With this Survey of America’s Physicians, The Physicians Foundation has endeavored to provide a “state of the union” of the medical profession. The survey was sent to over 630,000 physicians – 80 percent of physicians in active practice, It represents the Physicians Foundation’s efforts to provide as many physicians as possible with a voice.

A Survey of American Physicians, The Physicians Foundation, September 24, 2012

This second  book consists of Medinnovation blog posts  on the Physicians Foundation.  These were composed over a 5 year  period.  My title A New Voice of American Physicians testifies to the fact that the Physicians Foundation is a relatively new organization.  The Foundation is a nonprofit, non-lobbying, charitable organization founded in 2003 as the result of a settlement between 19 state and country medical societies and major HMOs.

The Foundation is acutely aware that American Medicine is in  a state of profound transformation. The Foundation’s voice is objective, analytical, rational, and nonpartisan. It fears the legacy of health reform will be a deep and lasting shortage of physicians.

The Foundation’s stated mission is to advance and defend private practice. This is appropriate because private physicians provide 80% of America’s health care. Indeed, private physicians are the very foundation of American medicine.  For me, the mission of the Foundation is grander than its formal mission statement.  Its mission is to preserve and protect American physicians’ dignity, purpose, capabilities, and livelihood without sacrificing humanity and compassion while maintaining affordability and access for all patients.

The Foundation issues grants, commissions White Papers, does research studies, and conducts far-reaching surveys on the state and direction of American Medicine.

One voice for the Physicians Foundation that is particularly compelling. It is the voice of Phillip Miller. Vice-President of Communications for Merritt Hawkins and Associates. This national physician recruiting firm is close to the ground and to reality. It speaks every day to physicians seeking a job and to hospitals, medical groups, and other organizations seeking physicians.

Phillip knows the lay of the physician land. He is fine writer. He has written a series of books on physicians – their needs, wants, and dilemmas.  His books include Will the Last Physician in America Please Turn off the Lights, A Look at the Looming Physician Shortage, In Their Own Words: 12,000 Physicians Reveal Their Thoughts on Medical Practice in America.

Three years or so ago, I put the Physicians Foundation in touch with Phillip for the purpose of conducting a national survey of physicians. Philip helped Merritt Hawkins survey 100,000 physicians.  The survey appeared in October 2010.  Phillip served as the principal author.

Here is his summary of the White Paper based on the survey. His summary captures perfectly the quandary in which practicing physicians find themselves. The White Paper, prophetically, is entitled Health Reform and the Decline of Physician Private Practice.  

Private practices are disappearing fast, with less than half of American doctors working in them. An alternative title might have been American Physicians– Victims of Their Own Success.

In any event, here are Phillip’s words. The words will serve nicely as an introduction into this book of blog posts  on the Physicians Foundation.

“Like society itself, medical practice has been evolving rapidly in the United States over the last 50 years, in response to technological, economic, demographic, political and related influences. Passage of the Patient Protection and Affordable Care Act (“health reform”) promises to accelerate this evolution in a variety of ways.”

“The Physicians Foundation called upon Merritt Hawkins and an Advisory Board of healthcare experts to assess how health reform is likely to affect practices in the United States. “

“This White Paper reflects the results of Merritt Hawkins and the Advisory Board’s analysis.”

"1) Health reform is comprised of two elements” “informal reform,” (i.e. societal and economic trends exerting pressure on the current healthcare system independent of the Patient Protection and Affordable Care Act) and “formal reform," (i.e. The provisions contained in the Act itself).

2) The current iteration, both formal and informal, will have a transformative effect on the health system. This time, reform will not be a “false dawn, “analogous to the health reform movement of the 1990s but will usher in substantive and lasting changes.

3) The independent private physician private practice model will be largely, though not uniformly replaced.

4) Most physicians will be compelled to consolidate with other practitioners, become hospital employees, or align with large hospitals and health systems for capital, administrative, and technical resources.

5) Emerging practice models will vary by region –one size does not fit all. Large, Accountable Care Organizations (ACOs), private practice medical homes, large independent groups, community health centers (CHCs), concierge practices, and small aligned groups,will proliferate.

