Dear SIMPD member:

I am thrilled to announce that SIMPD was asked to testify before the House Ways and Means Committee regarding Health Care Reform.  The invite came today (Tuesday) for tomorrow.  We were able to submit the testimony below.  It will be read into the record.  This is our first step into the debate !   SIMPD is making the national scene and we are thrilled to be working on your behalf.   

We have been invited to go to Washington, DC, on the 14th and 15th of July, working with the Alliance for Patient Access.   The Alliance for Patient Access will host its Washington, D.C. Capitol Day Fly-In on July 14th and 15th. AfPA physicians will meet with Members of Congress and congressional staff who serve on the committees considering healthcare reform issues respecting patient access and physician autonomy. Participants will have the opportunity to join with other physicians in sharing their perspectives on issues such as clinical effectiveness research, therapeutic substitution and creating a pathway for follow-on biologics.   This is another wonderful opportunity for SIMPD to work with Americas' physicians who work for their patients.  

Thanks for all your support.  Our members know that we bring value to their day by representing them in the marketplace and in the legislature.  For those who have yet to join, please join us ... engage the conversation.   Join the doctors who speak for YOU and for your patients.  If you have forgotten, the website is www.SIMPD.org.

To be entered into the public record…. June 24, 2009

 Dear Congressperson:

I believe American health care is the best in the world.  I am privileged to serve my patients every day and am dedicated to assuring they have opportunities to make health care decisions appropriate for their needs.

I am concerned about the health care debate ongoing in Washington DC.  Reform is necessary, but we must build on what we do best and change only those things that don’t work for our patients.  We must not take actions we will later regret in the process.

Healthcare is personal and should be private, making it difficult to legislate improvements.  Government guaranteed universal coverage here and abroad has not assured excellent, timely care.  “Insurance is not Assurance.”  Government mandates often add to the cost of care and discourage providers from giving the best of themselves in their service.  

A recent survey by the Physicians’ Foundation found that government mandates and regulations are the major reason physicians today, particularly primary care doctors, are leaving the practice of medicine in unprecedented numbers.  Universal coverage legislation in Massachusetts is an example of legislation that actually brings the healthcare system to the point of bankruptcy without improving, and in fact in many ways reducing, access.  Patients in Massachusetts now wait for months or years to find a primary physician while doctors leave the state or abandon the practice of medicine entirely.  Clearly, this is not the answer.

The threat of rationed care is real if we look at other nations that guarantee coverage.  The stories from England and Canada are abhorrent to healthcare professionals who work so hard to see our patients get the care they need to make their lives better and more productive.  The best quality of care is not measurable by computers but is precisely what individual doctors provide their individual patients one at a time.  

Electronic medical records have not been shown to improve care and provide little opportunity for more face-to-face time with our patients.  Studies show that they often decrease productivity.  Most doctors feel that they are “not ready for prime time” particularly in the primary care office.  That said, most would agree that having our patients’ data at the point and time of service is essential to timely, effective, and efficient care.  The privacy issue has not been solved to most of our patients’ and many physicians’ satisfaction.  We want our patients to own their data.  We don’t support any institutional means of getting our patients’ private data into the governments’ hands.   

We know that regional differences in care patterns exit.  The problem is not so simple as to conclude that if more hip replacements are done in Minnesota than in Arizona, doctors in Minnesota are “too busy.”  Rather the data suggests that it is not the doctors in Minnesota doing too many procedures but that there are in fact regional differences in the legitimate need for hip replacements.  We believe that standards of care should be published and available to patients and to all doctors.  They should be authored and monitored by specialty societies.  But, quality can only be judged by our patients.  Rating systems are expensive and useless.  Surveys have demonstrated that the public ignores websites citing doctors and hospital ratings.  The public trusts THEIR doctor to do the right thing.  Patients should not be patronized.  They are deserving of directly contracting with their doctor for the care they want and need.  This is not the government’s business.  

Go slow and carefully on the reform process.  Let’s not make mistakes that could cost lives and put the country into bankruptcy.  There are legitimate reforms we could make right now, like looking at a way to finance the primary care medical home through direct patient financing.  Patients who have chosen to pay for their medical home directly have unparalleled primary care relationships with their doctors and spend far fewer total dollars for their healthcare than those who use insurance in an attempt to gain access to care.  More important, their access is immediate.  Delayed care is denied care.

There are any number of issues coming before the committee and as many ideas as there are people giving testimony.  I believe we have not heard enough about our patients' rights for self-determination, their rights to make their own health care choices and their rights to privately contract with physicians, hospitals, or other provider entities.  Frankly, "concierge practices" have shown remarkable cost savings and as much as 50% reductions in hospital admissions.  We are the authors of the medical home and we are the only growing mode of practice in the country.  While the government is looking for a way for primary care to grow ... we are growing.  It's all about quality health care and affordable access and we are the best example in this country of 24/7 access-to-care with the same caring primary care physician.  

I might suggest something very simple to help define the debate.  Patients do not know the cost of their care; neither does the government.  If physicians, hospitals and all providers were to publish their fee schedules and insurers and the government had to publish their payment schedules, the public would be able to start to understand the cost of their care.  Until costs are defined, value remains an enigma.  The irony of the discussion remains…. we have never defined the product.  Further, the value of our health is personal and can never be calculated by the government.  How much is too much health care?  How can we know that we have lowered the cost, if we don’t know what we are buying?  Is health the absence of disease or the perception of well being?  And finally, what is our social commitment to one another?  Are we morally committed as a society to taking care of anyone who is overwhelmed by a sudden illness or injury?  Perhaps, yes.  But, does that moral commitment extend to paying for our neighbor’s diabetes.  I say, probably not.  BUT, anyone with diabetes should be able to find affordable solutions in the marketplace.  That is where reforms need to happen.  This where the difference can be made.  This is why the right for our patients to privately contract with their individual physician must be the core of the reform solution.

As professionals, might we work together to address healthcare reform constructively and rationally?  Can I count on you to work with America’s practicing physician professionals who know that the best care is individually based patient directed care that does not involve the government?  Can I trust that you will not cast a vote until you have spoken with physician professionals seeing patients in your community who know and understand the “business” of medicine far better than the lobbyists who solicit your attention?  

Health is my patients’ most precious possession and one in which they need to independently invest.  It is personal.  It should be private.  Any reforms that could interfere with opportunities to choose a doctor, a treatment modality, or a treatment strategy is deserving of painstaking debate and discussion.  

Thank you for your thoughts and your service.  I am available to discuss these issues with you at your convenience.  

Marcy L Zwelling-Aamot, MD FACEP

President, SIMPD (Society for Innovative Medical Practice Design)

marcy@z-doc.com

562-596-7584 (w)

562-900-2650 ©

Marcy@choicecare.md