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Posted on 07/30/2009 3:34:15 AM PDT by 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.
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SENIOR CITIZENS, EVERYBODY, CALL YOUR DEMOCRATIC POLITICIAN’S LOCAL OFFICES AND FIND OUT IF/WHERE THEY WILL BE HOLDING A TOWN HALL MEETING, OR ANY KIND OF GATHERING LOCALLY WHEN THEY ARE IN RECESS. THEN GATHER A GROUP TOGETHER, OR GO SEPARATELY, AND ASK THE POLITICIANS LOUD AND CLEAR WHO THEY ARE GOING WITH..OBAMA/PELOSI? OR YOU, THEIR CONSTITUENTS WHO VOTE FOR THEM! THEN TELL THEM IF THEY CROSS YOU AND VOTE FOR OBAMA’S DEATHCARE BILL, YOU WILL FUND THEIR OPPONENT AND VOTE THEIR OPPONENT IN, AND YOU AND YOUR FRIENDS, FAMILY WILL VOTE THEM OUT. IF THEY HAVE NO GATHERING PLANNED, GO TO THEIR OFFICES AND MAKE YOURSELF HEARD..NO TO OBAMA SOCIALIST GOVT TAKEOVER OF HEALTH CARE..NO TO PAYING FOR ANY OBAMA HEALTHCARE ON THE BACK OF SENIORS BY DENYING/RATIONING CARE AND KILLING SENIORS IN THE PROCESSS. WE HAVE NOTHING TO LOSE AND EVERYTHING TO GAIN BY SHOWING OUR ANGER AND DETERMINATION TO STOP THESE DEMOCRATIC POLITICIANS FROM DESTROYING OUR COUNTRY. CONTACT YOUR REPUBLICAN PARTY AND FIND OUT WHAT THEY ARE DOING ABOUT HANDING OUT A FACT SHEET SHOWING PEOPLE THE INFO FROM OB’S DEATHCARE BILL...ESPECIALLY TO SENIOR CITIZEN ORGANIZATIONS, AND SENIORS INDIVIDUALLY THRU THEIR HOMEOWNER’S ASSOCIATIONS AND INDEPENDENT LIVING APARTMENT COMPLEXES OBAMA LIES AND THIS FACT NEEDS TO BROUGHT OUT NON-STOP. GET UP, GET OUT AND GET IN THE FACE OF THE DEMOCRATIC POLITICIANS...OUR OPTIONS HAVE DWINDLED...WE MUST DO THIS WHILE THE POLITICIANS ARE IN RECESS AND BACK IN THEIR HOME TERRITORY.
Does Stalin Oboma consider them useless eaters and therefore expendable?
The democrats in the house and senate are members of this new death cult. It would be a good idea to discuss this with the democrat voters you know, so they don;t forget this Universal Death Sentence bill in 2010. They, too, will someday be sent to one of the democrat death camps.
The “medical home” is not a literal home or place. It’s a way to organize a practice, so that the patient is followed by the same group of “providers,” doctor (or nurse practitioner), midlevels such as nurse practitioners and physician assistants, nurses and staff. There’s some talk of making the docs and/or Medical homes join an “Accountability Care Organization,” that will bundle disease care, hospital care and post-acute care (nursing home, rehab, disease management and any re-admission to the hospital).
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Thank you mommy for voting democrat all your life so after we pay to put you in a nice assisted living home and nursing home you can leave it for us to be warehoused in govt run “medical homes”, but you voted for the dems and that’s the important thing. /sarcasm
I just got home from my yearly gyn exam. I’ve been going to the same wonderful women’s clinic for over thirty years. As I was on the exam table waiting for my doctor to come in, I noticed an empty chair in the corner of the room. I had a mental image of Obama sitting in that chair with his clipboard, ticking off Yes or No, Approved or Disapproved, to each of my doctor’s suggestions.
Personal, private medical decisions are hard enough as it is. It is a sacred dialogue that exists between a physician and the patient. The two of them must come to an agreement and meeting of the minds as to which avenues to pursue. Should I take the bone density enhancing medicine? Should I use any hormone therapy? What is best for MY body, Doctor? We don’t need a know-nothing interloper like the Feds sitting there in that office.
:)..sad but true
Another wonderful site with great information is the American Association of Physicians & Surgeons, whose opposition to socialized medicine has been ongoing for many years. Visit it here
From there, there are links to other sites and to upcoming events, including this one, pertaining to this weekend.
