Since 1990, the annual TED conference (Technology, Entertainment, and Design) has been a popular destination for inspirational, invitation-only speakers offering “ideas worth spreading.” Well, that spreading spilled over into healthcare and inspired the creation of TEDMED, a veritable who’s who of innovators in medicine who happen to be outstanding speakers and entertainers. Unfortunately, TEDMED is a bit pricey and exclusive – charging $4000/ticket to attend – and so some creative young folks decided to create a free sister conference at the same venue. They called it “BIL:PIL” as a kind of riff on Bill & Ted’s Excellent Adventure, and keeping “PIL” for a rhyming medical theme. Pretty funny.
Funnier still is that my friend and Better Health contributor Jonathan Sheffi has lured me into presenting at BIL:PIL. I’ll be joined by some speakers from TEDMED and a gaggle of social media and medical technology innovators. In fact, it’s not too late to register or vote for your favorite speaker at BIL:PIL as programming will not be finalized until September 30th.
The meeting will be held October 30th and 31st at the San Diego State University BioScience Center in San Diego, California.
Today marks the fourth year anniversary of Emergiblog, a delightful collection of Emergency Medicine musings by nurse Kim McAllister.
Kim doesn’t know this, but I use excerpts from Emergiblog when I teach blogging courses to healthcare execs. Her writing is a favorite with them – and when I ask what kind of person they think she might be (judging from her blog) they say things like:
“An experienced nurse with a heart of gold.”
“Someone who’s seen it all and still kept her marbles.”
“I want her to be my nurse when I show up in the ER.”
I agree with all those sentiments… and I wish you a very happy blogiversary, Kim! I’ll see you in Las Vegas*
*Attention – anyone who reads/writes blogs should join us at Blog World Expo, October 15-17. This is our very first year for a special medblogger track. All are welcome!
Better Health bloggers from across the country participated in a historic discussion about healthcare reform at the National Press Club on July 17th, 2009. I managed to condense a 3 hour event into a 4 minute video… for those of you who were unable to make it, here’s my highlight reel… Thanks to Freddie Dorn at Picture This Video for helping to create it!
I should talk about how passionately he spoke about health care reform (he did), about why he does not believe government should be running health care (he doesn’t) or that he took the time to come and speak at 8 am even though he had been up until 2 am working on the health care bill (he did) or that he spoke right up until he – literally- had to run back to the House to vote (he did).
And I will talk about these things.
But first, let me state the obvious and get it out of the way so that I can go on to discuss the serious nature of the health care reform debate before us.
Whoa.
Seriously, is it just me or are politicians getting better looking?
There. Now I can move on to the meat of the matter.
(I had to say it because you all know I was thinking it!)
*****
This event marked my first time in Washington, and just being there is awe-inspiring. Seeing the White House from the car window took my breath away, literally. I felt like Ellie May Clampett marveling at the ce-ment pond. The National Press Club is a museum in and of itself. Mother Jones and I were hoping we’d catch a glimpse of Sanjay Gupta, but he must have been off doing neurosurgery or something.
*****
By now, you’ve probably read who was on the panel (Dr. Wes, DrRich, Dr.Rob, Dr.Kevin, me, and Better Health contributors Dr. Alan Dappen, Valerie Tinley, NP and “token” – his words, LOL – surgeon Dr. James Herndon).
I will tell you straight up that I learned much more than I contributed.
The panel shot from the hip and spoke from the heart. Some of us had notes, some of us illustrated our comments with anecdotes and one of us (*cough*) had no clue what was going to come out of her mouth until that moment.
I’ll give you a hint….it wasn’t Valerie…..
*****
For the record, those of us on the panel were not told what to say, how to say it or what to believe, nor were we chosen based on what we do believe. Some discussed concepts that should be taken into account no matter what plan we end up with, others were definitely against a single payer plan run by the government (*raising hand*).
