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    <recommendedItem id="20100101_19_423"
                     title="Week 31: Baucus Quotes Gandhi; Obama Wants $80 Billion HHS Boost"
                     score="0.014"
                     href="http://www.medpagetoday.com/Washington-Watch/Reform/tb/18337?impressionId=1265750487851"
                     
      &lt;p&gt;WASHINGTON  --  Sen. Max Baucus (D-Mont.), chairman of the Senate Finance Committee, likes to start hearings with a quote from a famous leader. This week, he quoted Mahatma Gandhi.&lt;/p&gt;
&lt;p&gt;&quot;Every worthwhile accomplishment . . . has its stages of drudgery and triumph; a beginning, a struggle, and a victory,&quot; said Baucus, who has been an integral part of the negotiations that stalled last month with Congress apparently just weeks away from passing a healthcare reform bill.&lt;/p&gt;
&lt;p&gt;The effort to enact healthcare reform &quot;has certainly seen its struggles,&quot; Baucus said. But he said he agrees with President Barack Obama, who urged Congress during his State of the Union address not to give up on passing comprehensive reform.&lt;/p&gt;
&lt;p&gt;&quot;We have gone well past this effort&apos;s beginning,&quot; Baucus said. &quot;We have endured our share of struggle. Now let us at last bring this bill to victory.&quot;&lt;/p&gt;
&lt;p&gt;Since the election to the U.S. Senate of Massachusetts Republican Scott Brown  --  a vocal opponent of healthcare reform  --  and the president&apos;s State of the Union message, which focused strongly on job creation and improving the economy, healthcare reform has been moved to a back burner.&lt;/p&gt;
&lt;p&gt;But &quot;I&apos;m very confident we&apos;re going to pass healthcare reform this year,&quot; Baucus said during Wednesday&apos;s hearing.&lt;/p&gt;
&lt;p&gt;Obama also urged Congress again not to give up on a bill when he spoke to Democrats at a question-and-answer session on Thursday.&lt;/p&gt;
&lt;p&gt;&quot;All that&apos;s changed in the last two weeks is that our party&apos;s gone from having the largest majority in a generation to having the second-largest majority in a generation,&quot; Obama said. &quot;We&apos;ve got to remember that.&quot;&lt;/p&gt;
&lt;p&gt;Although Baucus used most of his speaking time talking about healthcare reform, the purpose of this week&apos;s hearing was to question Department of Health and Human Services secretary Kathleen Sebelius about the $80 billion increase in funding for HHS requested in the &lt;a href=&quot;http://www.medpagetoday.com/Washington-Watch/Reform/18248&quot; mce_href=&quot;http://www.medpagetoday.com/Washington-Watch/Reform/18248&quot; target=&quot;_blank&quot; title=&quot;Obama&amp;#8200;Requests&amp;#8200;$80&amp;#8200;Billion&amp;#8200;Increase&amp;#8200;in&amp;#8200;Healthcare&amp;#8200;Funding&quot;&gt;president&apos;s 2011 budget&lt;/a&gt;.&lt;/p&gt;
&lt;p&gt;Under Obama&apos;s blueprint, HHS would receive $911 billion in 2011, most of which would be Medicare and Medicaid spending. But the National Institutes of Health (NIH) would also get a $1 billion boost for medical research, and there would be money for improving food, drug, and device safety, and to intensify efforts to help Americans quit smoking and get healthy.&lt;/p&gt;
&lt;p&gt;The President&apos;s budget doesn&apos;t make any provisions for healthcare reform should it be enacted.&lt;/p&gt;
&lt;p&gt;Healthcare spending now accounts for 17.3% of the nation&apos;s total spending, according to &lt;a href=&quot;http://www.medpagetoday.com/Washington-Watch/Washington-Watch/18302&quot; mce_href=&quot;http://www.medpagetoday.com/Washington-Watch/Washington-Watch/18302&quot; target=&quot;_blank&quot; title=&quot;In&amp;#8200;Bad&amp;#8200;Economy,&amp;#8200;Record&amp;#8200;Growth&amp;#8200;in&amp;#8200;Health&amp;#8200;Spending&quot;&gt;new data&lt;/a&gt; released by the Centers for Medicare and Medicaid Services.&lt;/p&gt;
&lt;p&gt;The recession of 2009, coupled with growing use of medical services, led to the fastest one-year growth in health spending since the 1960s, according to the CMS report.&lt;/p&gt;
&lt;p&gt;By 2019, national health spending is projected to reach $4.5 trillion and account for about 19% of gross domestic product (GDP), according to the report.&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_399"
