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32 posts from August 2009

August 31, 2009

Health Care Reform: Doctors for Health Insurance Reform – White House Conference Calls and Guides


Sometime in the beginning of August the rhetoric changed at the White House, Health Reform has suddenly become “Health Insurance Reform” this is more than likely the result of a pollster who found that Health Reform wasn’t selling so it is time to move on to something well more sellable like attaching Insurance to the title. 

It is safe to say that most Americans are leery of insurance companies (though 80% say they like their current healthcare), they are these monolith organizations that decide what healthcare we receive, in the past insurance was a relational activity, and a benefit provided by your employer today they are much less personal and always a favorite wiping post for politicians.


In an effort to get “Health Insurance Reform” passed the White House this past week held a conference call with physicians and provided this Health Insurance Reform Action Guide , though I was not able to find any reference to the call or the guide on the and 


The stated goals in the guide include: 


  • Bring stability and improved cared to Americans by offering new consumer protections;
  • Reduce costs to make health care affordable;
  • Protect a patient’s choice of doctors, hospitals, and insurance plans; and
  • Assure quality affordable health care for all Americans 

The guidelines also detailed the goals of doctors for health insurance reform such as: 


  • Emphasizing the urgent need to pass health insurance reform this year in order to bring stability and improved care to all Americans and to address rapidly escalating health care costs that are crushing family, business, and government budgets;


  • Explaining how health insurance reform legislation will build on what works in our health care system, fix what’s broken, and ensure stable costs, secure choices, and quality care; and


  • Developing momentum and support for health insurance reform this year.


According to the report, ways to support health insurance reform include the public include hosting Health Reform Action Forums, roundtable discussions, and so on.


Instead of the White House asking Americans to investigate and read the health care bill to really see what it will do to Americans, they would rather distract us with rhetoric and no plan of their own. 


While Americans might be easily distracted by the idea that they might get coverage, they should not be distracted by the enormous taxes it will take to pay for it, the debt our grandchildren will have to pay to finance it, and the destruction it will do to all employers.


The administration also wants to distract Americans through this guide by taking them to their Health Reform Website,, to take quizzes and see videos and stories.  (I am not kidding) 


While this website tries to address the so called myths about health insurance reform, the website gives no mention of reports from agencies such as the Congressional Budget Office, and the Office of Management and Budget which predict the bill will bankrupt America. 


This website is merely another attempt for the Obama administration to use its media and internet campaigning techniques from the elections to distract Americans from the real picture: health care reform is too big to happen right now, and the economy needs to be fixed first.   People need jobs and a healthy economy. 


Although the website makes reference to certain reports and events about healthcare, these were just “for show” as Dr. Ezekiel Emanuel would say. Similarly, the website does give reference to some important studies and data on health insurance and patients. 


For example, the guidelines ask Americans to consider the following: 


  • Insurance premiums have doubled over the last 9 years – 3 times faster than wages. 
  • Out-of-pocket costs have climbed by 32 percent in five years, as deductibles and co-pays rise. 
  • 14,000 Americans lose their health insurance each day when they lose their jobs, change jobs, move or become seriously ill. 
  • Today, only 38 percent of small business offer insurance – was 61 percent in 1993 
  • Americans are routinely denied care if they have pre-existing medical conditions, and many see their coverage dropped if they become seriously ill. 

The White House wants Americans to believe that the above problems can only be fixed by health insurance reform through the following consumer protections: 


-    No Dropping of Coverage for the Seriously Ill

-    No Discrimination for Pre-existing Conditions

-    No Charge for Preventive Care

-    No Exorbitant Out-of-Pocket Expenses, Deductibles or Co-Pays:


These are points that no one would be against, who is not for no charge preventative care, or low deductibles and co-pays and the first two easily fixed by simple legislation.


The White House also claims that anyone who loses their health insurance will be covered, and that insurance reform will strengthen small business by reducing their costs, increasing health insurance choices for their employees, and being more competitive (e.g. Tax credits to make covering employees affordable;Lower insurance administrative costs through the insurance exchange; and Increased health plan choices through the insurance exchange.  The problem with this small business reasoning is if you force small businesses to pay insurance for their employees and their family’s jobs will be eliminated. 


The guide also states thathealth insurance reform will be fully paid for and will not add a penny to the deficit because a majority will be paid by reducing waste and overpayments to insurance companies. The report also states that the health system reforms will improve quality and reduce costs, and the health insurance reform will strengthen Medicare and add years to the Medicare trust fund for America’s seniors.  This is more wishful thinking than political reality, there is a real concern that health “insurance” reform will add to Medicare’s problems not help them. 


Paying for more does not mean getting more. Prevention will not help reduce costs. A public option will not cover more people because it will result in rationed care. Small business and industry will be forced to pay a large burden of this reform, and taxpayers will pay the rest. Americans should use these guidelines skeptically, and get the real information directly from their doctors.  


Additional Resources:

Affordable Care Act: Obamacare & Health Reform Facts 


Understanding the Impact of Obamacare on Medicare 


What does Marketplace health insurance cover?




Affordable Care Act: State-by-State Impact




The Lifestyle Revolutionaries Guide to Addiction Intervention











ACCME: Increased Transparency and Enforcement

The Accreditation Council for Continuing Medical Education (ACCME) has posted an updated list of ACCME accredited providers on its Web site, including more data than the ACCME has released previously. Accredited providers are institutions that produce continuing medical education (CME) that meets the ACCME's high standards for educational excellence and independence from commercial influence.

