The Franklin News-Post
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Rocky Mount, Virginia 24151
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| Reader is disappointed with Perriello's health reform vote |
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Wednesday, November 18, 2009
(Open letter to Congressman Tom Perriello)
I am confident your shoulder is quite sore from the "arm twisting" endured from Speaker Pelosi, Steny Hoyer from Maryland and the Speaker's "Assistant," Congressman Van Hollen. The pressure of being a "freshman" and the promises and lures for further advancement in the Congress given by these folks, was significant. Perhaps, they reminded you of what would happen, as well as what would not happen should you decide to not "play ball."
Surely your conscience was in turmoil, as you voted to put rural hospitals out of business, decrease reimbursement to physicians providing health care to seniors to a level below that of being able to "do business." In addition, the CHIP, Children's Health Insurance Program, is put on the block for annihilation. And then there is the issues of Title VII, Section 747 funding, funding that is intended to strengthen the primary care work force. Once again these funds have been reduced.
In addition, you have voted to reduce physician reimbursement by 21 percent, with the following effects: Primary care doctors cannot see Medicare patients, with this reduction and stay in business.
Secondly, there is a shortage of primary care providers already, while you are significantly reducing funds for the training programs for these disciplines, the emergency rooms are straining under the burden of the current lack of these providers and facilities for them, while spending huge amounts of government money seeing patients from Medicare and Medicaid populations.
Finally, medical students who might be drawn to serve in rural and under served location will likely choose another specialty; a sad and preventable situation that could be prevented with the application of some common sense, a rare commodity inside the Beltway.
With the reform bill passed, the one you voted for, you have put most of the small rural hospitals on a thread. Let me give you an example.
Carilion Franklin Memorial Hospital has been seeing nearly 26 thousand patients a year in their Emergency Department. The vast majority of these patients do not approach the level of being considered an emergency, but the legal mandate is to see everyone who darkens the door. The hospital is "writing off" a million dollars a month in bad debt regularly. Cost shifting and "creative billing" has made this sustainable in the past but not for the future. The shortage of primary care access points, other than Urgent Care facilities, which operate similarly to emergency rooms and equally expensive, is a major cause of the "abuse" of emergency rooms.
Once the patient has arrived at the Emergency Room, triage personnel, who are driven by protocols and algorithms, assess the patient, who is then placed on a "conveyor belt" taking them to specific areas for specific tests. Of course they are examined but fear of litigation shapes the plan of care from beginning to end. When the patient has reached the end of the "conveyor" system, a gigantic bill has been generated and Medicaid or Medicare is often the "Primary" insurance for these patients. The remaining patients fall into the following categories: Private pays - insured with an insurance plan of some sort and the uninsured.
Reducing reimbursement for Medicare and Medicaid patients will put these folks, the same rural hospitals, out of business. Remember, you have already put the physicians and other primary care providers in jeopardy in two ways: by expecting providers to see geriatric patients at below cost for doing business and secondly, making reimbursement so unattractive that few well qualified medical students will be attracted to the primary care specialties and certainly not to the next level, Geriatric Medicine. And, guess what, the "Baby Boomers" are just now opening the Medicare door!
Fear was mentioned above and you and your colleagues do not care to relieve the system of the threat of trivial lawsuits, a daily plague for the practicing physician and a "golden goose" for the trial lawyers and a major contributor to the cost of health care. Tort reform is needed in addition to health reform.
Of course, you are privy to the deal cut between the White House and the AARP, to "buy" their endorsement. Well, in short, the AARP, which is an insurance company, will reap a huge financial windfall. And, by the way, I do not know any doctors who belong to the AMA and I know many. So, whom do they represent?
Let me be clear, I want health care reform more than you, as I have been on the front line for nearly 50 years and have practiced in the ditches where the homeless live and the poor, uninsured and unemployed need medical assistance and seen the plight of these people first-hand. So, do not label me as some oppositional conservative. I am not. I am a concerned Primary Care doctor, who hates to stand by and allow a bunch of rank amateurs try to shape the future of health care without comment.
So, what am I to conclude? You know the above but chose to vote with Pelosi? If so, your conscience is placated, attenuated or dead. You did not know the above? If so, you should be replaced a the time of the next election.
J.A. Hagy, Sr. M.D.
Rocky Mount |
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