Posted on 07/30/2009 3:34:15 AM PDT by Man50D
The House health-care reform bill proposes to decrease hospital visits by establishing a “medical home pilot program” for elderly and disabled Americans.
Such a medical home would not require a physician to be on the staff, and therefore could be run solely by nurse practitioners and physician assistants. Medical homes also would practice “evidence-based” medicine, which advocates only the use of medical treatments that are supported by effectiveness research.
But physicians’ groups say the legislation could lead to restrictions on which treatments may be used for certain conditions, despite the fact that some patients might require a unique or unconventional approach. It also may lead to dumping Medicare/Medicaid patients in facilities that are not required to have physicians on staff.
The Center for Medicine in the Public Interest (CMPI) expressed its concerns in a report that explains why statistical evidence does not always reflect reality of effective medicine.
“‘One size fits all’ rarely does,” the report said. “From clothes to shoes to hats, few people find that items carrying that label work with their individual bodies. So why do we entrust the health of our bodies -- one of the most important assets we have -- to a one-size-fits-all mentality?”
According to CMPI and individual physicians, however, this one-size-fits-all mentality is just what congressional health-care reform suggests.
“Unfortunately, policies being advanced under the guise of ‘evidence-based medicine’ (EBM) could do just that,” the CMPI report said. “The idea behind EBM, empowering physicians with sound evidence to incorporate into their treatment decisions for individual patients, is a good one.
“Unfortunately, EBM now is being distorted by government bureaucrats and HMOs in ways that impose top-down, one-size-fits-all restrictions on patients and their healthcare providers.”
Rather than enforcing a formulaic approach to medicine based on statistical and clinical research, CMPI says health-care reform should preserve physicians’ autonomy to use the research in conjunction with their experience and knowledge of the patient.
”It is so critically important for the physician to maintain his or her ability to combine study findings with their expertise and knowledge of the individual in order to make the optimal treatment decisions. Evidence-based medicine in its present, distorted form emphasizes just one aspect of the clinical pie over all the others,” the report found.
Kathryn Serkes of the American Association for Physicians and Surgeons echoed the observation.
“There is no typical patient,” Serkes told CNSNews.com. “Every patient is different from a medical perspective. If we have evidence-based medicine that basically says ‘well, we start at treatment one, which leads you to treatment two, to treatment three to treatment four. In practice, that doesn’t work for the patient. That’s the ‘art’ part of the art and science of medicine. That’s what we still need doctors to do, is to figure out what’s right for the patient.”
In the long run, according to CMPI, evidence-based medicine may not even cut costs as Congress suggests it would.
“Evidence-based medicine may provide transitory savings in the short term, but the same patient who takes the cheapest available statin today may very well be the patient costing you -- the taxpayer, the policymaker, the thought-leader, the sister, the spouse -- big bucks when that patient ends up in the hospital because of improperly treated cardiovascular disease,” .
“The repercussions of choosing short-term thinking over long-term results and cost-based medicine over patient-based are pernicious to both the public purse and the public health,” the CMPI report said.
Provisions for the medical home pilot program are an amendment to the Social Security Act, which governs the administration of Medicare and Medicaid services.
The medical home is an approach to medical practice that “facilitates partnerships” between patients and physicians, according to the proposed bill.
The pilot program targets Medicare beneficiaries who have a high medical “risk score” or who require regular monitoring, advising or treatment. This currently applies to more than 22 million Americans, according to Kaiser Family Foundation statistics.
At least $1.5 billion would be redirected from the Federal Supplementary Medical Insurance Trust Fund to fund the medical homes, “in addition to funds otherwise available,” according to the bill.
The Senate health-care reform bill also includes provisions for medical homes, although to lesser detail than the House bill.
If this portion of the legislation passes through Congress, medical homes will be part of the greater health-care reform experiment known as "the public (health insurance) option."
According to the committee, the provisions for medical homes will make the public option a stronger competitor against private health insurance companies.
“The public health insurance option will be empowered to implement innovative delivery reform initiatives so that it is a nimble purchaser of health care and gets more value for each health care dollar,” the House Committee on Energy and Commerce’s summary says about the bill.
Medical homes are tied to “comparative effectivness research” via something called “evidence-based medicine.”
“It will expand upon the experiments put forth in Medicare and be provided the flexibility to implement value-based purchasing, accountable care organizations, medical homes, and bundled payments. These features will ensure the public option is a leader in efficient delivery of quality care, spurring competition with private plans,” the committee’s summary also said.
A statement by the American College of Emergency Physicians (ACEP) said that the effectiveness of the medical home model should be carefully evaluated before applying the model far and wide.
“There should be more research to demonstrate the benefits and continuing costs associated with implementation of the full (patient-centered medical home) model,” the ACEP statement said.
“Demonstration projects being conducted by the Centers for Medicare & Medicaid Services must be carefully evaluated. There should be proven value in healthcare outcomes for patients and reduced costs to the healthcare system before there is widespread implementation of this model.”
The proposal, meanwhile, specifically allows for facilities to be run by staff who do not possess medical degrees – including nurses and nurse practitioners.
