Archive for June 2009

U.S. Chamber of Commerce Fighting For Small Businesses

Recently the US Chamber of Commerce was on the hill speaking to Congress about the health care system and the impact it has on small businesses.  The Chamber called for measured a approach to health care reform.  Click on the link for more details about what happened.

Obama to Forge a Greater Role on Health Care

Article from the

WASHINGTON — After months of insisting he would leave the details to Congress,
President Obama has concluded that he must exert greater control over the health
care debate and is preparing an intense push for legislation that will include
speeches, town-hall-style meetings and much deeper engagement with lawmakers,
senior White House officials say.

Mindful of the failures of former President Bill Clinton, whose intricate
proposal for universal care collapsed on Capitol Hill 15 years ago, Mr. Obama
until now had charted a different course, setting forth broad principles and
concentrating on bringing disparate factions — doctors, insurers, hospitals,
pharmaceutical companies, labor unions — to the negotiating table.
But Mr. Obama has grown concerned that he is losing the debate over certain
policy prescriptions he favors, like a government-run insurance plan to compete
with the private sector, said one Democrat familiar with his thinking. With
Congress beginning a burst of work on the measure, top advisers say, the
president is determined to make certain the final bill bears his stamp.
“Ultimately, as happened with the recovery act, it will become President Obama’s
plan,” the White House budget director, Peter R. Orszag, said in an interview.
“I think you will see that evolution occurring over the next few weeks. We will
be weighing in more definitively, and you will see him out there.”
On Saturday, while Mr. Obama was traveling in Europe, he used his weekly radio
and Internet address to make the case that “the status quo is broken” and to set
forth his ambitious goals.

Broadly speaking, he wants to extend coverage to the 45 million uninsured while
lowering costs, improving quality and preserving consumer choice. His budget
includes what he called a “historic down payment” of $634 billion over 10 years,
accomplished mostly by slowing Medicare growth and limiting tax breaks for those
with high incomes.

“We must attack the root causes of skyrocketing health costs,” Mr. Obama said,
pointing to the Mayo Clinic in Minnesota and other institutions as among those
that offer high-quality care at low cost. “We should learn from their successes
and promote the best practices, not the most expensive ones. That’s how we’ll
achieve reform that fixes what doesn’t work and builds on what does.”
The radio address was the start of a public relations campaign coinciding with a
50-state grass-roots effort that Organizing for America, the president’s
political group, began Saturday to promote a health care overhaul. His hope is
to provide what his chief of staff, Rahm Emanuel, called “air cover” for
lawmakers to adopt his priorities. It is a gamble by the White House that Mr.
Obama can translate his approval ratings into legislative action.
“Obviously,” Mr. Emanuel said, “the president’s adoption of something makes it
easier to vote for, because he’s — let’s be honest — popular, and the public
trusts him.”

But as Mr. Obama wades into the details of the legislative debate — a process
that began last week when he released a letter staking out certain specific
policy positions for the first time — he will face increasingly difficult
choices and risks.

Aides say he will not dictate the fine print. “It was never his intent to come
to Congress with stone tablets,“ said his senior adviser, David Axelrod. But he
will increasingly make his preferences known.

If he embraces a tax on employee benefits, an idea he attacked when he was
running for president, he may infuriate labor and the middle class. If he
insists on a big-government plan in the image of Medicare, he could lose any
hope of Republican support and ignite an insurance industry backlash. If he does
not come up with credible ways to pay for his plan, which by some estimates
could cost more than $1 trillion over 10 years, moderate Democrats could balk.
Many Republicans are already angry over the emphasis Mr. Obama placed on the
public plan in last week’s letter. Senator Mitch McConnell, the Republican
leader, said Friday that “the key to a bipartisan bill is not to have a
government plan in the bill.”

Mr. Obama is well aware of these risks, advisers say. “This is what he is now
very focused on,“ Mr. Orszag said. “What are the key things that are
nonnegotiable? He is asking those sorts of questions: What are the drop-dead
things that we need to have in order to have some hope of addressing long-term
cost growth?”

Senator Charles E. Grassley of Iowa, the senior Republican on the Finance
Committee, recalled how Mr. Obama made a personal pledge of bipartisanship when
he and Senator Max Baucus of Montana, the committee’s Democratic chairman,
joined the president for a private lunch at the White House last month.
“I said, ‘Yeah, it’s a problem,’ ” Mr. Grassley said of the public plan, “and he
said something along the lines of, ‘If I get 85 percent of what I want with a
bipartisan vote, or 100 percent with 51 votes, all Democrat, I’d rather have it
be bipartisan.’ ”

On Friday, Mr. Grassley said he viewed the letter as “a political document, not
a policy document,” intended to shore up Democratic support while letting Mr.
Obama remain flexible.

