Expect longer waits for appointments as physicians get pinched on reimbursements.
Article by: SCOTT GOTTLIEB
Image by: CHAD CROWE
At the heart of President Barack Obama's health-care plan is an insurance program funded by taxpayers, administered by Washington, and open to everyone. Modeled on Medicare, this "public option" will soon become the single dominant health plan, which is its political purpose. It will restructure the practice of medicine in the process.
Republicans and Democrats agree that the government's Medicare scheme for compensating doctors is deeply flawed. Yet Mr. Obama's plan for a centrally managed government insurance program exacerbates Medicare's problems by redistributing even more income away from lower-paid primary care providers and misaligning doctors' financial incentives.
Like Medicare, the "public option" will control spending by using its purchasing clout and political leverage to dictate low prices to doctors. (Medicare pays doctors 20% to 30% less than private plans, on average.) While the public option is meant for the uninsured, employers will realize it's easier -- and cheaper -- to move employees into the government plan than continue workplace coverage.
The Lewin Group, a health-care policy research and consulting firm, estimates that enrollment in the public option will reach 131 million people if it's open to everyone and pays Medicare rates, as many expect. Fully two-thirds of the privately insured will move out of or lose coverage. As patients shift to a lower-paying government plan, doctors' incomes will decline by as much as 15% to 20% depending on their specialty.
Physician income declines will be accompanied by regulations that will make practicing medicine more costly, creating a double whammy of lower revenue and higher practice costs, especially for primary-care doctors who generally operate busy practices and work on thinner margins. For example, doctors will face expenses to deploy pricey electronic prescribing tools and computerized health records that are mandated under the Obama plan. For most doctors these capital costs won't be fully covered by the subsidies provided by the plan.
Government insurance programs also shift compliance costs directly onto doctors by encumbering them with rules requiring expensive staffing and documentation. It's a way for government health programs like Medicare to control charges. The rules are backed up with threats of arbitrary probes targeting documentation infractions. There will also be disproportionate fines, giving doctors and hospitals reason to overspend on their back offices to avoid reprisals.
The 60% of doctors who are self-employed will be hardest hit. That includes specialists, such as dermatologists and surgeons, who see a lot of private patients. But it also includes tens of thousands of primary-care doctors, the very physicians the Obama administration says need the most help.
Doctors will consolidate into larger practices to spread overhead costs, and they'll cram more patients into tight schedules to make up in volume what's lost in margin. Visits will be shortened and new appointments harder to secure. It already takes on average 18 days to get an initial appointment with an internist, according to the American Medical Association, and as many as 30 days for specialists like obstetricians and neurologists.
Right or wrong, more doctors will close their practices to new patients, especially patients carrying lower paying insurance such as Medicaid. Some doctors will opt out of the system entirely, going "cash only." If too many doctors take this route the government could step in -- as in Canada, for example -- to effectively outlaw private-only medical practice.
These changes are superimposed on a payment system where compensation often bears no connection to clinical outcomes. Medicare provides all the wrong incentives. Its charge-based system pays doctors more for delivering more care, meaning incomes rise as medical problems persist and decline when illness resolves.
So how should we reform our broken health-care system? Rather than redistribute physician income as a way to subsidize an expansion of government control, Mr. Obama should fix the payment system to align incentives with improved care. After years of working on this problem, Medicare has only a few token demonstration programs to show for its efforts. Medicare's failure underscores why an inherently local undertaking like a medical practice is badly managed by a remote and political bureaucracy.
But while Medicare has stumbled with these efforts, private health plans have made notable progress on similar payment reforms. Private plans are more likely to lead payment reform efforts because they have more motivation than Medicare to use pay as a way to achieve better outcomes.
Private plans already pay doctors more than Medicare because they compete to attract higher quality providers into their networks. This gives them every incentive, as well as added leverage, to reward good clinicians while penalizing or excluding bad ones. A recent report by PriceWaterhouse Coopers that examined 10 of the nation's largest commercial health plans found that eight had implemented performance-based pay measures for doctors. All 10 plans are expanding efforts to monitor quality improvement at the provider level.
Among the promising examples of private innovation in health-care delivery: In Pennsylvania, the Geisinger Clinic's "warranty" program, where providers take financial responsibility for the entire episode of care; or the experience of the Blue Cross Blue Shield plans in Pennsylvania, Michigan and Virginia, where doctors are paid more for delivering better outcomes.
