House Health-Care Bill Would Establish 'Medical Homes' for the Elderly and Disabled

CNSNews.com ^ | July 30, 2009 | Marie Magleby

[Man50D]

The House health-care reform bill proposes to decrease hospital visits by establishing a “medical home pilot program” for elderly and disabled Americans.

Such a medical home would not require a physician to be on the staff, and therefore could be run solely by nurse practitioners and physician assistants. Medical homes also would practice “evidence-based” medicine, which advocates only the use of medical treatments that are supported by effectiveness research.

But physicians’ groups say the legislation could lead to restrictions on which treatments may be used for certain conditions, despite the fact that some patients might require a unique or unconventional approach. It also may lead to dumping Medicare/Medicaid patients in facilities that are not required to have physicians on staff.

The Center for Medicine in the Public Interest (CMPI) expressed its concerns in a report that explains why statistical evidence does not always reflect reality of effective medicine.

“‘One size fits all’ rarely does,” the report said. “From clothes to shoes to hats, few people find that items carrying that label work with their individual bodies. So why do we entrust the health of our bodies -- one of the most important assets we have -- to a one-size-fits-all mentality?”

According to CMPI and individual physicians, however, this one-size-fits-all mentality is just what congressional health-care reform suggests.

“Unfortunately, policies being advanced under the guise of ‘evidence-based medicine’ (EBM) could do just that,” the CMPI report said. “The idea behind EBM, empowering physicians with sound evidence to incorporate into their treatment decisions for individual patients, is a good one.

“Unfortunately, EBM now is being distorted by government bureaucrats and HMOs in ways that impose top-down, one-size-fits-all restrictions on patients and their healthcare providers.”

Rather than enforcing a formulaic approach to medicine based on statistical and clinical research, CMPI says health-care reform should preserve physicians’ autonomy to use the research in conjunction with their experience and knowledge of the patient.

”It is so critically important for the physician to maintain his or her ability to combine study findings with their expertise and knowledge of the individual in order to make the optimal treatment decisions. Evidence-based medicine in its present, distorted form emphasizes just one aspect of the clinical pie over all the others,” the report found.

Kathryn Serkes of the American Association for Physicians and Surgeons echoed the observation.

“There is no typical patient,” Serkes told CNSNews.com. “Every patient is different from a medical perspective. If we have evidence-based medicine that basically says ‘well, we start at treatment one, which leads you to treatment two, to treatment three to treatment four. In practice, that doesn’t work for the patient. That’s the ‘art’ part of the art and science of medicine. That’s what we still need doctors to do, is to figure out what’s right for the patient.”

In the long run, according to CMPI, evidence-based medicine may not even cut costs as Congress suggests it would.

“Evidence-based medicine may provide transitory savings in the short term, but the same patient who takes the cheapest available statin today may very well be the patient costing you -- the taxpayer, the policymaker, the thought-leader, the sister, the spouse -- big bucks when that patient ends up in the hospital because of improperly treated cardiovascular disease,” .

“The repercussions of choosing short-term thinking over long-term results and cost-based medicine over patient-based are pernicious to both the public purse and the public health,” the CMPI report said.

Provisions for the medical home pilot program are an amendment to the Social Security Act, which governs the administration of Medicare and Medicaid services.

The medical home is an approach to medical practice that “facilitates partnerships” between patients and physicians, according to the proposed bill.

The pilot program targets Medicare beneficiaries who have a high medical “risk score” or who require regular monitoring, advising or treatment. This currently applies to more than 22 million Americans, according to Kaiser Family Foundation statistics.

At least $1.5 billion would be redirected from the Federal Supplementary Medical Insurance Trust Fund to fund the medical homes, “in addition to funds otherwise available,” according to the bill.

The Senate health-care reform bill also includes provisions for medical homes, although to lesser detail than the House bill.

If this portion of the legislation passes through Congress, medical homes will be part of the greater health-care reform experiment known as "the public (health insurance) option."

According to the committee, the provisions for medical homes will make the public option a stronger competitor against private health insurance companies.

