Big Ben, Covent Garden and The Thames: Lessons Learned from a Visit to London—Collaboration Improves Outcomes

This past week I had the honor and pleasure of introducing my book on Women and Cardiovascular Disease in London. During the book-signing event, I was able to meet with many of my European colleagues from both the media as well as the healthcare space. As the evening’s discussions continued into the night, I once again realized just how much we have left to do in addressing gender disparities in care—it is not just a problem of a single country, it is truly a global issue.   More importantly, I once again became aware of just how small the world really is—and how many problems we share as a world community of healthcare providers. While we are separated by oceans and answer to different governments, healthcare systems and regulations, one thing remains constant—our devotion to the care of our patients as well as our desire to improve care and outcomes for all patients.

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In the US, we have worked diligently over the last ten years to raise awareness for women and cardiovascular disease. We have made great strides in the identification and treatment of women with occult heart disease. While the numbers are improving, disparities in care remain. The American Heart Association and the annual Go Red Campaigns have made a remarkable difference in promoting awareness, advocacy and research. We cannot, however, rest on our accomplishments—we must do more in the US to continue to close the gap. In Great Britain, I think that we can and must do even more. After my discussions during the book signing I realized that the level of awareness in the UK among women, media and healthcare providers is even less than in the US. During the event, I was able to chat with numerous bright and motivated attendees who are excited to be part of a wave of change in cardiac care for women throughout the UK. We identified many ways in which we may be able to improve education and awareness of women and heart disease in Britain and throughout Europe.   Even though the event lasted a little more than 2 hours, we were able to brainstorm numerous ideas and made plans for future discussions. It struck me that through collaboration and cooperation across oceans and among different nationalities that we can not only make an impact in our own countries–We make even bigger impacts (both at home and abroad) through a more global approach. When we work together towards a common goal we are able to tap ideas and harness the potential of larger numbers of professionals with disparate academic and social backgrounds. This can lead to novel solutions.

Collaboration is a way in which individuals or groups can work together to generate solutions. However, collaboration is a complex process where people from different backgrounds must come together to effect change.

But how can we be effective and make the biggest impact?

  1. Collaboration is a Journey: Collaboration does not happen overnight. Relationships develop over time. Some of the most important keys to success are communication, mutual respect and compromise as well as a commitment and “buy in” from all invested parties. There are always initial periods of brainstorming and conversation that lead to even bigger ideas. As we work together to solve global issues such as disparities of care for women with heart disease, we must pursue a common goal. Teaming up with others is a powerful way to improve outcomes and improve success.
  2. Collaboration may be best when spontaneous: Collaboration cannot be forced. We must learn to appreciate the talents of others and leverage those talents in a way that produces successful ideas. Working sessions followed by dinner or other gatherings in social settings often produce the most important breakthroughs. Amazing ideas commonly result when we least expect them.
  3. Collaboration requires that we Know Ourselves and Manage Diversity Effectively: The benefit of collaboration is the ability to bring together a diverse group of people with different backgrounds. Collaboration requires that we have cooperation both horizontally and vertically—there must be mutual respect and while maintaining structure and leadership within the group. The diversity of opinions allows us to attack issues from unique angles. The most important factor in producing measurable results for patients is the assimilation of ideas into a new and coherent way of thinking about common problems.

I am excited about the opportunity to collaborate with others throughout the world in order to improve care for women. I believe there is a great opportunity to raise awareness of disparities in care in the UK and throughout Europe. It is my hope that through cooperation and collaboration with my European colleagues, we will be able to improve cardiac care for women all over the world.

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Attending a Funeral: Mourning the Loss of a Friend AND Learning More About the Art of Medicine

(Please note that this blog is based on real people and actual events.  I am grateful to Ed’s family for granting me permission to use his real first name in this blog)

One of the best things about the practice of medicine is the ability to develop long-term relationships with patients and their families.  As physicians, we have the unique privilege of meeting and interacting with thousands of people throughout our careers.  Every once in a while, there are certain people who really make a lasting impact and forever change us as caregivers and as human beings.  Ed was one of those patients.

This week, I said goodbye to one of my long time patients and dearest friends.  Ed, a Korean War veteran, was an amazing man.  He was a dedicated father, a devoted spouse and lived a life that was an example of faith and service to others.  I met Ed through his daughter years ago.  He had moved locally to live near his children and needed a new cardiologist. Fortunately for me, his daughter asked me to take him on as a patient.

