Is America Prepared for Ebola?

Published in the Orange County Register: October 10, 2014

What does the Dallas Ebola virus experience tell us about the U.S. health care delivery system? It is the first demonstration to the world that Obamacare and a delivery system that focuses on large groups of people over individuals has failed us.

These population-based practices require needless record keeping. To comply, doctors have been forced behind a computer rather than engaging with their patients.

We have known for some time that the Ebola virus is spread by the transmission of bodily fluids. We also know there is no cure. In the case of a possible pandemic in 2014, the mortality rate could be as high as 50 percent.

As of Oct. 2, 2014, the Centers for Disease Control reports: 7,157 have contracted Ebola in Africa and 3,330 have died of the virus. The only way to limit the spread of the disease is to contain it. The first line of defense must be to quarantine patients.

And yet, Thomas Eric Duncan entered America and announced to a triage nurse in an Emergency Room that he had just come from Liberia. Afterward, it was reported that while in Liberia he moved a known Ebola patient to her deathbed. Not surprisingly, he developed a fever and flu-like symptoms but was nonetheless sent home where he continued to expose family members and children to the virus.

We can admonish the Liberian government for allowing him to get on a plane after lying on a report. But we should also scold our public health agencies for not establishing protocols to triage anyone entering the United States from Guinea, Liberia or Sierra Leone and quarantine those exposed to any sick person for a full 21 days.

Duncan, who died this week, was failed by the American health care delivery system. “Meaningful use” and other government quality parameters in electronic medical records only track population-based care parameters. Compliance is reimbursement-focused, not patient-focused.

To that point, Medical Care Group, a practice management company advertises, “If you want the incentive money but don’t have time to read up on it and implement, that is our specialty. We will work with any qualified vendor to get your $18,000 per physician this year and your total of $44,000 over the next three years.”

Mandates for electronic medical record keeping systems have made doctors commoditized robots delegated to filling out forms rather than hearing our patients’ concerns and finding complex solutions to their problems. We have put our brains “on hold” while we execute our way through processes that are more about government regulations and reimbursement than patient care.

These mandates do not work. None of the once-lauded government quality programs has been shown to decrease cost or improve quality. Dr. Hayward Swerling has reported, “meaningful use, as things stand in 2014, has not shown to improve patient care.”

Sarah Kliff of the Washington Post stated in January of 2013, “savings have not materialized” with the use of the Electronic Medical Record. She also notes that doctors have been slow adopters of the EMR. That is because the EMR is the wrong utility to improve quality care. Quality care requires communication among professionals; the transference of salient data in the proper context.

By most accounts, there was a breakdown in communication in Texas Health Presbyterian Hospital in Dallas.

If a productive dialogue had taken place, the doctor would have appropriately isolated the patient, protecting many from exposure, saving our nation from the angst of the spread of this offensive virus. I call on my collaegues to step away from a computer culture that does not work and get back to the business of collabotive care the old fashioned way.

Let’s open the conversation. Dallas has shown us that our patients’ lives depend on it.

Marcy Zwelling-Aamot is the past president of American Academy of Private Physicians.

Administrative Causalities are not Uncommon

Published in the Orange County Register: June 5, 2014

The only surprise about the tragedy concerning patients dying while waiting in line at our Veterans Affairs hospitals is that anyone would be surprised. I am surprised that no one is addressing the fact that these types of administrative casualties go on daily all across the country.

For years, doctors have been filling out forms and waiting days or weeks to get procedures “authorized.” Patients in obvious distress are “filtered” by way of their primary doctor before they can get to the specialist who might treat them. And now with Obamacare, those wait times are expected to get longer and longer. In January, before the Affordable Care Act kicked in but years into “mass care,” Merritt Hawkins, a physician search firm, published that the average wait time in Boston to see a primary doctor was 66 days, far above the national average of 18.5 days.

The culture of providing care in a bureaucracy is tedious and burdensome. What purpose do the forms fulfill? How do forms further a patient’s care? Those questions have become irrelevant in a culture that is about process and without purpose. We should all be nauseated by these stories.

Health plans and the government reward doctors (with money) for filling out forms. The paperwork has little to do with care and everything to do with government compliance. They (insurers and government bureaucrats) even require that we try a treatment protocol consistent with a government guideline before we can offer the treatment we know will work. How is this any different than the horrific VA story?

