What's at Stake for Docs in Va. Election Results? Page 1 of 15

The Leg.Up Local, state and national news of interest to the physician community November 6, 2013

Mark B. Monahan, MD Urology

Richard A. Szucs, MD Commonwealth Radiology

Ritsu Kuno, MD Pulmonary Associates of Richmond

In This Issue Vote for your 2014 Board of Trustees Vote to AFFIRM Your RAM Board! Please VOTE now to AFFIRM the proposed McAuliffe & Northam leadership of the Academy for 2014. Yes, Victories and You! it's an uncontested election, but by casting your vote of affirmation you send a strong Coming Soon: "Obama message of support for the proposed 2014 Billionaires" officers and trustees. SNL, Stewart and For 2014, we are voting on the following trustees: Congress Target Sebelius

Meet Your Legislators! • Immediate Past President - Richard A. Szucs, MD • President - Peter A. Zedler, MD You Also Can't Keep Your • Vice-President - Harry D. Bear, MD Doctor • Treasurer - Ritsu Kuno, MD • Secretary - Sidney Jones III, MD Why HealthCare.gov • Trustee - Carolyn A. Burns, MD Flopped • Trustee - W. Colin Gallahan, MD • Trustee - Rhoda B. Mahoney, MD • Trustee - Harry (Chip) J. Shaia, MD

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Most New Coverage in • Trustee - Thomas A. Gallo Medicaid

Dr. Avital to Speak at Bon Please click here to learn more Secours' Lecture about each candidate. Should Feds Oversee EMR Please click here to vote in the Errors? 2014 elections OR join us at The Devil (and the the University of Richmond's lawsuit) is in the Details Jepson Alumni Center on November 13th to vote! "Gentlemanly Cavaliers" and Dirty Money in Va. Politics

Will Congress Replace What McAuliffe's and Northam's Wins Mean for Medicare's SGR? Physicians

To Sleep Perchance to ... Democrat Terry McAuliffe's narrow 3 point victory over Cleanse? Republican - by a 48 to 45 margin, with "I no longer wanted to be Libertarian Robert Sarvis getting 7 percent of the vote - a surgeon" is sure to keep reverberating across the state and national political landscape. Struggles of Boston Amputees Mount The disastrous roll Cabbage Compound out of the Protects Healthy Tissue federal health from Radiation Damage insurance exchange Is "Scrubbing In" the helped WORST Doc Show Ever? Attorney General What's Coming Up on Cuccinelli RAM Calendar? defy pundits' predictions of a much larger win by McAuliffe's Victory Wave McAuliffe. And with the General Assembly set to take up Medicaid expansion as a first order of business in 2014, physicians will want to keep a close eye (and be part of the conversation) in the days ahead.

Doctors have a new advocate in the No. 2 Virginia office, one who can cast tie-breaking votes in the state Senate: Democrat Ralph Northam, a veteran state senator and pediatric neurologist in Norfolk, handily defeated Republican E.W. Jackson by a 12 point margin (56-44) for Lieutenant Governor.

In the hotly contested race for attorney general, the battle between the GOP's Mark Obenshain and Democrat Mark Herring was considered a virtual tie today and is expected to require a recount. Click here for the most

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recent results.

"What Republicans will debate was whether Cucinelli was personally too conservative - and his party too toxic after the recent government shutdown - for what is now a classic swing state," writes political analyst Dan Balz in today's Washington Post.

With the overwhelming victory of Republican Gov. Chris Christie in New Jersey - making him a leading contender for the GOP's 2016 presidential nomination - Future President Emerges? Balz writes that "the outcomes set up a battle for power between competing wings of the Republican Party. Call it the establishment vs. the tea party, or the gubernatorial wing against the congressional wing. This competition is less about ideology or policy - there is no disunity, for example, when it comes to the party's dislike of President Obama's Affordable Care Act - than about purity vs. pragmatism, tactics and strategy. Or, as Christie has put it, it is about winning an argument vs. winning elections."

However that struggle for the heart and soul of the Republican Party plays out, it's pretty clear that Cuccinelli's success in improving his own vote count by attacking Obamacare is sure to "make opposition to the health-care law the first page of the playbook for 2014 races, and possibly for 2016 as well," writes Balz.

