Sunday, December 6, 2009

Letter from 240,000 physicians to Senator Reid opposing the legislation as currently written

240,000 doctors from 19 organizations have sent this letter to Senator Reid stating they "oppose the legislation as currently written." This is a letter that provides an appropriate answer and not the too-soft-to-be-effective approach of the AMA. Needless to say that the AMA does not represent me! And as far as I know, the AMA does NOT represent the majority of physicians!

Here is a copy of a letter by Dr. Palmisano to Senator Reid. I support the opinion expressed in this letter, it represents my feelings very accurately.

Start of letter of Dr. Palmisano:

Lots of different opinions exist and if one takes this collection of doctors plus the Coalition of State and Specialty Societies led by MAG plus the Coalition to Protect Patients' Rights, one has a large number of physicians opposing the current legislation as written. So when Washington, DC says trust the doctors and doctors favor the reform as written, remind them of the "rest of the story."

Imagine a simple bill of about 20 pages containing individual ownership of health insurance policies, tax credits to help those who buy their own insurance rather than being job-locked, proven medical liability reform, the right to privately contract for patients and physicians without penalty, convert current Medicaid to a voucher system and give those patients the same rights as senators and representatives, namely the right to pick insurance from an array of choices and periodically change the policy if needed. Encourage medical saving accounts rather than putting up barriers or trying to eliminate them. Address pre-existing conditions via purchasing exchanges. And yes, allow people to buy health insurance across state lines to ensure real competition.

Wow! That is a plan that will keep doctors in practice, give the patients control of their destiny, and not bankrupt America. If the plans in the House and Senate pass, the system will collapse and in the end the doctors will be blamed for the failure. Count on it.
Meanwhile, here is the letter that went to Senator Reid on behalf of 240,000 doctors.

December 1, 2009

The Honorable Harry Reid
Majority Leader
United States Senate
Washington, D.C. 20510

Dear Leader Reid:

On behalf of the over 240,000 surgeons and anesthesiologists we represent and the millions of surgical patients we treat each year, the undersigned 19 organizations strongly support the need for national health care reform and share the Senate’s commitment to make affordable quality health care more accessible to all Americans. As you know, we have been working diligently and in good faith with the Senate during the past year and have provided input at various stages in the process of drafting the Senate’s health care reform bill. To this end, we have reviewed the
Patient Protection and Affordable Care Act of 2009.

As you may recall, on November 4 our coalition sent you a letter outlining a number of serious concerns that needed to be addressed to ensure that any final health
care reform package would be built on a solid foundation in the best interest of our patients. Since those concerns have not been adequately addressed, as detailed below, we must oppose the legislation as currently written.

We oppose:

• Establishment and proposed implementation of an Independent Medicare Advisory Board whose recommendations could become law without congressional action;

• Mandatory participation in a seriously flawed Physician Quality Reporting Initiative (PQRI) program with penalties for non-participation;

• Budget-neutral bonus payments to primary care physicians and rural general surgeons;

• Creation of a budget-neutral value-based payment modifier which CMS does not have the capability to implement and places the provision on an unrealistic and unachievable timeline;

• Requirement that physicians pay an application fee to cover a background check for participation in Medicare despite already being obligated to meet considerable
requirements of training, licensure, and board certification;

• Relying solely on the limited recommendations of the United States Preventive Services Task Force (USPSTF) in determining a minimum coverage standard for
preventive services and associated cost-sharing protections;

• The so-called “non-discrimination in health care” provision that would create patient confusion over greatly differing levels of education, skills and training among health care professionals while inappropriately interjecting civil rights concepts into state scope of practice laws;

• The absence of a permanent fix to Medicare’s broken physician payment system and any meaningful proven medical liability reforms; and

• The last-minute addition of the excise tax on elective cosmetic medical procedures. This tax discriminates against women and the middle class. Experience at the state level has demonstrated that it is a failed policy which will not result in the projected revenue. Furthermore, this provision is arbitrary, difficult to administer, unfairly puts the physician in the role of tax collector, and raises
serious patient confidentiality issues.

This bill goes a long way towards realizing the goal of expanding health insurance coverage and takes important steps to improve quality and explore innovative systems for health care delivery. Despite serious concerns, there are several provisions in the Patient Protection and Affordable Care Act of 2009 that the surgical community supports, strongly believes are in the best interest of the surgical patients, and should be maintained in any final package. Specifically these include: health insurance market reforms, including the elimination of coverage denials based on preexisting medical conditions and guaranteed availability and renewability of health insurance coverage; strengthening patient access to emergency and trauma care by ensuring the survival of trauma centers, developing regionalized systems of care to optimize patient outcomes, and improving emergency care for children; welldesigned
clinical comparative effectiveness research, conducted through an independent institute and not used for determining medical necessity or making coverage and payment decisions or recommendations; and the exclusion of ultrasound from the increase in the utilization rate for calculating the payment for imaging services.

Further, while redistribution of unused residency positions to general surgery is a positive step in addressing the predicted shortage in the surgical workforce, we
believe that the Senate should look more broadly at the issue of limits on residency positions for all specialties that work in the surgical setting that are also facing severe workforce problems.

Finally, we are pleased that you have accepted our suggestion and removed language which would reduce payments to physicians who are found to have the highest
utilization of resources - without regard to the acuity of the patient’s physical condition or the complexity of the care being provided. We thank you for making this important change.

While we must oppose the Patient Protection and Affordable Care Act as currently written, the surgical coalition is committed to the passage of meaningful and comprehensive health care reform that is in the best interest of our patients. We are committed to working with you to make critical changes that are vital to ensuring that this legislation is based on sound policy, and that it will have a long-term positive impact on patient access to safe and effective high-quality
surgical care.


American Academy of Facial Plastic and Reconstructive Surgery
American Academy of Otolaryngology-Head and Neck Surgery
American Association of Neurological Surgeons
American Association of Orthopaedic Surgeons
American College of Obstetricians and Gynecologists
American College of Osteopathic Surgeons
American College of Surgeons
American Osteopathic Academy of Orthopedics
American Society of Anesthesiologists
American Society of Breast Surgeons
American Society of Cataract and Refractive Surgery
American Society of Colon and Rectal Surgeons
American Society for Metabolic & Bariatric Surgery
American Society of Plastic Surgeons
American Urological Association
Congress of Neurological Surgeons
Society for Vascular Surgery
Society of American Gastrointestinal and Endoscopic Surgeons
Society of Gynecologic Oncologists
cc: United States Senate

Stay well,

Donald J. Palmisano, MD, JD
Intrepid Resources® / The Medical Risk Manager Company
5000 West Esplanade Ave., #432
Metairie, Louisiana USA 70006
504-455-5895 office
504-455-9392 fax
312-560-0180 cell

This DJP Update goes to 2156 leaders in Medicine representing all of
the State Medical Associations and over 100 Specialty Societies plus
some other friends.

You can share it with your friends and colleagues and it has the potential to reach
800,000 physicians.

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