Class of 2001-02
Abstracts of Policy Papers
Submitted for Completion of Certificate Requirements

Dale J. Carlson, MM
Federal Regulation of Physician Work Hours Will Not Enhance Patient Safety

The Patient and Physician Safety and Protection Acts of 2001(H.R.. 3236) and 2002 (S. 2614) seek to address the patient safety issue caused by resident physicians' excessive work hours. The acts would reduce work hours to eighty per week and increase supervision of resident physicians. The proposed legislation would not solve the problem of medical errors occurring in hospitals, and is redundant of current standards. The American Osteopathic Association (AOA) and the Accrediting Council for Graduate Medical Education (ACGME) 80-hour week work requirements are reasonable and verification mechanisms are accurate. The majority of residency programs do not require residents to work excessive hours; when averaged over a four-week period, many work fewer than eighty hours per week. Fatigue is often a result of residents moonlighting to supplement their income and to pay off student loans. Training hospitals have better quality of care and lower mortality rates when compared to non-teaching hospitals. While working excessive hours may lead to a decrease in some resident physicians' ability to provide safe patient care, hospitals and residency accrediting bodies, not legislation, should control the regulation and enforcement of work hours.

Charles Finch, D.O
Emergency Departments In Crisis: The Need for a Safety Net

The nation is in a crisis with respect to emergency care. In addition to the burdens created by increased demand for care and decreased number of facilities, hospitals are facing financial ruin by providing uncompensated care to the uninsured. Hospitals who treat Medicare patients have been compensated through disproportionate share hospital (DSH) payments. But in spite of the fact that 34% of all hospitals are operating in the red, the total value of DSH allotments nationwide will fall by nearly $1.3 billion (13%) in 2003, cutting off funds to hospitals at a time when emergency rooms (ER's) are seeing an increase in visits by uninsured patients. Continued funding made available through the Medicaid Safety Net Hospital Preservation Act would enable more hospitals to remain open and would provide continued access to quality medical care.

Darrel Lynn Grace, D.O.
Impact of Centers of Excellence and
Health Career Opportunity Programs on the Number of Underrepresented Minority Physicians

Center of Excellence Programs (COE) and Health Careers Opportunity Programs (HCOP) increase the number of minority physicians available to treat underserved populations by improving student recruitment and performance, improving curricula and cultural competence of graduates, facilitating faculty-student research on minority health issues, and training students to provide health services to minority individuals. The 2003 Health Resources and Services Administration budget plans to cut funds to these programs. In the 1990's, underrepresented minorities, (African-Americans, Hispanic, and Native Americans; American Indians, Alaska Natives, and Native Hawaiians), comprised approximately 25% of the US population, yet they represented only 4% of all practicing physicians in the US. Minority patients are four times as likely to receive care from minority physicians, and African-Americans and Hispanic medical school graduates are five times more likely to practice in predominately African-American and Hispanic neighborhoods. If the thiry-five support programs are cut, the four black medical schools will not be able to close the gap in training doctors to provide health care to the underserved. HCOP and COE funding should continue to be made available to all eligible universities in order to continue to train minority physicians to provide health care for the 45 million Americans who currently lack access to health care.

Dr. Robert Kessler
Model State Emergency Health Powers Act

The Centers for Disease Control (CDC) has commissioned the Model State Emergency Health Powers Act (MSEHPA) to help states establish a legal framework for a fast and effective response to bioterrorism. The broad nature of the powers that would be granted by MSEHPA lead to questions about the proper balance between individual civil rights and the needs of society. MSEHPA infringes on individual civil rights to a greater extent than necessary to provide an adequate response to bioterrorism, without improving access to or quality of patient care. Individual liberties must be balanced with society's needs. Civil rights should be protected to the greatest extent possible, not only because our society expects it, but because people will cooperate more fully with measures they perceive as being respectful of those rights. Therefore, any laws, regulations, or procedures enacted should protect civil rights to a greater extent than MSEHPA provisions allow. States should reject MSEHPA, and should develop their own detailed plan for the implementation of public health measures and the protection of civil rights during catastrophic events.

Stephen D. Laird, D.O.
Putting out the Fire: Tobacco Education Will Improve Missouri's Health

Tobacco's toll in Missouri is devastating. 17,100 kids become regular smokers every year; one-third will die prematurely as a result. Smoking costs Missouri $1.6 billion in direct medical care costs and an additional $2.1 billion in lost productivity each year. In order to reduce tobacco consumption and decrease smoking-related illness and health care costs, $36.6 million of the Tobacco Master Settlement Agreement (MSA) funds should be allocated consistently to fund teen tobacco education programs. Although smoking has a devastating affect on health and health care budgets, smoking-related diseases are among the easiest to prevent. The 2000 Surgeon General's report, Reducing Use, shows that comprehensive school-based programs combined with community and media-based activities can effectively prevent or postpone smoking onset in twenty to forty percent of US adolescents. At present, Missouri's tobacco education programs are funded on an annual basis, which jeopardizes their continuity and success. Funding for tobacco education programs needs to be doubled from the current $3.46 per capita to $6.77 per capita. Programs should be financed by utilizing $36.6 million (approximately 20%) of the Master Settlement Agreement (MSA).