Back in Virginia, Dr. Ralph Northam, 54, thanked female voters for their support, "returning to the abortion rights theme of his campaign, saying male legislators have no place telling women what to do with their bodies," reports the Virginian-Pilot.

"Among the lessons he learned, he said, is that Virginians want their leaders to focus on the economy and jobs. He called for investments in transportation and education."

McAuliffe's victory marks the first time since Reconstruction that a political party has held Virginia's governorship for only one term. Voters also bucked a trend going back to 1976 of electing a governor of the opposite political party the year after a president's election.

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With voter backlash against Obamacare helping Cuccinelli improve his odds at the ballot box, and the uncertainty about expanding Medicaid, RAM members will have plenty to chew on before next year's White Coats on Call visits to the General Assembly! You can get a head start on chatting with YOUR legislators by joining in on our "Legislator Meet & Greets" later this month (please see item below!)

Click here to read this analysis by veteran political writer David Ress in The . "McAuliffe's precedent shattering election leaves Virginia with an even more divided state government," he writes. "The GOP remains in firm control of the House of Delegates. There now will be a Democratic lieutenant governor to break tie votes in the evenly divided state Senate, a role that Republican Lt. Gov. Bill Bolling used to help make GOP-backed voter ID and education reforms law. And McAuliffe seems likely to be working with a Republican attorney general."

While the latter statement is questionable -- the recount may go the Democrats' way -- Ress and other pundits are seeing possibly polarizing times ahead. Though McAuliffe thanked "historic numbers of Republicans who crossed party lines to support me," and, according to this report in The New York Times "invoked a tradition of bipartisanship in Richmond" (lauding outgoing Republican governor Bob McDonnell), others see hard times ahead in Virginia's capital.

"It will be just like Congress - just an ugly, ugly mess," one veteran Richmond lobbyist told the Times-Dispatch. "Look what the Republicans did to and Tim Kaine. I can't see how they're going to let (McAuliffe) have a free ride."

So when it comes to Democratic proposals to expand Medicaid, McAuliffe will have his "hands full, " Schapiro said today on WCVE/NPR.

Coming Soon: "Obamacare Billionaires"

From the "if you can't beat 'em, join 'em" department:

While many Republicans still oppose Obamacare, other members of the GOP on Wall Street have seen its profit potential, priming the pump for the first wave of "Obamacare billionaires," Adam Davidson writes in The New York Times Magazine.

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While the prevailing narrative among Republicans has been a "government takeover" of medicine, Tom Scully, former CMS director under President George W. Bush in 2001, and a longtime Republican-turned- entrepreneur, told a crowd at New York's posh "21" Club:

"It's not a government takeover of medicine. It's the privatization of health care," Scully said. Obamacare "was largely based on past Tom Scully Republican initiatives. If you took George H.W. Bush's health plan and removed the label, you'd think it was Obamacare."

Scully, who helped design and execute Medicare Part D while at CMS, has been telling interested investors, the Times reports, that "no matter what investors thought about Obamacare politically ... the law was going to make some people very rich."

The ACA, Davidson writes, "wasn't simply a law that mandated insurance for the uninsured. Instead, it would fundamentally transform the basic business model of medicine. With the right understanding of the industry, private-sector markets and bureaucratic rules, savvy investors could help underwrite innovative companies specifically designed to profit from the law. Billions could flow from Washington to Wall Street, indeed."

And that's why this Republican health care advisor turned investor has taken a different tack: "During the past three years, as other Republicans have tried to overturn Obamacare, Scully searched for a way to make a killing from it."

He co-founded a company based in Nashville, naviHealth, "designed to streamline an enormous but often overlooked corner of the health care market that, many studies conclude, is the most financially wasteful: post-acute care."

Though the idea appears sound, the current competition for market dominance reminds Davidson of the early days of (which beat out Yahoo) and Amazon (which beat out many other online retail stores, such as Pets.com).

So while Scully might make another billion or two, there's no guarantee. But, the article concludes, someone will. "Maybe we're too early," he said of his start-up. "In five years, there will be a dozen companies like naviHealth competing in the space. I hope we make it."