                     title="In Bad Economy, Record Growth in Health Spending"
                     score="0.013"
                     href="http://www.medpagetoday.com/Washington-Watch/Washington-Watch/tb/18302?impressionId=1265750487851"
                     
      &lt;p&gt;WASHINGTON  --  The recession of 2009, coupled with growing use of medical services, led to the fastest one-year growth in health spending since at least the 1960s, according to a report by the Centers for Medicare &amp;amp; Medicaid Services (CMS).&lt;/p&gt;
&lt;p&gt;In 2009, national health spending grew 5.7% to reach $2.5 trillion, according to preliminary estimates from CMS actuaries and economists published in &lt;em&gt;Health Affairs.&lt;/em&gt;&lt;/p&gt;
&lt;p&gt;That $2.5 trillion accounts for 17.3% of total GDP, which declined by 1% in 2009. In 2008, healthcare spending accounted for 16.2% of the GDP.&lt;/p&gt;
&lt;p&gt;&lt;em&gt;&lt;/em&gt;&lt;/p&gt;
&lt;p&gt;By 2019, national health spending will reach $4.5 trillion and account for about 19% of the gross domestic product (GDP), according to the report.&lt;/p&gt;
&lt;p&gt;National heath expenditures have grown faster than the GDP for years. But in 2009, the bad economy, job losses, an increasing Medicaid population, and more people seeing a doctor powered the unprecedented growth.&lt;/p&gt;
&lt;p&gt;While the 2009 numbers are preliminary, the authors singled out job losses that resulted in more people qualifying for Medicaid. Spending on Medicaid grew by nearly 10% in 2009, twice as fast as the year before.&lt;/p&gt;
&lt;p&gt;Another spending growth driver: More people utilized healthcare services in 2009, in part because so many sought H1N1 pandemic flu vaccinations.&lt;/p&gt;
&lt;p&gt;Utilization of medical services grew at a rate of 1.5% in 2009, compared with just a 0.9% growth rate in 2009. That translated into growth in spending on physician and clinical services as well: up 6.3% compared with 5% growth in 2008.&lt;/p&gt;
&lt;p&gt;The report also found: &lt;ul&gt; &lt;li&gt;Hospital spending increased 5.9 percent in 2009 compared with 4.5 percent in 2008, and reached $760.6 billion.&lt;/li&gt; &lt;li&gt;Spending on prescription drugs reached $246 billion, up by 5.2% compared with growth of 3.2% the previous year. &lt;/li&gt; &lt;li&gt;Government spending on healthcare in 2009 outpaced private insurance company spending, despite subsidies in the stimulus bill that allowed recently laid-off workers keep their private health insurance plans through COBRA. The number of people with private insurance plans declined by 1% in 2009. &lt;/li&gt; &lt;li&gt;Growth in out-of-pocket spending slowed in 2009, which the study authors attribute to the recession. &lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;The good news is the economy is expected to grow in 2010, and analysts predict the growth rates in healthcare to be closer to the growth in GDP. Health spending is expected to decelerate to a growth of less than 4%, while GDP is anticipated to rebound to a 4% growth rate.&lt;/p&gt;
&lt;p&gt;However, that assessment may not be accurate because the estimate is based on a 21% cut in Medicare payments to physicians. Those cuts are slated to go into effect on March 1, but Congress is expected to vote at the last minute to stall the cuts  --  as it does every year.&lt;/p&gt;
&lt;p&gt;If Medicare payments for physicians hold steady  --  &lt;a href=&quot;http://www.medpagetoday.com/Washington-Watch/Washington-Watch/18094&quot; mce_href=&quot;http://www.medpagetoday.com/Washington-Watch/Washington-Watch/18094&quot; target=&quot;_blank&quot; title=&quot;AMA&amp;#8200;Pushes&amp;#8200;for&amp;#8200;Permanent&amp;#8200;Doctor&amp;#8200;Pay&amp;#8200;Fix&quot;&gt;either by Congress voting to put the cuts on hold for the next decade, or by voting to overhaul the sustainable growth rate (SGR&lt;/a&gt;)  --  healthcare spending would grow at a rate of about 4.7% in 2010.&lt;/p&gt;
&lt;p&gt;The authors point out the difficulty of forecasting future spending levels in the midst of a recession.&lt;/p&gt;
&lt;p&gt;&quot;How quickly economic growth rebounds, and to what extent, will affect the growth of healthcare spending over the next decade,&quot; the authors said.&lt;/p&gt;
