Class of 2007
Abstracts of Policy Papers
Submitted for Completion of Certificate Requirements

A Child’s Right to Nurse Act
West Virginia H.B. 2244 and S.B. 7

Craig Boisvert, D.O.

Forty-six states have found it necessary to pass legislation protecting a mother’s and infant’s right to breastfeed. West Virginia is one of the few states in the nation that has not passed similar legislation. As a result, the state ranks 49th in the nation in breastfeeding, and the cost to the healthcare system is enormous.

Breast milk is the most complete food for an infant and protects the infant and mother from numerous diseases. Breastfeeding reduces infant mortality rates by 21%. If West Virginia increased the rate of breastfeeding from its present 52 % to the national goal of 75%, the state could save $6 million from the prevention of ear infections and gastrointestinal illnesses. The state’s Women Infants and Children program (WIC) would save an additional $7.5 million in formula costs. Establishment of breastfeeding support programs by employers could save $400 per baby in healthcare costs.

Passage of legislation is encouraged that would protect a woman’s right to breastfeed away from home, exempt nursing mothers from jury duty, and educate the public and employers about the importance of breast feeding and the savings that are possible from work site lactation programs.

Physician Interactions with Pharmaceutical Companies and
Decreased Quality and Increased Cost In
The U.S. Healthcare System

Jonathan D. Colen, D.O.

As long as pharmaceutical companies have existed, there has been direct pressure on physicians to recommend or prescribe their products. Patient advocate groups, leaders in organized medicine, and leaders in the field of bioethics are concerned that physician interactions with pharmaceutical representatives affect their prescribing practices in a significant way which can compromise quality care and increase health care costs.

In 2000, the pharmaceutical industry spent $54 billion annually in gifts and other marketing practices to physicians attempting to get them to prescribe their products. According to PhRMA, they spent approximately 30% of their total revenues that year which totaled $179 billion. Companies spend approximately $10.5 billion annually in the provision of samples of medications new to the market.

Sociological research has shown a ‘gifting’ relationship that results in a person feeling obligated to reciprocate no matter what the size of the gift. Based on this research, one can conclude that even a gift as insignificant as a pen may have an impact on a physicians’ prescribing practices. The concern is that doctors will prescribe less effective medications, including new brand name drugs without a generic equivalent, drugs which are not generally considered first line treatment in an evidence-based practice, and/or more expensive drugs, because doctors feel obligated to the pharmaceutical sales representative and depend on his provision of samples. Because of this, some medical organizations have advocated for limiting, or even avoiding, physician contact with pharmaceutical companies and their representatives.

Universal Health Coverage

William J. Garrity, D.O., M.A.

Healthcare in the United States is broken and unsustainable. Major health reform is needed to cover the uninsured. Lack of insurance worsens disease and weakens the economy. The effectiveness of medical interventions, particularly medical technologies and pharmaceuticals, continues to increase, improving health and longevity and demand for health services. However, about one in six people - 46.6 million - lacked insurance for all of 2005, according to the US Census Bureau, an increase of 6.8 million since 2000. More than eight out of ten of the uninsured are in working families.

Those in favor of universal health care argue that it would provide healthcare to people who currently do not have it. Opponents of universal healthcare argue that universal healthcare will require higher taxes, and a great likelihood of poorly performing healthcare facilities and physicians. These opponents also claim the absence of a market mechanism may slow innovation in treatment and research and lead to rationing of care through waiting lists. Both sides of the political system have debated whether or not people have a fundamental right to have health care provided to them by the government.

The benefits of universal coverage based on a plan similar to the original Clinton reform effort will enrich all Americans in terms of improved health and longer life span. Greater economic productivity, financial security and the stabilization of community health care systems will result. Unless universal coverage can be assured, the nation will continue to suffer the unintended consequences of the status quo.

“HIT” A Higher Standard of Healthcare

Joseph A Giaimo, D.O., FACOI, FCCP

Health Information Technology (HIT) is the wave of the future. Like it or not, electronic medical records (EMR) will likely be implemented in most medical practices within the next five years.

The primary beneficiary of EMR will be the patient. The quality of the patient’s healthcare experience will improve because EMR will create a structure for a disease-management approach to caring for patients. All members of a patient’s care team will have full access to the patient’s complete chart as they each see the patient. This will reduce medical errors, reduce redundant testing, and reduce health care costs by cutting back on paperwork and administrative expenses. Overall public health will also benefit from EMR by providing early detection of disease outbreaks and improved tracking of chronic disease management.

