Physicians

10,000 US physicians have something to say and we’re not wasting time.

Today, as Congress returns to session, all 100 Senators will be listening to physicians on SERMO when they deliver the “US Physician’s Appeal” on Capitol Hill.   Wasting no time, my physician colleagues and I, armed with the over 10,000 signatures will deliver the Appeal directly to lawmakers, requesting them to include us in national health reform strategy.

We are pledging our commitment to true healthcare reform focused on the real sources of spiraling, bureaucratic costs and by doing this on day one of Congress’ return, we are telling them that true healthcare reform will only succeed IF:

  1. Tort and malpractice laws are reformed;
  2. Billing is streamlined and pricing made transparent, ending systemic support of the AMA owned billing codes (CPT Codes);
  3. The insurance industry is reformed; and
  4. Payment systems are simplified so they align with the growing need for preventive medicine.

US physicians have a unique perspective on the systemic changes needed because we are on the forefront of care every day-in between patients, hospitals, Medicare, Medicaid, and insurance companies.  Physicians more than any stakeholder group understand the need for pragmatic reform, not politically negotiated reform and we must be included for solutions to work.

With the Appeal, the SERMO community is seeking participation from every member of the US Senate to work with us to bridge a communication gap dominated by the influence of special interest groups; inviting policy makers to engage directly with us by posting questions, discussion topics and blog entries directly into the largest physicians-only online network, in an electronic online forum to discuss ideas and developments in the healthcare reform debate, in real time.  Today, in Washington, we’ll formally deliver the “US Physician’s Appeal” for lawmaker’s consideration to all 100 Senator’s offices. If you can’t be there, find us onlineat http://www.sermo.com/reform where you can sign the appeal; and then make your opinion known by getting in touch with your Senators by visiting www.senate.gov and click on “Senators”. We have strength in numbers and if the physician voice is loud enough, it will be heard.

Dr. Daniel Palestrant is the CEO of SERMO and was recently named one of the country’s “50 Most Powerful Physicians” by Modern Physician, and Business Week has named SERMO as one of the “Top 50 Tech Startups” globally. SERMO is where over 110,000 physicians are leveraging the power of social media to drive better patient care and have their voices heard.

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47 replies »

  1. Responding to Johnson: Mr Johnson, will you stop whinning please ! Insurance companies, Doctors and lawyers combined together have created this healthcare mess. Why are you ( Doctors ) Letting the insurance companies control you so tightly ? If all of you had the courage to stand up to the insurance companies , you would be boycotting the worst ones in the bunch and the rest of them would get the message. Tell me something. … and you politicians listenup too…… I own and operate two national brand retail outlets. Our politicians mandate that every thing we have in our aisles reflect the actual selling price that would be charged at the register, even a 25 cent piece of gum. So the customer would know exactly how much he or she will be paying for it. Each city and county even has staff who will come down and snoop on us. For a 25 cent piece of gum ! God forbid it be mistakenly marked 24 cents ! The biggest expenses in our lives, ie medical costs are allowed to run rampant. Even with that, I have no problem. At least,mandate that ther be some kind of firm qoute on medical procedures and doctor visits so that the medical consumer is well informed about the costs and can shop around intelligently. Its capitalism which all of you ,so dearly cherish right ? Well make it work like capitalism then. Open it up to competition and the one who competes the best ( With price and service) gets out ahead like all the rest of us small business people out there have to do. I finish my prayer every night with a four letter blessing for all the components listed above, who are making health care in the richest country in the world, a living hell to deal with. As do millions of Americans like me. Mr. Johnson. Everybody works as hard as you do. Even the minimum wage workers who come and shop at my stations. Sorry if I’ve ruffled any feathers.

