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.
No thanks Bozo I don’t want it. Communism sucks, it sucks now, it sucked in 1917 and it will always frickin’ suck. Anyone who believes communism could ever work had sh** for brains. JMO.
Ive tried, but haven’t generated much interest yet. Like they say, managing doctors is like herding cats!
But be assured there are plenty of us out there who are speaking out strongly against this kind of stuff, and will vote with our feet if necessary.
If Obamacare passes they will have to find physicians to run it - most I know are not willing to play.
This is chilling.
“Last Day” Homes
Soylent Green Homes
mandatory senior homes
constription for death
and yet the seniors pay for the AARP
HELLO SENIORS WHY ARE YOU NOT CALLING THE AARP WHICH HAS SO OBVIOUSLY BETRAYED YOU AND SENTENCED YOU TO DEATH?! (for a mere 30 pieces of life insurance silver)
the signed directive should say, “take all measures” and then have a seperate family member declared health care surrogate in the event of unconsciousness due to coma.
NEVER trust the hospital.
Remember Obama wants the same people who run the DMV to run your Medical decisions.
Obamacare=death by DMV.
Amen.
BTW, what does your script at the bottom of you posts say?
If push comes to shove, there are going to be plenty of us who need a doctor that’s not within the system.
Maybe we can start a FReepercare network......
There were “ok” arguments when the gov took over car companies, since the gov. gave them so much money.
There were slightly plausible arguments when the gov took over the banks, because they wanted to add regulations to prevent another meltdown.
There are NO good arguments for letting the gov. control your healthcare. Say it’s a liberal in charge (far fetched, I know), then what? What decisions can they dictate? Free abortions? No priests allowed in hospitals to visit the sick and give last rights?
This may have been in the works for a while.
A friend heard a couple of Physical Therapists talking about centers like these and offices run by Nurse Practicioners, PAs and PTs with advanced degrees in the past couple of weeks.
The friend had brought up the math problem of the new 40-50 million people under 0b0z0 care, needing medical care with no new doctors.
He was informed that wouldn’t be a big problem as many of the people now being treated in MDs’s offices and hospitals could easily be handled by new treatment centers run by PHD RNs, PAS and PTS. That would free up MDs for more seriously sick patients (probably younger).
When my friend asked who would these centers hire to handle the elderly and those move from primary care, he was told that the SEIU was ready with trained personnel to do these jobs.
For more info re the scary SEIU check out this link: http://www.seiu.org/splash/ and their ad how their Change Works.
Then my friend heard that many insurance companies were financing studies re these options.
We need to Abort 0b0z0 Health Care, before it does late term abortions on those of us over age 60.
..most of them were lawyers, overcrowded ER's are congress's fault by not enforcing laws and in some cases hindering law enforcement, and three the liberal voting block...the stupidity factor...that isn't gonna change
There were “ok” arguments when the gov took over car companies, since the gov. gave them so much money.
There were slightly plausible arguments when the gov took over the banks, because they wanted to add regulations to prevent another meltdown.
There are NO good arguments for letting the gov. control your healthcare. Say it’s a liberal in charge (far fetched, I know), then what? What decisions can they dictate? Free abortions? No priests allowed in hospitals to visit the sick and give last rights?
You are absolutely right, sir.
Where was it- France, I think, several years ago, had 12,000 elderly die “from global warming induced heat waves” while in state-run nursing homes.
Bet it saved a pile of evidence-based medical cost!
Didn't Hitler call them ovens?
My Mom lived in a Personal Care Home for about 18 months before she died. It was actually, overall, a good experience for her. She wound up having a lot more fun than she had been having living alone. There were problems, but on the whole it was good — far better than a nursing home.
I don’t believe anything these thug leftist progressive commos create will resemble that.
OTOH, the Nurse Practictioner degree is to be upgraded to a Doctoral level degree by 2015, so there really isn’t any reason for them not to be running these things, in my opinion.
Thanks!
Excerpt:
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...
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