“The public health insurance option will be empowered to implement innovative delivery reform initiatives so that it is a nimble purchaser of health care and gets more value for each health care dollar,” the House Committee on Energy and Commerce’s summary says about the bill.

Medical homes are tied to “comparative effectivness research” via something called “evidence-based medicine.”

“It will expand upon the experiments put forth in Medicare and be provided the flexibility to implement value-based purchasing, accountable care organizations, medical homes, and bundled payments. These features will ensure the public option is a leader in efficient delivery of quality care, spurring competition with private plans,” the committee’s summary also said.

A statement by the American College of Emergency Physicians (ACEP) said that the effectiveness of the medical home model should be carefully evaluated before applying the model far and wide.

“There should be more research to demonstrate the benefits and continuing costs associated with implementation of the full (patient-centered medical home) model,” the ACEP statement said.

“Demonstration projects being conducted by the Centers for Medicare & Medicaid Services must be carefully evaluated. There should be proven value in healthcare outcomes for patients and reduced costs to the healthcare system before there is widespread implementation of this model.”

The proposal, meanwhile, specifically allows for facilities to be run by staff who do not possess medical degrees – including nurses and nurse practitioners.

[Man50D]

The socialist universal health care bills proposed in the House and Senate are unconstitutional. No where in Article I Section 8 is the power to regulate health care listed. Let you Congress critters know! Toll free capital switchboard numbers are below.

800-828-0498
877-762-8762
800-517-5696
866-338-1015
866-220-0044
877-851-6437

[Doogle]

death camps

[Diogenesis]

PG 59: The federal government accesses your bank accounts for mandatory funds transfers.
PG 65, Sec 164: Creates special, federally-subsidized coverage for Unions and “Community Organizing” groups.
PG 84 Sec 203 HC bill - Dictates the benefits packages of all private health insurance plans.
PG 85, Line 7: Limits what private insurers can offer (rationed care).
PG 91, Lines 4-7: Mandates that health care providers pay for interpreters for illegal immigrants.
Pg 95, Lines 8-18: The mandatory use of ACORN and Americorps for signing up Americans to government insurance.
PG 85, Line 7: Imposes more limits on coverage (rationing).
PG 102, Lines 12-18: Mandates Medicare for all who fit criteria (removes all choice).
PG 124, Lines 24-25: Bans companies from suing the federal government, bans the entire judicial system from hearing any cases on the legitimacy of this blatantly unconstitutional socialist health care takeover (no judicial review allowed whatsoever).
PG 127, Lines 1-16: Instructs doctors/AMA on what salaries they are allowed to make.
PG 145, Line 15-17: Requires all employers to enroll all new employees in the government system (no choice whatsoever).
PG 126, Lines 22-25: Requires employers to independently provide insurance for part-time workers, whether they can afford it or not (no choice).
PG 149, Lines 16-24: Imposes an 8% payroll tax penalty for any employer (making over $400k) who fails to force his employees onto government insurance.
PG 150, Lines 9-13: Employers making between $251k and $400k pay 2-6% penalty.
PG 167, Lines 18-23: Imposes 2.5% income tax penalty on any privately-insured individual who fails to get “adequate” private insurance.
PG 170, Lines 1-3: Stipulates that all non-resident aliens pay nothing (we foot the bill).
PG 195: Federal officers will have full access to every citizen’s most private records.

[screaminsunshine]

Sounds good. Send Granny off to be exterminated as a drag on the collective. It is for the good of the Hive. Yikes these liberals are reminding me of the BORG in Star Trek. “We will assimilate”. Time for escape plans.

[Jim Robinson]

These people are scumbags. They are creating the equivalent of Nazi death camps. The American Holocaust is expanding from mass murder of our innocent unborn to the mass murder of the elderly and handicapped.

[thecabal]

“Evidence-based medicine may provide transitory savings in the short term, but the same patient who takes the cheapest available statin today may very well be the patient costing you -- the taxpayer, the policymaker, the thought-leader, the sister, the spouse -- big bucks when that patient ends up in the hospital because of improperly treated cardiovascular disease,”

No, they're not going to cost the taxpayer, because they'll have to do their duty to the State to die.

