The Orthopedic Posterous

Musings of a Patient Centric, Social Media Savvy, HC 2.0 *Friendly* Orthopedic Surgeon 

Letter to Senator Bayh from an MD who actually read the Senate #hcreform Bill.

Here is a letter I sent to Senator Bayh.  Feel free to copy it and send it around to all other representatives.

Stephen Fraser 

July 23, 2009 

Senator Bayh,
As a practicing physician I have major concerns with the health care bill before Congress.  I actually have read the bill and am shocked by the brazenness of the government's proposed involvement in the patient-physician relationship.  The very idea that the government will dictate and ration patient care is dangerous and certainly not helpful in designing a health care system that works for all.  Every physician I work with agrees that we need to fix our health care system, but the proposed bills currently making their way through congress will be a disaster if passed. 

I ask you respectfully and as a patriotic American to look at the following troubling lines that I have read in the bill. You cannot possibly believe that these proposals are in the best interests of the country and our fellow citizens. 

Page 22 of the HC Bill:  Mandates that the Govt will audit books of all employers that self-insure!! 

Page 30 Sec 123 of HC bill:   THERE WILL BE A GOVT COMMITTEE that decides what treatments/benefits you get. 

Page 29 lines 4-16 in the HC bill: YOUR HEALTH CARE IS RATIONED!!! 

  Page 42 of HC Bill:  The Health Choices Commissioner will choose your HC benefits for you. You have no choice! 

Page 50 Section 152 in HC bill: HC will be provided to ALL non-US citizens, illegal or otherwise. 

Page 58 HC Bill:  Govt will have real-time access to individuals' finances & a 'National ID Health card' will be issued! 
  
Page 59 HC Bill lines 21-24:  Govt will have direct access to your bank accounts for elective funds transfer. 

  Page 65 Sec 164: Is a payoff subsidized plan for retirees and their families in unions & community organizations: (ACORN). 

Page 84 Sec 203 HC bill: Govt mandates ALL benefit packages for private HC plans in the 'Exchange.' 

  
Page 85 Line 7 HC Bill:  Specifications of Benefit Levels for Plans -- The Govt will ration your health care! 

  Page 91 Lines 4-7 HC Bill: Govt mandates linguistic appropriate services.  (Translation: illegal aliens.) 

  Page 95 HC Bill Lines 8-18: The Govt will use groups (i.e. ACORN & Americorps to sign up individuals for Govt HC plan. 

Page 85 Line 7 HC Bill: Specifications of Benefit Levels for Plans. (AARP members - your health care WILL be rationed!) 
Page 102 Lines 12-18 HC Bill:  Medicaid eligible individuals will be automatically enrolled in Medicaid. (No choice.) 

Page 12 4 lines 24-25 HC: No company can sue GOVT on price fixing. No "judicial review" against Govt monopoly. 

Page 127 Lines 1-16 HC Bill: Doctors/ American Medical Association - The Govt will tell YOU what salary you can make. 

Page 145 Line 15-17: An Employer MUST auto-enroll employees into public option plan. (NO choice!) 

Page 126 Lines 22-25: Employers MUST pay for HC for part-time employees AND their families.  (Employees shouldn't get excited about this as employers will be forced to reduce its work force, benefits, and wages/salaries to cover such a huge expense.) 

Page 149 Lines 16-24: ANY Employer with payroll 401k & above who does not provide public option will pay 8% tax on all payroll!  (See the last comment in parenthesis.) 
Page 150 Lines 9-13: A business with payroll between $251K & $401K who doesn't provide public option will pay 2-6% tax on all payroll

  Page 167 Lines 18-23: ANY individual who doesn't have acceptable HC according to Govt will be taxed 2.5% of income. 

Page 170 Lines 1-3 HC Bill: Any NONRESIDENT Alien is exempt from individual taxes. (Americans will pay.) 

Page 195 HC Bill: Office rs & employees of the GOVT HC Admin..  will have access to ALL Americans' finances and personal records. 

  Page 203 Line 14-15 HC: "The tax imposed under this section shall not be treated as tax." (Yes, it really says that!) 
Page 239 Line 14-24 HC Bill: Govt will reduce physician services for Medicaid Seniors.  (Low-income and the poor are affected.) 

Page 241 Line 6-8 HC Bill: Doctors: It doesn't matter what specialty you have trained yourself in ---you will all be paid the same! (Just TRY to tell me that's not Socialism!) 

Page 253 Line 10-18: The Govt sets the value of a doctor's time, profession, judgment, etc.  (Literally-the value of humans.) 

Page 265 Sec 1131: The Govt mandates and controls productivity for "private" HC industries. 

  Page 268 Sec 1141: The federal Govt regulates the rental and purchase of power driven wheelchairs. 

  Page 272 SEC. 1145: TREATMENT OF CERTAIN CANCER HOSPITALS - Cancer patients - welcome to rationing! 

  Page 280 Sec 1151: The Govt will penalize hospitals for whatever the Govt deems preventable (i.e.re-admissions). 

