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In This Issue:  President’s Message Scientific Session participants enjoy variety of educational opportunities Foundation positively impacts trauma care in Pennsylvania PNS launches new online searchable database PNS Fall Newsletter/REGIONAL NEWS Why we won't see affordable universal health care anytime soonPresident’s Message
The health care reform debate has occupied center stage of the domestic agenda of the new President and Congress in Washington for the better part of this year. While the partisan rhetoric has become predictably shrill and counterproductive, there are still many honest, hard-working public servants in our government who are struggling to reach compromises that will lead to meaningful and positive reform. As for me personally and for most of our PNS members, we are not trained in economics or public policy. But we should, as responsible members of the health care profession, educate ourselves as much as possible and participate in this important debate as actively as we can. At this juncture, it seems that the overwhelming momentum for reform from last fall’s election has petered out a bit, and the enthusiasm for dramatic, single-step change in our health care system has been dampened. Instead, an incremental approach over several years of progressive legislation may allow a more reasoned, sustainable solution to this baffling problem. Many would agree that our current systems of health care delivery, insurance and liability are inefficient, blatantly unfair and ultimately unsustainable. We are constantly exposed to statistics that show how much more equitable and effective other nations’ systems are when compared to our own. However, we also face the dilemma that for those of us with proper insurance, we have the luxury of access to the finest health care in the world. The challenge is to preserve the quality we cherish at the top of the system while providing access to at least the barest minimum of health care to those who are currently struggling at the bottom. The experiments in health care reform that are beginning to occur at the state level are certainly facing tremendous resistance and criticism, but at least these initial attempts will provide some real-world experience for reformers who are otherwise navigating in uncharted waters. It seems inevitable that some form of legislation will ultimately result in changes in our current system of health care delivery. These changes are likely to include some items that may be unpalatable for many physicians, such as increased government regulation and oversight, reduced reimbursement and more bureaucracy. Those of us who have had direct experience with government-run health care, e.g. in the VA system, know full well the many inefficiencies and frustrations that such a system can produce. However, most patients still trust and respect their personal physicians more than their politicians and attorneys, and from this important position of strength we should continue to insist that our priorities for our patients and for ourselves must be given due consideration. If we must accept oversight in the form of “pay for performance” initiatives, we should be the ones setting the performance standards, not the politicians. If “Never” events are to be avoided, such as wrong site surgery, then physicians should be the ones who specify what those events are. If cost-effectiveness of health care is a major goal of these reform efforts, then a comprehensive revision of the current liability system must play a role in this process. Otherwise, there is no reasonable motivation to practice anything other than “defensive medicine.” Change is on the way, though it will take longer and will be less dramatic than candidate Obama predicted. But the new President has succeeded in bringing this crucial debate to the center of attention, as it should be. We need to participate actively in this process, and to defend our vital interests in maintaining the primacy of the physician-patient relationship through this difficult ordeal. Scientific Session participants enjoy variety of educational opportunities
The 2009 Scientific Session of the Pennsylvania Neurosurgical Society was wide and varied. It included topics on international neurosurgery, socioeconomics, chiari malformation, hydrocephalus, spinal trauma, nonfusion treatments for spine, spinal metastatic disease, robotic use in neurosurgery, deep brain stimulation, peripheral nerve disorders, utilization of nurse practitioners and physician’s assistants in the neurosurgical office, endoscopic treatment for brain lesions and treatment for pain as well as updates on electronic medical records. There were a large number of abstracts and posters. The scientific session was well received by the participants and demonstrated the range, breadth and depth of academic and clinical leadership in Pennsylvania. There were prizes awarded for best clinical and scientific abstract presentation. The Scientific Session continues to meet CME requirements and will be expected to do so in the future. I am grateful to the speakers, presenters and all who submitted abstracts and posters. The scientific session next year will be overseen by Paul Marcotte, MD, of the University of Pennsylvania. We are sure that this program will be quite successful. I encourage everyone to be as active a participant as possible.