[Brad from Tennessee]

[. . .EBM now is being distorted by government bureaucrats and HMOs in ways that impose top-down, one-size-fits-all restrictions on patients and their healthcare providers.”]

This provides the perfect setting to conduct experiments in treating patients with healthcare robots.

[Thrownatbirth]

[PSYCHO-FREEP]

Not only that, they will use this as a platform to perform abortions. One of ObaMao’s staff members said that a child born is not “Human” until he or she displays “proper social traits”. Which must mean that even after born, a human child can still be “aborted” for the “Greater Good”.

This administration is purely evil. It is as simple as that.

[Tennessee Nana]

Modern concentration camps..

Complete with Dr Mengler

[This_far]

death camps

I get your inference, but I wonder what will happen to someone (like me) who won't succumb to MANDATORY HEALTH INSURANCE?

It IS possible to live without having taxable income. Not as free or as pleasant as now, but do able.

All this to "insure" (or ensure), but not provide health care, for a small percentage of our population.

Certainly seems contrary to the Hippocratic Oath.

[Doogle]

..unfortunately my bother passed 5 years ago.
He had an operation and was put in a “recovery” facility
three days after the operation. While there he had clothes stolen,bandages that were supposed to be changed daily WERE NOT, a doctor, one of his surgeons, went berserk when he witnessed the poor care he got....
After I was allowed to “break him out”, I got him home to his apartment where HE wanted to be. We both knew what the end results were going to be, but I was determine that he wasn't going to be subjected to shoddy medical care and wind up with more to deal with then the cards he was dealt.

[screaminsunshine]

In Communism everything is free. But there isn’t any of it. Case closed.

[mkjessup]

"Welcome to your new home, senior Americans, REST will set you FREE!"

[MarkL]

These people are scumbags. They are creating the equivalent of Nazi death camps. The American Holocaust is expanding from mass murder of our innocent unborn to the mass murder of the elderly and handicapped.

I'm sure that the AARP will get the elderly to stop off at the polling places to vote for this and other leftist schemes one last time on their way to these "medical homes." Hey, the dead can't ask for a refund of their annual dues.

Mark

[1951Boomer]

Calling these hellholes “medical homes” is like calling the Nazi concentration camp ovens “warming rooms for the Jews.”

[hocndoc]

Actually, they’d create just a bunch of screening sites for the death camps.

The “Patient Centered Medical Home” is the name of a well-meaning scheme to re-create the solo family doctor type of care within big practices. The “team” would be bound by all sorts of protocols and electronic reminders to follow up and follow through, so that a patient is more likely to be followed by the same people, less likely to fall through the cracks or get the run around through unnecessary and redundant tests, sub-specialists, etc.

The problem, in addition to the assumption in Washington that you’re only worth your next donation to the DNC, is that the bill would allow these PCMH’s to be headed by nurse practitioners, not just family docs, internal medicine docs or pediatricians.

They would also probably be lumped in with a local hospital and out patient care group to ‘manage’ the patients’ disease care:
30 day bundling of hospital and post-hospital care.
Bullet points to be met for each disease classification.
Step wise “evidence based” medication and therapy, with little recourse for those of us who don’t fit the protocol or who wish to skip a few steps, even if we can afford to pay out of pocket.

And, yes, 4 States allow “physician assisted death” (which still stinks of suicide and murder, no matter what you call it).

Some docs will probably find ourselves practicing under ground, eventually. And if our experience with Shalala (who threatened to prosecute Medicare patients who dared to pay their own money) is any indication, the patients will have to find a back alley doctor, too.

[Doogle]

Certainly seems contrary to the Hippocratic Oath.

..an Oath means nothing to an narcissistic socialistic dictator like you witnessed on Jan 20,2009. Many doctors are leaving the often mentioned AMA because of very recent decisions.

[magooey]

Modern concentration camps..

Complete with Dr Mengler

The Obama version won't even have a doctor in the house. Only Mengele's assistants will be available. You can guess what level of twisted care that will result in.

[savedbygrace]

death camps

No.

Obama Death Camps.