There are plenty of alternatives to Mr. Obama's plan that expand coverage to the uninsured, give them the chance to buy private coverage like Congress enjoys, and limit government management over what are inherently personal transactions between doctors and patients.
Rep. Nydia Velazquez (D., N.Y.) has introduced a bipartisan measure, the Small Business Cooperative for Healthcare Options to Improve Coverage for Employees (Choice) Act of 2009, that would make it cheaper and easier for small employers to offer health insurance. Mr. Obama would also get bipartisan compromise on premium support for people priced out of insurance to give them a wider range of choices. This could be modeled after the Medicare drug benefit, which relies on competition between private plans to increase choices and hold down costs. It could be funded, in part, through tax credits targeted to lower-income Americans.
There are also measures available that could fix structural flaws in our delivery system and make coverage more affordable without top-down controls set in Washington. The surest way to intensify flaws in the delivery of health care is to extend a Medicare-like "public option" into more corners of the private market. More government control of doctors and their reimbursement schemes will only create more problems.
Dr. Gottlieb, a former official at the Centers for Medicare and Medicaid Services, is a fellow at the American Enterprise Institute and a practicing internist. He's partner to a firm that invests in health-care companies.
http://online.wsj.com/article/SB124208383695408513.html
Gary's Comments:
Article by: SCOTT GOTTLIEB
Image by: CHAD CROWE
At the heart of President Barack Obama's health-care plan is an insurance program funded by taxpayers, administered by Washington, and open to everyone. Modeled on Medicare, this "public option" will soon become the single dominant health plan, which is its political purpose. It will restructure the practice of medicine in the process.
Republicans and Democrats agree that the government's Medicare scheme for compensating doctors is deeply flawed. Yet Mr. Obama's plan for a centrally managed government insurance program exacerbates Medicare's problems by redistributing even more income away from lower-paid primary care providers and misaligning doctors' financial incentives.
Like Medicare, the "public option" will control spending by using its purchasing clout and political leverage to dictate low prices to doctors. (Medicare pays doctors 20% to 30% less than private plans, on average.) While the public option is meant for the uninsured, employers will realize it's easier -- and cheaper -- to move employees into the government plan than continue workplace coverage.
The Lewin Group, a health-care policy research and consulting firm, estimates that enrollment in the public option will reach 131 million people if it's open to everyone and pays Medicare rates, as many expect. Fully two-thirds of the privately insured will move out of or lose coverage. As patients shift to a lower-paying government plan, doctors' incomes will decline by as much as 15% to 20% depending on their specialty.
Physician income declines will be accompanied by regulations that will make practicing medicine more costly, creating a double whammy of lower revenue and higher practice costs, especially for primary-care doctors who generally operate busy practices and work on thinner margins. For example, doctors will face expenses to deploy pricey electronic prescribing tools and computerized health records that are mandated under the Obama plan. For most doctors these capital costs won't be fully covered by the subsidies provided by the plan.
Government insurance programs also shift compliance costs directly onto doctors by encumbering them with rules requiring expensive staffing and documentation. It's a way for government health programs like Medicare to control charges. The rules are backed up with threats of arbitrary probes targeting documentation infractions. There will also be disproportionate fines, giving doctors and hospitals reason to overspend on their back offices to avoid reprisals.
The 60% of doctors who are self-employed will be hardest hit. That includes specialists, such as dermatologists and surgeons, who see a lot of private patients. But it also includes tens of thousands of primary-care doctors, the very physicians the Obama administration says need the most help.
Doctors will consolidate into larger practices to spread overhead costs, and they'll cram more patients into tight schedules to make up in volume what's lost in margin. Visits will be shortened and new appointments harder to secure. It already takes on average 18 days to get an initial appointment with an internist, according to the American Medical Association, and as many as 30 days for specialists like obstetricians and neurologists.
Right or wrong, more doctors will close their practices to new patients, especially patients carrying lower paying insurance such as Medicaid. Some doctors will opt out of the system entirely, going "cash only." If too many doctors take this route the government could step in -- as in Canada, for example -- to effectively outlaw private-only medical practice.
These changes are superimposed on a payment system where compensation often bears no connection to clinical outcomes. Medicare provides all the wrong incentives. Its charge-based system pays doctors more for delivering more care, meaning incomes rise as medical problems persist and decline when illness resolves.
