This may be a controversial post on my favorite holiday, where we celebrate nurturing, sacrifice, and unconditional love; one day is insufficient.

I admit that in previous posts( Gotcha and Uncollaborative Insurance ) I have complained about what I felt were arbitrary regulations on physical therapy for cancer survivors like me who sustained spine injuries and back and neck pain as complications of lifesaving therapy.

I cheered the decision that sent $6.6 million from Aetna to business owners due to a violation of Maine state law that requires small-group insurers to spend at least 75% of premiums on medical claims [Modern Healthcare 39(17)16].

Yet, today, in the spirit of Mother’s Day, I have chosen to focus on what I agree with in Karen Ignani’s article [Uniquely American Solution: Collaboration, leadership required to bring change. Modern Healthcare. 39(17)20-21]. Anticipating criticism from readers who become as frustrated as I do with caring for patients amid denial codes, telephone calls, and burdensome paperwork and regulations, I disclose that I have received no money from anyone in the health insurance industry. On the contrary, I send Harvard Pilgrim Healthcare nearly $17,000 in annual premiums.

Here are points from her recent article on which I agree with Ms. Ignani:
1) Successful reform will require a comprehensive cost-containment strategy: I hope that physicians and hospital share with insurers, pharma, and device manufacturers in the sacrifices required to bring costs down considerably. I support insurers converting to a universal claim form which will save providers time and administrative staff costs.  I also support regulations that increase transparency for physicians and organizations who receive payments from drug and device companies for research, consulting, and speaking.
2) Preventive care and screening reduce future catastrophic outlays. I would be willing to sign a 5-year contract with my insurance company in return for a guarantee that premium costs would not rise more than the agreed upon amount, so that they could reap the benefits of their investment in my wellness
3) Investing in anti-obesity and anti-smoking campaigns can improve the health of the nation and reduce related costs. Even though I am not overweight and do not smoke, I support these efforts.
4) Providing scholarships and loan forgiveness for physicians specializing in primary care will help provide and sustain the workforce necessary to achieve the above objectives. In the Southern Surgical Association Presidential Address, Dr. James O’Neill stated, “I believe that the reason many students are selecting so-called “lifestyle specialities” characterized by shift work, is because these fields are relatively protected in terms of reimbursement under Medicare and other insurance reimbursement.  This is primarily because of enormous student debt, now averaging close to $200,000 and rising, an insidious influence…  Currently, no one is taking responsibility for this and it is up to us.” [Journal of the American College of Surgeons. 208(5),659.] The sooner we institute this reform, the better. 
General surgeons, especially those who work in rural settings, deserve to be included in the primary care category; without our active assistance, emergency departments, intensive care units, and medical wards cease to provide comprehensive care.  General surgeons allow a hospital function as an acute-care facility that can provide life-saving care to our communities.
5) All of us can do better. Amen
6) Acting now to identify reductions in all sectors can provide significant relief to purchasers of healthcare insurance, improve the solvency of the Medicare trust fund, and free up resources to finance healthcare reform. No disagreement here either.

The following are some ways that we physicians can make it easier to reach a sustainable equilibrium:
1) Invest in interoperable electronic health record software that allows us to share data without the need to re-enter it into our computers
2) Use software displays that show us clearly the results and date of previous laboratory testing and imaging studies, so that we avoid duplication
3) Obtain palliative care consults for patients entering the intensive care unit to avoid squandering limited resources on patients at the end of their lifespan for whom there is little hope of extended survival. Questions about rationing need to give way to questions about how we can deploy scarce resources more effectively
4) Support legislation that requires patients to fill out living wills signed by their next of kin and power of attorney when they apply for/ renew their health insurance coverage. This is especially important for aging patients before significant cognitive decline occurs
5) Play a greater role in health education not only for individual patients but also in schools and public forums
6) Be more pleasant and rethink conspiracy theories to cultivate mutual respect. As I wrote in Facilitating Physician Engagement, breakthrough innovation occurred at the Pittsburgh Regional Health Initiative once participants moved from an accusatory, “Why don’t you …” approach to a more welcoming, “What if We …?”

What do you think?

• What reforms do you support in the upcoming healthcare reform debate
• What can we do better
• As you look into the mirror, what would you like to change 

As always, I welcome your input to improve healthcare collaboration.

Kenneth H. Cohn
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