Page 298 Lines 9-11: Doctors: If you treat a patient during initial admission that results in a re-admission the Govt will penalize you. 

  Page 317 L 13-20: PROHIBITION on ownership/investment. (The Govt tells doctors what and how much they can own!) 

  Page 317-318 lines 21-25, 1-3: PROHIBITION on expansion.  (The Govt is mandating that hospitals cannot expand.) 
Page 321 2-13: Hospitals have the opportunity to apply for exception BUT community input is required.  (Can you say ACORN?) 

  Page 335 L 16-25 Pg 336-339: The Govt mandates establishment of=2 outcome-based measures. (HC the way they want -- rationing.) 
Page 341 Lines 3-9: The Govt has authority to disqualify Medicare Advance Plans, HMOs, etc.  (Forcing people into the Govt plan) 

  Page 354 Sec 1177: The Govt will RESTRICT enrollment of 'special needs people!'   Unbelievable

  Page 379 Sec 1191: The Govt creates more bureaucracy via a "Tele-Health Advisory Committee."  (Can you say HC by phone?) 

  Page 425 Lines 4-12: The Govt mandates "Advance-Care Planning Consult."  (Think senior citizens end-of-life patients.) 

  Page 425 Lines 17-19: The Govt will instruct and consult regarding living willsdurable powers of attorney, etc.  (And it's mandatory!) 
Page 425 Lines 22-25, 426 Lines 1-3: The Govt provides an "approved" list of end-of-life resources;& nbsp;guiding you in death. (Also called 'assisted suicide.') 

  
Page 427 Lines 15-24: The Govt mandates a program for orders on "end-of-life."  (The Govt has a say in how your life ends!) 

  Page 429 Lines 1-9: An "advanced-care planning consultant" will be used frequently as a patient's health deteriorates. 

  Page 429 Lines 10-12: An "advanced care consultation" may include an ORDER for end-of-life plans.  (AN ORDER TO DIE FROM THE GOVERNMENT?!?) 

Page 429 Lines 13-25: The GOVT will specify which doctors can write an end-of-life order.  (I wouldn't want to stand before God after getting paid for THAT job!)    

Page 430 Lines 11-15: The Govt will decide what level of treatment you will have at end-of-life!  (Again -- no choice!) 

  Page 469: Community-Based Home Medical Services = Non-Profit Organizations.  (Hello?  ACORN Medical Services here!?!) 

  Page 489 Sec 1308: The Govt will cover marriage and family therapy.  (Which means Govt will insert itself into your marriage even.) 

Page 494-498: Govt will cover Mental Health Services including defining, creating, and rationing those services. 

  Senator, I guarantee that I personally will do everything possible to inform patients and my fellow physicians about the dangers of the proposed bills you and your colleagues are debating. 

  Furthermore, if you vote for a bill that enforces socialized medicine on the country and destroys the doctor-patient relationship, I will do everything in my power to make sure you lose your job in the next election. 

  Respectfully, 

  Stephen E. Fraser, MD 

Dear Reader, 
   I urge you to use the power that you were born with (and the power that may soon be taken away) and circulate this email to as many people as you can reach.  The Power of the People can stop this from happening to us, our parents, our grandparents, our children, and to following generations.

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Posted by Howard Luks 

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Patients Turn To Online Community For Help Healing #pm #WhyPM #hcsm

When Americans go looking for information on health, they turn to the Internet as one of their first sources. According to a recent survey by the Pew Internet and American Life Project, 61 percent of adults say they look online for health information. There's a term for them: e-patients.

Most e-patients go online to read about a health condition. But that seems almost passive compared to the way a small group of Internet-savvy people are connecting to get their health information.

About 20 percent of e-patients go to Internet and social-networking sites where they can talk to medical experts and other patients, says Susannah Fox, with the Pew Internet and American Life Project.

Patients are going online, patients are engaged and collaborating in pursuit of *quality* health care information.

The physician community needs to engage WITH these patients...eyes wide open--- as a team leader. We need to engage to help filter the noise--- and aid in minimizing the risk of information overload or analysis paralysis.... and perhaps even the physician will learn a thing or two. Different patients have different needs --- different patients have differing abilities to synthesize the information and make the *right* choice.

How should the physician engage with these communities?

How can you help me to help you ??

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Filed under  //   epatient   health care information   informed choice   medical googlers   participatory medicine   social media  
Posted by Howard Luks 

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Shared Decision Making: Informed Consent v. Informed Choice #pm #In #hcsm

here's what people more typically do after a diagnosis: Gather up a hodgepodge of information—online and by talking to friends—that is often incomplete, inaccurate, and incomprehensible. "Generally speaking, the perception of chances of good and bad outcomes is very poor," says Annette O'Connor, a researcher at the University of Ottawa in Canada who has long studied how best to get patients informed. A patient may think a treatment is going to cure him when it might only lessen symptoms, for example, or that the risks are more serious than they actually are. The Foundation for Informed Medical Decision Making (www.informedmedicaldecisions.org), a nonprofit patient advocacy group that is supporting the 12 centers, cites research showing that most people can't answer even basic questions about their illnesses. Often, they simply defer to their physician. But doctors rarely give comprehensive information. Time is short, they often have biases—surgery and rehab for that torn ligament beats trying rest, exercise, or physical therapy, say—and many assume patients don't want the burden of overwhelming information.