  2. Since when did we become socialists and let the government decide whats best for us, what we do and how we do it? I work hard, really hard for my money and I would like to spend it on my family not helping other people pay their mortgages to help clean up congresses mess. Fixing salaries is a dumb idea because there will be no incentive to work hard. I agree with restructuring the payment system but not with fixed salaries. Once the government does this its a slippery slope. Then they might as well put everyone on a fixed income. Pay everyone that has a job 75K a year and tax the hell out of them. This is America, you work hard and you prosper. Contrary to popular belief not all doctors are millionaires and crooks. To lump all of us into one category because of a few bad apples is not right. If you are gonna do that then we might as well say our Dear President has a mistress and doesnt pay his taxes like the rest of his buddies in Washington. I work hard for my money. Ohby the way I dont get paid for all the after hour BS I have to do as a physician. I dont get overtime, I dont have a pension, I dont get sick leave, I dont get a guaranteed vacation, I odnt work 9-5. So anybody that thinks its easy is flat out wrong. I do have to deal with insurance companies,dictations,pharmacies,patients, running a small business,getting sued and now you wanna pay me even less? Good Riddance I’ll go drive a UPS truck and retire with a pension, get overtime and work 9-5 with a lunch break to boot.

  3. MD as HELL: tort reform has its place, that I’m not argueing per se. But I suspect it won’t change behavior (or reduce total costs) as much as you think. And to use your football player – perhaps the problem isn’t giving him the CT “just in case”, perhaps the problem is a system where each CT scan carries a seperate cost to a payer. The “cost” of each CT scan itself is essentially artificial. We have constructed a set of charges around each scan to help pay for the piece of equipment and people’s time in a fee-for-service, “piece work” world. And a little research will tell you there is tremendous variation in the cost. What I’m talking about is a system of care that reframes the “cost” and puts the focus back on excellent care – the kind of care you would provide to your kid or wife or parent.

  4. twa,
    It will make a difference if I don’t have to aderess BS as if it were an emergency.

  5. This is a very typical “conversation” which in the end totally misses the point. Its not tort reform, or primary care, or salary vs. FFS or evidence-based medicine or or or etc. that will make a difference.
    It’s not about any one of these things. Its about systems of care that end up addressing all of them. We know from Wennberg/Fisher et. al. that there are high performing areas. But the physicians don’t want to talk about this. Moving towards higher performing systems requires them to practice differently, organize differently, and be paid differently (and to accept some accountability).
    And the irony is that only physicians can lead this type of change.

  6. “The situation calls for a negative CAT scan.”, a concept that clearly illustrates the other side of evidence-based medicine and the defensive posture necessary to continue to survive as a doctor in this tort environment.
    It is not losing a suit that is the heartache in malpractice, but defending a suit. It will take years. It does not require daily time, but it requires daily contemplation. It is always there, the spectre of events to come. Depositions. Arbitration. Trial.
    In the past doctors have folded up like lawn chairs, settling suits just to get it behind them. It really amounts to extortion. In my community docs have chosen to defend suits. A doc has not lost a suit in our county in a long time. I am not aware of who might have settled a suit, but none have lost in court since 1991. But the time and emotional invested is huge.
    Try it some time. You won’t like it.

  7. In a recent hearing that Docs 4 patient care attended they were told that physicians do not participate enough in the political process. Interesting remark, so where is the AMA? Maybe they are cozying up with their political cronies, and our lobbyists do not represent us. The senator stated that individual physicians must participate AS INDIVIDUALS. It is okay to have multiple organizations representing us. THE POWER OF ONE is us as individuals…Members of SERMO should also look at Docs4patients.org

  8. Also, thinking through the numbers further, it struck me that the approximately 7% of physicians who denied ever ordering tests for “defensive” reasons is an awfully similar number to the 5.3% Greg Pawelski cites (as the perpetrators of the majority of cases of “malpractice”).
    This led me to wonder — could this be the same group of doctors? Is this 5-7% of doctors practicing substandard medicine, and thus appropriately being sued more often?
    Or, is this 5-7% really practicing reasonable medicine, and getting hit with lawsuits, because they can look at a patient, feel 99.99% comfortable they’ve got the right diagnosis without a $1000 test, and therefore skip the test. Is this 5-7% then, unfairly, being sued, because they didn’t spend that extra $1000 (or $10,000, or $50,000) PER PATIENT, to get to 100% certainty? Could it be that the majority aren’t sanctioned by medical boards, not (as Greg Pawelski implies) because the boards are negligent, but rather because a group of people who really understand medicine (as opposed to 12 random citizens) can look at the case and say “Yeah, this was tragic, but the doctor didn’t do anything wrong here…”
    I’m not saying this is necessarily the case, but it sure makes you wonder…