Senator Ron Wyden, an Oregon Democrat who is a longtime proponent of revamping
health care, said Mr. Obama seemed to be wrestling with how far he could push

“The president is very much aware that to bring about enduring change — health
care reform that lasts, gets implemented, wins the support of the American
people and does not get repealed in a couple of years — you need bipartisan
support,” said Mr. Wyden, who was among two dozen Senate Democrats who met with
Mr. Obama about health care last week. “So he’s grappling with, how do you do

Mr. Obama began taking steps to make his case early in his administration. He
convened a “fiscal summit” where health care was a major topic, followed by a
“health summit.” Not long ago, he invited industry leaders to the White House,
where they pledged to cut $2 trillion in health care costs over the next decade.
But he has been restrained in his dealings with Congress.
He has, however, shown himself willing to exercise his presidential muscle when
he thinks it is necessary. In April, Senator Kent Conrad of North Dakota, the
Budget Committee chairman, balked at the idea of having the Senate consider
health legislation under the fast-track process known as reconciliation, which
could avoid a Republican filibuster. At a private meeting, Mr. Obama pressed him
on it.

“ ‘I want to keep it on the table as an option,’ ” Mr. Conrad recalled the
president saying. Not long after that, Mr. Emanuel, the White House chief of
staff, visited Mr. Conrad on Capitol Hill. Mr. Conrad was not convinced, but
decided not to stand in the way. “The Budget Committee chairman does not top the
president of the United States,” he said.

Going forward, Mr. Emanuel said, lawmakers could expect “quiet one-on-one
discussions” with the president.

But Republicans like Mr. Grassley say that after promising to leave the
legislative process to Congress, Mr. Obama must be cautious about his words, and
about the appearance of meddling.

“He’s doing good by staying out of it as much as he is,” Mr. Grassley said.
“He’d better use kid gloves at the start.”

Streamlining Healthcare Process W/O Streamlining Claim

The Wall Street Journal
Editorial Submission

Submitted by:
  Matthew Radin, Conflict Management Attorney and Mediator 
Liberty Group/ Healthtors Association

 Electronic Medical Records

Streamlining Healthcare Processes without Streamlining Claim, Legal and Conflict Resolution Processes Will Increase Medical Malpractice Claims, Increase Costs and Drive More Physicians Out of the Practice of Medicine 

A November 2008 report from The Physicians’ Foundation says that nearly half the nation’s practicing primary care physicians—more than 150,000—will stop practicing or reduce the number of patients seen. The reasons for dissatisfaction among primary care physicians, once referred to as general practice or family doctors, include “increased time dealing with nonclinical paperwork, difficulty receiving reimbursement and burdensome government regulations.”

Doctors are leaving their practices often because of overwhelming and ever-increasing malpractice costs and ever-decreasing reimbursements.  The premiums malpractice insurers charge physicians keep increasing to keep pace with the enormous awards lawyers often seek, through settlement or a jury trial. At the same time, doctors are paid less for services because of reimbursement reductions. 

This Physicians’ Foundation report was written before the President announced his goal to digitize medical record systems in both the hospital and physician’s office.  If implementations of these systems do not address the needs of physicians, the flight of physicians from the practice of medicine can be expected to increase even further. 

Physicians need an advocate to represent their interests in these discussions.  Physicians need solutions to their primary business problem; i.e., shrinking profits.  They need solutions that will increase reimbursements and decrease costs.  With respect to Electronic Medical Records (EMRs), they need solutions that will enable the physician to pay for the EMR and use the EMR in a way that enhances physician profitability. 

Dr. Sam Bierstock, Founder of Champions in Healthcare, has been educating me about the handful of major vendors of Hospital EMR Systems and the hundreds of vendors of Physician EMR Systems … most of which do not communicate with each other. While the Hospital EMR systems are helping the hospital to enhance profitability, little is being done to help the physician.  I have interviewed several physicians who report that the incidence of medical errors in physicians offices are increasing with EMR implementations, because the EMR systems are time consuming and cumbersome to use in comparison to their paper-based counterparts.  In most cases, physicians are straddling two systems, one paper and one electronic … which, in reality is NO system at all.  Without a single comprehensive EMR and document management solution, these systems can be expected to increase, not decrease, administrative costs and malpractice risk.