The VA failures are representative of what happens when doctors are governed by systems that are more about paperwork than care. The VA story is the story of everyday care in many venues across this country. The medical community should be standing up for our patients and refuse to “play the game.” All patients deserve our professional best.

Marcy Zwelling-Aamot, M.D., is the vice chair of the American Academy of Private Physicians.

Doctors Aren’t an Afterthought

Published in the Orange County Register: May 22, 2014

It may not be long before a hospital will be the least likely place to find a doctor. Pressures are mounting to replace physicians with computers, guidelines, nurse practitioners and even pharmacists. The assault on the patient/doctor relationship continues to mount.

Centers for Medicare & Medicaid Services recently made a final ruling that finds the regulation requiring a doctor sit on the governing board of a hospital to be “unnecessary, obsolete, and unduly burdensome on health care providers and suppliers.” Hospitals must now only “consult” with a physician “periodically throughout the fiscal or calendar year on matters related to the quality of care.”

Doctors have become the “problem child” of hospital administrators, government officials, insurance companies and the media. That is until their loved one becomes ill. But does CMS really believe that doctors are just an afterthought when it comes to patient management?

Hospitals would have you believe that that they are service centers. When was the last time you got “good” service”? In fact, hospitals are financial institutions that “sell” health care. They are large corporate entities designed to make a profit in an ever-increasing regulatory environment.

Doctors advocate working on behalf of patients. Does anyone really believe that hospitals should be making end-of-life decisions about patients without a doctor? Is it always about the money? Where will the line be drawn?

Amanda Goodall has led research into the question of “whether physicians can be efficient hospital managers.” Her hospital management study cites research suggesting leaders of sports teams are often better when they have “walked the walk” as a player and that the best universities are often led by scholars.

So why wouldn’t doctors be the best hospital managers? Her research concludes using the Index of Hospital Quality and establishes that in the fields of cancer, digestive disorders, heart and heart surgery doctors disproportionally lead the U.S. News and World Report’s list of Best Hospitals.

This is not conclusive evidence that a doctor should lead every hospital. But surely it is convincing evidence that CMS was not interested in patients when it made the ruling about governing boards.

It is about time Marilyn Tavenner, the head of CMS, takes a stroll into the workplace she represents.

Ms. Zwelling-Aamot is a member of the American College of Private Physicians.

Our Intrusive Medical Bureaucracy

Published in the Orange County Register: April 17, 2014

Every day in my office it seems I am confronted with a government or insurance clerk telling me that he or she knows better about the treatment of my patient than I do. Too often my patient asks me what their insurer will “authorize.” I always answer, “Who cares?” Sadly, the government bureaucracy has instilled itself into the subconscious minds of Americans everywhere. Big brother is not just watching; he/she is indigenous, unseen and pervasive.

Government intrusion into our lives is more than about the poor judgment of unqualified clerks or administrative bureaucrats denying care.

A patient once asked if I would let him go home from the hospital a day early because he feared that Medicare would make him pay for his stay. He knew about the penalties the government imposed when they denied days in the hospital. And another patient did not see one of my obstetrics colleagues for a second evaluation because she “had heard” that she could only have one pap smear per year.

Furthermore, the news is filled with stories about “new” government guidelines. Most recently, the media featured a story with the punch line: Mammograms don’t save lives. But that is not news. They were not designed to save a life. Most women have a mammogram because she wants to “buy” reassurance that she doesn’t have cancer. But reassurance is personal and has no value to the government that wants to control your choices and diminish your expectations.

And it’s working. In some hospitals, no one is surprised by a 12-hour wait. We are also experiencing a scarcity of medications we use every day to save lives, like intravenous nitroglycerin. Doctors have hired staff just to take care of the administrative burden imposed on our offices. That is now a part of our fixed overhead. Expectations have changed. Lines are long. Life is expensive and resources are scarce.

Obamacare gave the uninsured the illusion that with a magic card bought with (other) Americans’ hard-earned tax dollars they can get health care for free. It’s not true. Our rudimentary need for self-determination must find its way into our hearts and souls. Truth is not optional.

Marcy Zwelling [is a] Long Beach resident and is a member of the American College of Private Physicians.

Deceptive Communications Threaten Patient Treatment

Published in Orange County Register: March 21, 2014

Some California pharmacy benefit managers may be intentionally misleading doctors and making it more difficult for doctors do their jobs. As is often the case when health plans and benefit managers insert themselves into the physician-patient relationship, patients could ultimately pay the price.