6) Reform will drastically increase physician legal compliance and potential liability under federal fraud and abuse statutes, enhances funding for enforcement, additional latitude for “whistle blowers” and suspension of government’s need to prove “intent” will create a compliance environment many physicians will find problematic.

7) Reform will exacerbate physician shortages, creating access issues for many patients. Primary care shortages and physician misdistribution will not be resolved. Physician will need to redefine their roles and rethink delivery models in order to meet rising demand.

8) The imperative to care for more patients, to provide higher perceived quality, at less cost, with increased reporting and tracking demands, in an environment of high potential liability and problematic reimbursement, will put additional stress on physicians, particularly those in private practices. Some physicians will respond by opting out of private practice, or by abandoning medicine altogether, contributing to the physician shortage.

9) The omission in reform of a “fix” to the Sustainable Growth Rate (SGR) formula and of liability reform will further disengage physicians from medicine and limit patient access. SGR is unlikely to be resolved by Congress and will probably be folded into new payment mechanisms within the next five years.

10) Health care reform was necessary and inevitable. The impetus of informal reform would likely have spurred many of the changes above, independent of formal reform. Net gain in coverage, quality and costs are to be hoped for. But the transition will be challenging to all physicians and onerous for many.

Conclusion

For physicians, the future is not what it used to be. For the present, as revealed by Physicians Foundation's research, and White Papers, the majority of physicians have responded unfavorably to the passage of health reform and are experiencing increased patient loads with decreased financial viability. They are altering their practices to reduce patient access, and are taking steps to minimize 3^rdparty influences through hospital employment, part-time work, locum tenens, and concierge practices. What the future holds no one knows for sure, nor do we know the fate of Obamacare.

For physicians, the top four legacies of health reform will be: 1) acute and chronic physician shortages; 2) large scale bureaucratic burdens and regulations; 3) rapid decline of private practice; and 4) massive consolidation into large organizations and employment by these organizations.

What follows in this 2nd book in a series on health reform are interviews conducted and blog posts written over the last five years. These posts provide insights the Physician Foundation what it  has contributed to knowledge of the reform process.  These blog post contain redundancies. Sometimes something worth saying is worth repeating.
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Table of Contents  -  Blog Posts and   Dates

·         In One Era and Out the Other – An Interview with Tim Norbeck, Chief Executive Office of Physicians Foundation, June 1, 2007

·         The State of Medicine in Texas – And the Work of the Physicians Foundation, March 25, 2010

·         Physician Access and Loss Physician Civility, July 17, 2008

·         Who Speaks for Independent Physicians,  December 1, 2008

·         Primary Care – Dissolution, Restoration, or Transformation, January 17, 2009 ___

·         Physician Working Conditions – An Interview with Phillip Miller, Vice-President of Communications, , Merritt Hawkins and AMN Healthcare, April 27, 2010 

·         A Private Physicians View of Health Reform,  December 4, 2010 

·         The Newly Insured: Who Shall Care for Them,  March 26, 2011

·         A Forced Marriage: Hospitals and Doctors in Accountable Care Organizations, April 4, 2011 

·         The Physicians Foundation Awards $1 Million Grant to Health Leaders, May 13, 2011 

·         Washington Report on ACOs, May 24, 2011 

·         Roadmap for Physicians to Health Reform, June 3, 2011

·         Visit physiciansfoundation.org,  June 7, 2011

·         Views of Donald J. Palmisano, MD, JD, former president of AMA (2003-2004), Jule 21, 2011 

·         Doctors “Prescribe” Social Cures to Meet Needs of Poor, August 1. 2011

·         Rolling Back Tide Against Independent Physicians,  November 12, 2011 

·         Physicians Foundation Helps Poor Find Social Services, December 8, 2011 

·         Greatest Challenge Facing Health Reform, January 25, 2012

·         Washington Report for Physicians Foundation, January 28, 2012 

·         New Voice of Medicine, April 17, 2012

·         Physicians Foundation Survey of 630,000 Physicians, Interview with Walker Ray, MD, Chair, Research Committee, Physicians Foundation, September 24, 2012

·         Comprehensive Survey of U.S. Physicians, September 24, 2012

·         Why Obamacare Has Doctors Depressed and Discouraged, October 2, 2012

·         Thoughts on George Halvorson, Kaiser Permanente CEO, October 6, 2012

·         The Future of Medical Practices: Creating Options for Physician Practices, October 9, 2012

