Baucus Proposal

In case you're interested, here is the response to the latest Senate health care reform proposal from the American College of Surgeons along with approximately 20 other surgical organizations.

Letter to Senate Finance Committee Chairman Max Baucus

There are several concerns raised in the letter, including:

In 2011, without further legislation to correct the problem, physician payments from Medicare would be cut by 25%. If that were to happen we would see immediate, massive non-participation by physicians in Medicare. Few if any practices could afford to keep the doors of their practices open long with a 25% reduction in income. That in turn would result in severely restricted access to care for Medicare patients.

The creation of a Medicare commission would remove oversight of the program from Congress and give it to unelected, unaccountable individuals who could conduct business with uncertain transparency.

The PQRI is essentially an unfunded mandate on physicians. It's one thing to provide quality care routinely. It's another thing to have to document that care for each patient and submit separate reports to the government in order to receive payment for that care. It requires a great deal of time and paperwork, which is why few doctors have participated in the program to date. It's not that they aren't doing the things the program requires. It's that it is not worth the time and expense required to earn the small "bonuses" that are currently paid out. With this bill, the program becomes mandatory and rather than paying extra for those who meet the standards, it penalizes those who do not. The entire cost of participation will therefore be borne by physicians.

This bill does nothing to address tort reform, which is a major factor in controlling the escalating cost of medical care in this country.

It concludes with ideas for real reform which will address the issues of availability, cost containment, and continued improvement in quality.

You've got mail!

So, Chris Tomlin never responded to my open letter, but Steve Green responded to my daughter's email rather promptly. H and I wrote to him on Saturday. He wrote back today. No, really, Steve Green himself wrote an email to my 3 year old daughter.

Seriously!

You see, H really, really wanted to send Mr. Green a message this weekend. (Mr. Green, not Steve Green - because when you're 3 you shouldn't be on a first name basis with grown ups. Even famous ones. I'm old fashioned like that.) Actually, what she really wants is for him to come over and play with her. And to read books. And to stay all day until she has to go to bed.

Let me back up. . .

Several years ago, we got the Hide 'Em In Your Heart DVDs from Steve Green Ministries. They're various Scripture verses put to music. The accompanying videos show Steve singing the songs with groups of children. Hannah loves these videos. Really loves them. She begs to watch "Bible Songs," as she calls them. And, well, if my child is going to be glued to a video, I'd just as soon it be these.



When she was about 18 months old, she started getting her Bible and crawling into our bed to read. Sometimes it was actually a Bible, more often it was hymnbook (which when you're pre-literate, looks quite similar to a Bible, and was always sitting on the piano where she could reach it easily). It took us a while to figure out where this came from. We finally realized she was imitating one of the little girls in the video "When I am afraid I will trust in You." There was a storm at night and she reads her Bible for comfort. For her second birthday, Uncle Eddie and Aunt Suzi got H a real Bible. A great big one, just like in the video. She likes to sleep with it now.

H would very much like to be in the next children's DVD that Mr. Green makes. She's not looking for fame or anything. She just likes to sing, and sees those other kids having a good time, and thinks that Mr. Green is a really nice man. She would totally be good at it - if he ever does make another one, he should invite her.

Over time, her tastes have broadened slightly. She's become fond of some of Mr. Green's grown-up songs. I have one of his old CDs on my ipod. She loves to hear "Household of Faith" (aka, "Mr. Green and Mrs. Green's duet"), "Embrace the Cross" (aka, "Mr. Green's duet" because through the miracle of mixing, he actually sings a duet with himself in that song), and "Find us Faithful" (aka "That Faithful Song"). We could take a 30 minute trip and she'd just want me to play That Faithful Song over and over the whole way.

Since she enjoys his music so much, it's only natural that he come over and play with her sometime. That's been her latest hang-up. She makes me feel like a bad mom for not letting him come. I try to explain that he lives a long way away and is a very busy man. She's certain that he would come over if I would just let him. So this weekend when she was begging to send him a message, we did. We went to his website and found the "contact us" page. I asked her what she wanted to say and she said, "Thank you." I added a little bit more, telling him how much she enjoyed his music.