So how should we reform our broken health-care system? Rather than redistribute physician income as a way to subsidize an expansion of government control, Mr. Obama should fix the payment system to align incentives with improved care. After years of working on this problem, Medicare has only a few token demonstration programs to show for its efforts. Medicare's failure underscores why an inherently local undertaking like a medical practice is badly managed by a remote and political bureaucracy.
But while Medicare has stumbled with these efforts, private health plans have made notable progress on similar payment reforms. Private plans are more likely to lead payment reform efforts because they have more motivation than Medicare to use pay as a way to achieve better outcomes.
Private plans already pay doctors more than Medicare because they compete to attract higher quality providers into their networks. This gives them every incentive, as well as added leverage, to reward good clinicians while penalizing or excluding bad ones. A recent report by PriceWaterhouse Coopers that examined 10 of the nation's largest commercial health plans found that eight had implemented performance-based pay measures for doctors. All 10 plans are expanding efforts to monitor quality improvement at the provider level.
Among the promising examples of private innovation in health-care delivery: In Pennsylvania, the Geisinger Clinic's "warranty" program, where providers take financial responsibility for the entire episode of care; or the experience of the Blue Cross Blue Shield plans in Pennsylvania, Michigan and Virginia, where doctors are paid more for delivering better outcomes.
There are plenty of alternatives to Mr. Obama's plan that expand coverage to the uninsured, give them the chance to buy private coverage like Congress enjoys, and limit government management over what are inherently personal transactions between doctors and patients.
Rep. Nydia Velazquez (D., N.Y.) has introduced a bipartisan measure, the Small Business Cooperative for Healthcare Options to Improve Coverage for Employees (Choice) Act of 2009, that would make it cheaper and easier for small employers to offer health insurance. Mr. Obama would also get bipartisan compromise on premium support for people priced out of insurance to give them a wider range of choices. This could be modeled after the Medicare drug benefit, which relies on competition between private plans to increase choices and hold down costs. It could be funded, in part, through tax credits targeted to lower-income Americans.
There are also measures available that could fix structural flaws in our delivery system and make coverage more affordable without top-down controls set in Washington. The surest way to intensify flaws in the delivery of health care is to extend a Medicare-like "public option" into more corners of the private market. More government control of doctors and their reimbursement schemes will only create more problems.
Dr. Gottlieb, a former official at the Centers for Medicare and Medicaid Services, is a fellow at the American Enterprise Institute and a practicing internist. He's partner to a firm that invests in health-care companies.
http://online.wsj.com/article/SB124208383695408513.html
Gary's Comments:
Being in the middle of the battle between the FDA, alternative medicine and pharmacy, I am often privileged to inside info:
The State Board of Pharmacy in Texas has secret legislation that is unknown to pharmacists; this secret legislation prevents anyone from see the Board's communications with the FDA. I am currently challenging these processes in the Texas Supreme Court, and I suspect this may be happening in all states.
All Employees from the Executive Director down to all inspectors are commissioned FDA officials and no other pharmacists in Texas are aware of this or they accept this. This is one big conflict of interest, don't you think?
I have been involved in a preemptive conflict in Texas in which there is a battle between the Texas Health Department, the FDA and the State Board of Pharmacy over who controls compounding. The case is headed for the Texas Supreme Court.
Two bills I wrote for the Texas Congressional session in last 2009 that promoted compounding and tried to clean up the TSBP, mysteriously disappeared.
ABC wrote an article stating that Functional Medicine vs. today's medicine would cure not only people but the financials mess we are in as Big Pharma treats symptoms! http://tifm.blogspot.com/2009/11/is-functional-medicine-cure-for-us.html
One of the Democrat State Senators in Texas I met with a year ago stated the major problem as of 3 years ago was Federalization of Medicine and now it is here! We need to get active and support those who are trying to take away our rights to practice good medicine.
So hats off to all of us that dare practice really good medicine, challenge our bureaucracy and have the stamina to stick with it! BUT WE NEED MORE!
Discontinued Drugs:
From time to time often pharmaceutical manufacturers will remove a product from the market for any of several reasons and sure enough, it was one of your favorite tools in your practice. The natural next step is to find any drug that is similar, but often it is a lot more expensive and doesn't quite fit what you need.
