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Podcasts
Global Academy for Medical Education is pleased to announce its Audio and Podcasting program.
Now you can listen to Podcasts on your computer or MP3 player by clicking on the 
Audio (MP3) links.
THREE WAYS TO ACCESS THE PODCASTS:
1. Open and download any of the individual files below.
2. If you have the iTunes media player, you can subscribe to listen to Policy & Practice podcasts at the iTunes
Music Store.
3. For automatic delivery of content of each issue, copy and paste podcasts.elsevierhealth.com/imng/policypractice_rss_audio.xml to your
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February 8, 2010
Audio (MP3)
NARR: The president's vision for health care...while reform waits in the wings. Welcome to Policy & Practice, the weekly podcast from Global Medical News. I'm Todd Zwillich.
NARR: President Obama has released his proposed budget for 2011, requesting hundreds of billions of dollars for federal health programs, like Medicare, Medicaid, and the Children's Health Insurance Program. What's missing is any kind of focus on health reform. This is in stark contrast to last year, when his proposal centered on a 600 billion-dollar-plus set aside to get health reform done. This year's proposal still contains many elements that are consistent with reform and are good for doctors, says Dr. Lori Heim, president of the American Academy of Family Physicians. She praised a proposal to increase funding for the National Health Service Corps.
Heim AX: "That opens up an additional 449 opportunities for new physicians. And we know that those physicians provide care in rural and underserved areas. So I think that that's been an important part of encouraging medical students to go into primary care."
NARR: The HHS budget was also the main topic on Capitol Hill last week. Senate Finance Committee Chairman Max Baucus said that he was pleased that President Obama's proposal assumed passage of health reform. Baucus sees another plus: the budget assumes reform could cut the deficit by $150 billion over the next ten years. Baucus urged his colleagues to continue their reform efforts. HHS Secretary Kathleen Sebelius -- emphasized that the budget did not cut Medicare payments to physicians. And she said, HHS supports an overhaul of the Medicare physician payment formula so that the yearly debate over how much to pay doctors could end.
NARR: Health reform may reduce the deficit, but it's not clear how it will affect the ever-increasing rate of health spending. The latest projections were released last week. For more on the estimates, here's Alicia Ault.
AULT: Medicare's actuaries are projecting that, barring any change, spending on health care will outpace the annual growth in the economy over the next 10 years. By 2019, the nation's $4.5 trillion health bill will make up 19% of the gross domestic product. Last year, spending took a big jump, as the recession drove growth in Medicaid enrollment. Spending also rose as more people took advantage of the government's health insurance subsidy for the unemployed. If the Congress votes to keep Medicare physician pay at 2009 levels, total health spending will grow just under 5% this year, or about a percentage point less than last year. But that outlook could change - with the passage of a reform plan, or with any change to the Medicare physician pay formula.
NARR: Health reform, or at least a piece of it, will likely be front and center on Capitol Hill next week. The House looks at repealing the anti-trust exemption for health insurance companies and medical malpractice providers. It's part of a strategy to pass smaller-and Democrats hope-more popular parts of the health reform bill to avoid losing all their momentum. And that's the Policy & Practice Podcast. I'm Todd Zwillich.
February 1, 2010Audio (MP3)
NARR: The President shifts his focus from health reform...to health INSURANCE reform. Welcome to Policy & Practice, the weekly podcast from Global Medical News. I'm Todd Zwillich.
NARR: As expected, health care did come up during President Obama's State of the Union address last week....but not until about 32 minutes into the speech. Although jobs and the economy were his early focus, the President said that America still needed what he called "health insurance reform." He refrained from giving Democrats any specific direction on how to pass a bill in the wake of their recent loss of a 60-seat majority in Congress. Instead, he simply urged everyone to press on:
AX OBAMA (16 secs.): "Here's what I ask Congress, though. Don't walk away from reform. Not now. Not when we are so close. Let us find a way to come together and finish the job for the American people. Let's get it done."
NARR: In his opposition response, Virginia governor Bob McDonnell said Republicans had already offered ideas for reform, including letting families and businesses buy health insurance across state lines and reforming the tort laws. He chided the Democrats, saying the huge bill was been fully read by anyone, and that was crafted behind closed doors with special interests.
NARR: A broad coalition of unions, patient advocates, and physician organizations gathered the day of the speech...urging the President and Congress to keep working. They proposed several pathways for passing a reform bill. One was for the House and Senate should finish negotiations on the Senate-passed measure and find enough compromises to win approval in the House. Or, legislators could use reconciliation, they said. That process would include reform provisions that affect the budget, but would leave out many other policy changes. Congress should find a way to bring lawmakers together, even if it takes awhile, said Dr. Jack Lewin. He's president of the American College of Cardiology.