&lt;p&gt;In addition, if a healthcare reform bill ultimately passes, new projections would have to be issued.&lt;/p&gt;
&lt;p&gt;&quot;Should such legislation ultimately be signed into law, there would undoubtedly be many changes in healthcare delivery and financing,&quot; they said.&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_462"
                     title="BLOG: Good Conscience is Bad Business"
                     score="0.012"
                     href="http://www.medpagetoday.com/Blogs/18386?impressionId=1265750487851"
                     
      &lt;span style=&quot;font-family: Times; font-size: medium;&quot;&gt;&lt;div style=&quot;margin: 0px; padding: 0.6em; background-color: rgb(255, 255, 255); font-family: Georgia,&apos;Times New Roman&apos;,&apos;Bitstream Charter&apos;,Times,serif; font-style: normal; font-variant: normal; font-weight: normal; font-size: 13px; line-height: 19px; font-size-adjust: none; font-stretch: normal; -x-system-font: none;&quot;&gt;&lt;p&gt;I am going to state something that is completely obvious to most primary care physicians:  &lt;span style=&quot;font-style: italic;&quot; mce_style=&quot;font-style: italic;&quot; mce_name=&quot;em&quot;&gt;I do not accept Medicare and Medicaid patients because it is good business, I accept them despite the fact that it is bad business.&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;In truth, I could make that statement about insurance as a whole; my life would be easier and my income would be less precarious if I did not accept any insurance.  If I did, I would charge a standard amount per visit based on time spent and require payment at the time of that visit.  This is totally obvious to me, and I suspect to most primary care physicians.  A huge part of our overhead comes from the fact that we are dealing with insurance.  A huge part of our headache and hassle comes from the fact that we are dealing with insurance.&lt;/p&gt;
&lt;p&gt;If I chose to post my charges up front and expected payment at the time of the visit, the impact to the business would be huge. As  it stands, the percentage of my collections that goes to overhead is between 50 and 60% (depending on the month).  A huge amount of that overhead is due to the need to hire a large billing staff to deal with the complexity of coding, billing, and documenting.  If I dropped insurance and charged a fixed amount, I could:&lt;/p&gt;
&lt;ol&gt;
&lt;li&gt;Cut my billing staff nearly to zero (someone would still have to do bookkeeping).&lt;/li&gt;
&lt;li&gt;Increase my payment per visit, which would allow me to see fewer patients per day.&lt;/li&gt;
&lt;li&gt;Document for the sake of patient care, and not for the sake of getting paid.&lt;/li&gt;
&lt;li&gt;Add extra services like email access and house calls without worrying about how I would get paid.&lt;/li&gt;
&lt;/ol&gt;
&lt;p&gt;In short, I could make my life better, my hassles less, and improve the quality of the care I offer.&lt;/p&gt;
&lt;p&gt;So why just single out Medicare and Medicaid?  Dropping insurance would force all of my M/M patients to find another doctor, while my patients with insurance could still choose to see me.  There are several reasons why this is possible for insured patients:&lt;/p&gt;
&lt;ul&gt;
&lt;li&gt;Insured patients generally have the option of filing for their own insurance (there are some that still don&apos;t allow this, but that number is dwindling with the decrease of HMO&apos;s).&lt;/li&gt;
&lt;li&gt;Insured patients could choose to just pay me cash if they choose.&lt;/li&gt;
&lt;/ul&gt;
&lt;p&gt;Can&apos;t Medicare/Medicaid patients do this?  No, for several reasons:&lt;/p&gt;
&lt;ul&gt;
&lt;li&gt;If a doctor does not accept M/M, the government will not pay anything for the visit regardless of who files.&lt;/li&gt;
&lt;li&gt;If the doctor &lt;span style=&quot;font-style: italic;&quot; mce_style=&quot;font-style: italic;&quot; mce_name=&quot;em&quot;&gt;does&lt;/span&gt; accept M/M, they are required to accept that payment and cannot charge anything outside of that (aside from the 20% not covered).  So if I charge a M/M patient $50 cash for a visit and am signed up to accept M/M, I am committing fraud.&lt;/li&gt;
&lt;li&gt;If I drop M/M, I cannot sign up for it again for 3 years, so the impact of that move is too large to consider at this time.&lt;/li&gt;