  9. I think trblmkr hit the nail on the head. It isn’t the SOLE reason for ordering the test.
    Beyond the percentage chance of a given outcome, it also is an issue of what rate of bad outcome are you willing to accept? Finding out what is causing a set of symptoms is not always straightforward — it’s weighing the likely vs. the unlikely, the minimally problematic vs. the devastating. So doing a test to make sure it isn’t something trivial is useless; doing a test to make sure it isn’t something fatal
    As MD as HELL pointed out, the current standard is NEVER. So, even if the risk of that football player having serious bleeding in their brain is 0.01%, and you’re the ER doctor seeing them, you do the CT? Why? Because in the span of your career, you’re very likely to see over 10,000 football players who hit their head hard and have a headache, you know it’s just a matter of time before one of those kids IS the 1 in 10,000 who’s got the hard to find bleed, and you don’t want to be on the witness stand defending why you “let” a 16 year old leave your ER with bleeding in their brain. The normal physical exam, the unlikelihood of the problem, the fact he felt better by the time he left are ALL not defenses in the mind of the plaintiff, his attorney, and the jury. All they see is a paralyzed (or dead) teenager, and you’re to blame!
    So, 9999 football players who don’t need a CT get one. So, the question is, what rate of missed problems is the public willing to accept? With current tort law, the answer is none. And getting to that none costs a lot of money…

  10. “I am a poor doctor, frightened by the prospect of litigation, and it is for this reason, and this reason alone, that I might order an unecessary test/hospital stay/medication.”
    “Furthermore, as much as it pains me, I have had to turn away ‘high risk’patients because of this fear. Don’t ask me how I knew they were ‘high risk’ without seeing them.”
    Scenario: Patient comes in with an ailment, the Doctor thinks the cause is most likely X but there is a certain per cent chance the cause is Y. What is the cut off point for ordering the test for Y? 50%, 25%, 10%, 5%, 1%? It’s like BlackJack, every player has a different ‘hit me’ number. Anyway, Doc thinks Y might be 10% and goes ahead and orders the test because 1)”what’s the harm” and 2)”You never know” and 3)The patient’s insurance covers the test and 4)”If it turns out to actually be Y, I’ve learned something and I’ve won a patient for life and MAYBE 5) “If I don’t order the test for Y and Y kills the patient, I might be sued.”
    A couple months later, the Doc gets this survey which asks him if he’s ever ordered a test for ‘defensive reasons’ and he remember’s “Yeah, I did for that guy.” Forget that it wasn’t his primary reason, saying it was defensive is the only choice that might lower his malpractice insurance and/or get him additional legislative protections from lawsuits. Gee, what’s he gonna pick?

  11. All types of enemies, and even some friends, of healthcare reform love to cite the alleged heavy cost burden malpractice insurance puts on our poor, poor doctors. They tell us this evil plight is two-headed, the cost of malpractice payouts themselves and the darker but supposedly ‘indirect cost’ of , oooh, ‘defensive medicine’.
    ‘Defensive medicine’ is when doctors, so afeared of evil litigious patients, order uneccesary tests and procedures ‘just in case’ the patient later falls ill and claims the doctor comitted a ‘sin of omission’ by not finding what ailed him/her. The other example is when doctors hold off on so-called ‘risky procedures’ like some types of surgery.
    As proof, makers of these spurious claims like to point to this study by JAMA ,the Journal of the AMA. The problem is its methodology, premise, and the survey is carried out by DOCTORS!
    It only covered one state, Pennsylvania, it only covered the 6 ‘high risk’ specialties, AND it allowed anonymous response. What’s wrong with that, you ask?
    Well, let’s see. Imagine you’re a doctor who HATES to pay malpractice insurance premiums which seem to rise every year (we’ll get into why in another post) but LOVES your fee-for-service setup. It greatly behooves you to answer the survey, anonymously, that you would have never, ever ordered those extra tests if it weren’t for your abject fear of being sued. It certainly wasn’t for the money! This answer helps you feel better about yourself, and might even someday down the road tie your patients’ hands legally in the case you really do screw up.
    No wonder 93% admitted, anonymously, to having practiced ‘defensive medicine’!
    Any survey return in which 93% admit to something unethical is bad polltaking.

