The Bird in the Hand Might Have Avian Influenza

Awhile back, I wrote fondly of a great preceptor of mine during med school. The most repeated, enduring lesson he taught to his students, residents, and fellows was encouragement to “Do nothing.” With our ever-increasing armamentarium of medications, devices, and medical procedures, it’s increasingly easy to forget that, sometimes, the best thing for us to offer is restraint, lest we do more harm than good.

For better or worse, we have long since entered an era where the greater issues in health care are no longer decided by physicians, or indeed people with any education in medicine whatsoever. The regulators, bureaucrats, and politicians calling the shots are not at all interested in slowing this trend, let alone reverse it. Many no longer even pretend to show interest in receiving input from the physicians whose work and professional lives they seek to control. Which is a shame, since there would perhaps be nobody more suited to remind them that doing nothing, or at least pausing and thinking carefully before taking action, might be better than acting hastily.

Current case in point: HR-2, recently passed overwhelmingly by the House. (For many citizens considering themselves in the know, the SGR-repeal bill.) (Editor’s note: Since the writing of this blog, the senate has now passed the bill as well.) If the reader is blissfully unaware of SGR’s prolongedly-painful history, there’s plenty of material online to get up to speed…or just ask anybody who’s been trying to practice medicine for the past couple of decades. Everyone involved seems to hate the SGR, yet it’s never quite been removed from the field of play. Just put off, for a matter of months at a time, before coming back with greater urgency than ever. Sort of like a bookie coming by every now and then to collect his due, with the unspoken message that, whenever his forbearance runs out, he can get what he wants at your expense…one way or another.

Eventually, this repeated song and dance will wear anyone out: Physicians trying to earn a living, and elected officials who have grown bored of playing with this political football. So, voila! A bill to get rid of it. No surprise that physicians who don’t live and breathe politics were thrilled at the prospect, organizations claiming to represent docs cheered and urged its passage, and the House voted it through with (especially nowadays) strong bipartisan support.

Bringing to mind an old line about how, if you think you have gotten a good deal, you should perhaps count your fingers afterwards to make sure you still have all of them…because the bill, after dispensing with SGR in Section 101, proceeds on to matters unrelated from Sections 102-525. Things that a practicing physician, and professional societies acting in physicians’ best interests, should consider twice before swallowing in the same gulp.

Don’t like Maintenance of Certification (MOC)? The bill codifies it into Federal law. Find “meaningful use” troublesome? That also gets etched into stone. Still wondering how the transition to “value”-based reimbursement for health care goods and services will be instituted? Doesn’t matter that nobody else knows, either…the bill gives carte blanche for the government to figure that out as it goes along (and guess who will live with the consequences). And there’s more…NPI number required for licensure, and thus participation in Medicare/Medicaid no matter how untenable they become. Go ahead and read the bill for yourself…one hopes that some of the Congressmen did before voting for it. Unlike the blind-supermajority acceptance of the massive PPACA, which had to be “passed to see what was in it.”

The Senate chose to go on recess rather than be an eager participant in railroading this thing into law, and took some flak for it. Perhaps it was simply a desire to get out of town and enjoy some time off…but I’m hopeful that at least some Senators recognized that this was not to be treated as yet another case of “something [anything] must be done!” If so, such individuals might be physicians’ best friends in DC nowadays. Hopefully, the recess will provide them with enough time to receive our thanks and support, so that they will be encouraged to fight the good fight when they return. One hopes that our professional societies will be on the right side of these issues when that happens.