Whether it’s by government mandate or whether HIT is adopted willingly and embraced by physicians and patients—it is important for physicians to be vocal and participate in this process. Physicians could be particularly helpful in shaping the HIT system as it pertains to privacy concerns. These concerns should be addressed before any federal or physician endorsement.

Trends in Employer Health Benefits for Early Retirees: Gloom, Doom
or some Hope?

Wolfgang G. Gilliar, D.O., FAAPMR

Retiree health benefits bridge a potentially risky gap in coverage for many who retire before they are eligible for Medicare. But over the past two decades, a steady erosion of retiree health insurance benefits threatens to increase the number of early retirees who are uninsured. Large employers’contributions to retiree benefits has dropped by nearly half - from 30 percent in 1993 to 18 percent in 2006. Employers are responding to rising health insurance premiums by shifting more of their costs to employees in the form of greater premium contributions, higher deductibles, larger co-payments, and slower wage increases. Currently about 800,000 early retirees (pre-65) have no health insurance. Postponing retirement may help provide coverage for some, but more widespread solutions are needed.

Three in four surveyed firms say they have not set aside money in the past three years to help cover their anticipated future expenses for retiree health benefits. Furthermore, employers generally reserve the right to change retiree benefits at any time; many workers, especially younger ones now employed by firms that offer retiree health benefits, might find their benefits have been eliminated by the time they retire.

Employer-based solutions, individual early retiree options, and government intervention must address eroding employer-sponsored retiree health benefits. Unless tenable, long-term solutions are implemented today, lack of access to healthcare for people between the ages 50 and 59 will assume hitherto unknown proportions during the next ten years.

Impact of Health Savings Accounts on Access to Affordable Health Insurance

Roy W. Harris. D.O., FACOI

Of the 45 million uninsured, approximately sixty percent work for a small business. Concerns mount this number will continue to grow because businesses are finding it more and more difficult to offer health insurance. The percentage of US workers covered by employer-sponsored insurance declined from 81% in 2001 to 77% in 2005. The smallest employers provide coverage least often: 72% of those with ten to twenty-four employees, and fewer than half of those with three to nine employees.

High-deductible health plans (HDHPs) coupled with tax exempt health savings accounts (HSAs) are consumer-driven health plans that offer an affordable alternative to conventional health insurance. The Government Accountability Office (GAO) estimates as many as eight million people who would have been uninsured now have insurance due to the lower premium costs of high-deductible health plans. While they are not a viable option for low wage families or for the chronically ill, high-deductible health plans do offer a potential opportunity for over 17 million currently uninsured individuals earning over $50,000 a year to obtain affordable health insurance.

A Rand Corporation study tracked health-care spending by 2,000 families over eight years. Families who received free health care spent 40% more than the families with cost-sharing arrangements, but the health outcomes for the two groups were the same. Market-based health insurance systems such as high-deductible health plans and health savings accounts cut out inefficiencies and lower costs without compromising quality.

Obesity Prevention and Education Proposal

Robert Hasty, D.O.

Over 2000 years ago, Hippocrates said, “Persons who are naturally fat are apt to die earlier than those who are slender.” Modern evidence suggests this observation is true. Obesity is directly associated with 300,000 deaths each year and may soon cause more preventable disease and death than cigarette smoking. Obesity causes many adverse health conditions such as heart disease and diabetes. Due to the effects of obesity on public health, human longevity is expected to shorten in the US during the 21st century.

The prevalence of obesity is rapidly and steadily increasing. 64% of all adults are overweight, while over a third are obese and 5% are morbidly obese. Obesity causes more deaths each year than AIDS, breast cancer and motor vehicle accidents combined. Additionally, obesity consumes 9.1% of all health care expenditures annually or approximately $178 billion. Obesity prevention and education has the potential to positively affect health care and will help to control health care costs.

Public health law has become the most powerful tool to affect healthcare. This brief will present an innovative and comprehensive public health proposal that has the potential to improve the health of our citizens. The intent of the Obesity Prevention and Public Education program (OPPE) is to promote and maintain a healthy weight for Americans. The proposal includes education, incentives, public awareness, and re-branding campaigns.

Medicare Prescription Drug Price Negotiation Act of 2007

Chellappa Kumar Ph.D.

The Medicare Modernization Act of 2003 (MMA) created a drug benefit within Medicare, the Part D benefit. This benefit, welcomed by more than 38 million beneficiaries, covers most of their prescription drug expenses. The MMA legislated that the prescription drug benefit be managed and administered essentially by the private sector. The Secretary of Health and Human Services was prohibited from negotiating the prices of drugs, nor could he set price restrictions or formularies in place.

