managed-care
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Spread these words.
========================
Date: Fri, 17 Jan 1997 15:27:00 -0600
From: Eiluned Hogenson <hoge...@students.wisc.edu
To: ram...@peak.org Subject: Acceptance speech by WAFP president
HI! I was sent this and thought you might be interested in passing it on
to the mailing list.
This was the acceptance speech by Brad Fedderly, M.D., the president of
the Wisconsin Academy of Family Physicians, and deals with the problems
doctors (and patients) face in working with HMOs.
--Eiluned
A young lion went out for a walk, not sure of his past or of his future.
He knew he couldn't change his past, where was he to go in the future?
And then the monkey appeared. He was just your average ordinary monkey.
But the monkey began to taunt the lion, and the lion, becoming
frustrated, asked "Who are you?" The monkey replied, "The question is,
who are you?". And the lion looked dejected and said "I thought I knew".
The monkey replied "well I know then who you are. You are the son of the
King and it is time.
It's time my friends. We have to startspeaking up for ourselves. We have
to start defending ourselves. We have to start telling the world what
physicians do, what physicians are, and how medicine needs to be
practiced. I'm truly tired of hearing people say that "so and so in the
HMO told us that I have to discharge my patient tomorrow and she's not
ready. It's just not fair, it's not right. The practice that I introduced
you to earlier was an independent family practice for 60 plus years when
I bought it in 1991. Within two years I made a decision that I had to
sell the practice. We were busy. We were seeing 70-80 patients a day. Now
why in the world couldn't we make a go of it? Because the HMO's weren't
reimbursing us fairly and we were trying to provide good quality family
practice that our consciences saw fit to provide. As time has gone on, we
found that we cannot do lab work in our offices. We have all the
equipment. But we have to draw blood and send it to a reference lab.
Recently we were told by one of Milwaukee's HMOs that we could no longer
do x-rays in our office. Now this is a particularly interesting catch 22.
This HMO tells us not to send people to the emergency room because that's
too expensive and we need to access them in our offices but we can't
x-ray them in our offices. So if someone me comes in with what appears to
be a broken arm, ankle, or head, we have to send them to the hospital and
what that accomplishes is, allegedly, according to the HMO, a savings for
them, but it doesn't provide the right care to the patient. Now what has
to happen is that I have to have the patient come back to my office, or I
have to call the patient and give them their results and then phone
prescriptions in or send them to the durable medical equipment supplier
on the other end of town for their crutches. It makes no sense! I had to
sell my practice to a large system because under this system I would be
able to negotiate better rates with the HMOs so that we could practice
the kind of family practice that we need to practice, and that I felt in
my heart I had to practice. And they're still trying to change it.
Managed Care. What are they managing? Are they managing care or are they
managing money? I would argue that they are managing money, because they
really don't care. I had a patient with hepatic encephalopathy present to
the emergency room recently and the HMO told me that he didn't meet the
criteria for admission because the treatment was oral. The man was
comatose, but he didn't meet criteria for being admitted to the hospital.
There was an article in the Cincinnati Enquirer that I am going to read
briefly to you because I feel that it says it all. I will preface this by
telling you that I was angry when I read this article I felt how dare she
say this? It's not my fault, it's not our fault, it's the HMOs, it's the
insurance companies- The title is "How Could All Those Brilliant Docs
Wimp Out."
Memorandum to: Physician
From: A person who occasionaUy gets sick.
Subject: Health Care.
Isn't it about time you rescue medicine from the questionable mercies of
the business and politics. You were the smartest kids in your class. So
what happened. Why are you letting everyone else tell you how to do your
job. Most of us are acquainted with dullards who became journalists and
lawyers and insurance executives. But I can't think of a single instance
where I heard someone say "Gees, did you hear that Barry Binkly became a
doctor? I always thought he was a little slow. You people who became
doctors were the good students, the book worms, the merit scholars, the
brains, the eagle scouts, the hall monitors. You were the one whose
homework the rest of us copied because you had the answers. You were the
people who had an arrogance so magnificent that you could put your hands
around a pulsing human heart, You were the people with the grit to triage
on one battlefield to decide who will live and who will die, You were the
voice that gives the bad news. You were the one we trust with our babies,
Only for you would we have worn those drafty paper robes sitting on your
cold examining tables. Only for you would we have waited in a roomful of
sick people and old magazines. So what's the problem? Are you scared of a
bunch of bean counters? You whipped their butts on the SATs and now
they're making medical decisions in consultation with you. Consultation?
Why aren't you running the show? Why have you allowed insurance companies
and managed care to demand that young couples leave the car running when
they enter the maternity ward? I'm not saying that all new moms need to
hang around the hospital for 3 or 4 days. I'd just like for you to be the
one to decide when they go home. Now in addition to shorter stays,
hospitals are planning to use fewer nurses. Are you going to let
hospitals cheap out on the people who care for us when you're not there.