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SNL Skit: "Have You Tried Restarting Your Computer"

HHS Secretary Kathleen Sebelius had plenty of chances to prepare for her ongoing grilling in Congress. Click here to watch a sketch about her on "Saturday Night Live" which includes such computer tips as "have you tried restarting your computer" and the Web address for "kayak.com" so "you can visit Canada and buy cheaper drugs."

If you missed Jon Stewart's actual interview with Secretary Sebelius, click here.

Check out this feature article about how D.C. "exults in counting coffin nails" for cabinet officials who, like Sebelius, are under fire.

Legislator Meet & Greets

Please join us for an upcoming legislator meet and greet. It's important to know your elected leaders and to take every opportunity to meet with them. Come enjoy light refreshments and a discussion of physicians' concerns. We want to see you there!

TUESDAY, NOVEMBER 19TH 7:00 ­ 8:00 a.m. at

1115 Boulders Parkway, Suite 200 North Chesterfield, VA 23225

Meet with Senators Martin & Watkins and Delegates Ingram, Loupassi, O'Bannon and Ware!

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CLICK HERE to register!

*************************

THURSDAY, NOVEMBER 21ST 6:00 ­ 7:00 p.m. at

Reynolds Crossing 6605 West Broad Street, Suite A Richmond, VA 23220

Meet with Delegates Dance, Ingram, Massie, McQuinn and Peace!

CLICK HERE to register!

Questions? Contact Lara Knowles at 643­6631 or via email at [email protected]

You Also Can't Keep Your Doctor

As physicians lose patients who are having individual health insurance policies cancelled as a result of Obamacare, this column in The Wall Street Journal may be of interest:

"Everyone now is clamoring about Affordable Care Act winners and losers," writes Edie L. Sundby, a cancer patient from San Diego, Calif. "I am one of the losers."

Sundby says her grievance "is not political" because, as someone with stage-4 gallbladder cancer, she says she doesn't have time for politics. But though she has defied the odds thus far, she says, "this luck may have just run out. My affordable, lifesaving medical insurance policy has been canceled effective Dec. 31."

She describes her poor choices: Either obtain coverage through California's health exchange and lose access to her cancer doctors, "or pay much more for insurance outside the exchange (the quotes average 40 percent to 50 percent

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more) for the privilege of starting over with an unfair insurance company and impaired benefits."

She was happy with her United Healthcare health insurance policy - which has paid $1.2 million with no questions of any treatment or procedure recommended by her top-flight medical team in California and . But now UHC has informed her they're pulling out of the individual California market - with little option than to seek coverage on her state's health exchange.

"What happened to the president's promise, 'You can keep your health plan'? Or to the promise that 'You can keep your doctor'? Thanks to the law, I have been forced to give up a world-class health plan. The exchange would force me to give up a world-class physician...

"Take away people's ability to control their medical- coverage choices and they may die. I guess that's a highly effective way to control medical costs. Perhaps that's the point."

Click here to read how Obamacare is now "getting real" for millions of people losing their individual coverage. And here for a Journal article detailing how "many new health exchanges don't yet let shoppers see which doctors accept which insurance plans."

And where exchanges do post provider lists, "They often contain inaccurate or misleading information, some doctors say, including wrong specialties, addresses and language skills, and no indication whether providers are accepting new patients."

And here for an NPR report about matching affordable insurance plans with the right providers. "Insurers are often locked in a tug-of-war over prices. Smaller clinics and doctors' offices have a lot less leverage than hospitals - but they also need to make decisions about which insurance networks to join. And many are sitting on the sidelines."

As one doctor at a large family health clinic in New York complained, "They claim that they are putting their premiums out on the street at a very low rate to make them affordable. But we can't afford to see a patient for the same amount of money that a private doctor in their office with one assistant can."

A poll of New York doctors found that three-fourths of them are either not participating in exchange plans or are unsure if they are.

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Why HealthCare.gov Flopped

So WHAT HAPPENED? Click here to read an in-depth look at how President Obama and his advisors dropped the ball when they failed to get the federal health exchange ready for business Oct. 1.

In May 2010, two months after the Affordable Care Act squeaked through Congress, some of Obama's top economic advisers issued a "pointed four-page memo from a trusted outside health advisor" warning the president "that no one in the administration was 'up to the task' of overseeing the construction of an insurance exchange and other intricacies of translating the 2,000-page statute into reality."