 

·         New Survey Finds 80 Percent of U.S. Patients Satisfied with Primary Care Physicians, October 17, 2012

·         Health Reform: Trust Your Doctor – Glass Half Full- Trust the System – Glass Half Empty, October 20, 2012

·         In Michigan, Obamcare to Cause 25% of Doctors to Stop Seeing Medicare Patients, November 5, 2012

·         101 Letters of Kaiser Permanente CEO to Kaiser Employees, November 28, 2012

·         Physician-Hospital Consolidation – Thd Downsides, December 2, 2012

·         Cliff Notes on Obamacare Future, December 6, 2012

·         Obamacare: Promises, Promises, and Prescription for Change, December 8, 2012

·         Political Partisanship and Physician Leadership,  December 20, 2012

·         Quest for Physician-Patient Led Altrnatives, Interview with Hal Scherz, MD,  Founder and President,  Doctors for Patient Care, December 22, 2012 

·         Why Does U.S. Rank so Low in Life Expectancy,  January 10, 2013

·      What Doctors Can Do to Improve Patients Health, January 12, 2012 

            
              Medinnovation

Where Health Reform, Medical Innovation, and Physician Practices Meet

Friday, February 1, 2013

The Big Health Reform Kabuki Dance

We have piped into you, and you have not danced.

Matthew 11:7

Not to go back is somewhat an advance,

And men must walk, at least before they dance.

Alexander Pope (1688-1744). An Essay on Man

In common English usage, a kabuki dance, also kabuki play is an activity or drama carried out in real life in a predictable or stylized fashion, reminiscent of the Kabuki style of Japanese stage play.^[It refers to an event that is designed to create the appearance of conflict or of an uncertain outcome, when in fact the actors have worked together to determine the outcome beforehand.

Kabuki Dance, Wikipedia

February 1, 2013 - My second book in the series, New Voice of Health Reform: The 3 R's - Rhyme, Rhetoric, and Reality, is available today. The title of the second book in the series is The Physicians Foundation- A New Voice for Physicians. It is a $19.95, 250 page paperback and may be ordered at 1-203-245-3959 or at rrjulia@ondemandbooks.com.

As I make this announcement, I am thinking health reform is an elaborate Kabuki dance. The dancing instructor is the federal government. The dancing partners include employers, physicians, hospitals, health plans, the 50 states, health care companies, 260 million Americans with health insurance, and 50 to 60 million uninsured and underinsured. In essence, every American is invited to the Dance and has a chance to dance.

The problem with this metaphor is that so far, the Big Kabuki Dance has been one step forward, and two steps backward. There is no going back, but the way forward remains uncertain. The promises of the Big Dance – lower costs, smaller deficits, preservation of existing insurance, greater access for all, increased efficiency, and improved outcomes – have not been fulfilled.

It takes two to tango. It takes millions to Kabuki. The majority of the dancing partners remain reluctant to move forward until they receive further and clearer instructions and can determine where the Big Kabuki Dance is headed or whether their toes will be stepped upon.

The instructor, to help the Big Kabuki Dance advance, has elimiated certain dance steps– the CLASS act for long-term care, 1099 forms for businesses; modified other steps – the contraceptive mandate, 1700 waivers for small businesses, unions, and friends of the instructor in other fields; and is thinking of ending still others, like the Independent Payment Advisory Board (IPAB) and the tax on profits and revenues of medical defict makers.

The Supreme Court decision declaring the Big Dance, the Affordable Care Act constitutional – was a step forward – but the Court's concomitant decision to let states opt out of Medicaid expansion was a step backward. This is very much a dance in progress., or possibly in reverse. The music is causing stutter steps among the dancers, and some dancers are dropping out until they see if the music stops or if this is indeed the last dance.

The umbrella title for the series of books purposefully implies that there is often no Rhyme or Reason behind the Affordable Care Act’s various provisions, that the dancing instructor is a powerful Rhetorician with large megaphone, and that the Realities do not always match the Rhetoric.

Tweet: My new book “The Physicians Foundation- A New Voice for Physicians,” is now available at 203-245-3959 or rjjulias@ondemandbooks.com.