Ed had an ischemic cardiomyopathy and suffered from complications of congestive heart failure (CHF).  He was fairly well compensated on medical therapy but continued to have worsening CHF.  During the course of his illness, we eventually  implanted a Biventricular ICD and his symptoms improved significantly.  As with most patients with CHF, over the years, he began to have more frequent hospitalizations for CHF exacerbations.

Through it all, Ed was always cheerful and never complained–in fact it was sometimes difficult to monitor his symptoms due to his demeanor.  Ed always put others before himself.  His wife, suffering from her own chronic illness, was the focus of his final days.  He loved her deeply and wanted to be sure that she was comfortable and well cared for.  Because of my relationship with Ed and his family, I have been made a better cardiologist, and most importantly, a better man.

Men like Ed are few and far between–I was honored to care for him.  My professional role as his cardiologist is what provided me with the fortunate opportunity to be a part of his life and develop a relationship with he and his wonderful family.  As I have said many times before, Medicine is best practiced when relationships and tight bonds are formed between Doctor and patient.  As I left the chapel where the Catholic Mass celebrating Ed’s life was held, I could only wonder if I would ever have the chance to meet another “Ed”.  Healthcare in the US has become more fragmented than ever and care is no longer contiguous in many cases.  Many patients are experiencing access issues and are being told that they can no longer see their long time physicians because of “network” issues or insurance coverage rules.  Doctors are forced to spend more time typing and glaring at  computer screens and less time actually getting to know the “people” behind the diseases they treat.  Connections like I had with Ed are harder to form and personal bonds are less likely to occur in the current environment.  I fear that medicine is becoming more about the “system” and managing regulation than it is about listening and caring for those who suffer from disease.

Ed taught me many things during the time that I cared for him.  He taught me humility, kindness and selflessness–I have never met anyone quite like him. Most importantly, he taught me the value of relationships and TIME.  Even in death, he inspires me to be more to each of my patients–in spite of increasing government demands on both my time and talents.  Ed never stopped caring for others–he never wavered in his commitments to his God, his wife and his children.  It is my hope that I can stand firm and continue to fight for my patients and their right to receive exceptional care.  While I continue to actively speak out against the Affordable Care Act and the regulation of medicine that separates doctor from patient, I must do so in a way that is constructive and advocates for the patient rather than for the doctor.  That is how Ed would see it–of that I am sure.

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Using Twitter and Social Media to Predict Disease: Identifying Risk and Impacting Change

Social media can be an exceptionally useful tool in Medicine.  Many platforms are  ideal for educating colleagues, patients and the community at large about chronic medical conditions as well as spreading the news of new medical innovations and treatments.  Social media platforms such as twitter, YouTube and Facebook (among others) can allow communication between people from different backgrounds and can connect those separated by oceans and thousands of miles all across the world.  While the medical establishment remains skeptical of social media and is often slow to adopt its routine use, it is emerging as an important part of many practices.

Twitter–both in and outside of its use in medicine–certainly has been shown to stir media controversies, influence politics and significantly impact careers (both positively and negatively) due to its ease of use and potential for immediate widespread dissemination.  Beyond the more traditional uses of social media platforms in medicine, a new study has recently been released that shows that one particular platform may actually be useful in predicting disease.  Researchers at the University of Pennsylvania published a study in the January issue of Psychological Science in which they carefully examined the relationship between the “type” of language posted on twitter and an individual’s risk for cardiovascular disease.  Stress, anger and other hostile emotions have long been associated with increased levels of cortisol, catecholamines (stress hormones) and increased inflammation.  These biologic byproducts of anger and hostile emotion have been associated with an increased risk for cardiovascular events.  Based on this information, researchers set out to identify whether or not the type of language utilized in tweets by a defined population could predict those at greater risk of cardiac events such as heart attack and stroke.  In the study, researchers analysed tweets between 2009 and 1010 using a previously validated emotional dictionary and classified them as to whether they represented anger, stress or other types of emotions.  They found that negative emotion laden tweets–particularly those that expressed anger or hate–were significantly correlated with a higher rate of cardiovascular disease and death.  Conversely, those whose tweets were more positive and optimistic seemed to confer a much lower risk for heart disease and cardiovascular related death.

