However, the House Energy and Commerce Committee recently announced a bi-partisan effort to solicit ideas, feedback and proposals from national physician and hospital groups in an effort to permanently fix this flawed provision.  The key word is “permanently” as over the past decade, Congress has elected to only temporarily patch the problem passing a variety short-term fixes to prevent 15, 20, or even 30+ percent cuts to physician Medicare payments.  But like many efforts seeking to do the same – preventative procrastination hasn’t done much to solve the long-term, hugely expensive problem.

Problematically there is little agreement on a solution and the proposals vary greatly, and with so much emphasis on the federal deficit and budget debate in Washington D.C. its unclear what will come next on this issue.  However, the budget debate could present Congress with an opportunity for a fix, as it has become clear that in order to fix the nation’s budget – everything must be on the table.

The letter to stakeholders requests feedback by early April and the committee could hold as early as May. Key recipients include: The American Medical Association, American Academy of Family Physicians, American Hospital Association, Federation of American Hospitals, Medical Group Management Association and many others.

IHA has been meeting in-person with each of the offices of Iowa’s congressional delegation and has drafted a delegation letter to CMS urging immediate action on this issue.  To date, Senator Tom Harkin, and Representatives Leonard Boswell, Steve King, Tom Latham, and Dave Loebsack have all confirmed their support on the issue and have agreed to sign onto the letter.  Staff from the offices of Senators Chuck Grassley and Harkin have also been in contact directly with CMS to outline their concerns and staff for Senate Finance Committee Chair Max Baucus have been in communication with CMS on this issue as well.

Earlier this week, CMS hosted a rural health open door forum conference call and spent most of the time discussing physician supervision.  CMS acknowledged the arising complications and encouraged hospitals to continue reaching out to help CMS understand the “real-world” impact of its policy.

CMS verbally qualified its position by stating that physicians or other allied professionals, recognized in the outpatient rule should be “fairly immediately available” and recognized that the rule doesn’t anticipate clinicians “hanging around the emergency department” with no knowledge of anticipated patient arrivals.  CMS stated that determination of “immediately available” is essentially at the discretion of the hospital.  CMS also acknowledged that this billing policy predominantly creates an issue with observation status, which is currently billed as a therapeutic service.  However, CMS stopped short of backing away from the rule as written, but confirmed that further written guidance will be provided on this topic.

IHA will continue working with Iowa’s Congressional Delegation, the Senate Finance Committee staff as well as the American Hospital Association to seek clarification and resolution of this issue.  Pending further guidance from CMS, IHA will survey Critical Access Hospital members to further refine its understanding of the scope of the problem and potential solutions.

Dr. Judy Paley

Anyone who spends enough time around health care and medicine knows there is no shortage of reading material.  More heavily regulated than the nuclear power industry, the sum of federal, state and local health care policies make the tax code look like a walk in the park.  The 2,400-page health care reform bill? Somewhat impressive, but far from unprecedented.

Outside the regulatory arena, the reading becomes somewhat more interesting. Journals and assorted periodicals cover every specialty.  Health care books could fill a whole aisle or more at Barnes & Noble, and they do.  Many of them are huge tomes by self-indulgent practitioners that leave one immediate impression: When did this guy have time to see patients? 

But there are treasures out there, and one of them is a blog by Judy Paley, a primary care doctor with a two-person practice in Denver.  And the Denver she works in is the one in Colorado, not in northwest Iowa.  That needs to be pointed out, because Dr. Paley sounds and writes like a small-town, patient-centered, community-loving doc.  Her “Medical Moments in 55 Words or Less,” as she calls her blog, have been described as health care haiku.  They are sad, funny, illuminating and the very definition of poignant. 

Give yourself a treat and check out what Dr. Paley so generously shares.

William B. Galbraith, M.D., personifies the truest definition of a “Hospital Hero.”  For years, he has reached out to those in need.  His selfless commitment to his practice and the community is remarkable and genuine, a reflection of his true character.

His professional knowledge, skill and expertise as a medical practitioner are impeccable. Dr. Galbraith directed the University of Iowa Medical Outpatient Clinic for four years and practiced internal medicine for more than 30 years in Cedar Rapids. He was a consultant internist before subspecialty internal medicine became the rule. He was president of the Linn County Medical Society, the medical staff of Mercy Medical Center and a Director/Emeritus Director of the American Board of Internal Medicine. His efforts established the Crawford Diabetes Education Center at Mercy in 1986 and he served on its board.  Upon retirement from private practice, he returned to the university as a Professor of Clinical Internal Medicine before retiring again in 1998.

But Dr. Galbraith truly shines in his tireless advocacy for those with the most urgent need for health care: the working poor.  His leadership helped establish the Community Health Free Clinic in 2001. Funded entirely through charitable donations, this clinic has become a major medical facility in its own right, tending to the medical needs of the uninsured and under-served of east-central Iowa.

But the clinic would not be where it is today without Dr. Galbraith’s perseverance. Thanks to his acumen in organizing, fund-raising and problem-solving, the Community Health Free Clinic is still able to charge no fees for its services.

Clinic co-founder Darlene Schmidt characterizes Dr. Galbraith as a “one of a kind” gentleman, consensus builder, visionary, listener and patient advocate.  Colleagues praise him as a healer and mentor whose moral and ethical standards are above reproach.

• Medical education in the United States has become specialized, centralized and urban.
• Many practitioners emerge from medical programs with a staggering amount of debt and go on to practice in urban areas, where they often receive a higher salary.

More doctors is not the answer

Simply increasing medical school slots is not the answer. According to the Robert Graham Center: Policy Studies in Family Medicine and Primary Care, “Sizeable growth of the physician workforce in the last two decades has not resolved the maldistribution of physicians.”  On March 24, 2009 — House Energy and Commerce Committee Chairman Henry A. Waxman said that a congressional overhaul of the health care system must not only provide for universal coverage but also for more primary care doctors and nurses to ensure that an insurance card actually gives the holder access to treatment.

Physicians need to be rooted in the rural community

In a joint 2008 statement, the American Academy of Family Physicians and the National Rural Health Association stated that medical education anchored in rural places, nourished and funded through significant federal, state and local community support, and meaningfully connected to both regional academic institutions and local physicians in practice has great potential to address both present and future needs for physicians who provide care to rural populations.

DMU launches program to combat rural physician shortage with incentives

Concerned about the growing physician shortage in rural Iowa, Des Moines University (DMU) has embarked upon a “grow your own” program.  DMU and its Area Health Education Center have created the Rural Iowa Provider Education (RIPE) Program.

The RIPE Program provides specialized education, training and tools to better prepare students for service in rural, underserved areas of Iowa.  Because one of the known barriers for students choosing a rural medical practice is the tuition debt load from medical school, DMU has made an on-going commitment to annually provide the equivalent of six full tuition scholarships to students enrolled in the Rural Medicine Educational Pathway. In return, graduates agree to maintain a fulltime primary care medical practice in an approved Iowa community for a period of four years.

Are plans like DMU’s RIPE the answer to the shortage of physicians in rural areas? Are there other concerns or issues at hand? How would you bring more physicians into rural areas?

You can find more information about the RIPE Program on DMU’s website.