In the end, though, "the economic team never had a chance" because Obama had made up his mind to leave the mega-project in the hands of his health policy team, led by Nancy-Ann DeParele, director of the White House Office of Health Reform."

Now, "Three-and-a-half years later, such insularity - in that decision and others that would follow - has emerged as a central factor in the disastrous rollout of the new federal health insurance marketplace, casting doubt on such a complex undertaking."

David Cutler, a Harvard professor and former health advisor to the Obama campaign, wrote the "pointed" memo rejected by Obama. "They were running the biggest start-up in the world, and they didn't have anyone who had run a start-up, or even run a business."

Here's a related article, "Five Myths about the Affordable Care Act."

The New York Times reported this week that millions of people are eligible for free "bronze" level polices, but the insurance companies and the Obama administration aren't promoting them as much as slightly more expensive "silver" level policies that have fewer out of-of-pocket costs.

Most New Coverage in Medicaid

Amid the disastrous startup to the federal health insurance exchange comes this news from :

Even as few people have been able to sign up for private insurance, there has been "crush of people applying for an expansion of Medicaid" around the U.S.

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Will it happen in Virginia, which so far has chosen not to expand Medicaid? (Read election story above!)

Bon Secours' First Ken Drumheller Gastric Cancer Lectureship

Dr. Itzhak Avital, MD, FACS, executive medical director of the Bon Secours Cancer Institute , will speak at the first Ken Drumheller Gastric Cancer Lectureship at 6 p.m. Thursday, Nov. 14 at Ruth's Chris Steak House at 11500 W. Huguenot Road, Midlothian, Va. 23113.

His topic will be "Gastric Cancer: Early Diagnosis, Carcinomatosis and Implications for Diagnosing Physicians." All diagnosing physicians are invited to attend. To register, or for more information, call 804- 287-7809.

Dr. Avital is a fellow of the American College of Surgeons and a nationally- recognized expert in surgical oncology, gastric cancer and hepatobiliary surgery. He joined Bon Secours in June Dr. Itzhak Avital to speak 2012 from the National Institutes of Health, and before that was at Memorial Sloan- Kettering Cancer Center.

Should Feds Oversee EMR Errors?

With more than half of all U.S. doctors adopting electronic medical records, Scientific American comments, "For all of their promise, however, electronic medical records have their own flaws. In dozens of known cases, caregivers have entered information into the wrong chart or listed important details - such as drug dosages - incorrectly."

The magazine calls for the creation of a national safety board - under the control of the U.S. Department of Health and Human Services - to collect data on e-record errors.

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"The board would operate much like the National Transportation Safety Board," and could be modeled on a state system in Pennsylvania that "has uncovered thousands of e-record problems - from misreported laboratory tests to incorrect prescriptions," the magazine says in an editorial.

"Almost 90 percent of these reports are close calls instead of adverse events, but still the data help to pinpoint what is causing the problem."

The VA also tracks electronic errors on a voluntary basis, providing "only a partial snapshot."

Still, given the terrible rollout by HHS of Healthcare.gov, physicians are sure to be leery of anything else involving the government and data entry any time soon!

Click here to read a FierceEMR.com article about how "the inadequate use of Memphis VA Medical Center's" electronic health record "led to the deaths of at least two patients in its emergency department." Those errors were discovered by the Department of Veteran Affairs' Office of Inspector General.

The Devil (and the lawsuit) is in the Details

Physicians must be certain there's a process in place to ensure that no imagining, laboratory, or consultant's report is ever filed unless it has been dated and initialed by the physician as proof that it was reviewed. Many medical liability claims would be prevented by this simple policy.

It's also important to create a suspense file or electronic health record follow-up list for all ordered imaging studies, laboratory tests, diagnostic procedures, and consultation - to ensure that they were completed and that the physician reviewed the reports.

Click here to see the rest of this informative advice from The Doctors Company. See "recent updates" for the rest of the story!

"Gentlemanly Cavaliers" and Dirty Money in Va. Politics

"It's known as the Virginia way," writes Peter Galuszka in this Washington Post Outlook column.