While this is certainly not a randomized controlled clinical trial–and while we must interpret these results in the context of the study design–it does illustrate an new utility for social media.  As we continue to reach out and engage with patients on social media, our interactions may actually provide more than just communication of ideas–these interactions may produce important clinical data that may provide clues to assist us in the treatment of our patients in the future.  This particular study allowed researchers to predict risk for entire communities based on an analysis of random tweets from those residing in that geographical area.  For primary care physicians, using clues provided from social media interaction may provide insight into both an entire community’s health risk as well as an individual patient’s demeanor and allow for more aggressive screening and treatment for a wide variety of diseases from depression to cardiovascular disease.

Social media use will continue to grow among medical professionals.  I believe that when healthcare providers use all available tools and data in the care of their patients, outcomes will improve.  We must continue to explore the use of social media platforms such as twitter in clinical care and we must continue to examine ways in which the social media behavior of patient populations can predict disease.  I commend the researchers from the University of Pennsylvania for their creativity and vision–we need more creative minds who are willing to use pioneering strategies to improve care for our patients.  We can no longer shy away from social media in medicine–we must embrace it and begin to learn how to use it as a tool to effect change.

 

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“Veritas”, Ivy and the Affordable Care Act: What’s Good for the Goose May Now NOT be Good for the Gander at Harvard

Prominent academics within the prestigious Harvard University department of Economics have long been vocal supporters of President Obama and his Affordable Care Act legislation.  In fact, many Harvard professors helped develop some of the concepts that were utilized in the drafting of the ACA.  During the debates over the ACA in Congress, these professors were frequently seen (and heard) touting the legislation as a fiscally responsible way to provide affordable care to all Americans.  The current Provost, Dr Alan Garber,  (not to be confused with MITs Gruber), was part of a group of economist who sent letters to the President in the early days of the ACA praising certain aspects of the bill such as “cost sharing” and the Cadillac tax applied to the best plans.

My how things have changed.  This week, as reported in the New York Times, these same Harvard faculty are in an uproar as they have seen their own healthcare plans completely overhauled.  Rather than being allowed to maintain their long time low cost (out of pocket) plans, the university has now implemented healthcare coverage that is consistent with the provisions in the ACA.  Now there are more up front out of pocket expenses for basic insurance plans and the Cadillac plans are much more expensive.

During a faculty meeting the vast majority of Harvard professors voted to oppose the changes in the Harvard health plan that would require them to pay more for their own healthcare—How dare Harvard adjust their own benefits and how dare the University actually expect them to be a part of a new ACA influenced health care plan at Harvard???

This type of attitude is even more prevalent among lawmakers in both the White House and in Congress.  Members of Congress as well as the President and all staffers are EXEMPT from the individual mandate.  This type of paternalistic governance is what is wrong with Washington today.  Many Democrats seem to have taken the attitude that they were elected not to represent the people but rather to do what they think is best for their constituents.    In an era when the ACA is wildly unpopular, many politicians continue to refuse to believe that changes to the legislation should be made.

If the ACA is such a great thing, why then do those who designed it and legislated it refuse to participate?

  1. The President and His Legacy:  The President continues to see the ACA as his legacy.  In spite of plummeting approval numbers and a negative referendum on his failed policies during the 2014 Midterm Elections, Obama refuses to examine the numerous issues associated with the healthcare law and does not appear to have any willingness to compromise on amending the act.  Unfortunately, Obama’s pursuit of his legacy appears to trump sensible bipartisan negotiations and will severely limit Washington’s ability to actually govern.
  2. Paternal Governance:  Currently, Many in power feel as though they know what is “best” for the rest of us.  Rather than represent a constituency, many of our leaders actually believe that the American people are incapable of making sound decisions for themselves and their own healthcare.  The “Big Brother” knows best attitude continues to alienate millions of voting Americans.  Interestingly, when those that helped craft the legislation (i.e. the now disgruntled Harvard economics professors) are subjected to the law that they supported, the outlook quickly changes.
  3. Partisan Politics:  Our country is the more divided politically than ever before.  Relationships in Washington are so polarized that compromise will be difficult to achieve.  Our elected government is divided with the President refusing to even consider bills that are put forward–instead he threatens vetoes in advance on any bills that address issues concerning the reform of the ACA.

So, What’s Next?