  12. Hope everyone’s happy seeing a mid-level nurse-practitioner with two years of training.
    Anything’s better than a burned-out physician with a bad attitude.
    Q – What do you call the person who graduates last in their medical school class?
    A – ‘Doctor.’

  13. Keep on beating up primary care docs with more work, less compensation, and give them no relief from tort lawyers, patients with severe “entitlement-itis”…and good luck finding a doc in a few years. I happen to be one, and will be retiring as soon as I can…hopefully in five years or less. Primary docs are leaving in droves. Hope everyone’s happy seeing a mid-level nurse-practitioner with two years of training.

  14. Based on the recommendations of SERMO, it sounds like they’re on the same page as the AMA. “Give us everything we want and thank us for letting you give it to us”. So which doctors aren’t like this?

  15. The AMA does not represent physicians, they only claim to. They represent themselves and this is why the majority of physicians arent memebers, yet the only voice you hear is the AMA lobbying on “behalf” of them. Individual physicians have little say on how this reform is going to affect how they practice, how you get health care and their livelihood and they have no way of changing anything. If you want a disinterested doctor who is working just hard enough to justifyy his paycheck go for it.

  16. Because the people providing it are more responsible than any other group for why our health care system is so screwed up right now. If the AMA and the American Hospital Association hadn’t been money-grubbing medicine while pulling the “woe is me” card every time someone tried to call them on it we’d probably have a reasonable system by now.
    Go to a health care conference that helps providers. HFMA, HIMSS, etc. Tons of money spent trying to game the system, very little trying to deliver a better, safer, higher quality product.
    10,000 US Physicians may not be wasting time, but they’re wasting our money by perpetuating a horribly inefficient system and pulling the “but I’m a doctor” card every time they’re asked to move towards efficiency, evidenced-based medicine, etc.

  17. If you think doctors are greedy and should make 80K a year then make medical school free and the training shorter so they dont spend ten years on top of primary schooling working for low wages while they are in debt 100k. Oh, and why is it that everyone is having a say in how healthcare reform is going to happen except for the people actually providing it?

  18. Caps are not tort reform. It is the need to avoid suits and to defend suits that drives defensive medicine costs. Each court case establishes a “standard of care”. It changes from case to case and from state to state. Evidence based medicine is not going to help, since there is little evidence that applies to an individual. Evidence based medicine still studies populations, not individual patients.
    So we will continue to CT scan the football player with a normal exam who hit his head and complains of headache, looking for that rare person who might have an abnormality byt very likely does not. In court “very likely” is not a great defense, at least not right now.

  19. Monica said:
    “Thank God for healthcare reform and a public option. More physician’s assistants, an avalanche of new doctors and everyone on a fixed salary.”
    Wow.

  20. The only thing between incompetent doctors and patient death is the ability to file a lawsuit.
    News flash: Patients are many more than 10k strong and we want better quality healthcare at a lower cost, and that means doctors will have to become good at their jobs. We know doctors have the power and we don’t like what they’ve done with that power.
    Thank God for healthcare reform and a public option. More physician’s assistants, an avalanche of new doctors and everyone on a fixed salary.

  21. Where’s the statement — pro or con — on universal health coverage? A 50 yr old woman, making $30,000 a year, no health insurance, and facing breast cancer doesn’t care about billing codes or tort law. What do you tell her is in your “reform” proposal?