&lt;/ul&gt;
&lt;p&gt;So why in the world do I accept M/M still?  Why would I continue to make my life so difficult?  Two words: duty and calling. I view my seeing M/M patients as a social responsibility (especially Medicare).  These people need to be seen and they deserve good care, and despite the hassle and drain on income they cause, I make a reasonable income.  So far.&lt;/p&gt;
&lt;p&gt;Plus, I just like to take care of the elderly and the poor.  My personal reasons for going into medicine included both a desire to have a good job and the calling to care for people in need.  If I dropped M/M I would reject the calling for personal gain, which is something I can&apos;t do in good conscience at this time.&lt;/p&gt;
&lt;p&gt;The fact that the only thing keeping me accepting M/M is my conscience (and tolerance of pain) gives a really clear explanation as to why M/M are failing in the realm of primary care.  The government is not paying enough to make a good business case to accept M/M; instead it is relying on the consciences of primary care physicians like me who are willing to put up with the &lt;span style=&quot;font-style: italic;&quot; mce_style=&quot;font-style: italic;&quot; mce_name=&quot;em&quot;&gt;huge&lt;/span&gt; hassle of the system.  I am personally willing to continue on this course as long as (it doesn&apos;t get too much worse) but I have complete sympathy for PCP&apos;s who drop insurance and no longer see M/M patients.&lt;/p&gt;
&lt;p&gt;One of the biggest costs to our system is the high proportion of specialists to PCP&apos;s.  PCP&apos;s keep down cost, as their success is measured by keeping people healthy, away from specialists, and out of the hospital.  The system is just holding on with the PCP&apos;s we have; decreasing that number would be devastating and perhaps fatal to the system.  It&apos;s a very bad sign when the best business model for PCP&apos;s is to do something that, if done by all PCP&apos;s, would wreck the system.  Yet even physicians like myself, who have a strong sense of duty and social responsibility, wonder how long we can afford to take M/M.&lt;/p&gt;
&lt;p&gt;I am sure some are thinking: &lt;span style=&quot;font-style: italic;&quot; mce_style=&quot;font-style: italic;&quot; mce_name=&quot;em&quot;&gt;Poor Doctors!  They have to earn less money!  They have to actually have a conscience!  What a horrible thing! &lt;/span&gt;To that I answer with the fact that I &lt;span style=&quot;font-style: italic;&quot; mce_style=&quot;font-style: italic;&quot; mce_name=&quot;em&quot;&gt;have&lt;/span&gt; chosen to earn less money, increase my hassle, and live by my conscience.  At this time, most PCP&apos;s accepting M/M are doing the same.  But setting up a system that requires the choice between conscience and sanity, between doing the right thing and self-care, is foolish.  Pushing down M/M payments for PCP&apos;s will make a bad situation worse.&lt;/p&gt;
&lt;p&gt;That&apos;s bad politics, bad medicine, and bad business.&lt;/p&gt;
&lt;p&gt;Consider yourself warned, Washington.&lt;/p&gt;
&lt;/div&gt;
&lt;/span&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_459"
                     title="Murtha Dead at 77"
                     score="0.012"
                     href="http://www.medpagetoday.com/Washington-Watch/Washington-Watch/tb/18388?impressionId=1265750487851"
                     
      &lt;p&gt;Representative John P. Murtha (D-Pa.), 77, long-time chairman of the House Appropriations Subcommittee on Defense, died yesterday afternoon from complications following a planned laparoscopic cholecystectomy, according to a statement from the congressman&apos;s office.&lt;/p&gt;
&lt;p&gt;He had been admitted to the intensive care unit at Virginia Hospital Center in Arlington on Jan. 31, days after surgeons at the National Naval Medical Center in Bethesda, Md., accidentally nicked his intestine during the operation, according to a report in &lt;em&gt;The Washington Post&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;In that same report, Rep. Bob Brady (D-Pa.), a close friend of Murtha&apos;s, said the congressman developed an infection and fever.&lt;/p&gt;
&lt;p&gt;Citing a request for privacy from the Murtha family and patient privacy laws, a spokesperson for the National Naval Medical Center declined to provide information on the operation.&lt;/p&gt;