As a country we must begin to deal with the issue of healthcare in a more productive and collaborative way.  Politics as usual will result in another two years of decline in both the quality and affordability of the American healthcare system.  We must hold Washington accountable and the Obama administration MUST begin to work with Congressional leaders to find workable, effective solutions to the mountain of problems that has been created by the poorly thought out and recklessly implemented Affordable Care Act legislation.  And, those at Harvard (as well as those in Washington) should have to live with the same healthcare insurance programs that are mandated for the rest of us–No Exemptions.

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Boo-yah! Lessons From Stuart Scott and His Legacy of Courage

Stuart Scott revolutionized the sportscasting industry with his unique style and likable demeanor on ESPN.  On Sunday morning, Mr Scott passed away after a 8 year battle with recurrent appendiceal cancer.  Mr Scott was a devoted father and put his relationship with his two daughters above everything else.  He was a sensational broadcaster and was passionate about his craft.  He inspired many young athletes and mentored many young broadcasters and has forever left his mark on the sports world.  However, Mr Scott’s greatest legacy may be his example of unmatched courage while battling a rare and deadly disease.

In a powerful moment at this year’s ESPY awards in July (and his last public appearance), Mr Scott made one of the most important and meaningful comments in all of sports.  After a week-long hospitalization prior to the event, Mr Scott found the strength and courage to appear on stage and deliver his passionate acceptance speech for the Jimmy V Award for Perseverance.

In this speech, Mr Scott made the comment that “When you die, it does not mean that you lose to cancer. You beat cancer by how you live, why you live, and in the manner in which you live.”

These words have reach far beyond the stage on which they were delivered.  They have the potential to impact us all–to make us better people–better fathers, mothers, spouses, and professionals.  I think that there are four important points that each of us can take from Stuart Scott’s life, moving ESPY speech and his battle with terminal cancer:

1. Appreciate and Savor Each Moment

Life is a precious gift.  While there are always ups and downs and imperfections in all    that we experience, we must always take a moment to enjoy the moment.  Make the most of the small things that bring a brief smile to each of our faces. Stuart Scott embodies this  principle of  maximizing every moment and making the most of every experience.  Even when he was battling the worst of his cancer, he always had time to enjoy moments with his family–his daughters–as well as his coworkers at ESPN.  He always gave of himself to others.  Many in the ESPN family reported that even as he was suffering from his own illness he was quick to provide support for others battling cancer as well.  We can all take a lesson from Stuart’s example.  When the world gets the best of us and we become obsessed with deadlines and the pressures of everyday life we must remember to breathe and appreciate all of those around us.  Do not let the simple, small special moments fly past without taking pause to appreciate them to their fullest.

2. Do Not Let Adversity Define You

When we struggle to achieve, we are made better.  Mr Scott entered a world of broadcasting determined to succeed.  He met each and every challenge head on.  When diagnosed with cancer, he did not allow the cancer to change the way in which he lived.  Even when suffering through surgeries and chemotherapy treatments, Mr Scott continued his passion for sports and broadcasting.  He trained as an MMA fighter and sought to continue to be the best sports broadcaster in the business.  We all will face challenges in our lives–at work, at home–both personally and professionally.  How we respond to these challenges is what can make us excell.  Mr Scott has left a legacy of battling adversity for all of us to witness.  We must all honor him and his memory by accepting our own personal challenges and battling with the same ferocity as Stuart battled his cancer.

3. Strive for Excellence

Life is a gift and we must all decide exactly how to maximize our own individual potentials.  Excellence is not just an idea–it is a way of life.  Mr Scott was always pushing the limits–He wanted to be the very best at what he did and had the reputation of always treating others with respect.  He worked diligently to advance in the broadcasting world.  He began on local television in his home state of North Carolina and ultimately auditioned for a new network called ESPN2.  Ultimately he became the face of sports journalism and was a featured personality on ESPN’s flagship network.  We all have a job to do.  We all have expectations set before us for performance–let Stuart’s legacy inspire us to go beyond expectations and always seek to become better in all that we do.

4. Believe in Yourself

Success is often dependent on how you are able to develop your own talents.  Even when the status quo in sportscasting was not Stuart’s style, he blazed into the spotlight with his own unique approach to sports journalism.  He remained true to himself throughout his career and never wavered in his approach.  It is Mr Scott’s belief in himself and in his abilities that, in my opinion, resulted in his unparalleled success.  We should all take notice from Stuart’s example.  As we approach our daily lives–at work and at home–we must continually evaluate our own performance and work every single day to improve and maximize and realize our own individual potential.