  22. Maybe some trade-offs are in order: Tort reform, yes, But only if fee-for-service is eliminated as the major means of paying physicians. Streamlined billing, yes, but how about a government run system that is a model for streamlined and electronic billing? Reform the insurance industry? Well, we can all agree on that. Payment systems are simplified – let’s pair that with electronic medical records (using an open-code, flexible system) which are surely the best way to achieve simplified payment systems.

  23. I cannot open the link. Does anyone know the specific details of their proposals with regards to prevention and insurance reform?

  24. Our health care reform has to include a government run non-profit insurance option.
    The plan also has to include doing away with co-pays, co-insurance, and deductibles. If this is not encluded in the reform we are not accomplishing anything. It is rediculus that a family pay over $300. a month for insurance and it doesn’t cover anything until these expences are met. It’s a ripoff. Our premiums should cover almost anything from the beginning. We aren’t going to accomplish anything unless these co-pays, deductibles, and co-insurance are removed for the policy.

  25. The healthcare system is going to hell in a hand basket and physicians, who have been silent so far, are independently uniting and requesting to…. change the CPT codes????
    How disappointing…..

  26. Birel86x nailed it. If you’re really interested in improving quality and reducing cost, the most depressing thing you can do is spend some time on Sermo reading what physicians think. Not a source of innovation or even responsibility for being part of change.

  27. Come on. The question to be asked is how much medical costs _would_ have risen in states such as Texas in the absence of tort reform.

  28. Doctors as indiviuals are usually above average in intelligence. When we get into groups, we are still individuals, and we get stupid.
    We are politically naive and gullable.
    The government couldn’t care less about quality of care and universal coverage, unless it is a politically advantageous position for them.
    The government is about to confront the reality that they will experience significant political pain reducing benefits to Medicare and Medicaid patients, unless they compensate by appealing to a large number of less expensive-to-cover voters to replace the seniors they are about to piss off.
    They will leave the large middle alone, giving them coverage fairly similar to their present coverage. But they must create the dependence on government, just like a cocaine dealer gives out first samples to create a steady return customer.
    It is politics as usual. So if you presently get a benefit from the government, watch is go away.
    If you think doctors are going to accept a rediculous compensation for care in this new plan, then think again. Tomorrows doctors will not apply to med school.

  29. MG, doctors are already the most sued professional in America. There is no shortage of doctors ready to armchair quarterback a case that has gone awry. The problem with our current malpractice system is that most cases are wrongly decided.
    Doctors have little faith in the legal system. This is very expensive for the society as a whole, because it leads to excessive defensive medicine.
    Most of the malpractice money goes to lawyers, not proported victims. Lawyers are paid like rock stars, not administrative functionaries. Why should we pay lawyers any more than primary care doctors? Pay lawyers like they do in Europe, like schoolteachers. That would put an end to the talk of “greedy” lawyers.
    Sympathetic plaintiffs are more successful that ugly ones. Similar injuries do not recieve similar awards.
    If we are going to lower costs, we must allow patients and doctors to agree to dammages before treatment, not after injury by jury. Allow patients who believe that workman’s compensation level payment is inadequate to purchase their own “adverse outcome” insurance.

  30. Greg why would a doctor sue their malpractice insurer? What are you trying to say? Or are you just looking for a new revenue stream for your attorney buddies? What is your cause of action?

  31. My experiences has been that doctors are very much like physicians in many aspects. Very insular and they discipline their own as they see fit.
    I would bet that physicians (or provider for that matter) who have publicly spoken out or testified against his colleagues in a malpractice case have received treatment similar to what Frank Serpico got.

  32. Dan,
    You reflect an interesting perspective from the physicians. Is there not anything for THEM to do? How about organize into coherent groups (instead of the 160,000 practices that exist today) to iron out standards, coordination processes, and distribute best practices more rapidly? Or even better publish cost and quality information in a consumable way so stakeholders can make informed decisions?
    See Bodenheimer et al “A Perilous Journey Through the Healthcare System.”
    See Cebul et al “Organizational Fragmentation and Care Quality in the US Healthcare System.”
    See Tollen, et al “Physician Organization in Relation to Quality and Efficiency of Care: A Synthesis of Recent Literature.”
    The highest quality and lowest cost providers work very hard as a multi-functional, multi-disciplinary team to evolve their operations. It’s surprising that SERMO doesn’t detect what is a big lever to improve the situation. Sure the four points have merit at some level, but left out are some big actions that those who actually spend the money can undertake.

