President Letters - Dr. Laufer 2011

Dr. Laufer is the founder & medical director of the Heart & Vascular Center of Arizona.


The Past, the Present and the Future or, the Good, the Bad and the Ugly

Nathan Laufer, MD

This is my last editorial as president of MCMS. The year has gone by very quickly. The practice of medicine continues to change and evolve at a rapid pace as well. I would like to summarize my past editorials, discuss our present situation with ACO’s and medical practice in general, and look ahead to the future of healthcare delivery.

The Employment of Doctors by Hospitals – Indentured Servitude or Practice Salvation

Nathan Laufer, MD

Hospitals are showing renewed interest in employing physicians. They have moved down this path before. Many hospitals acquired physicians' practices in the early '90s and, after multimillion dollar losses, divested them before the end of the decade.

Health Plan Preauthorizations – A necessary evil to lower cost, or an obstacle to care?

Nathan Laufer, MD

The health insurance industry has labored over many years to perfect methods that obstruct sensible use of medical services. As their abilities improve we should expect worsening patient care, higher insurance prices, and a poorly served, frustrated population unless organized medicine and policy makers intervene. Current preauthorization policies use physician time and delay treatment. These policies were designed to save money. And they do, for the insurer, but they cost money for everyone else.

Are Hospitals Creating a Hostile Work Environment for Physicians? Disruptive Physicians or Disrupted Physicians

Nathan Laufer, MD

Physicians, both male and female, often have hard-driving, type A personalities and may have little training in interpersonal skills. We may have high IQs but occasionally lack emotional intelligence. In the past, physicians were revered as charismatic people who could do no wrong; now we are seen as one part of the health care team. Temper outbursts - with throwing of instruments and loud profanity directed at any unfortunate person who happens to be near at hand - are no longer tolerated. Nurses and technicians have the right to be treated with respect, and they know it.

Accountable Care Organizations (ACO) – or Lack of Accountability in a Disorganized Organization

Nathan Laufer, MD

Editor's Note: Please read the supporting article "A Review of the Current Status of Accountable Care Organizations"

In the August 2011 issue of Round-up I wrote an article reviewing the current status and rules of ACO’s. There has been much discussion in the medical literature and much angst about this new type of healthcare delivery system. There is also much confusion and speculation. As of this article, the final rules have not yet been written. It is the development of the ACO that has caused so many physicians to hide under the hospital umbrella, lest they be left out and risk losing their patients. My personal opinion is that this type of organization will not survive. There is already much pushback from organized medicine, payers, and patients. This system is essentially a modified form of capitation where under-delivery of healthcare is the incentive.

A Review of The Current Status of Accountable Care Organizations

Nathan Laufer, MD

Editor's Note: Supporting article related to August 2011 President's Page

By Nathan Laufer MD, FACC

After many years of dwindling government funding for testing new approaches to healthcare delivery, a key component of the Patient Protection and Affordable Care Act (ACA) reverses that slide. The law allocates $10 billion over a decade to a new Center for Medicare and Medicaid Innovation, which will test other new Medicare payment models, including partial capitation. But Congress also promoted its own preferred delivery model by launching a “shared savings program” involving ACOs. Underscoring its interest in rapid change, Congress made ACOs a permanent program (rather than a pilot project) with a start date of January 1, 2012. Participation in an ACO, by both providers and patients, will be voluntary.

Repairing the House of Medicine

Nathan Laufer, MD

I would like to introduce Jane M. Orient, MD, who has written this month’s guest editorial on the fragmentation of physicians and her suggestions for repairing the House of Medicine.

Nathan Laufer, MD
President

I was happy to be asked to provide suggestions on ways to unify physicians and to repair the house of medicine. Let me begin with a little reminiscence...

Do Not Resuscitate Orders; Let's Prolong Life, but Not Prolong Death

Nathan Laufer, MD

Introduction

I frequently come across hospitalized patients who were labeled as a "no code" or "do not resuscitate" (DNR). Some of these designations are a surprise since I, as the attending physician, may have just completed a procedure on the patient, and assumed they were a full code. Nurses or residents are now having these discussions without fully knowing the patients. Code status has now become part of the hospital admission checklist. When probed, patients may have the understanding that if they agree to a full code, they will be kept on artificial life support for the rest of their days and therefore refuse to be coded. However, when asked about a simple shock for ventricular tachycardia that may allow them to leave hospital, more will readily agree. Patients may not realize that when they undergo surgical procedures they are kept alive by artificial means.

Organized Medicine - Why it Matters: Part II

Nathan Laufer, MD

Last month I spoke about the physician wish list for easing the burden of practicing medicine, the history of U.S. medicine and the evolution of the AMA and its role in medical education and advocacy. I concluded with the new practice models that evolved in the latter half of the twentieth century, that is, the HMO and Academic Medicine models.

I will now focus on the weakening of the AMA, and the present and future challenges to the practice of medicine.

Organized Medicine: Why it Matters - Part I

Nathan Laufer, MD

Lately, I have heard many questions about the value of organized medicine. Physicians are looking to limit their expenses and are trying to decide if they are getting their money’s worth out of their memberships in local associations, such as, MCMS and ArMA. I will try and answer their concerns in a two part series.

Continuity of Care - Starts with Caring

Nathan Laufer, MD

Before the turn of the century, most primary care doctors followed their own patients in the hospital when they became ill enough to be admitted. Patients liked this; and there was good continuity of care since the doctor who knew the patient the best was the one taking care of him or her.

The Hospital Peer Review Process – Fair or Flawed?

Nathan Laufer, MD

The peer review process as practiced in most hospitals may be inherently biased. In my opinion, in its current state, peer review may allow for the worst-case scenario to occur with devastating consequences. In certain circumstances, this process can allow poorly qualified physicians to continue to practice and can penalize competent physicians who may have a rare complication.

Private Practice - Evolution or Extinction?

Nathan Laufer, MD

I would like to thank the membership of the Maricopa County Medical Society for the privilege of serving as your president for the coming year. I am indebted to Dr. Susan Whitely for her excellent leadership and guidance during the preceding term. I would also like to thank the Society staff, especially Dan Mitten, for transitioning me into this role. I will try and live up to everyone’s expectations.