I forgot about it after that until today. This morning I had a message in my inbox from "SGM." I thought it was spam and almost deleted it. Instead it was a very nice response from an assistant at Steve Green Ministries. She wrote several paragraphs and told H that she would forward her email to Steve, but couldn't promise that he would have time to respond personally since he gets so many emails. Well, just a few hours later, he did! It was only a couple of sentences, but it was awfully nice. He explained that it would be fun to come visit, but since he lives so far away he can't right now.

How sweet is that?! A very busy, award-winning, internationally known singer takes the time to answer email from a preschooler. When he sings, "Let the Little Children Come," he takes it to heart. I think that shows a lot of class!

Practical Theology

Proverbs 9:10 The fear of the Lord is the beginning of wisdom,
and knowledge of the Holy One is understanding.

"Seek God's face. Understand His character. Pursue knowledge of Him, for apart from the 'fear of the Lord' and 'the knowledge of the Holy One' we have no hope for being a wise mother, sister, wife, or friend."

--Wendy Horger Alsup, Practical Theology for Women, How Knowing God Makes a Difference in Our Daily Lives

Random thoughts about our day

Today was my first really light day since I've been back to work. I was able to be home by 10:00! We gave Grandma the day off - a much deserved day to herself.

I had hoped to be really productive around home, but felt paralyzed by the sheer volume of things that need to be done around here. I never seem to catch up. I did manage to accomplish a few things. I now have one seriously clean bathroom. And, well, another bathroom that I'd rather not talk about today. I got two loads of laundry nearly done (prompted by one explosive diaper and two muddy kids). Maybe I'll get around to putting them away tomorrow.

I let the kids watch an episode of Tom and Jerry this morning while I did some work in J's room. My work in his room always involves a big trash bag. I can't get away with that while he's around. I find it very gratifying to fill up the trash with clutter from our house, but the kids find it traumatic. I like to spare them the agony by doing it when they're not looking. They rarely ever miss anything I've pitched, and it makes it easier for them to find the things they actually use.

D wore a darling little teddy bear outfit today. He looked adorable in it. It also turns out that brown is a very practical color for him to wear, if you know what I mean. I wish I'd gotten a picture of him in it.

The kids and I went on an adventure in the woods behind our house. We have a great yard for kids: trees and water and mud and a playhouse. I remember having a little grove of trees in the backyard where we lived until just before my 5th birthday. It probably didn't look like much to the adults around, but my brother and I thought it was a great "jungle" to play in. I think my children will have happy memories of our back yard too.

We encountered a little wild life while we were out and about. J called out of the playhouse, "Hey, Mom, there's a mouse in here."

"A live one?" I inquired.

"Yes, come up here and see him."

"Uh, no thanks." I felt like quoting John 14:9 "Don't you know me? Even after I've been among you for such a long time?" Do I strike him as the sort of person who would intentionally go into a small enclosed space with a rodent? I don't think so. Thirty years ago, maybe, but not anymore.

Later we found a praying mantis in the flower bed. He was eating some sort of beetle. It was pretty educational and entertaining for all of us. Particularly since we recently watched, "Milo, the Mantis who Wouldn't Pray." Now H knows that they don't actually live in snack shacks and serve ice cream to other insects.

I finished the day up with a trip back to the hospital to see someone with a sick gallbladder. It was well-timed just after the kids were all tucked in for the night.

I'm going to go tuck myself in now and pray that D and my pager let me get some sleep. Good night!

You say Verrucous, I say Varicose

We have wonderful staff in our office. I wouldn't trade any of them. Our reception ladies are friendly and efficient and attentive to details. They know how to use the computer and answer the phones and file and schedule tests and do all sorts of things that we couldn't run an office without.

They aren't, however, trained in medicine.

Most of the time they get it right, but sometimes it makes for some interesting appointments on our calendars.

I was thoroughly impressed one day to see that my partner had a "thymus" biopsy on her office schedule. The thymus is a gland that lives behind your breast bone, right next to your heart. It's pretty small by the time you're grown up. It's not the sort of thing we typically stick a biopsy needle into in our office. I asked her about it later. Turns out it was actually a "thigh mass" biopsy. "Thymus". . . "Thigh mass". . . Close enough.

We had one receptionist who regularly scheduled people to be seen for ambilical (not umbilical) hernias (I always wondered if an ambilical hernia could walk) and verrucous (which means wart-like, although I'm pretty sure she meant varicose) veins.