  33. Well it looks like SERMO just gave all the docs in McAllen TX everything they wanted – now can we have some reform for premium payers and patients.

  34. The microchip implanted in m skull by Karl Rove prompts me to observe that the net income of the 10 largest for-profit health insurers, in 2008, comes to a collective total of $8.395 billion (netincomeofmajorhealthinsurers.) The yearly cost of malpractice litigation, incuding “defensive medicine,” is $153 billion, according to Price Waterhouse. Other estimates are, of course, much higher.

  35. Well said, Greg, regarding the manufactured outrage and real agenda of those advocating ‘tort reform.’
    Dan – while I can appreciate and respect your perspective on these general policy issues as a (non-practicing?) physician, the days of setting doctors above and apart from the many other participants in the health care system are long gone.
    Doctors = one group among many surrounding the individual patient, and the public health, who rightfully hold the center.

  36. Greg: Doctors have sued the insurance companies, and they are continuing to do so. In 2003, state medical societies brought a suit against insurance companies for delayed, low, and bundling payments and won in federal court in Miami. The settlement ultimately resulted in the formation of The Physicians’ Foundation, a 501 C3 corporation representing state and local medical societies. Insurance companies fund the Physicians’ Foundation, which, incidently is four-square behind tort reform. Tort reform is an important tool in addressing the physician shortage. In Texas, tort reform has dramatically reduced malpractice premiums and has attracted more than 7000 physicians to Texas. In my book Obama, Doctors,and Health Reform, the Texas Medical Society CEO, Lou Goodman, describes the positive impact of health reform in softening the impact of doctor shortages, especially in rural Texas.

  37. I don’t know about other states but I believe that, in Texas, the major players in the malpractice insurance area are risk retention groups and pooling arrangements formed by physicians and other providers when the major insurers fled the field, badly mangled.

  38. Opps! I forgot. Doctors don’t want to sue the insurance companies. Doctors ARE the insurance companies. According to the PIAA, a trade group of about 50 doctor-owned malpractice insurers, they cover about 60% of U.S. doctors in private practice and hospitals.

  39. how do doctors feel about CPT and ICD9 codes? I always assumed it was only the payors that where bitter about being forced to use propriatary codes and pay licensing fees. No one should own these. The only thing more annoying was paying for UCR data.
    Do providers see a need to expand to more codes? I think we need to simplify billing not add more digits to acomodate more codes.

  40. Dr. Palestrant
    The way to reform tort and malpractice is to help eliminate medical malpractice. State Medical boards have to do a better job of weeding out the bad doctors who cause most of the harm. Just 5.3% of doctors are responsible for 56% of medical malpractice, according to the NPDB. Of those bad doctors, only 7.6% have ever been disciplined by state medical boards.
    Tort reform isn’t about fixing a “broken” justice system; it’s about protecting the public image and bottom lines of the biggest and most powerful companies in the world. Tort reform isn’t about protecting doctors from high insurance rates; it’s about protecting their insurers from having to pay large judgments. Tort reform isn’t about keeping “greedy lawyers” from filing frivolous lawsuits; it’s about keeping those who are severely injured out of the court system and away from the public eye.
    Why don’t the doctors who whine about medical malpractice insurance premiums band together and sue the insurance companies? Better yet, why dosen’t Congress do something like this, for the doctor’s benefit?

  41. > 2.Billing is streamlined and pricing made
    > transparent, ending systemic support of
    > the AMA owned billing codes (CPT Codes)
    Hmmmmm. Does this mean some other billing codes should be used, or that none should, or that sometimes CPT codes should be used, but other times they should not be used? I am having trouble reconciling “streamlined” and “transparent” with “ending systemic support of … (CPT Codes)”
    t

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