Foundation positively impacts trauma care in Pennsylvania The Pennsylvania Trauma Systems Foundation (PTSF) continues to strongly advocate for optimal trauma care for citizens of the Commonwealth. Given the primarily rural nature of the state outside of Philadelphia, Allegheny and surrounding counties, Level III trauma center accreditation was initiated five years ago. To date only four such centers – two just this past July – are accredited. While there are a number of reasons for this, two important ones are resource commitment and general surgery coverage. As a result, the PTSF created an ad hoc committee on rural trauma that recently proposed accrediting Level IV centers. These centers would primarily function to stabilize injured patients and facilitate their rapid transfer to higher levels of care. It is anticipated that accreditation standards will be forthcoming in 2010-2011. There has recently been considerable discussion about the role, if any, of the PTSF in a comprehensive, statewide trauma system. Presently, PTSF accredits any new trauma center that may apply so long as it meets, and continues to meet, the accreditation standards – irrespective of any consideration of need for a new trauma center. There can not, however, be a true trauma system without such considerations. As a result, an ad hoc committee on needs assessment has been created. PTSF is not advocating to be given the authority to make such determinations but does want to bring the issue to the forefront. It is anticipated that a white paper outlining the types of criteria that are reasonable to consider in making these determinations will be forthcoming. PTSF was able to assert peer review protection for accreditation documents in a recent malpractice proceeding in Erie County. While the PTSF is not specifically mentioned in Pennsylvania’s peer review legislation, a judge ruled that documents being sought by plaintiffs were indeed protected from discovery. This is the first ever ruling on such documents. PTSF encourages those interested in trauma research to take advantage of one of the largest state databases in the country. An up-to-date standardized data set is readily available and customized data sets can be provided if needed. If more information is desired visit www.ptsf.org/research. PNS launches new online searchable database In the coming weeks, PNS will launch a new web page called Find a Neurosurgeon, which is a searchable database the public can use to find member physicians in their area. The page is part PNS’s web site, http://www.paneurosurgicalsociety.org. Any PNS member physician can add his or her contact information to the database. But members must first fill out the Member Consent Form that was e-mailed to members in early November. If you did not receive this form, please e-mail the PNS staff at pns@pamedsoc.org and request a form by either mail or e-mail attachment. Here are some important tips to keep in mind when completing your Member Consent Form: 1. Be sure to select up to three subspecialties from the drop-down box under practice information or you will be limiting your search/find potential. 2. All PRACTICE INFORMATION must be typed carefully and correctly as it will appear in the search results the same way that you type it on the screen. 3. To be included in the public search options, you must select YES to all questions in the PATIENT DIRECTORY section at the end of the form. 4. After hitting the submit button, you will receive confirmation at the end of the update when it has been processed successfully. Due to processing time, your practice won’t appear in the Find a Neurosurgeon database until 4-5 days after you finished filling out the form. PNS Fall Newsletter/REGIONAL NEWS Lancaster NeuroScience & Spine Associates Opens Spine Surgery Center and Welcomes Sixth Neurosurgeon The neurosurgeons of Lancaster NeuroScience & Spine Associates opened its ambulatory surgery center, The NeuroSpine Center, in June 2009. The new outpatient facility is located on the second floor of the Eden Road Medical Center adjacent to the main office. The NeuroSpine Center is equipped with two state-of-the-art operating rooms providing streamlined, centralized patient care. The practice also expanded its physician roster in August when James C. Thurmond, MD, joined the group. The group already includes neurosurgeons Drs. Eddy Garrido, John Gastaldo, Keith Kuhlengel, Christopher Kager, William Monacci; and physiatrists Drs. Elliot Sterenfeld, Tony Ton-That and Eric Finkelstein. Dr. Thurmond is a graduate of Indiana University School of Medicine, where he also served his internship. He completed a neurological surgery residency and an endovascular fellowship at the University of Medicine and Dentistry, New Jersey. He will specialize in open vascular and endovascular surgery, intracranial tumors and complex spine procedures, including minimally invasive spinal procedures. If you have news about your practice, please send it to pns@pamedsoc.org and call it "Newsletter Regional News." Why we won't see affordable universal health care anytime soon
I sincerely hope I am wrong. Sixty years ago, President Truman recognized the need for, and called for, universal health care. Now look at us. While other countries have health care systems that are not perfect, but provide universal health care to a population that is largely appreciative, the divide between health care haves and have-nots in the United States is greater now than ever. The rise of private health insurance after the Great Depression created large pools of money. Somewhere along the way we came to accept the idea that those ever enlarging pools of money were there primarily for the benefit of providers, insurers, pharmaceutical companies, device manufactures, and technology companies. Insurance companies hired more people to get more money and manage it. Health care providers found that the more health care they could provide, the more money they could make. The pharmaceutical industry, medical device manufacturers, diagnostic equipment manufacturers, health information technology (HIT) vendors, lawyers, and others staked their claims. Physicians continue to see their share of the health care dollar rapidly decreasing, yet many seem to not recognize the need for fundamental change. Catering to “stakeholders” at the outset will not allow us to turn the page on an inefficient, expensive, and – for millions of people – virtually inaccessible system of health care. Individuals need to pay for their health care. We all should recognize that a mandatory premium based on income, is, yes, a tax – so just call it a tax and get over it. We need to eliminate the historically peculiar and anachronistic system of employer-provided health insurance (just another way for politicians to avoid the “T” word). We need either a single payer system or a highly-regulated system of multiple private insurers (the latter is not likely to work in the United States unless we can change our long legal tradition of leaving regulation of insurance to the states and repeal the anti-trust exemption) that everyone pays into (in politics, none dare call it taxes). Most doctors and most people who have actually needed to use health care services and experienced the complexity and attendant frustration of dealing with the present set of multiple payers, want