&lt;p&gt;In a statement, Virginia Hospital Center said Murtha died &quot;despite aggressive critical care interventions.&quot;&lt;/p&gt;
&lt;p&gt;According to the American College of Surgeons, risks of laparoscopic cholecystectomy include bleeding, infection, injury to the bile duct, liver injury, numbness, hernia at the incision site, anesthesia complications, and puncture of the intestine.&lt;/p&gt;
&lt;p&gt;Death is extremely rare in healthy individuals, occurring in no more than one per 1,000 patients, according to the college.&lt;/p&gt;
&lt;p&gt;A 2009 Cochrane Review comparing laparoscopic versus open cholecystectomy for patients with symptomatic cholecystolithiasis found no difference in mortality in 38 trials. No patients died in the laparoscopic group and only 0.09% died in the open group.&lt;/p&gt;
&lt;p&gt;Severe complications were reported in 2.2% of the laparoscopic patients and 6.8% of the open patients.&lt;/p&gt;
&lt;p&gt;Murtha had recently become the longest serving member of Congress in Pennsylvania state history.&lt;/p&gt;
&lt;p&gt;First elected in 1974, Murtha, a former Marine, was the first Vietnam War combat veteran to serve in Congress, and he served as an advocate for the military throughout his career. He was also a prominent critic of the Iraq War.&lt;/p&gt;
&lt;p&gt;Murtha is survived by his wife, Joyce, and three children.&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_378"
                     title="First Lady and Lawmakers Discuss Childhood Obesity"
                     score="0.01"
                     href="http://www.medpagetoday.com/Pediatrics/Obesity/tb/18270?impressionId=1265750487851"
                     
      &lt;p&gt;WASHINGTON  --  Still engaged in an intensely partisan debate over healthcare reform, the White House is ready to launch an initiative that&apos;s likely to have widespread backing: a push to combat obesity.&lt;/p&gt;
&lt;p&gt;First Lady Michelle Obama has announced a four-pronged assault on childhood obesity that focuses on increasing the number of &quot;healthy schools,&quot; adding more physical activity to youngsters&apos; lives, encouraging consumers to make smart food choices, and improving access to healthy foods, which she calls a major barrier to healthy eating.&lt;/p&gt;
&lt;p&gt;She invited a bipartisan group of lawmakers and leaders to the Old Family Dining Room of the White House Tuesday to ask for suggestions on dealing with the epidemic.&lt;/p&gt;
&lt;p&gt;&quot;One of the tougher challenges that we need to look at is improving the accessibility and affordability of foods because there are many food deserts in this nation, which makes it difficult for families trying to access good options,&quot; Obama told Senate leaders who oversee agriculture and health, as well as the Secretaries of Agriculture, Education, and Health and Human Services.&lt;/p&gt;
&lt;p&gt;By that she referred to low income areas of many cities where there are no supermarkets, and the only food outlets are neighborhood convenience stores whose inventories are high on snacks but almost devoid of fresh fruit, vegetables, protein, and other healthy foodstuffs.&lt;/p&gt;
&lt;p&gt;She said childhood obesity is a problem that is &quot;eminently solvable,&quot; adding, &quot;Anyone who has access to children in their lives is going to have to work together. And one of the things that&apos;s also very clear is that this problem won&apos;t be solved by any single federal solution. This is going to require national action.&quot;&lt;/p&gt;
&lt;p&gt;Revising federal child nutrition programs, which include school lunch guidelines, will be part the initiative, Obama said, offering &quot;an opportunity to impact more than 30 million kids.&quot;&lt;/p&gt;
&lt;p&gt;Congressional leaders pledged their support.&lt;/p&gt;
&lt;p&gt;&quot;Together with the First Lady, the secretaries of Education, Agriculture, and Health and their congressional counterparts, we are starting a dialogue to combat childhood obesity, one that holds the promise of making real progress toward addressing this public health crisis,&quot; Sen. Tom Harkin (D-Iowa) told reporters after the meeting.&lt;/p&gt;

    </recommendedItem>
</recommendedContent>