The AMA Monopolizing Patient Access to Other Providers.

From Earth Times, an article on how the Coalition for Patients Rights is working to ensure that patients can access cheaper, effective health care professions other than MDs. The AMA has a stranglehold on not only medical training but licensing, they represent a strong lobby that pressures states to qualify the scope of what other medical professions may provide. It's an old story, big pushy association works to make it's members only game in town.

Here's a clip from the article:

“There is an abundance of evidence that shows patients achieve equal or better health outcomes at lower cost to themselves and the health care system when they fully incorporate a range of health care professionals in their delivery system,” said Maureen Shekleton, PhD, RN, FAAN, a spokesperson for the Coalition for Patients’ Rights™ (CPR). CPR is comprised of more than 35 member organizations representing a variety of licensed health care professionals who provide a diverse array of safe, effective and affordable health care services to millions of patients each year.

There are numerous studies that show the high quality and cost-effectiveness of the care provided by professionals other than MDs/DOs. Collectively, these data substantiate the likelihood for more cost-effective care. Highlights include:

States are charged with overseeing each profession’s scope of practice and ensuring it is safe based on the education and training of the professionals. While research backs the clinical value of promoting access to health care providers besides MDs/DOs, state regulations can hinder access for patients. There are significant lobbying and advocacy efforts under way by some of the physician community to seek restrictions to the scope of practice of other health care professionals. For example, the American Medical Association (AMA) is actively working on advocacy documents that question, despite clear evidence to the contrary, the quality of care delivered by health care professionals who provide some of the same services as physicians.

“These efforts to lobby lawmakers and regulators are not only wasteful and divisive, but do a disservice to the public who have been benefitting from the care of these practitioners for decades,” said Shekleton. “Our health care system is already overburdened with shortages of qualified practitioners. As the oldest professional health care society in the United States, the AMA should be fostering a collaborative environment that meets the needs of patients, not looking to restrict the practice of qualified licensed practitioners and trying to prevent patients from seeing the provider of their choice.”

CPR members are dedicated to achieving optimal health outcomes for patients in a cost-effective way. As policymakers address how to control costs and expand insurance coverage, it will be critical to include all qualified health care professionals. “Ensuring and promoting the rights of patients to choose this kind of care is good for patients and it’s good for our health care system overall,” said Shekleton. “If we can be prudent with our financial resources and still ensure good outcomes for patients - it’s a win-win situation that policymakers should support.”

How to discuss Costs in End of Life Care.

More GeriPal fandom. Today they have a discussion about how end of life care and cost should be discussed:

If I have to take a stand on what I see as an essentially normative ethical issue, I would argue that promoting informed patient choices should be the objective of the palliative care community (one could make a similar argument about the geriatrics community). While reducing costs and reducing suffering are laudable goals, for both ethical and pragmatic reasons, they are unlikely to be successful in today’s political climate.

I also believe that these issues are inextricably intertwined. How we (we meaning the palliative care community in this case) promote ourselves and address the cost issue depends on our audience. Hospitals and health systems see palliative care clinicians as cost reducers and referring providers see us as reducers of suffering. Costs savings mean little to referring providers, and reducing suffering means little to health systems (I’ve heard Diane Meier say of reduced suffering as a goal in and of itself, "that and 50 cents will get you a cup of coffee”). We need to demonstrate cost savings to grow outside of the inpatient and hospice settings. We need to demonstrate reduced suffering so providers will refer patients to us. And for ourselves, for our patients and their families, we need to say honestly that we are helping them navigate serious illness with the goal of promoting their best interests.

I've long said that providing patients with informed choices for their care, particularly their end of life care, ameliorates rationing by reducing costs. It's great to see end of life care professionals debating this subject.