There is no difference. This meets the definition of Concentration Camps.
Agree.
A Hypocritical oath, while logical, is too obvious (and self nullifying) isn’t it?
I’ll settle for a large asterisk (for now).
Barry Bonds, Barry 0. *
“According to the committee, the provisions for medical homes will make the public option a stronger competitor against private health insurance companies.”
Whew! Just stick all the undesirables in camps, and they will stop draining the medical system. Out of sight, out of mind. Everybody happy.
House Health-Care Bill Would Establish ‘Medical Homes’ for the Elderly and Disabled
I didn’t know they still had those trailers they sent to New Orleans.
Not only unconstitutional IMO, but also more proof of the imbalance in the mentality of those proposing, and supporting such Government collective activities. It’s right back to the restricted perspective that for every have there is a have not, because somebody else, or something has taken away by the act of possession from somebody else.
IOW “the Rich” are evil because they possess that which belongs to the poor. They (”the rich”) took away the sum of whatever from the limited pool, therefore others cannot partake of that which is their right to have as well. It’s not fair sayeth the collectivist whom cannot see beyond the zero-sum.
This collectivist health-care crap is based upon that same bullscoot mentality that is the retarded Leftist zero-sum perspective.
Liberalism is a mental disorder. No kidding.
So I guess this means that the elderly and the disabled have no rights to see a real doctor.
How could this be Constitutional?
We have to stop this nightmare.
“Such a medical home would not require a physician to be on the staff, and therefore could be run solely by nurse practitioners and physician assistants.”
I imagine the staff to patient ratio will be abysmal. Speaking as a nurse who also reads at allnurses.com, I know that the long term care homes are already tragic, and this will not make it better.
It’s also disgusting how nurses have been hypnotized by SEIU plants among them. HYPNOTIZED
Pray for our country.
they (the gov...)couldn't get most people who lived there FREE to buy them for $1.00...most have been destroyed
I don't doubt that this could be in there, I'd just like to read it myself.
But you can bet it will require an "affiliation" with a physician so that there's someone to sue.
“There is no typical patient,” Serkes told CNSNews.com. “Every patient is different from a medical perspective. If we have evidence-based medicine that basically says ‘well, we start at treatment one, which leads you to treatment two, to treatment three to treatment four. In practice, that doesn’t work for the patient. That’s the ‘art’ part of the art and science of medicine. That’s what we still need doctors to do, is to figure out what’s right for the patient.”
Heaven help us. Reality is, you will be allowed one doctor, who may misdiagnose you, or not diagnose you at all. The doctors won’t have time to properly care for the patients. All power given to the system and one doctor whose duty is cut costs. There will be no “art” and NO APPEALS.
Yet the same leftists that propose such barbaric treatment of our elderly and disabled citizens fight with every breath to get terrorists out of Gitmo, criminals out of prison, and to keep the dangerous mentally ill on our streets. Not to mention their relentless fight to let millions of illegal aliens stay in our country and millions more to come!
It’s insane!
My spouse is a top-ranking hospital administrator. He just received correspondence yesterday that under the anti-christ’s socialist plan, NO ONE can be admitted into a hospital unless or until that person (or guardian) has signed a “directive” for end of life decisions.
I guess that “directive” will put the decision of whether you live or die in the anti-christ’s hands.
I belong to a group who monitors nursing homes and assisted living facilities.
Right now, with the legislation we have, there are abuses, medical malpractice, and a severe shortage of CNAs in these places leading to all sorts of patient abuse.
This pending legislation is an open door to elder abuse and abuse of the disabled.
I’m making some phone calls to the director of my outfit and she will be burning up the phones to other organizations who also monitor care.
This needs to be stopped dead.
I especially like the National Health Service Corps, Training of Medical Residents in Community Based Settings, Scholarships for Disadvantaged Students, Educational Assistance in the Health Professions Regarding Individuals from Disadvantaged Backgrounds, Nursing Workforce Diversity Grants, Diversity and Cultural Competency Programs, Cultural and Linguistic Competency Training - all funded by us with preferences given to underrepresented and disadvantaged groups. See Sec. 2201 - National Health Service Corps.
So, stick old people in community homes (probably not Park Avenue, though) and pay activists to train our future healthcare workers there. What a deal!
Waitaminute....Is this idea from the same folks who decided in the late 50’s, that institutionalizing the mentally disabled was inhumane, encouraged the release of people who were incapable of taking care of themselves, who then became the newly named homeless?
Sigh. Liberalism - Saying/Doing whatever suits your purposes on any given day...
*DISCLAIMER - Yes, fully aware here, that some institutions were run in such a way as to be detrimental for their patients,(much like some nursing homes today), and that many of the mentally handicapped can, and do thrive outside of an institutional setting. Just commenting on the tendency of the Left to enact broad sweeping changes that usually result in bigger and better problems, not to mention the throwing out of said baby with the bathwater ; }
....
Thank you. I am sitting here trying to remember if I have ever read a more heart-stopping post...
God help us.
Tatt
Do you have a URL or link to the actual bill which you list of items refer to?
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