Like so many physicians and citizens, I find myself frustrated, saddened, and more than anything scared by what is playing out in the healthcare reform effort.  While I believe people understand the concept that the ends justifies the means, one cannot help but wonder what the ends are at this point.

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The subversion of our democratic system violates every lesson we learn as school children about separation of powers in the government.  If this bill is so good for the public, then why do opinion polls overwhelmingly say that the public is not in favor of this and why are some legislators doing things that can only be described as extraordinary?

The worst thing?  I hope this bill passes.

It is our last best hope at ANYTHING meaningful occurring.  That being said, I think the damage is done.  This is no longer about the goal, it is about the process.  The proponents HAVE to pass the bill.  It has become a self fulfilling prophesy.  Rationality and what is "best" for our country have long since left the conversation. Unfortunately, true healthcare reform will be just the first casualty here.  The healthcare system, the broader economy, and ultimately our nation will pay the price.  We have squandered the opportunity of a lifetime for the benefit of a tiny number of special interests.  On this point, I truly hope that I am wrong.

Almost two years ago, the Sermo community called for healthcare reform with over 12,000 physicians signing the open letter.  This community went on to predict that the AMA would fail physicians in their moment of need, pointing out that the AMA's business model made them beholden to the government and insurance companies, not physicians.  Finally, this community consistently pointed to the key elements needed in meaningful healthcare reform (not one of which is in the bill).  Lately, this community has been making perhaps the most alarming prediction of all:

• Physicians are opting out of medicine in alarming numbers. 
• We are opting out of Medicare/Medicaid in even larger numbers. 

Ultimately, it will be our patients that pay the price.  As our nation holds its collective breath on the eve of this historic vote, we all should all remember that.

Daniel Palestrant, MD

Founder & CEO

Sermo, Inc.

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Originally Posted to the Sermo Community
By: SenatorCoburnMD, OBGYN

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Sen. Coburn Wants to Share Your Opinions with the US Senate

I will share the results of this poll and your comments with members of Senate. Please participate by Saturday, March 13th.

I recently attended the bipartisan summit on health reform President Obama hosted at the White House. I was pleased to see the President acknowledge that lawmakers on both sides of the aisle understand many of the problems in health care and have policy solutions.

Unfortunately, despite the spirit of cooperation at the summit, now the White House and Congressional majority seem determined to push the deeply flawed health bills through Congress on a party line vote. They have chosen this path despite the American people's clear rejection of these bills. A recent CNN poll  showed that more than 7 in 10 Americans want Congress to start over on health care, or stop working on the issue altogether.

Many politicians in Washington, DC are not listening to the American people, much less physicians. But Congress needs to again hear what you as physicians think about "health reform." In fact, at the end of this message I invite you to take a poll - and I plan to share your responses with each of my colleagues here in the U.S. Senate. Please consider participating. Physicians and patients-not politicians and special interests-should be the prominent voices in reform.

The bills in Congress are untenable.  According to the analysis of non-partisan Congressional Budget Office and the Administration's own actuary (here and here), the bills in Congress would dramatically increase taxes, slash Medicare, increase premium costs above the status quo, and bend the cost curve up. The bills also would dramatically increase the federal government's interference in health care, despite that government already directs nearly two-thirds.

I believe the American people are right. Congress should start over and work together on common-sense incremental reforms..

During the White House summit I underscored that reform must seriously reduce needless costs in health care - such as defensive medicine practices and fraud. American taxpayers lose an estimated $100 billion to waste, fraud and abuse in public health programs each year.

Because one of my comments in particular has generated a lot of attention, allow me to briefly explain what I was thinking.

• First, my suggestion to conduct a demonstration project with undercover patients, is similar to the idea of mystery shopping. In my mind, health care providers could target suspected bad actors in high-fraud areas. My intent was to point out how rampant fraud is and suggest the need to take it seriously.

• Second, as a physician, I was not intending to suggest  increasing regulations or interfering with the patient-physician relationship. I would never support increasing bureaucratic interference in this primary relationship.

• Finally, as I pointed out in a letter to President Obama, the amendment is merely one idea to combat fraud, but it is "insufficient to staunch the flow of taxpayer dollars into the hands of criminals." In fact, that is why I cosponsored two bills (S. 2128, S. 975), which would change the way Medicare and Medicaid pay providers. These bills would change the current enforcement culture of "pay and chase," to one of "check and pay" where verification technology would ensure claims are not fraudulent before they are paid.

I think reform should combat fraud, tackle defensive medicine, and lower costs to all Americans. What do you think reform should accomplish? How do you think these bills measure up?  Please let me know your thoughts by Saturday, March 13th.

Thank you for participating in this important dialogue. I appreciate your service to your patients and our nation. I look forward to hearing from you.

Respectfully,

Tom Coburn, M.D.
U. S. Senator

From Sermo: Sermo is a platform intending to help all of America's physicians have a voice in the health care reform debate. All Senators and advocacy groups have been offered (and will continue to be offered) the opportunity to access the community.  The opinions of these individuals or groups are their own and not a reflection of a Sermo position or that of Sermo's employees.  Similarly, their posting to Sermo should not be a misconstrued as an endorsement by Sermo of those views.  

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A recent survey of 1,000 physicians, part of the soon to be released Physician Sentiment Index (PSI) done on Sermo, confirms what many of us already know; we as physicians have remarkably little insight into the business underpinnings of our profession, and even less optimism about the future of our profession. While 82% of physicians state that they have a "clear" or "vague" understanding of what cash flow is, only 25% of respondents could select the correct definition from a list of options. Perhaps most striking, a disturbing 70% of MDs surveyed believe their financial situation will be the same or worse next year. While this isn't surprising, after all we went to medical school, not accounting school, it is certainly not encouraging and makes me wonder if these trends are linked.

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As physicians, the loss of control of our financial fate is inseparable from the gradual demise of our profession.

By any measure, doctors find themselves in an increasingly untenable position. Payers have long had intrinsic advantages over physicians and even shifting to fee-for-service introduces unique challenges to physician owned and managed practices. I have discussed these challenges for over a year now, and even predicted that companies or technologies would come along that help address inefficiencies and the information imbalance that exists between payers and physicians. This week, Sermo will announce a partnership between Sermo and athenahealth. Positioned between the doctor and the payer, athenahealth pools the collective experience of thousands of physicians' claims data into something called a rules engine to help even the playing field between physicians and insurers. In key metrics, such as claims rejection rate, accounts receivable, and yes cash flow, athenahealth has shown that technology can help physicians directly benefit from one another.

I believe the appeal of companies like athenahealth and Sermo is their unique ability to allow individual physicians to leverage many of the same technologies and strength in numbers that the insurance companies have long benefitted from. For the healthcare industry, it is the opportunity to help level the playing field. For physicians, it is the opportunity to turn the billing process into a strategic advantage, increasing the ability for us to stay in practice and provide the best possible care to our patients.

So, the discussion for the community…..do you think EMR, EHR, and/or billing technologies can be used to improve the financial independence of physicians?

Daniel Palestrant, MD

Founder & CEO

Sermo, Inc.

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