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"Richmond political culture clings to a quaint notion that its elected representatives are gentlemen and ladies who are above the petty venality that afflicts lesser states."

Galuszka, a longtime Virginia reporter and former editor of Virginia Business, details everything from the McDonnell gift scandal to the easy money doled out by the state's tobacco commission.

Though there will plenty of talk about forming an ethics commission in the 2014 General Assembly, he predicts merely "small, cosmetic shifts" in the laws that govern giving (and receiving) to legislators.

"The current political structure is just too entrenched to change more dramatically," he writes. "Plus, deep down, some Virginians still want to believe the myth of the gentlemanly cavaliers."

Will Congress Replace Medicare's SGR?

Republican and Democratic lawmakers have agreed on a framework to replace the disastrous Medicare SGR formula for doctors.

By creating a formula for doctors that would link their reimbursements to the quality of care provided, "the plan could end the annual 'doc fix' debate," reports The Washington Post.

Unless Congress intervenes, the formula once again would reduce Medicare doctor payments by nearly 25 percent.

"For the doctors, the prospect of facing big payment cuts is a source of mounting frustration," the Post reports. "Some say the uncertainty has caused them to quit the health-care program for senior citizens and people with disabilities, and others are threatening to do so. As a result, some beneficiaries fear that they may lose access to doctors who have treated them for years."

To Sleep Perchance to... Cleanse?

"When we sleep, our brains get rid of gunk that builds up while we're awake, suggests a study that may provide new clues to treat Alzheimer's disease and other disorders," reports Foxnews.com.

The report cites a recent by scientists at the University of Rochester Medical Center. The study was praised by a colleague at the Stanford Sleep Medicine Center, where the

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medical director said that the "cleaning" was detected in the brains of sleeping mice, and there's reason to think it happens in people too.

If so, the findings may mean that for people with dementia and other mind disorders "sleep would perhaps be even more important in slowing the progression of further damage," according to the report.

The study appears in the journal Science. The Rochester study "adds fresh evidence to a long-standing view: When we close our eyes, our brains go on a cleaning spree," Foxnews.com reports.

"I no longer wanted to be a surgeon"

After describing a bus accident in Africa, a blogger in Kevinmd.com, who is a surgeon in South Africa, writes: "So it fell to me to wait ... for the helicopter to land and deliver to us what was described as a severely injured young man. It was a situation I had been in many times before...

"So when I saw my patient for the first time I was surprised by my reaction. Looking at this young man with a broken and battered body touched me... I determined to do everything and anything in my power to prevent that, although I knew that is what I would have done anyway. Only with him there was an emotional aspect to my determination."

Read on to see what happened next.

Struggles of Boston Amputees Mount

Amputees of last April's Boston Marathon bombing "find themselves on a lonely road, grappling not only with pain and repeated surgeries but with emotional fallout that includes pressure to be billboards for Boston's resilience," reports The Wall Street Journal.

"Counselors say some amputees are starting to withdraw from all the appreciative attention they've gotten - throwing out first pitches at Fenway Park and being honored at a Patriots football game - amid the realization their recoveries aren't straightforward tales of resolve and success."

Cabbage Compound Protects Healthy Tissue from Radiation Damage

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A team of U.S. researchers has found that an anti-cancer compound present in cruciferous vegetables, such as cabbage, cauliflower and broccoli, also protects rodents from lethal doses of radiation, reports Medicalnewstoday.com.

The compound, known as DIM, is already shown to be safe in humans, "so the researchers expect it could serve as a shield to protect healthy tissue in human cancer patients from damage by radiation therapy, or lesson its side effects.

"DIM has been studied as a cancer prevention agent for years, but this is the first indication that DIM can also serve as a radiation protector," said one of the researchers from Georgetown University Medical Center. The findings are reported in the Proceedings of the National Academy of Sciences (PNAS).

Is "Scrubbing In" the WORST Doc Show Ever?

Blogger "Skeptical Scalpel" writes that he doesn't watch much TV except for sports. "But I feel it is my duty to comment on medical TV shows, which I generally hate."

Critiquing an MTV offering called "Scrubbing In," he writes that not only is it the "worst medical show I've ever seen, it might also be the worst television show in history."

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