Prime Minister Raffarin, along with many French doctors, weighed in by blaming the 35-hour working week, introduced by the Socialists, for creating chronic staff shortages as the crisis unfolded. Certainly, the 35 hour week has plenty to answer for, including a tanking economy, but this entire government appears to be in denial. You will note that every man jack of them is missing the point: No air-conditioning. Not even any ice. Ten thousand four hundred old people died because they couldn’t lower their body temperatures.
http://www.frontpagemag.com/readArticle.aspx?ARTID=16614
As many as half the deaths were at nursing homes, which were short-staffed because many aides and doctors were on vacation and were overcrowded because many families had checked in elderly relatives and also headed off to beaches and mountains. During August, much of the nation goes on vacation, and it is common for elderly relatives to be left at nursing homes. Most nursing homes and hospitals lack air conditioning because of health laws. French authorities have long believed air-conditioning systems do more harm, by spreading germs, than good.
http://www.usatoday.com/weather/news/2003-08-26-france-death_x.htm
As far as we are aware, the publication of this estimate prompted only a little activity to investigate the specific conditions that led to the excess mortality, and no large-scale public actions to prevent heat-related deaths in the future. The general feeling that the only victims of the extreme summer temperatures were very elderly and frail people who would anyway have died within a few weeks (this is sometimes referred to as ‘harvesting’) may partly account for this equanimity.
http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=557
Doctors and health experts, the people no one listened to during the heat wave, are telling a larger, darker story. The heat wave only made visible, they say, a crisis that had been under way for years: a chronically under-funded and understaffed elder care system combined with a national habit of shutting senior citizens out of sight and mind.
“The French family structure is more dislocated than elsewhere in Europe, and prevailing social attitudes hold that once older people are closed behind their apartment doors or in nursing homes, they are someone else’s problem,”
http://www.time.com/time/magazine/article/0,9171,477899,00.html
European heatwave caused 35,000 deaths
http://www.newscientist.com/article/dn4259-european-heatwave-caused-35000-deaths.html
Mengele, no doubt the new HealthCare Czar appointed by the Fuhrer. Sound familiar anyone?
Godbless EG Robinson. I liked that guy.
Most likely the new "HealthCare Czar" will be Zeke (The Freak) Emmanuel, Rahm's big bro. Zeke has long been a leftist apparatchik on health care and medical ethics, favoring abandonment of the Hippocratic ethic (physicians should do their best to maximize the health and longevity of the individual patient) and replacing it with a "utilitarian," "communitarian" approach (The patient, at some point, has a "duty to die" for the benefit of the "community.").
FUBO!!!!!!!!!!!!!!
The one word that comes to mind regarding these people including Obama is sick.
Love him or hate him, I am forever grateful to Sen. Phil Gramm for personally vowing to put an end to ClintonCare back in 1993, delaying this horror for a few years. In 2007, I finally found a neurosurgeon who understood my situation, he corrected as best he could a problem that other NS had caused back in 1988, was evident on MRI continuously over those years. He diagnosed me based on what he saw with his own eyes and heard from me in describing difficulties, he had no answer for me when I asked why none of these other physicians could see what was clearly occurring in my body year after year after year.
In various threads discussing this monstrous *reform*, I have had FReepers argue with me though I post my own experience. I have had others ridicule my real fear that what is being talked about in this thread is in my future. Gramm got me a few years, enough time that the neurosurgeon was available and I was able to get the surgery I needed from him to help me, but I am not *fixed*, I am still permanently and totally disabled. I can take care of my personal needs, I occupy my time with things that require little in the way of physical exertion, but I am not able, physically, to do much of anything else. It is almost unbelievable and sad to see the thing that was standing in the way of these idiot Blue Dog Dems from getting their Yeas was the price tag and NOT the absolute evil this bill is.
God help anyone who votes this thing into being, pray God none of you ever have to live under its ramifications. I keep trying to warn, it's not just the elderly that will have to deal with this, I was 23 when my nightmare began. I don't know what else to do except hope that someone will listen to me sometime, somewhere.
Thanks again.
And I'm certain I heard either Rush, or Tom Sullivan state yesterday that ACORN will be used to enroll people in Obamacare (in place of insurance agents) according to the House Bill pending!!!
I've known about ACORN since about 1993, but I NEVER thought I'd see the day they would be given my business in this country!!! The Kennedy Bill in the Senate is said to replace that Long-Term Care policy that you were concerned about holding up with Genworth a few months ago and you KNOW that will contain "End of Life" care, for certain!!!
This whole "public option/plan" concept changes ANY patient from an "asset" to a distinct "liability" when the government is the insurer!!! "Preventive Medicine" by any government insurance insures that they will be controlling each and everyone of your activities and habits till the cows come home!!!
That link requires me to “sign up” and I think I’ll pass on that!!!
And to think “Logan’s Run” used to be a favorite movie of mine.
Indeed, TN... see my tagline.
Ya know, I've always gotten a kick out of the names developers come up with for private senior citizen residential facilities: 'Autumn Hills', 'Silver Shadows' & such.
What's the President gonna call his HorrorbamaCare 'homes'? Treblinka Arms? Auschwitz Manor? Kervorkian Kastle?
Fasten your seatbelts, grannies. I hear cattle cars offer a particularly bumpy ride.
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