The list includes basic contact information plus the following details for each ACCME accredited provider:

  • Current accreditation status (Accreditation, Accreditation with Commendation, Probation or Provisional Accreditation)
  • Accredited based on the ACCME 2006 Accreditation Criteria (yes or no)
  • Total numbers of activities, hours and participants reported
  • Types of activities produced
  • Receives commercial support (yes or no)
  • Receives income from advertising or exhibits (yes or no)
  • Participates in joint sponsorship (yes or no)

The provider list includes information supplied to the ACCME by accredited providers. To make the list most useful, it is posted in three formats: a PDF with providers listed alphabetically, a PDF with providers listed by state and an MSExcel® document.

"The ACCME is making more data public because we believe it will increase the system's transparency and accountability, allowing all stakeholders -- including physician learners, licensing and certification bodies, and the public -- to assess size, diversity, oversight, and enforcement of the accredited CME enterprise for themselves," said Murray Kopelow, MD, ACCME Chief Executive.

Rewarding Excellence

There are 729 ACCME accredited providers on the list. Of those, 124 (17 percent) have received Accreditation with Commendation, including 16 that have received Accreditation with Commendation under the 2006 Accreditation Criteria. The ACCME 2006 Accreditation Criteria raise the bar, positioning CME as a strategic partner in national initiatives to improve the quality and safety of patient care. The guidelines foster leadership and collaboration by rewarding providers with Accreditation with Commendation if they demonstrate (among other accomplishments) engagement with their environment through participation in institutional or system-wide initiatives to improve health care quality.

Increased Monitoring

Of the 729 accredited providers, 33 (5 percent) are on Probation for Non-compliance with ACCME requirements. Approximately 10 percent of providers are put on Probation in each accreditation review cycle, up from 2 percent in the past. This higher percentage represents the ACCME’s increased monitoring efforts and accelerated review procedures. The ACCME's strengthened enforcement process safeguards CME's independence and seeks to ensure that CME is free of commercial bias. Providers that are on Probation are allowed to continue to provide accredited CME, but are required to prepare immediate improvement plans for those areas found in Non-compliance, and to provide verification to ACCME that the improvements have been implemented within a specified time frame in order to maintain their accreditation.

ACCME Compliance Data

As part of the ACCME’s efforts to improve transparency, it has also released the aggregated and blinded compliance findings for 170 providers reviewed during the last three accreditation review cycles. These decisions were made in November 2008, March 2009 and July 2009. Figure 1 represents the aggregated compliance findings for providers. Each bar represents findings for all Providers for the specified Criterion, and shows the percentage of providers that have received findings of Not Applicable, Compliance, or Non-compliance. Figure 2 features a detailed breakdown of individual provider’s compliance findings. Providers are not identified by name.


For more information about the ACCME's accreditation system, check out the following resources:

The ACCME is taking strong steps to ensure compliance and enforcement of their standards.  They should be applauded for their increased diligence.   Policy makers should take notice of these actions as important to ensuring the independence of the accredited CME system.

August 30, 2009

University of Wisconsin CME: Dean Directs Sunshine on Journal Sentinel Attacks

In this weekend’s Milwaukee Journal Sentinel, Robert N. Golden, MD dean of the University of Wisconsin-Madison School of Medicine and Public Health and vice chancellor for medical affairs sets the record straight on their CME program. 

Contrary to articles written in that paper that attempt to discredit the program the University shows that after significant review the CME program at Wisconsin they are being wrongly attacked. 


Bellow is the editorial in its entirety.

Academic integrity in UW's CME program


The Milwaukee Journal Sentinel has lauded its recent coverage of the continuing medical education program at the University of Wisconsin School of Medicine and Public Health (Editorials, Aug. 16). These articles may mislead readers into viewing our CME program as little more than a paid mouthpiece for commercial interests that seek to manipulate physicians.

Nothing could be further from the truth.

An objective, unbiased assessment confirms that the academic integrity of the UW School of Medicine and Public Health's Office of Continuing Professional Development is not in question. The Accreditation Council for Continuing Medical Education, the nonpartisan organization that sets and monitors the standards for CME programs across the country, recently completed an independent inquiry, which was triggered by the Journal Sentinel's first article about our CME activities.

The ACCME wrote that we had "implemented a careful and deliberate process to ensure that large amounts of commercial support do not in any way compromise the integrity of the university or the integrity of the continuing medical education program."

This assessment of our Office of Continuing Professional Development is consistent with other recent evaluations of our approach to identifying and managing apparent conflicts of interest.

Within the past few years, we have received public praise from the Institute on Medicine as a Profession at Columbia University and have been cited in the Journal of the American Medical Association for our leadership in managing physician conflicts of interest.

We have never rested on our laurels in this vital area. We always note the constantly changing landscape of medical education and implement cutting-edge standards of excellence. In fact, just a few days after the publication of a Journal Sentinel editorial that criticized our CME programs, the American Association of Medical Colleges cited a UW-produced CME activity that provided a comprehensive primer on swine flu as an example of "best practice" in Web-based CME.

From the very beginning, we have supported U.S. Sen. Herb Kohl's Physician Sunshine Act, legislation that would grant the public unprecedented access to information on outside activities by physicians nationwide.

If Sen. Kohl's efforts are successful, patients will be able to make their own determinations as to whether their physician's activities present a problematic conflict of interest - rather than having the news media make that judgment for them.

The UW School of Medicine and Public Health is committed to setting the standard in Wisconsin, and through the country, in transparency. For more than a century, our medical education programs have reflected the ideals of the Wisconsin Idea - we embrace a heartfelt commitment to meet the needs of the people of our state.

Journal Sentinel readers would be better served by reporting that presents the complete picture and acknowledges our successes as well as the challenges that we and our peer institutions must address.


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