such a system. If people wish to seek care in addition to what such a system offers – i.e. “Cadillac” care – then it, and insurance for it, should be permitted. The fact is that most health care costs in the United States today are covered by taxes already, but in the case of the uninsured, and underinsured, too often only after their illnesses have progressed to a point where the cost and extent of care is far more than it could have been, or, after non-treatment of communicable disease, such as TB or AIDS, has caused disease in others. Those are precisely the reasons why politicizing health system reform by denying care to illegal immigrants and denying payment for abortions is a bad idea. We need to devise a system of compensating physicians and other health care providers that does not have incentives for providing marginally necessary care, or to withhold care. We need to remove the incentives for the use of expensive drugs and devices and related technology of questionable benefit. There need to be incentives to efficient and appropriate use of resources. Most of all, we need to recognize the role of physicians as vital to a sustainable health care system and compensate them accordingly. That will never happen until the yoke of special interest groups – e.g. insurance and pharma lobbies, and others whom physicians can never outspend – is removed from the necks of Congress. We cannot do that by giving money to Congress: we have to do it by talking to Congress and getting the message out to their constituents. We are already seeing a strained primary care infrastructure because of flawed compensation schemes, and it will not be long before we see it in specialty care. All of this means many job losses in the insurance industry, and in the promotional components of the drug and device industries – not a good time for that. But it also means more jobs for information technology entrepreneurs, and health care and public health workers. All of these things can be done. But we do not need just health care payment reform, we need to reform the way health care is apportioned and provided. Yes, that includes answering the need for compassionate and frank communication between physicians and their patients (or families) at the end of life. Patients with compensable injuries should not have to be pawns in a battle between a health insurer and a liability insurer. We need to integrate public health entities and health care providers with HIT that, as much as technologically possible, protects the privacy of individuals. We need to make HIT available to every provider at nominal cost, with innovative mechanisms for input from practicing physicians and their patients to develop it in a way that protects the privacy of patients and the confidentiality of physician-patient communications. Physicians need to be able to influence the design of electronic health record (EHR) systems so that they can, among other things, know the consequences of their and their peers’ treatment (or non-treatment) decisions. We need to think of appropriate, creative ways to influence individual’s behavior in a way that benefits the public health, and at the same time helps to finance health care – such as taxing soda pop, potato chips, and other foods that are known to be deleterious to personal health, in addition to what we already tax – tobacco and alcohol. With some in Congress and the President committed to “do something” about this crisis in availability and affordability of health care by the end of the year, I, like the Republican opposition, am afraid we will wind up with a more complex (2,000 pages and counting) and unsustainable system than we have now, and that will, in the long run, please no one. That, however, is a view I come to from a direction opposite to that of the Republican leadership in Congress. Congress does not seem to recognize the extent of the change we need, and is too mired in protecting special interests to achieve any consensus, even on modest change. What we have today is the most complex, bloated and expensive health care system in the world. The President is right that health care reform is vital to our economic recovery. One would think that we as a nation would be more realistic and more willing to make the hard choices that need to be made to achieve a workable system. But it looks like we will need to see more escalation of medical costs and the resulting economic hardship to most Americans that result from the failure of our present health care system, or a hastily re-worked version of it, before we get to that point. The way things are developing now just about guarantees we will have the proverbial “sausage,” when and if Congress passes legislation. To make matters worse, health insurers and pharmaceutical companies have already raised their prices in anticipation of new health system legislation. We need a health care system designed from the ground up, with its primary goal being to protect and promote personal and public health. It should be simple, and it shouldn’t take a 2,000-page bill. The public is becoming more and more skeptical of reform, in no small part because the proposals for reform have become so complex. The more complex health care becomes, the greater the target for potshots by those who wish to destroy it, and the more it breeds confusion and uncertainty in the minds of average citizens. T.R. Reid, the author of recently published, The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care, has put his finger on a unique (and perhaps fatal) feature of the American health care system: fragmentation. What we need, above all, is a system that is simple, and uniform. Only then will the American people be able to get behind health care system reform. The paradox is that to achieve this simplicity and uniformity, government is needed. Yet when “government” is mentioned, we hear the cry of “socialism,” and you know the rest. After the present efforts at meaningful health system reform fail, our President should take a deep breath and study in a non-partisan and independent way, the successes and failures of health care systems in other parts of the world, as well as in our own country, and present a simple, uniform and workable plan to Congress, which may then speak on it while they reveal how much money they have received both directly and indirectly from “stakeholders,” as well as the identity of those “stakeholders.” Congress is now so riddled with money from special interest groups as to be dysfunctional, and not just in the area of health system reform. See, for instance, Puppets in Congress, New York Times, 11/17/09. Rather than railing against government control of health care (and thus supporting the status quo of control by special interest groups), people need to take control of government. That means transparency, and government by the people, who, after all, are the ones who need and deserve health system reform. That is not socialism, that is democracy. We are approaching a tipping point. Perhaps health system reform will even be the lightning rod for a needed, more fundamental change in the way our government operates. But that will not be anytime soon. The views expressed here are not those of the Pennsylvania Neurosurgical Society, or of the Pennsylvania Medical Society. |
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