The inefficiencies of national health plans of other countries were illustrated/discussed. This hit me later: we should look at what works in those plans, not just what is wrong with them. We don’t have to emulate them, just learn from them, and that includes the good and the bad. It also applies to any universal form of coverage, not just a government-run plan.
Wish I had said that at the time.
So much for thinking on my feet (or on my butt, as the case may be).
*****
There was some controversy about not having any patient bloggers on the panel. There should have been. I hope that, as a nurse, I spoke for patients, but it was not the same as having someone there who navigates the system as a patient every single day.
The patient bloggers were in the audience, though, and if you go to Twitter you can find the live tweeting at “#patientsfirst”. There was a pretty healthy debate going on in the Twitterverse while the panel was up on the dais.
While health care reform has been a hot topic for awhile, it was especially acute this week as the President was actively promoting a government run health care system and there seemed to be a huge sense of urgency to get what is called “Americas Affordable Health Choices Act of 2009″ passed ASAP.
The bill is over 1000 pages long.
I just downloaded it.
And Congress has not read it.
Folks, our representatives are being asked to pass legislation they have not had a chance to read.
While I will admit to being a bit unsure of exactly what happens in the Beltway (Civics classes and Schoolhouse Rock’s “I’m Just a Bill” notwithstanding), that can’t possibly be business as usual.
Can it?
*****
I’ll say one thing: no matter what we believe, why we believe it or what our role is in the health care system, it is a conversation rife with strong opinions and passionate debate.
And, in the end, because we are all patients in one form or another at some point in our lives, the conversation is about us.
So, when you hear the phrase “putting patients first”, think of it as “putting me first”.
That may help you get a foothold in the morass of information that is the health care debate.
It worked for me.
*This blog post was originally published at Emergiblog*
Asking a bunch of doctors and nurses what they want out of health care reform is like asking a group of teens what toppings they want on a pizza: You’re going to get a lot of different answers, with the loudest proclamations reserved for what they don’t want.
Such a group came together July 17 at the National Press Club in Washington, D.C. at an event called Putting Patients First, hosted by Better Health. The unanimous conclusion: Get government out of the health care delivery continuum.
Val Jones, M.D., CEO of Better Health, said, “I don’t think people outside the doctor-patient relationship should be making life and death decisions” on behalf of the patient or doctor. Rep. Paul Ryan (R-Wis.), the event’s keynote speaker, said government has an obligation to establish conditions for free markets to thrive. Ryan blamed insurance companies for the problems with health care today – essentiually stating that insurers dictate the care that providers can deliver – and he called for a solution that does not involve heavier government.
“Government bureaucracy is not the answer to insurance bureaucracy,” Ryan said. The government’s failure to control costs in Medicare and Medicaid “shows us we should get government out of the way and put more faith in the market. Providers should compete against each other for our business.”
Ryan claims that the so-called ‘public option’ in President Obama’s proposed health care reform initiative would allow the government to be “referee and player in the same game,” and that companies hoping to compete for consumer health care dollars would be at an unfair disadvantage. Obama’s plan would result in “cookie-cutter standards” for determining individual patient care, set unfairly low reimbursement rates and create an economic barrier to young talent hoping to enter the medical profession.
Ryan added that Obama’s plan offers no incentives for people to get and stay healthy, which would lower health care costs. But offering reduced insurance rates to a consumer who, say, quit smoking or lost excess weight “would be illegal” under Obama’s plan, Ryan noted. “So there’s no incentive” for people to take better care of themselves. Ryan has a plan that he says would include a “carrot and stick” provision to reward people for maintaining a healthy lifestyle.
Between two expert panels, Robert Goldberg, Ph.D., co-founder of the Center for Medicine in the Public Interest, showed a video, complete with scary background music, of patients in Canada and the U.K. complaining about abhorrent wait times to see doctors and government-mandated denial of life-saving treatments. Goldberg concluded that government-run health care in the U.S. would yield a similar system, with patients wasting away in the long shadows of a bureaucratic monster while doctors and nurses stood by, helplessly bound by the new rules. (One panelist later noted that polls show 70 percent to 80 percent approval among Canadians for that country’s health care system.)