Jeffrey W. Morgan, D.O.
Discount prescription Plans: President Bush's Proposal

The rising cost of prescription medications has made it increasingly more difficult for Medicare beneficiaries - who receive no outpatient prescription drug coverage - to afford their medications. The prices of eleven of the fifty best-selling drugs in 2001 rose 10% or more from 2000 to 2001, and prescription drug spending overall has risen 15% or more per year over the past several years. Severely disabled elderly people spend more than half their out-of-pocket expenditures on outpatient prescription drugs. An estimated 38% of Americans (15.2 million) will lack prescription coverage by 2002. In July 2001, President Bush introduced a plan to curb these costs: The Medicare-Endorsed Prescription Drug Card Assistance Initiative. This plan will rely on companies that manage drug benefits to buy prescription drugs in bulk. The companies would sell cards to Medicare patients who could use them at participating pharmacies to purchase medicine at a reduced rate. Although discount card programs are at best a stop-gap measure and at worst are a 'log in the road' on the path to Medicare reform, without them Medicare recipients will continue to be denied access to treatment. The proposed initiative can provide a modicum of financial relief and should be adopted by Congress and instituted immediately until such time as the other options available to 'modernize' Medicare can be more thoroughly developed.

Earle M. Pescatore, Jr., D.O
Medicare Documentation Guidelines and their Impact on Healthcare Access and Cost

In 1989 Medicare adopted documentation guidelines as a tool to use to control spending on physician services. In spite of three revisions, these documentation guidelines have failed to control Medicare costs. Medicare costs were $177 billion in 1995 and will reach $332 billion by 2002. Between 1990 and 2000, the number of patients increased by 9.2%, but costs increased by 300%. Medicare regulations have grown in scope and complexity; current guidelines contain more than 100,000 pages of regulations, roughly six times the size of the Internal Revenue Service federal tax regulations. The changes in documentation requirements have increased administrative burdens on physicians and have limited patient access by impinging on clinical time. The medical record has become a billing and reimbursement tool rather than a document to communicate health care. Documentation should support the practice of medicine rather than be the main work-product of the doctor-patient visit. I recommend adapting a simplified documentation model in which three levels of decision-making document medical information in a clear, concise, and clinically relevant fashion. Guidelines should provide for portability of information for future digital applications in an electronic medical record. In addition, CMS should provide an opportunity for all concerned parties to participate in revisions.

Michelle Powell-Cole, D.O.
Telepsychiatry: A Viable Option to Increase Rural Access to Mental Health Care

Over 54 million Americans live in rural areas, making up twenty percent of the population. Of the 518 mental health professional shortage areas, 75% were in rural areas. Telepsychiatry, an interactive psychiatric communication practiced through a telecommunications network, is a solution to the lack of mental health professionals in rural areas. Rural residents suffer higher rates of suicide, addiction, and substance abuse than do urban residents. 23% to 56% of individuals with a diagnosable Axis I mental disorder also have a substance abuse or dependence disorder. Due to the serious lack of mental health and substance abuse treatment options, rural residents often go untreated. Currently three significant bills support the funding, research and delivery of mental health to rural communities.

Rural Mental Health Accessibility Act of 2001/ S. 859 SEC.330L and the Rural Telecommunications Enhancement Act/H.R. 2669 would provide funding for the delivery of mental health care as well as mental health education. The Medicare Telehealth Validation Act of 2001/H.R. 2706 would provide grants for the development of telehealth networks and would improve the provision of telehealth services under Medicare Program, making telepsychiatry more affordable to rural residents. I recommend support of these bills and the use of telepsychiatry to increase access to mental health services for rural communities.

Thomas R. C. Ruetter, D.O.
Effects of New Jersey Budget Deficits on the State Children's Health Insurance Program

The State Children's Health Insurance Program (SCHIP) was created to provide insurance coverage to low-income children. Budget deficits in New Jersey are adversely impacting this program and the number of children served could be affected. Approximately 200,000 children are uninsured in New Jersey. According to a National Survey of American Families, close to 120,000 of these children live in low-income families. Enrollment in SCHIP has been very successful; approximately 100,000 children are enrolled. Medical care for New Jersey's uninsured children must be a high priority. Children must receive proper preventative care, as it will decrease the potential that they will face greater health problems as adults. Early intervention for children with physical illnesses as well as emotional and behavioral disturbances will improve clinical outcomes and save the state health care dollars. Legislators should use redistribution allotment funds, tobacco settlement money, and/or tax money to provide the $45 million necessary to fund the New Jersey SCHIP program in 2003.