Of course hospitals are simply doing what they have to do, compete, cut,
downsize, stay alive. At least they have a plan. What's your plan? Have
you sent your best and brightest out to do battle, attend the meetings,
work on the committees? Is it the money? Is it us? Are you tired of
taking care of us and our untidy illnesses? Does it cork you off that
Shaquille O'Neill will get $120 million to dunk round balls and you still
owe on Your med school loans? So maybe business is not your cup of tea.
Maybe you hate meetings. Maybe you don't want to become a personal expert
or crunch numbers. Fine. That's okay. You can hire someone to do that.
But when I get sick, I stilI like to know that there's a doctor in
charge, not some MBA, not a benefits manager at Procter or Gamble or
Kroger. I sure don't want Hillary Clinton or Newt Gingrich or Ted Kennedy
taking my temperature. You will notice that I have a lot of questions. Do
I have the answer. Of course not, I was not smart enough to be a doctor.
She really said it all. When I first read it I was angry and was going to
respond, but the more I thought about it the more I knew that she was
right on target. The public needs to get angry. We can't do it alone, we
need to have the public help us out. Fortunately, little by little it is
starting to happen. A columnist for the New York Times talked about the
misadventures of a woman in Garden City, NJ who was kicked out of a
hospital too early after her hysterectomy. Well, how many of us have been
seeing this for how many years? How many years ago did you hear for the
first time that your patient had to be out tomorrow or their benefits
would be cut off. The public is only now starting to find about this.
It's okay if you don't want to be a political activist. It's okay if you
don't want to go to the meetings. It's okay if you don't want to be a
manager. But, what you can do and what you do do every day is you teach
your patients. We have to educate our patients about what's going on.
They don't know. My patients, by and large, are told to sign on the
dotted line because the shop steward tells them to. They don't know what
they're signing up for. "It's all covered". "What's all covered?" We
have to tell them, we have to educate them. It's not about gag rules,
it's about education. It's about teaching, and physicians are teachers.
HMOs are accounting for every dollar and they're making us account for
every dollar that we spend. So why aren't they accounting for the dollars
they spend? Why is the John Hancock Tower in Chicago one hundred stories
tall? Why do we have to account for every dollar and not them. I think
that we have to start responding to that and we have to start standing up
for ourselves. We need to start telling them how things are going to be
and retake medicine. When our youngest child was born we received a
package containing a beautiful embroidered baby blanket and it said
"Welcome to XYZ HMO's Brand New Patient" . We were kicked out of the
hospital in a day. We had a seventeen month old toddler at home. I had
a wife who had gone through a long labor and we had to go home after 24
hours. There was no staff to help train the new mother how to nurse or
take care of the baby.
California, who has brought us a lot of changes in medicine actually
seems to be leading the battle in helping us regain our rightful place.
There are two propositions that will be on the ballot in November.
Proposition 213 and 214. One will prohibit managed care companies from
offering financial and other incentives to doctors to induce them to deny
or delay care, and specifically with health care providers ordering
physicians not to tell patients about alternative and possibly more
expensive treatment. The initiative also would require a second opinion
from a doctor before a company could deny care. It's a little bit of a
start. I am not an angry President, but as the monkey said. It is time.
Where do we go from here? We are in the business of patient care. We care
for people. We don't care for dollars. Unfortunately, the cynicism in
America and some of medicine's past makes people think that we're in it
for ourselves, that we're in it for lining our pockets. We have to
educate people that this is not the case. This is our job. This is not
somebody else's job. We can't expect Joe down the street to do it,
because if we let someone else do it, it's not going to be done. We care
for people. We don't care what kind of insurance they have. We don't care
how much money they have. And that's basic to all physicians. We make up
the same personality profile. That's why we went into medicine.
Another way that we can make change is through political activities. We
do make a difference. I participated in the AAFP's Visit to the Hill ln
April of this year and I spoke to Senators and Congressmen and their
aides and they really don't know what we want. They're listening to
spokespeople for special interests groups and if we don't speak up for
ourselves and let them know what we want, they're not going to know.
You've got to write a letter. I don't have time to write a letter. You do
have time to write a letter. It takes a minute on your dictaphone to
write a letter. They really do want to hear from us. Go to their fund-
raisers and go to their town meetings and meet them. You don't have to
travel to Washington or Madison to participate. They do come to your area.
I dedicate my presidency to activism. Speak up. Let them know who we are.
Teach. This is what we are supposed to do. We are teachers. As part of
teaching we teach people how to care for themselves, keep themselves
healthy and make themselves responsible for their health care decisions.
We need to show others that we are the ones whose homework they wanted to
copy and that they were right. We have to be careful not to sit back and
enjoy the glory. Family Practice is at an all time high in this country.
We've really got it made. But if we sit back and don't stay active and
teach and let the country know what we're about, we're going to lose it
just as fast as it came up. This is all about empowerment. You have the
power. Just go out and do it. It is Time.