For now, the *standard* is Informed Consent. Basically your doctor tells you what is wrong, details the treatment recommendation and tells you the reasonably foreseeable risks, potential complications, etc. For decades, this has been the standard. The problem with this is that it does not take into account the variables introduced by each individual patient and their values.

I have talked about this previously on this blog... I call it the "personality" of an injury. Assume two people slip and fall in the snow and tear their ACL (a ligament in the knee). One person plays tennis 4 days a week, skis 20 times a season, and has no desire to curtail activities. One person is a couch potato, and is not involved in any activities involving cutting, pivoting or twisting (when you need the ACL). Who *needs* a new ACL reconstructed? Each injury might take on a different personality, depending on the needs, desires, and values of the patient. This, in essence, is what I review with each patient as we determine whether or not surgery is *necessary* for their condition. A shared decision making process will incorporate the values of the patient, after they have been informed of what their limitations might be with or without the surgery and whether or not the potential complications are *worth the risk* to them. On my website, there has been a section on shared decision making aides for the past 3 years. I have reviewed these aides with many patients (some still do not want to) and I find that these patients, if they choose surgery are much *happier*. They understand the process, the procedure, the risks and the reasonable expectations.... and THEY made the decision to proceed after WE went through a thorough shared decision making process. Yes, it takes more time... so what, it was worth every minute.

The participatory medicine crowd and the social media savvy patient may not understand this--- but many patients still do not want to know anything about their condition.... "...just do what you think is right doc..." is not an uncommon utterance during a discussion about the options available. I have discussed this as well. When you (as the physician) believe in incorporating patient centric values and the shared decision making process into the treatment algorithm this makes you feel uncomfortable... but at least it was the patient's choice to proceed in such a manner.

Patients and physicians need to engage with one another as a team---incorporate these shared decision making principles--- and in the end the patient has made the choice that *feels* right.

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Filed under  //   #whypm   epatient   health care information   informed choice   informed consent   participatory medicine   shared decision making  
Posted by Howard Luks 

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GOOD.is | World Health

Yikes... sometimes looking at the numbers---again--- can, and should remind all of us what health care reform is all about... US (as in you and me) --- and our children's future.

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Filed under  //   World health  
Posted by Howard Luks 

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Emerging patient-driven health care models

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It's a really small picture... sorry.  Click through and check out the fully featured visualization....awesome

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Filed under  //   participatory medicine   visualization  
Posted by Howard Luks 

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The Max Baucus Health Care Lobbyist Complex

Nuff said...

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Get Up and Move

Issue a challenge, barter with exercise!

Great concept... the first app from Contagion Health and @Jensmccabe

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Filed under  //   challenge   contagion health   exercise   getupandmove   health care  
Posted by Howard Luks 

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Will a Move Away from Fee-for-Service Control Health Costs?

Paying doctors for every test and procedure creates an incentive to do more tests and procedures. But finding an alternative payment system that works has proved tricky.

In Massachusetts, where rising health costs are compounded by the state’s universal health-insurance policy, the push is on to find an alternative to the fee-for-service system to help rein in costs. An imminent deal will be a big move in that direction, the WSJ reports this morning.

The deal, between the state’s Blue Cross Blue Shield and a health system called Caritas Christi, will change the way the health system is paid for treating some 60,000 patients. Rather than being paid for every procedure, the system will be paid a fixed fee to take care of people whether or not they get sick. And they’ll be paid a bonus if they meet certain targets, such as keeping patients’ cholesterol low and lowering the rate of blood clots and pneumonia after surgery.

Capitation reborn? If this didn't work the first time, why do we think it will work this time? The FFS model is broken... and expensive--- no questions. But going back to a system of capitation is not the answer. The answer is NOT going to come from the Insurance industry... they will protect their shareholders, their profits and their top line salaries.

As Dr. Jay P says... "The faster we can pull our money out of the traditional health insurance game and start spending that money on purchasing healthcare as we need it, the faster the sick care industry will fall. Become true consumers by purchasing high deductible, catastrophic plans and watch what your money will buy you. Put the difference you save in monthly premiums in a bank account and build a buffer. Invest it and make interest on that money for when you get old and your health fails. Stop throwing it away to monopolies who care nothing about you and your health."

Does this work for everyone...perhaps not. Will it control costs... you betcha!

What are your suggestions?

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Filed under  //   Fee for service   FFS   health care reform   physician payment  
Posted by Howard Luks 

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101 Things To Do With A Mobile Phone In Healthcare |

101 Things To Do With A Mobile Phone In Healthcare

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Filed under  //   biometrics   health care   mhealth  
Posted by Howard Luks 

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Physician online behavior ... :-)

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Posted by Howard Luks 

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