Change is tough.  Let’s assume that these risks will diminish over time as the EMR systems improve and as younger, computer-savvy physicians figure out how to make them work for their offices.  We still must deal with the problem of keeping physicians in the practice of medicine over the next ten years. 


The “Four Cornerstones of Value-Driven Health Care" outlined by the United States Department of Health and Human Services (HHS)  are:

  1. Support health information technology
  2. Provide quality information
  3. Provide pricing information
  4. Promote quality and efficiency of care

In order to keep physicians in the practice of medicine, HHS should also support a companion proposed “Four Cornerstones of Value-Driven Healthcare Conflict Management.”  These proposed “Four Cornerstones” are: 

  1. Support health care conflict management information technology
  2. Provide quality information about health care related conflicts and the cost of medical malpractice insurance and claims 
  3. Provide financial information and metrics to drive early, cost-effective resolution of claims and potential claims and reduce unnecessary litigation expense 
  4. Promote quality and efficiency of claims, legal and conflict management services to reduce the overall cost of medical malpractice insurance and health insurance and reward the lawyers and mediators who help healthcare providers to achieve these goals.    

What is the alternative to a companion “Four Cornerstones of Value-Driven Healthcare Conflict Management?”  A medical malpractice litigation system that holds physicians accountable for failing to meet the appropriate “standard of care” while encouraging them to use EMRs that have “NO standards.” 

For EMR systems to work as envisioned by President Obama, we are going to need data standards and process standards that tie into the clinical standards, healthcare administration, banking and reimbursement standards, data privacy standards (e.g. HIPAA) and the standards that must be evolved for resolving healthcare related disputes.  Without such standards, every baby delivery represents the potential for a  multi-million dollar jury verdict that further plunges our healthcare system into financial ruin.  And, EMRs will only make these cases easier for a plaintiff’s attorney to prove medical malpractice (i.e., the failure to meet the appropriate “standard of care”) unless they are fully integrated with a paper-based document management and conflict management system.    

We have become all too familiar with the concepts of Managed Health Care and Health Management Organizations (HMO’s).  When are we going to have Managed Legal Care and Lawyer Management Organizations (LMO’s)?  The time has come! 

We need to avoid the jury system wherever it makes sense to do.  This can be accomplished by streamlining claim and legal processes in a way that promotes resolution through Alternative Dispute Resolution (especially Arbitration preceded by Mediation), reduces the cost of conflict resolution and promotes relationships between the patient and  provider and among the various providers involved in the patient’s care. 

Doctors and patients who are concerned about the quality of health care and minimizing medical errors and the exorbitant costs associated with medical errors (especially the cost of medical malpractice insurance and the cost of practicing defensive medicine) should be looking for insurance programs that streamline health care and claim/ legal processes in a way that enhances quality and reduces the cost of resolving conflict.    

Typically, medical malpractice defense lawyers get paid by the hour, without consideration of the quality of the result achieved.  Therefore, the lawyer who achieves an early, cost-effective resolution of a dispute loses tens of thousands of dollars that can be generated through a long and costly discovery, pre-trial and trial process.  Just like physicians, lawyers need a financial model that rewards them for achieving excellent results with a focus on quality, efficiency and client satisfaction. 

As an attorney, myself, I call on health care professionals to "Wake Up" and start taking control over their destinies, beginning with a critical examination of their planned EMR implementation and a dialogue focused on creating solutions that promote: 1.  better management of patient expectations;  2.  better communication with patients and providers (including hospitals, nursing homes, physicians and allied health providers such as nurses); 3. early identification and correction of medical errors;  4. early identification and resolution of medical malpractice claims; and 5. medical malpractice insurance programs that provide financial incentives for good EMR-focused risk reduction programs.    

We have the technology to do wonderful things in healthcare and reform the healthcare system entirely through exciting and innovative technology. We also have the technology to do wonderful things in insurance and legal care and reform the process of healthcare conflict management through exciting and innovative technology.  Without careful coordination of these technologies and practical standards that enable these technologies to share data and DOCUMENTS,  the costs of EMR systems will far outweigh their benefits. 

Matthew Radin,  Conflict Management Attorney and Mediator



Electronic Medical Records – A Good Idea?

The Wall Street Journal
Submitted by:
Samuel R. Bierstock, MD, BSEE
Founder & President, Champions in Healthcare, LLC
Former Chief Medical Officer, IBM Inc./ Healthlink, Inc.

 Electronic Medical Records A Great Idea That May Well Do Away With the Doctors Who Use Them

The President has announced his goal to digitalize our nation’s medical record system. If achieved, this wonderful and lofty notion would certainly reduce medical errors, increase the quality of care delivered, bring consistency of care to our citizens, reduce costs associated with delivering health care, and quite possibly drive the physicians who are supposed to use them out of business.