Remembering Stuart’s Legacy–

Stuart Scott has left a legacy in sports broadcasting.  More importantly, Mr Scott has inspired us all to achieve greatness.  As a human being, he has set a high bar for all of us to emulate.  As we reflect on his life, let’s all strive to exhibit the same devotion to family and pursuit of excellence that Stuart represented throughout his career and 49 years here on this earth.

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Reflecting on Medicine in 2014: Sailing Rough Seas and Finding Uncharted Waters Ahead

As we close out on a tumultuous 2014 in healthcare, many physicians are looking forward to a better and more stable 2015. For most of us, 2014 has been marked by significant change. Many healthcare providers have seen their jobs and their patient care roles transform completely. Physician autonomy has diminished and regulation and mandated electronic paperwork has more than doubled. Many physicians find that they are spending far less time caring for patients and a greater proportion of their available clinical time is now being spent interfacing with a computer—both at work and at home on personal time.

During the last year, we have all been affected by the rollout of the Affordable Care Act (ACA), changes in reimbursement, as well as the implementation of a new billing and coding system (ICD-10). For many of us, it also marked a year of transition to system wide electronic medical record systems such as Epic and the growing pains associated with such a major upheaval in the way in which medicine is practiced.   Many practices have continued the trend of “integration” with larger healthcare systems in order to remain financially viable. The American College of Cardiology estimates that by the end of 2014, nearly 60% of all physician members have integrated with hospital systems and this number is expected to rise even further in 2015—ultimately defining the death of private practice as we know it.

Why have these changes occurred?

Ultimately, I believe that the changes to the way in which healthcare is delivered has come about due to 3 distinct reasons:

 1. Declining Reimbursement

Currently reimbursement continues to fall. Multiple government budgetary “fixes” have led to much uncertainty and instability in medical practices (much like seen in any small business with financial and market instability). In addition, the implementation of the ACA has resulted in the expansion of the Medicaid population in the US—now nearly 1 in 5 Americans is covered under a Medicaid plan. Traditionally, Medicaid plans reimburse at levels 45% less than Medicare (which is already much lower than private insurance payments). While the Obama administration did provide a payment incentive for physicians to accept Medicaid, this incentive expires this week. Many practices are becoming financially non viable as overhead costs are risking to more than 60%. As for the ACA, many exchanges have set prices and negotiated contracts with hospital systems—leaving many practices out of network. Both patients and doctors suffer—longtime relationships are severed due to lack of access to particular physicians.

2. Increasing Administrative/Regulatory Demands

With the implementation of the ICD-10 coding system, now physicians are confronted with more than 85, 000 codes (previously the number of codes was approximately 15,000). In addition, “meaningful use” mandates for payment have resulted in increasing documentation requirements and even more electronic paperwork. In addition, the implementation of new billing and coding systems has required increasing staff (more overhead) as well as intensive physician training. Sadly, the new coding system that has been mandated by the Federal government includes thousands of absurdities such as a code for an “Orca bite” as well as a code for an “injury suffered while water skiing with skis on fire”.

3. Electronic Medical Record Mandates

Federal requirements for the implementation of Electronic Medical Records and electronic prescribing have resulted in several negative impacts on practices. While in theory, the idea of a universal medical record that is portable and accessible to all providers is a noble goal, the current reality in of EMR in the US is troubling. There are several different EMR systems and none of them are standardized—none of them allow for cross talk and communication. Many small practices cannot afford the up front expenditures associated with the purchase and implementation of the EMR (often in the hundreds of thousands of dollars).   In addition, the EMR has slowed productivity for many providers and resulted in more work that must be taken home to complete—not a good thing for physician morale. Finally, and most importantly, the EMR often serves to separate doctor and patient and hinders the development of a doctor-patient relationship. Rather than focusing on the patient and having a conversation during an office visit, many physicians are glued to a computer screen during the encounter.

So, What is next in 2015?

While I have probably painted a bleak picture for Medicine in 2014, it is my hope that we are able to move forward in a more positive way in 2015. I think that there are several very exciting developments that are gaining momentum within medicine and healthcare in general.  Innovation and medical entrepreneurship will be critical in moving healthcare forward in 2015.  Physicians must continue to lobby for the tools and freedoms to provide better patient care experiences for all stakeholders in the healthcare space.