Sometimes it's fun just to try to guess what the problem might really be before you actually get to talk to the patient. For instance, tomorrow I have a patient scheduled to be seen for a "breast rupture." I'm not sure exactly how that would happen, but it doesn't sound pretty!

The mystery just adds an element of excitement to the job.

I have a theory. . .

I think that babies must prefer chubby mommies. I don't know exactly why. Maybe it starts with wanting more padding while they're on the inside. Maybe it makes them feel more secure. Then once they're born, who wants to snuggle with someone bony? Cushy is probably preferable to those little ones.

Whatever the reason, they have a master strategy to meet their goal. It starts with the whole pregnancy weight-gain thing. Cravings, swelling, etc. . .

Once they're born they cause chronic sleep-deprivation. That slows Mom's metabolism and helps her keep on those pregnancy pounds.

Sitting down to enjoy a meal becomes a thing of the past. It's more a matter of grabbing what you can when you can and shoveling it in. It's hard to remember what or how much you ate like that - not exactly a healthy diet strategy.

Exercise? Are you kidding?! There is definitely some sort of sensor in babies that alerts them when Mom gets near the treadmill or the exercise DVD. It causes them to wake up and scream, or spit up, or overflow their diaper, or otherwise derail Mom's plans for calorie-burning.

So, hey, if you're hanging on to a few more pounds than you'd like since you've had your babies, don't feel bad. Wear them as a badge of honor. You're just doing what your babies want.

Let's disagree over things that are real, indeed!

In a recent town hall meeting in New Hampshire, President Obama decried his critics' "wild misrepresentations" of his proposed health care overhaul. He denounced their efforts to "scare and mislead" people and urged, "Where we do disagree, let's disagree over things that are real."

The President should take his own advice.



I don't know whether he is intentionally misrepresenting the facts or if he is really that poorly informed on the issue of physician reimbursement. Either way, it's frightening to see this from the man who has taken it as one of his major objectives to "reform" our health care system.

The amount a surgeon gets paid for performing an operation isn't a hard number to come up with. The President's advisers could find that out easily enough if they wanted to. Here, I'll help them: In 2009, Medicare allows $695.80 for performing a foot amputation.

That includes the physician's evaluation of the patient prior to the surgery, the operation itself, and all the care provided to that patient for the next 90 days in the hospital and in the office. Healthy people don't often need amputations. No, patients who need amputations tend to have a lot of medical problems. Things like diabetes, heart disease, high cholesterol, high blood pressure, a history of smoking, or sometimes all of the above. That means they're more likely to have complications after surgery like wound healing problems, heart attacks, strokes or other things that require a lot of time and care from their surgeon. All that care is included in the $695.80.

Furthermore, $695.80 may be what the surgeon gets reimbursed, but it's certainly not what he or she "takes home." Before anything is taken home, money comes out of that to pay for office space, staff, supplies, medical liability insurance, continuing medical education, and so on.

No one gets rich amputating feet.

I wouldn't imagine that the president makes up numbers like that off the cuff in the middle of a speech. Surely that was something he had prepared ahead of time to use when the moment was right. If anyone in the press bothered to call him on it, I'm sure he'd claim he "misspoke." Just like he did after he asserted in this same speech that the AARP endorsed this bill. They didn't. A slip of the tongue would be hard to believe in this case, given the fact that just a few weeks ago he asserted that surgeons cut out children's tonsils just to pad their pockets. No, he really intends to vilify physicians - particularly surgeons - in order to muster support for his health system overhaul. As if taking your child in for an operation isn't stressful enough, now you have the president telling you that surgery is probably unnecessary and your doctor is a greedy crook.

For the past two decades, Congress has been trying to control health care costs by trimming physician reimbursement. So much so, that many procedures done today reimburse less than they did 15 years ago. I don't mean when adjusted for inflation. I mean in actual dollars. Adjust for inflation, and they're worth even less.

If physicians, and particularly surgeons, were all the money-grubbing charlatans that the President would like you to think we are, there wouldn't be many left. There are a lot less stressful ways to make a lot more money than your doctor makes. (Take being a CEO of a health care-related company, for instance. Now, there's where some serious savings could be found! But I digress. . .)

The vast majority of physicians are compassionate people who do what they do because they love to help people. Which is a good thing. Or there might not be any left when the current administration gets done with their "reforms."