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Divisions Over Future Medicare Spending Surface In House
"A week-old agreement among House Democrats to smooth out disparities in the way Medicare reimburses rural and urban health providers is in danger of crumbling, as disputes erupted Friday over what actually was agreed to," The Wall Street Journal reports. "Some lawmakers from states with high health-care costs are also pressing House Democratic leaders for changes to the deal to ensure that their doctors and hospitals don"t see too big of a bite. ò€¦ Lawmakers from populous areas are questioning whether the deal on geographic disparities should be altered to allow more time for Medicare changes to take effect, since there is no longer the urgency of putting those changes into effect before the public option is rolled out. Another issue is for how long a period of time after changes go into effect urban hospitals should be "held harmless," meaning they won"t see their Medicare reimbursements cut" (Vaughan, 8/2).
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Dr. David B. Samadi Introduces New Prostate Cancer Care Center For Robotic Surgery Patients At Mount Sinai Medical Center
The Mount Sinai Medical Center has a new re center for prostate cancer treatment. Led by David B. Samadi, M.D., Chief of the Division of Robotics and Minimally Invasive Surgery in the Department of Urology, the new state-of-the-art facility at 625 Madison Avenue in New York City specializes in pre- and post-surgery care for patients who undergo a robotic prostatectomy at Mount Sinai"s main campus. It also provides expertise in the treatment of other urologic cancers, including bladder and kidney. A multilingual staff offers assistance with patient travel arrangements, accommodations, and translation services when required.
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Obama Says He Supports 'Robust' Protections For Health Workers With Moral, Religious Objections
President Obama on Friday said that although he intends to reverse the Bush administration"s provider "conscience" rule, he still favors a "robust" federal policy that would enhance the rights of health care workers to refuse to perform certain procedures because of moral or religious objections, the Washington Post reports. In a session with reporters one week before his first meeting with Pope Benedict XVI, Obama said that he is a "believer in conscience clauses." He added that a new policy from his administration "may not meet the criteria of every possible critic of our approach, but it certainly will not be weaker than what existed before the changes were made." According to the Post, Obama"s comments aimed to reassure Roman Catholic health care workers that they would still be able to refuse to perform abortions and other procedures that go against the Church"s teachings. Several federal laws in place since the 1970s protect the rights of health care workers with moral or religious objections (Salmon, Washington Post, 7/3). Nancy Berlinger, deputy director of the Hastings Center, said that conscience laws also "are on the books in almost every state." She added, "The idea was that when abortion moved from being an illegal procedure, therefore something that you did not offer in a hospital, to being a legal procedure, therefore something that you might offer in a hospital, there was a move to protect providers ... from having to participate in abortions." However, not all conscience laws are specific to abortion, NPR"s "Morning Edition" reports. For example, some allow providers to refuse to provide birth control, in vitro fertilization or end-of-life care (Rovner, "Morning Edition," NPR, 7/6).The Bush administration said its 2008 policy was designed to ensure that the federal laws are enforced. The policy would cut off federal funding to health care facilities and other entities that did not accommodate workers who refused to participate in certain procedures (Washington Post, 7/3). Joxel Garcia, the assistant secretary for health in the Bush administration who helped write the policy, said that it is necessary because few health care workers are aware of the protections. He added that the policy gives health workers "a mechanism to seek help" through HHS.However, critics of the Bush administration"s policy contend that it would widely expand the scope of health care covered by the policy and the type of health care workers who could object to procedures. Berlinger said, "Words like belief, when you talk about them in the context of health care, aren"t just anything you might think of." She noted that a "false belief about science or the promotion of ambiguity where things can be disambiguated," such as the claim that birth control is equivalent to abortion, "is not ethical" ("Morning Edition," NPR, 7/6).Obama"s plan to replace the policy has stoked concern from Catholic health care providers that they would be forced to perform abortions, sterilizations and other procedures that go against Catholic teachings (Washington Post, 7/3). A recent survey conducted for the Christian Medical Association found that 90% of doctors surveyed said that "they will quit their practices before violating their conscience," according to David Stevens, executive director of CMA. Stevens said that repealing the Bush administration"s rule "sends a clear message: It"s open season on health care professionals of conscience -- discriminate at will" ("Morning Edition," NPR, 7/6).Obama on Friday also said that although he and the pope have areas of "deep agreement ... there are going to be some areas where we"ve got some disagreements," such as abortion rights and embryonic stem cell research. The president will meet with the pope on July 10, while he is in Europe for a summit of the Group of Eight industrialized nations. Obama Addresses Catholic Concerns on Pregnancy PreventionObama also discussed opposition to the inclusion of comprehensive sex education and contraception in any legislative pac
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Doctor Shortage And Disparities After Reform Examined, Nurses Prepare For Changing Role

A former Clinton administration official said last week that there aren"t enough doctors in America to handle the increase in patients if health reform covers more uninsured, NPR reports. Donna Shalala, secretary of the Department of Health and Human Services in the Clinton administration, told NPR ""The shortage is related to primary care," ... "We have lots of specialists in the country. We"ll need more primary care physicians."" In addition to cutting costs in Medicare, "Shalala, now president of the University of Miami, says there will be opportunities for nurses to take on a larger role in offering primary care. "With all the advanced-practice nurses that we have in this country and more to be trained, there is a special role for nurses in our expansion of health care for all," she says" (Simon, 8/1). Time reports: "But there is an existing group of providers that health reformers are hoping can help fill this gap: nurse practitioners. Depending on the state in which they practice, nurse practitioners, with advanced training often including master"s degrees in nursing, can often treat and diagnose patients, as well as prescribe medication. And they can do these things at a lower cost than doctors - Medicare, for example, reimburses nurse practitioners 80% of what is paid to doctors for the same services. ò€¦ In addition to providing many of the same services more cheaply, nurse practitioners offer something else that makes them darlings to health reformers: a focus on patient-centered care and preventive medicine. In the recently released House health-reform bill, nurse practitioners (and physician"s assistants, another relatively new, but smaller, category of medical professionals who can perform medical procedures and often prescribe medication) are listed alongside doctors as primary-care providers. Nurse practitioners lobbied hard for this legislative language in meetings with White House health officials, including Nancy-Ann DeParle, Obama"s health-reform czar" (Pickert, 8/3). The Associated Press reports that smaller towns in rural America look to nurse practitioners to fill the gap already: "Small towns often lack specialists and rely on family physicians. But even incentives such as covering student debt for new doctors haven"t worked. Many small towns look to nurse practitioners for general care or seek foreign doctors using J-1 visa waivers. According to the Washington, D.C.-based National Rural Health Association, only about 10 percent of U.S. physicians practice in rural areas. The problem: Medical students know they can make more money, and work shorter hours, in a specialty practice in a city." For instance, a clinic in rural southern Colorado relies on nurse practitioners for basic exams, but many sick patients get referrals to a larger town half an hour away, The AP reports (Wyatt, 8/2). This information was reprinted from kaiserhealthnews.org with kind permission from the Henry J. Kaiser Family Foundation. You can view the entire Kaiser Daily Health Policy Report, search the archives and sign up for email delivery at kaiserhealthnews.org. © Henry J. Kaiser Family Foundation. All rights reserved.


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