2015 begins with much promise. I am excited to see what we as healthcare professionals will be able to accomplish in the coming year. We must continue to put patients first and strive to provide outstanding care in spite of the obstacles put before us. While 2014 provided challenges, we must rise above the fray and continue to advocate for a better healthcare system in the US today and in the future.

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Obama’s Latest Bait and Switch for Docs: Medicaid Payments to be Cut by 40%

As we enter year two of the Affordable Care Act, we have seen many issues arise during implementation.  Through both executive order and executive memorandum, President Obama has unilaterally changed the law more than 100 times in order to advance his own political agenda.  When it became important to publicize enrollment and increased coverage of the uninsured, the President and the ACA provided for an increased payment scale for patients with Medicaid.  With the rapid increase of Medicaid insured patients due to the implementation of the ACA, the administration utilized the increased payments as an incentive to attract more physicians to participate in Medicaid programs.  According to the New York Times, the ACA has resulted in the largest increase in Medicaid covered patients in history–now nearly 20% of all Americans are covered under this plan.  Attracting physicians to cover Medicare patients has been critical in order to meet the demand for access to care and  to adequately cover the newly insured.  Now, unless changes are made this week, Medicaid reimbursements will be cut once again leaving many physicians to wonder if they can continue to treat the increasing numbers of Americans covered thru these programs.

Traditionally, Medicaid has reimbursed physicians at rates significantly lower than Medicare–making practices with large numbers of Medicaid patients financially non viable.  As the ACA was rolled out, a provision provided for significantly better Medicaid payment rates to physicians in order to help provide larger networks of care for the newly insured.  Now, there looms an automatic payment rate cut of nearly 43% for Medicaid payments to primary care physicians–many of these are the same physicians who agreed to expand Medicaid within their practices in order to meet demand.  According to Forbes, traditional Medicaid reimbursement averages just 61% of Medicare reimbursement rates (which is often significantly lower than private insurance rates).  In addition, many Medicaid patients require a disproportionate amount of time and resources from the office–doctors are caught between a “rock and a hard place”–between a moral obligation to treat these patients and a desire to avoid financial ruin.  These patients tend to be sicker, have multiple medical problems and have suffered from a long time lack of preventive care.

Finances are not the only piece of the Medicaid puzzle. Government regulation and paperwork and processing often delays payments to physicians and impacts their ability to run a financially sound business.   Interestingly, a study from 2013 published in Health Affairs suggested that while physicians welcomed an increase in reimbursement rates as incentive to treat Medicaid patients that quicker payment times, reduced paperwork and simplified administrative processes would also need to be a part of any type of reform.  (of course, none of these items were included in the incentive package).

Many primary care physicians stepped up to answer the call for increasing coverage of Medicare patients when the ACA was initially rolled out.  Now, these same physicians are contemplating the need to drop these patients from their clinics with the pending change in reimbursement.  As mentioned above, in addition to lower reimbursement rates, the Medicaid program requires an enormous amount of administrative work in order to file claims and these claims are often paid very late–those running a small practice are forced with more work for less pay and often have to make difficult budgetary decisions in order to  payroll for their staff each week.   While the administration touts the swelling numbers of Medicaid covered patients–nearly 68 million currently–I suspect access to quality care will soon become an issue.  Just as with every other manipulation of the ACA over the last two years, legacy and political agendas have taken precedent over what really should matter–providing quality medical care AND prompt, easy access to care for the formerly uninsured.  In an effort to tout swelling numbers of “covered” Americans, the Obama administration has failed to anticipate the impact of short term financial incentives for primary care physicians to accept increasing numbers of Medicare patients.  Even in states such as California, officials are bracing for a large number of physicians who have announced that they will likely drop out of Medicaid plans if the planned cuts are implemented as scheduled.

It is time for the Obama administration to stop playing political games with our healthcare.  If the mission of the ACA is to provide affordable quality healthcare for all Americans, then we need to ensure that there are quality, dedicated physicians available to provide that care.  The Medicaid “bait and switch” is just one example of our President’s shortsightedness and lack of connection to those dedicated physicians who work tirelessly to ensure that ALL patients have access to care (regardless of insurance type).  It is my hope that the new Congress will engage with the physician community and find real solutions to the US healthcare crisis–and no longer allow the President to place his perceived legacy over the healthcare of those Americans who are in need.

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Image adapted from The Peanuts comic strip by Charles Shultz