Pharmacy benefit managers have sent misleading letters to California providers in both commercial and Medicare Part D in an effort to get them to switch patient treatments from brand to generic drugs or over-the-counter treatments. In their communications, the managers allege that doctors should switch because the alternative treatments are in some way superior and are the “preferred” agents for treating a specific patient type. However, in at least one case the claims have not been supported by the science.

Doctors I know aren’t swayed by such communications. I throw them away, myself. But doctors are also extraordinarily busy, inundated with emails, forms to fill out and forced to navigate costly bureaucratic hassles to even obtain simple treatments for their patients. If a doctor wasn’t reading the fine print, he or she might be misled into switching a treatment that shouldn’t be switched or feel pressured to make switch for fear of additional liability.

The pharmacy benefit managers’ claims have nothing to do with what is in the best interest of patients. They are sending misleading communications for one reason only – to drive up their profits on the backs of patients.

Doctors, including myself, choose a patient’s individualized medication strategy based on our years of experience and the specific needs of our patient. We know our patients, their conditions and the treatments that have worked. It is incumbent upon us to look after our patients and seek the best treatment regimen available to them. It is not in the best interest of our patient for doctors to allow benefit managers to change a medication based on their suggestions when they do not know the patient.

Fortunately for patients, California law empowers local officials to investigate and put a stop to this. In Section 790.03, the California Insurance Code prohibits “disseminating or causing to be made or disseminated before the public in this state … any statement containing any assertion, representation or statement with respect to the business of insurance … which is untrue, deceptive, or misleading, and which is known, or which by the exercise of reasonable care should be known, to be untrue, or misleading.”

To protect the safety and health of patients, California should investigate the efforts of pharmacy managers to mislead doctors. Decisions about how to treat patients should be made by physicians in consultation with their patients and based on the best clinical evidence available.

Marcy Zwelling-Aamot, M.D., is the vice chair of the American Academy of Private Physicians.

Bound by Medical Regulations

Published in the Orange County Register: January 24, 2014

It is understandable Americans are distraught about the health care exchange and about losing insurance and their doctors. But, so are doctors. And it is not all about the money. The frustrations and cost of providing care mostly due to regulations and the costs are enormous.

My office spends hours of time in order to execute the recommendations we make for our patients. To order a CAT scan we must often get an authorization and provide a reason that satisfies a clerk armed with a list of check boxes.

Just last week, an elderly patient called my office complaining of pain in her lower arm. The patient was told to come in immediately and upon exam, we found no pulse in the artery. After confirming the problem with an ultrasound we were challenged with treatment. Many doctors would have admitted that patient to the hospital for a procedure to remove the clot. The cost would have been tens of thousands of dollars to the taxpayer.

We called the local pharmacy. They could get us the medicine but not until the morning. So, we borrowed the medication from the hospital and started treatment immediately.

The following day my office spent six hours on the phone with the mail away pharmacy to get her medications. We called the following day to confirm that things were sent out only to find that nothing had happened.

In the end, it took daily calls and finally threats to get the patient the meds. The cost of that service is “not a covered benefit” nor is it accounted for in the “cost of care.”

Every day, doctors are on the phone or filling out forms begging a clerk to “allow” their patients the care or medications they need. In the meantime, the regulators, pharmacy benefit managers and other non-professionals are “eating up” your dollars and my time. Because the costs are hidden and doctors “just do it” you hear little about the onerous time consuming paper work until we just say “no.” That time is approaching.

There are some things that are beyond the power of the president and his executive privilege: the day is only 24 hours long.

Marcy Zwelling-Aamot, MD FACEP, is a member of American College of Private Physicians.

Nowhere to Hide your Data

Published in Orange County Register: January 16, 2014

Congress is back in session and the U.S. House of Representatives has passed the Health Exchange Security and Transparency Act to assure Americans that Congress is monitoring the website. Indeed, consumers need to know that their government is at least capable of securing Americans’ privacy, but there is more.

What Congress and your doctor may have failed to tell you is that the government is actively collecting your health data. So is your pharmacy and your insurer. Moreover, that has been going on under the guise of the Health Insurance Privacy and Accountability Act. The HIPAA was enacted in 1996 by Congress and governs how data is collected and distributed.

Any “covered entity” is entitled to know your medical data and “share” it with other “covered entities.” A covered entity could be your pharmacy or a company selling you diapers. Now you know why you get those crazy mailers about diabetes when your doctor wrote you a prescription for your medication. The pharmacy “shared” your data. But, there is more.