The event did yield some progressive ideas for improving the U.S. system.
Alan Dappen, M.D., associate clinical professor at Virginia Commonwealth University School of Medicine, Department of Family Practice, and founder of DocTalker, a practice in Fairfax, Va., has moved a huge chunk of his patient consultation onto the phone. Patients still pay for his time – just as they would for an office visit – but the system is much more efficient than having every patient come in for every ailment. “If you have a tick bite or an ear infection I don’t necessarily have to see you,” he says. Further, he says, the documentation for treating such minor ailments “should not go through 30 people” at an insurance company to ensure the doctor is paid or the patient is reimbursed. “That’s just ridiculous.”
Dappen has been practicing this way for eight years and says it takes on average 10 minutes to solve a patient’s issue over the phone. “Most of our patients are helped to satisfaction,” he said. And as a result of the time saved on patient visits, he added, he has time to do house calls – and is the only doctor in Fairfax County who does so.
Rich Fogoros, M.D., a former professor of cardiology and cardiac electrophysiology and longtime practitioner and researcher who is now a consultant and writer, suggested that primary care physicians go “off the grid” – i.e. refuse to participate in any insurance plan. That, Fogoros said, will force regulators and insurers to acknowledge that current practices by insurance companies have destroyed the doctor-patient relationship.
Kevin Pho, M.D., an internal medicine physician in Nashua, N.H., and author of the blog Kevin, M.D., said the most common complaint he hears from his patients is how little time they get to spend with him during a typical visit. “We are incentivized to see as many people as possible,” Pho said, not to provide the best care possible for each patient. One solution: hourly pay for doctors, siilar to the ‘billable hours’ system used by lawyers.
James Herndon, M.D., an orthopaedic surgeon and chairman emeritus of the Department of Orthopaedic Surgery at Partners health care (an integrated health system founded by Massachusetts General Hospital and Brigham and Women’s Hospital) in Boston, Mass., voiced concern about doctors in hospitals who won’t take care of the uninsured and underinsured. The doctors “keep pointing them elsewhere until they end up in the trauma unit, which is the last resort,” he said. “I would mandate that [all doctors on staff] see their share” of those patients.” Herndon added that he favors “public support,” such as some form of a tax, to ensure doctors are compensated for providing that care. He also conceded that the health care industry has become too profit focused. “The CEO of United Health made $1.2 billion” in one recent year. “We need to get rid of excess profit in insurance.”
Kim McAllister, R.N., the author of Emergiblog, said that, no matter which plan emerges from the ongoing debate in Washington, “People will circumvent it by showing up in the emergency room.” She recounted a story of a patient in California who went to the emergency room for a headache – twice – because he couldn’t get a timely appointment with his physician. She favors a health care savings account model under which each consumer could then “decide what provider they see and when they see that person.” McAllister suggested allowing the money to roll over from year to year – another nod to rewarding healthy lifestyles – although she strongly implied that allotments would be scaled based on a person’s income.
And this hit a point on which most of the participants seemed to agree: For consumers who really cannot afford health care in a free-market system, the government should have funds available to help them pay.
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Since 1990, the annual TED conference (Technology, Entertainment, and Design) has been a popular destination for inspirational, invitation-only speakers offering “ideas worth spreading.” Well, that spreading spilled over into healthcare and inspired the creation of TEDMED, a veritable who’s who of innovators in medicine who happen to be outstanding speakers and entertainers. Unfortunately, TEDMED is a bit pricey and exclusive – charging $4000/ticket to attend – and so some creative young folks decided to create a free sister conference at the same venue. They called it “BIL:PIL” as a kind of riff on Bill & Ted’s Excellent Adventure, and keeping “PIL” for a rhyming medical theme. Pretty funny.
This is 
