The JUA Journey

I am not a NH JUA policy holder but I believe it is important for all NHMS members to understand that lead plaintiffs in the NH Supreme Court case, Dr. Georgia Tuttle, Lakes Region General Hospital and Derry Medical Center, with support of NHMS, successfully sued the state and JUA to stop the state from taking $110 million excess surplus belonging to policyholders.   

Our Role in Price Transparency

“A lack of transparency results in distrust and a deep sense of insecurity.” Dalai Lama   Last week Time magazine dedicated it's entire feature to the high cost of medical care, the causes, and what can be done about it.  The journalist, Steve Brill, picked apart bills to better understand why health care costs so much.  It really is an interesting and thought provoking piece and I recommend it to you all.

Where there's smoke...

Smoking is on the minds of our legislators. Both tobacco and marijuana have been the subjects of spirited discussion and hearings the past few weeks and NHMS has been present bringing the voice of science, reason, and our patients. In regards to tobacco, NHMS has prepared a policy analysis (see report) that looks at the impact of a tobacco tax increase, taking into consideration the following:

• Smoking costs an average of $2,784 in direct medical expenses per smoker per year;
• Tobacco price increases of 10% consistently yield a 4% decrease in adult smoking and a 7% decrease in youth smoking;
• People of low socio-economic status have much higher smoking rates and poorer health outcomes; and
• The smoking rate among Medicaid beneficiaries is 57% compared to the overall NH of 19%.

A Worthwhile Trip to D.C.

Last week I had the pleasure of joining Scott Colby, the NHMS Executive Vice President and Dr. Gary Woods, the NHMS Delegate to the AMA, for the annual AMA National Advocacy Conference and Lobby Day in Washington, DC.  Each year the AMA sponsors this conference to update us on current national policy issues and to provide us an opportunity to meet with our congressional delegation to discuss those issues.  We learned about: the challenges of paying for Graduate Medical Education and workforce adequacy; proposals coming out of the CMS Innovations Center; and that everyone wants to fix the SGR but no one believes a permanent fix is possible... for now.  The conference was informational and prepared us to meet with our delegation.

Health Disparities & Patient Diversity - Our Call to Action

Several weeks ago I saw a patient who exhibited many of the classic signs of depression, depressed mood, trouble sleeping, fatigue, and weight gain, so I administered a PHQ-9, a standard assessment tool for depression and confirmed my suspicions.  We discussed the diagnosis of depression, what it means and options for treatment, as is usual for my practice as a family doctor.  Usually, we (the patient and I) make progress in creating a patient centered approach to address their condition, but that day, I found my usual practice came up short.  

NHMS Testifies in Support of Raising the Tobacco Tax

Yesterday, I testified on behalf of NHMS in support of HB490, a bill to change the tax rate on tobacco products -- other than cigarettes -- to a price which is equivalent to the tax rate on cigarettes. The bill also proposes to establish a tobacco use prevention and cessation program.

I went through a few familiar points such as tobacco being the only legal product that kills 1/3 of its users; and 31,000 of children in New Hampshire today will die from a tobacco related illness.

NHMS Focusing Advocacy Efforts To Address Excessive Alcohol Consumption.

All of us know the human costs of excessive alcohol consumption. In our work we see the impact on individuals, families and communities in human terms. Problem drinking is something we see all too often. New Hampshire ranks among the top five heaviest drinking states. Some estimates place us first in per capita beer consumption while at the same time we rank 49th in access to substance abuse treatment. An estimated 96,000 residents are in need of treatment for excessive drinking but only 4% of them receive treatment.  Unfortunately, these statistics and our patients' stories have had little impact in garnering attention to expand prevention and treatment given the current economic environment until now. Last Friday, New Futures released a report that quantifies the costs of excessive alcohol intake on New Hampshire in dollars and cents and the results are shocking.

NHMS Explores Physician Buddy Support System to Help in Time of Need.

To test a physician's reflexes, one need only say the words "malpractice lawsuit."  Virtually all of us have a visceral reaction when we talk about litigation.  While the financial costs of malpractice are what dominate the headlines, the emotional toll associated with malpractice is often much higher.  Because of this, NHMS has been very active for malpractice reform with legislative solutions such as Early Offer, I'm Sorry, and the 519-B Malpractice Panel law.

It is important we remember that individual physicians who are sued often experience fear and isolation -- feelings that affect their confidence and that may alter, or even end, their practice.  Once a suit has been lodged against us, we are immediately instructed by our lawyers to not talk to anyone about it -- thus cutting us off from our personal and professional support networks.  This isolation may last years, as cases crawl through the legal system, and have long term effects on the individual physician.

Supporting Mental Health Crisis.

On Monday of this week, I joined representatives from a variety of health profession, law enforcement, and patient advocacy organizations to speak about the mental health crisis in New Hampshire.  The National Alliance on Mental Illness New Hampshire (NAMINH) organized the press conference to share new data on the excessive wait times for people in mental health crisis.  

At the time of Monday's press conference, 31 adults and five children sat languishing in hospital emergency rooms across the state waiting for a bed to open at the New Hampshire State Psychiatric Hospital.  Since July, there have been a minimum of 30 patients per week waiting for admission, with a maximum of 120.  You can read full  details here.

Staying True to Our Values.

Happy New Year!  Many bring in the New Year with resolutions to go to the gym, quit smoking, read more, learn a new hobby or skill and the list goes on.  I won't be joining the estimated 40% of Americans who make these resolutions.  Like most Americans, I'm not very good at keeping them.  Rather, I plan to revisit my list of values that help guide me in life, those  things and ideas that anchor me in my work and home life.  The busy nature of our lives as physicians often leaves us with little time to reflect on our days and what gives meaning to the work we do.