Remember the stimulus bill? It contains provisions that govern your doctor’s electronic health records. Simply, your doctor will get a bonus from the government when he or she complies with “meaningful use” criteria.

And now Congress has the Sustainable Growth Rate formula on their plate. This is the formula used by Medicare to determine how doctors are paid. Congress thinks that the public is not capable of determining the quality of their doctor so Congress is going to “help” you make that decision. Once again, doctors are required to submit your personal data to Medicare so that the government can determine if your doctor ordered too many or enough of the “right” test. Doctors will be given a bonus or will be penalized on the data submitted.

It is a ruse for Congress to give Americans the idea that they care about your privacy. On the contrary, they are bribing your trusted physician with bonuses to “tell them your secrets.”

Marcy Zwelling-Aamot is vice-chair, American College of Private Physicians.

Health Care in 2014

Published in the Orange County Register: December 26, 2013

Who would have imagined that in our America something as basic as our choice of doctor could be in jeopardy? For millions of Americans, that is precisely the case. As of Jan. 1, 2014, many of our sickest patients who have had a long, trusting relationship with a physician will find themselves out on his or her own.

On Nov. 15, 2013, a number of physicians took the time to come together in Washington, D.C. We talked about what we might do to save our profession” and continue to care for our patients. We have decided to invest in a year-long campaign called “Keep your Doctor.” We want to work with you, our patients, to find a way (regardless of what has changed in your insurance plans) to continue your care and to assure you that our doors are open.

We all wanted to fix the system back in 2009. The Affordable Care Act was written to do exactly what it is doing. I spoke out against it from the beginning. Many doctors felt the same way. Doctors find ourselves in the awkward position of trying to save our profession so that we will be available for you in the future.

We are committed to preserving the sanctity of the relationship between patient and physician. This trusted relationship is the core of what is “right” about our American healthcare system. While insurance is important to pay for the care we must purchase, particularly when one suffers an acute illness, every patient needs a doctor to advocate his or her care and navigate the system.

We are committed to patient choice. By building any number of free market opportunities for doctors and for patients that are affordable, more doctors will continue to provide care within the system and patients will have expanded choices for their care.

We are committed to “true” transparency. By encouraging doctors and all providers of care (facilities, vendors, pharmacies) to publish their cash retail prices and by demanding insurers and the government publish their payments for all procedures, patients will be better able to make value based decisions for their health and for their life.

We are committed to protecting all patients’ privacy. The Affordable Care Act demands that patient data be transferred directly to the government. We have already been alerted to the problems with the government website. Patient privacy has been violated on the government site.

We are committed to allow patients to own their insurance. Once a patient purchases a policy, that policy should move with the patient regardless of his or her employment or where they live. That policy cannot be cancelled due to any medical condition.

We are committed to allowing the free market to dictate the healthcare marketplace and we will continue to advocate for this. This will allow for true competition and will bring the cost of care down. The only means of providing affordable care is a transparent market with choices. This would include the expansion of health savings accounts so that patients may spend their own dollars on their health investment. We will have to wait for our legislators to help with new legislation to realize our goal.

Marcy Zwelling-Aamot, M.D., is the vice chair of the American Academy of Private Physicians.

Restoring the Health Care System

Published in the Orange County Register: November 4, 2013

The GOP must become the party of solutions and guide Congress through revisions to the Affordable Care Act. That must happen now. Americans cannot afford to wait until 2014, when the GOP wins the Senate, to undo the consequences of this overreaching law.

American citizens have demanded repeal of unworkable laws and constitutional amendments in the past. Prohibition was passed in 1919 when Congress passed the Volstead Act over the veto of President Woodrow Wilson. Its intent was to save grain for the war. In fact, it promoted gangland crime. But it took America 13 years to finally repeal the amendment when the 21st Amendment was passed. We cannot wait 13 years to repeal the Affordable Care Act.

It has been said that the GOP has no plan. That is not true. Fortunately, many in Congress recognize the need for immediate action and have asked doctors from around the country to come to D.C. and work with them to prioritize amendments to the ACA and to articulate their vision.

More than 70 bills have been authorized in the GOP-led House, but Sen. Majority Leader Harry Reid refuses to even introduce these bills in the Senate.