The buzzards are already beginning to circle.

Physicians and nurses are the most pressured of all professionals, with expectations of their performance and its unimaginable responsibilities beyond the comprehension of people who have never made life and death decisions hundreds of times a day. With every decision and action comes the risk of being held liable and losing both their profession and their assets. The very mechanics of using electronic medical records in their current state of development has complicated the lives of many clinicians who use them and have been slow in being adopted for that reason. With luck, that will change.

What few people realize is that using a computer to document every decision, every action, and the assessment of every piece of information that streams to clinicians in real time represents a major change in the way clinicians have to think and work, and an audit trail that has begun the salivation process of every malpractice attorney who has finally realized what is about to be imposed on the medical profession. An electronic medical record system can track how long a doctor looked at a document, if he or she scrolled down to read the entire thing, how long it took a doctor or nurse to respond to an alert or notification of an abnormal result, how long it took for them to answer their email, and the accuracy of their every assessment, thought and action. It can track whether their decisions and actions meet the most recent guidelines or research results in a world where thousands and thousands of new papers and research are published every week.

This may sound wonderful for those receiving care, but how many people reading this article would want to use such a system in their work knowing that their every thought and action could be audited and evaluated by others who make their living suing you for everything you own?

The President’s plan calls for rewarding physicians who purchase and install electronic medical record systems through a series of financial incentives over a period of years.

Mr. President – thanks for the thought and the money, but if you really want to see this work – call off the dogs before the kennel doors open.

Instead of pouring still more money into yet another system in an effort to eliminate its problems, get to the heart of the matter. Reduce liability premiums for physicians and hospitals that install and use electronic medical records. Protect physicians who will have their every move, thought and action auditable at the most granular level. (Personally, I might like to know that I can finish dinner or brush my teeth before responding to a real time alert that someone’s blood sugar was a little high without someone suing me because I took too long to act.) Establish standards of expectation for clinicians who will be working in a world of real time data that is delivered to them as quickly as it is generated. Place limits on what audited user-activity information can be deposed in malpractice litigation, while still providing the opportunity for those who have been victims of genuine malpractice to seek justifiable compensation. There is a middle road wherein standards and expectations of how to practice in a whole new world of real time data can be established and it must be addressed in order to allow those who use electronic medical systems to do their jobs without apprehension and fear.

We have the technology to do wonderful things in healthcare and reform the system entirely through exciting and innovative technology. Most doctors recognize the wonderful benefits that an electronic medical system can bring to the quality of care they deliver, and want to use them. But what we also need is for our physicians and nurses to be able to use these tools without fear of the foxes lurking around the henhouse looking for the tiniest of opportunities to attack. Otherwise what we will end up with is a very expensive and technologically advanced universal electronic medical record system with no doctors who want to use it, and a lot of very rich lawyers.

Sam Bierstock, MD


Design Your Own Health Care Plan

Hello Friends, Family, Patients, & Colleagues:

You’re Invited To A Health Care Party


This Saturday June 6, 2009 from 9:00 AM  to 11:00 AM (EST)

Join us for this historic, phone and web simulcast, that will help you two-fold.  This call is first to help you design your own health care plan and second to help change health care in America. It’s your time to voice your concerns and opinions. Be part of this ground-breaking health care conversation.

EVENT: Designing My Own health Care Plan
FORMAT: Simulcast! (Attend via Phone or Webcast — it’s your choice)

Conference Call Information:
Phone-Number to Dial: 248-464-6062
Use Conference ID: 608776#

This Seminar is Being Done in Conjunction With

President Obama’s Health Care Initiative

Your input is vitally important to this initiative.  Each and every comment and suggestion will go straight to the White House and President Obama.

  • Your voice is needed to make effective change
  • Whatever your issues are, we want to know
  • Every issue, problem, and frustration may be expressed in this forum
  • Contribute to the change that is so desperately needed

So, make sure you attend . . . and create CHANGE in HEALTH CARE in AMERICA

To reiterate . . .


Conference Call Information:
Phone-Number to Dial: 248-464-6062
Use Conference ID: 608776#


I look forward to hearing you and your opinions on health care.


To your good health,


Dr. Cynthia Shelby-Lane, MD
Emergency Physician
Anti-Aging Expert

PS:  If you are unable to attend the call, please provide your comments, concerns, questions and opinions; and I will make sure they are included and submitted in our report to the White House and President Obama.