Based on the argument this prohibition on federal involvement in drug price negotiation is injurious to senior citizens, favors pharmaceutical companies, and that the abolition of this provision will produce lower drug prices for senior citizens, a legislative effort is underway to repeal parts of the prohibition.

The government should seek to regain and retain the power to negotiate with the drug manufacturers. True, such power should not be used hastily or haphazardly. But the very fact that such a blunt weapon exists is likely to forewarn pharmaceutical companies away from excessive profiteering and render the actual exercise of the power unnecessary. If the federal government is to pay most of the bill, why should it not be able to participate in negotiations and ensure that the money is wisely spent? Why should the one who pays the piper not call the tune?

The Resident Physician Shortage Reduction Act of 2007

George Mychaskiw II, DO, FAAP

The United States is facing a physician shortage as the baby boom generation reaches retirement. One solution is to increase the number of medical students. Medical school, however, does not make a physician qualified for practice. Nearly all graduates of medical schools must pursue residency training before they become practicing physicians. Since the Balanced Budget Act of 1997, the number of residency slots has been capped and cannot increase to meet the planned expansion of medical school enrollment.

The Resident Physician Shortage Reduction Act of 2007 would direct the Secretary of Health and Human Services to increase the Medicare caps on graduate medical education (GME) in states identified as having a shortage of residents. The Secretary would also be directed to consider whether the new programs are in primary care, preventative medicine, or geriatrics.

Organized medical and academic medicine groups believe the availability of physicians is a public good and the number of physicians should be increased as the population ages. These groups feel the bill is one step in the right direction to address the upcoming physician shortage. Opponents of the Act will likely be those who have opposed federal GME funding in the past, including CMS, free-market economists, and physician extender organizations.

The Resident Physician Shortage Reduction Act of 2007 should become law. For the first time, this legislation would make it possible to leverage GME funding to achieve workforce goals.

State Patient Safety Organizations: Creation of Non-Punitive, Sentinel Events Reporting System

Anthony F. Ognjan, D.O., FACP

Hospital errors kill more Americans than breast cancer, traffic accidents or AIDS. Preventable health care-related errors cost a large hospital more than $5 million per year and cost the economy from $8 to $15 billion each year.

In 2005, the Patient Safety and Quality Improvement Act of 2005 (PSQIA) authorized a state-created and supported network of Patient Safety Organizations (PSOs) intended to improve and promote patient safety by coordinating patient safety efforts. The PSO’s primary focus is educating health care professionals, purchasers, consumers, and policymakers about medical errors, the culture of safety, and strategies for reducing risks.

However, unintended consequences hamper patient safety efforts:

? Institutions and health care providers are less likely to cooperate with data collection if the PSO is used to collect non-relevant personal, financial, licensing or discipline data;
? Health care providers and institutions may avoid sicker patients to avoid poor patient outcomes data reports;
? CMS may (eventually) use the PSO database to implement pay-for-performance for hospitals and health care workers;
? Financial support for the activities of the centers is problematic.

For a safety data reporting network to be successful, it is essential it address health care industry and provider concerns; ensure that safety initiatives perform as envisioned; and function as a financial viable, voluntary, non-punitive, legally protected system of reporting, analysis, and feedback.

The Medical Home Model:
An Opportunity for Osteopathic Family Practice

J. David Scott, DO, MS

The US healthcare system is increasingly fragmented and expensive. Health care is poorly coordinated between providers, and reimbursement favors increased physician sub-specialization and procedures over preventive medicine and disease management. Not only are new graduates fleeing primary care, but current primary care physicians are getting older, and projections suggest significant shortages in the not too distant future. Primary care physicians have begun to question their relevance in the future of healthcare.

The Institute of Medicine’s (IOM) report Crossing the Quality Chasm: A New Health System for the 21st Century, argued for an overhaul of health care with an emphasis on safety, effectiveness, patient-centeredness, timeliness, and efficiency. The IOM report stressed the importance of primary care as a fundamental aspect of a viable health care system. Physician organizations re-evaluating primary care have embraced the concept of the Medical Home Model (MHM) as a vehicle to achieve the goals of the IOM report. In an environment where change in the healthcare system is incremental at best, the MHM can improve the value of delivered services and influence market and public funding for those services. A value-driven reform of primary care could catalyze change throughout the health care system as a whole.

Osteopathic family physicians are unique in that they are poised to provide additional value to their patients due to their holistic approach and training in osteopathic manipulative medicine. The MHM would be a natural fit for the osteopathic physician and measured outcomes would provide comparisons with other provider types. Integration of MHM and osteopathic medicine could further raise the profile of the profession in the public eye.