ApothéCure has been helping to fill this void for many years but now we have lists of discontinued drug that you can look up and call us to see the possibilities of duplicating this product. Also, often a manufacturer cannot supply a product in a timely manner and a compounding pharmacy can supply until such time the manufacturers products is readily available.
Simply click on this hyperlink below to view the over 8000 discontinued drugs. You can scroll thru, you can do a control F and type in the name of the drug or you can sort by any column.
Armour Thyroid is a good example of a medicine in shortage: www.apothecure.com/thyroidList of Discontinued Drugs:
http://www.apothecure.com/dc (Excel)
http://www.apothecure.com/dc_pdf (PDF)
http://www.fda.gov/Drugs/DrugSafety/DrugShortages/ucm050794.htm
Telomere:
Telomeres are DNA instructions located at the ends of all chromosomes. The DNA is the hereditary material in humans and almost all other organisms. A chromosome is a structure of DNA and protein found in the cell nucleus. Each chromosome contains hundreds and thousands of the genes that form our hereditary blueprint. Our genes carry the inherited blue print that makes us what we are. The telomeres protect our genetic data, and make it possible for cells to divide. Each time a cell divides, the telomeres grow shorter. When they get too short, the cells no longer divide and our body stops making new cells. As the telomeres shorten, cells begin to enter a state called senescence. The outward appearance of senescence is what you see in the mirror as your face and neck looks older. What you are really seeing in your reflection is wrinkled, sagging, dull skin. This is the aging process. Telomeres enable cells to divide without losing genes. We need cell division to make new skin. If we increase the lifespan of the cell, cell function is enhanced, tissue quality is improved and skin's youth span is extended, thereby reducing all visible signs of aging. The telomere cream has demonstrated a reversal of the skin aging process. Clinical evaluations on a panel of women showed the following results:
- Sun spots and skin moisture improved in 100% of the panelists.
- Redness and pore size reduced in over 90% of the panelists.
- Skin roughness, fine lines and barrier function improved in at least 75% of the panelists.
- Skin firmness, tone and elasticity increased in 75% of the panelists.
- Lines and wrinkles were reduced.
- Overall texture of the skin improved and restored to a more youthful state.
Ingredients:
Purified Water, Squalane, Hyaluronic Acid, Caprillic/Capric Triglyceride, Teprenone, Polyacrylate 13, Polyisobutene, Polysorbate 20, Xylityglucoside, Anhydroxylitol, Xylitol,Phenoxyethanol, Ethylhexlglyercin.
1 Ounce Jar
Telomere can be used in conjunction with other products/compounds.
"Aging Begins At the Cellular Level within the DNA"
Suggested Retail: $225
Physicians Price: $95
For more info, visit: www.apothecure.com/telomere
ApothéPeel Green: Hot, New Peel!
"ApothéPeel Extra-Strength Green is considered to be a more aggressive superficial peel with amazing efficacy. Glycolic peels usually have to be given in a series of 5 or 6 and they generally result in a lackluster effect. The "Green Peel' is virtually painless and induces a major exfoliation in 2 - 3 days. They can be repeated every 4 months if necessary. The "Green Peel" is simple to apply and post procedure care with moisturizers and sunscreen is all that is needed to maintain a great result. This peel is the workhorse of my practice as a standalone superficial peeling regimen." Dr. Kevin Light, Cosmetic Surgeon, TIFM.
This revolutionary NEW peel has increased volumes of certain ingredients and additional micro-nutrients, which create the "green" look of the peel in solution. This peel is deeper than the ApothéPeel as well, hence more effective for stubborn issues. This peel provides the physician with a simple and safe way to introduce skin care into their practice as a gateway to incorporating other cosmetic procedures. The combination of ingredients are a unique blend ofTCA, Salicylic Acid, Phenol, Retinoic Acid, and special microelements, providing a controlled wound to the level of the superficial dermis. The peel is extremely easy to use with a large patient safety profile and the results are predictable and very effective. This product was developed by Dr. Light, cosmetic surgeon at our sister clinic, TIFM, and by ApothéCure.