Working with doctors and industry leaders (rather than behind closed doors), the GOP has authored bills supporting choice, price transparency, privacy and personal responsibility. The GOP supports a health care system that has a moral foundation and that is maintained by the economic principles of a free market.

Plans with health savings accounts that can be built with tax deducible contributions and tax credits will ultimately be more affordable for all Americans. Those dollars can be used in a transparent marketplace where prices are posted and patients have the choice to walk in and out of doctors’ offices with their own money. Insurance plans, doctors and hospitals will have the opportunity to compete to raise the quality bar.

Ultimately, doctors just want to do their job and work for their patients. We do not want to sit behind a computer screen checking off boxes. Patients want a doctor who has the time to listen to their multiple issues and they want a treatment strategy that is about their personal needs. They do not want a government stamped protocol. If affordable, patients will pay for that opportunity.

The sanctity of the patient-physician relationship must be the foundation of health care in America and is the product of every individual’s right to choose. That sacred trust must never be violated. Privacy must stand at the core of the trusted and inviolable patient-physician relationship in order to maximize the quality of care we provide our patients. Our patients’ personal information, particularly digital, must be protected and the patient must own that information.

These are the natural GOP principles of health care delivery.

Good health is a privilege and an investment. The right to choose how we achieve our successes and our health care must remain in the hands of every individual. This must be the GOP plan and their core conviction. It must be the promise in the 2014 and 2016 elections.

Marcy Zwelling-Aamot, M.D., is the vice chair of the American Academy of Private Physicians. Rep. Pete Sessions, a Republican, is from Texas’ 32nd Congressional District.

Letter to the Editor: Affordable Care Act is No Panacea

Published in the Orange County Register: Sept. 27, 2013

LOS ALAMITOS, Marcy Zwelling, vice chair, American Academy of Private Physicians:

Just this week, a personal friend called with a medical dilemma. He had just learned he had lung cancer. What should he do? Where should he pursue his care? He was relieved that he was insured. He, like most patients, believed that insurance opens the door to care. What a surprise when he learned he had no choice of doctor or hospital, and what a terrifying shock when he discovered that the care he was offered would leave him dead.

That changed the moment he changed insurance. While he has some serious treatment ahead, he has a chance at a long life. He can choose his doctor and choose his care.

Doctors know that insurance is not the panacea the government would have you believe. Good health care is about a healthy relationship with a doctor. Sadly, the Affordable Care Act strips most patients of choice of doctor, hospital or care strategy. The exchanges opening in October are vacuous when it comes to finding a doctor. Most in the private community refused to participate in what appears to be a Medi-Cal-plus program filled with paperwork but void of state-of-the-art care.

Finally, many have commented that the premiums are more than patients can afford. Worse than that, the deductible and the co-pays make the insurance more expensive than paying cash at the time of service. Patients know that their willingness to negotiate with a doctor whom they trust is preferable to waiting for an authorization in a government-regulated plan.

While the political future of the ACA is a story yet to be written, I can almost guarantee that the first chapter in this saga will read, “America’s patients choose to manage their own lives.”

Defund: It’s the people’s will

HUNTINGTON BEACH, Steve Noble: Finally, a segment of our society is being listened to by Congress and the Senate. A website petition at has generated 1.6 million signatures and has the Obama administration worried. No longer can disapproval of this law by the majority of Americans be ignored. In addition to costing more than double what the initial projections were, the law infringes on everyday lives and liberties.

The president and his administration have vowed to fight defunding of Obamacare regardless of its disastrous effect on everyday life, more specifically, a sick economy and little to no job growth.

President Barack Obama cares only about his legacy, which would, unfortunately, spell disaster for our country.

Shutting down debate isn’t an option

SEAL BEACH, Tom Blackman: In America, Democrats, Republicans, Independents and everyone interested in good government need transparency and truth from government officials. It is unfair to blame people who seek answers to questions relating to poorly written legislation or government mistakes.

It is obvious that President Barack Obama is angry when any individual or group asks questions or criticizes him. His anti-Republican rant recently over the House’s attempt to defund Obamacare shows the real Obama. This is not the same Obama who promised to bring Americans together with his hope-and-change agenda.

His promise to listen to Americans and to work out compromises for the nation’s good falls flat as he moves toward more government control and tries to transform America according to his socialist agenda.

Lord Acton’s statement, “Power corrupts; absolute power corrupts absolutely,” can apply to the American Republic’s future if the people can’t debate the issues.