For more information, please visit: www.apothecure.com/apothepeelgreen
New Compounds:
Here is a list of newly created, hot products and compounds. For additional new compounds, please visit: www.apothecure.com/newcompounds
Autism:
Here is a list of compounds commonly prescribed by doctors for Autism: www.apothecure.com/autismcompounds
If you don't see a compound you are looking for please call us as we have many more compounds typically prescribed for autism. Also, please attend the Autism One seminar in Chicago! http://www.autismone.org/
HcG:
HcG is one of the hottest and weight loss compounds prescribed by doctors for their patients. ApothéCure makes cream, SDT's (slow-dissolving tablets), sublinguals, etc. We will soon have lyophilized HcG for injection! Here is a link with more information: www.apothecure.com/hcg Call Today!
Perfect Joint:
Perfect Joint is a new and unique blend of ingredients known to support joint functioning. This special blend contains: Glucosamine Sulfate, MSM, Chondroitin Sulfate and Hyaluronic Acid. Here is a link with more information: www.apothecure.com/perfectjoint
Training:
ApothéCure is dedicated to offering the most advanced compounded formulations. We pride ourselves on providing high quality products that have been formulated with many factors in mind, including research, development, safety and effectiveness.
Compounded products can offer your patients a more unique treatment approach. This is the very reason that we dedicate so much time in researching what ingredient combinations will be the most effective for certain conditions.
We consult with hundreds of physicians and attend over 25 medical conferences and training classes annually to ensure that we stay on the cutting edge and continue to be able to offer the best that medicine has to offer.
Some of the medical conferences/shows and training classes/seminars we attend are list below. For more information about upcoming conferences, training seminars and/or physician training discounts or tickets to an event, please email Jamie Osborn at vitamins@apothecure.com.
Medical Conferences/Shows:
- A4M : The American Academy of Anti-Aging Medicine
- AAAM : American Academy of Aesthetic Medicine
- AACS : American Academy of Cosmetic Surgery
- AACL : Anti-Aging Conference London
- AAEM : American Academy of Environmental Medicine
- AANP : American Association of Naturopathic Physicians
- ACAM : American College for Advancement in Medicine
- AMD : AestheticMD
- EMAA : European Masters in Anti-Aging and Aesthetic Medicine
- EuroMediCom
- IAOMT : International Academy of Oral Medicine and Toxicology
- ICIM : International College of Integrative Medicine
- IECSC : International Esthetics, Cosmetics & Spa Conference
- IFM : Institute of Functional Medicines
- InterCHARM
- NWNPC : Northwest Naturopathic Physicians Convention
- SAAAM : Swiss Academy of Anti-Aging Medicine
- SREC : Spa & Resort Expo & Conference
- TAS : The Aesthetic Show
- TOMA : Texas Osteopathic Medical Association
Training Classes/Seminars:
Email vitamins@apothecure.com with your country location and we can send any additional information we may have on training seminars in your area.
Aesthetics/Dermatology/Mesotherapy:
- Dr. Michael Delune: AAAM : American Academy of Aesthetic Medicine
- AACS : American Academy of Cosmetic Surgery
- AMCSA : Aesthetic Medicine Congress of South Africa
- Dr. Roman Chubaty : AMD : AestheticMD
- The Aesthetic Show : CAC : Certified Aesthetic Consultant
- Dubai Derma
- EuroMediCom
- IECSC : International Esthetics, Cosmetics & Spa Conference
- NPBAM : Naturopathic Physicians Board of Aesthetic Medicine
- Dr. Jacques Le Coz : Specialization Courses in Mesotherapy
- SREC : Spa & Resort Expo & Conference
Anti-Aging/Autism/Chelation/Functional Medicine/Heavy Metal Detox:
- A4M : The American Academy of Anti-Aging Medicine
- ACAM : American College for Advancement in Medicine
- Autism One
- ICIM : International College of Integrative Medicine
- IFM : Institute of Functional Medicines
- IPT : Insulin Potentiation Therapy
- TOMA : Texas Osteopathic Medical Association
- USAAA : US Autism and Asperger Association
Pain/Prolotherapy:
For other important seminars, please visit the Townsend Newsletter.
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Please visit http://www.apothecure.com/ for more information, or call our fast, friendly and knowledgeable pharmacists at (800) 969-6601 (Toll Free, U.S.) or (800) 203-2158 (Toll Free, Canada) or (972) 960-6601, or email info@apothecure.com (U.S.) or int@apothecure.com (International) to ask questions or place orders.