Lewin AX: "Let's get it done this year. Let's take this year in the congress and really have...and fix and develop a greater consensus. And maybe even more of a bipartisan consensus. Certainly between the democratic party constituencies, let's get the Blue Dogs and the rest of the democratic party together on the issues."
NARR: Physicians aren't willing to wait a year, however, to fix the Medicare payment formula, known as the sustainable growth rate, or SGR. In raising the national borrowing limit last week, the Senate made a promise to set aside enough money to avoid physician fee cuts for five years. But that promise still has to gain approval in the House and then...Congress has to agree to actually spend the money. This year's 21 percent cut will go into effect March 1 unless Congress acts. And that may not happen until late February.
NARR: House Speaker Nancy Pelosi said last week that she might break off some bits of the House and Senate bills and bring them to the floor by mid-February. But she said she was not giving up on a bigger reform package. There's guaranteed to be more maneuvering this coming week. That's the Policy & Practice Podcast, I'm Todd Zwillich.
January 25, 2010Audio (MP3)
NARR: The urgency for health reform gives way...to urgency for Medicare reform. Welcome to Policy & Practice, the weekly podcast from Global Medical News. I'm Todd Zwillich.
NARR: Last week began with the news that Massachusetts State Senator Scott Brown had pulled off an upset victory over the Democratic candidate for Ted Kennedy's vacant Senate seat. Alicia Ault has more on the chaos that followed.
AULT: Democrats found themselves blind sided - unprepared for what might happen if they lost their filibuster-proof majority. Now, with one less Democrat to vote in favor of health reform, party leaders are frantically weighing options to get a package passed. Defections began fast, with some Senate Democrats suggesting scaling back the already-passed bill. Others suggested the House quickly pass the Senate bill wholesale before the new senator was sworn in. But House Speaker Nancy Pelosi said that her Democratic colleagues would not vote for the Senate-approved plan. President Obama told an interviewer that he might accept a less-sweeping package, but that he preferred the broad plan. And perhaps slowing down the process.
NARR: While Congress considers what to do about the long term, the American Medical Association is more concerned about the short term -- specifically, an imminent 21% cut in Medicare payment rates. Under the current formula, known as the SGR, or Sustainable Growth Rate, the cut was supposed to take effect January 1st. But Congress delayed it until March 1st. Last week, in a multi-city press conference held jointly with the AARP and the Military Officers Association of America, the AMA called on Congress to permanently repeal the SGR at a cost of $200 billion. The AMA's Dr. Nancy Nielsen said the formula should be changed now before fixing it gets even more expensive.
NIELSEN: And so it's time now that Congress work with us and try hard to figure out how we're going to permanently repeal this, because to not do it now is fiscally irresponsible.
NARR: If Democrats do try to revamp their plans on health reform, they may want to pay more attention to nurses. At least that's what a new Gallup poll commissioned by the Robert Wood Johnson Foundation suggests. Gallup asked more than fifteen hundred leaders in government, health care, the insurance industry, and academia if they'd like to see nurses have more influence over health policy. More than eighty-five percent said nurses should have more clout when it comes to reducing medical errors, increasing quality, and promoting wellness and prevention. When asked what kept nurses from taking on an expanded role, sixty-nine percent said nurses aren't seen as decision-makers the way doctors are.
NARR: Well, the Massachusetts election seems to have reset at least part of the process in Washington, even though it appeared to be near its end just a couple weeks a go. We'll be following all of the agreements ... and the controversy ...including the President's State of the Union speech this week. And that's the Policy & Practice Podcast. I'm Todd Zwillich.
January 19, 2010Audio (MP3)
NARR: Crunch time for the Democrats health care plans. Welcome to Policy & Practice, the weekly podcast from Global Medical News. I'm Todd Zwillich.
NARR: Time seems to be running out for Democrats to iron out their differences and get a final health reform bill to President Obama. The President called Democratic leaders to the White House last week to reach a consensus. And labor union leaders went there too to protest the tax on high-cost health plans included in the Senate's bill. Congressional leaders agreed to delay the so-called Cadillac tax until unions can renegotiate their health benefits. That delay lasts until 2017. They also agreed to exempt more people from the tax and to shelter plans with larger numbers of women and seniors. Matt Coffina [Co-FEENA], a health insurance industry analyst at Morningstar, says the tax likely won't be a big problem for health plans' bottom lines.
AX Coffina (14 seconds): "So probably it's going to have a relatively small impact on health plans. The threshold above which the tax takes effect is going to be I think almost two times the average premium in the country."
NARR: With final deals seeming to fall into place, physicians and other health providers are looking to shore up their payments under Medicaid. A coalition of provider groups recently sent a letter to congressional leaders urging them to boost Medicaid rates for primary care in the final health reform bill. Higher rates are vital, they said, if Congress plans to dramatically expand Medicaid. The House bill increases Medicaid rates for primary care to Medicare levels over a four-year period. But the Senate bill would leave Medicaid rates as they are-and that's just not acceptable, say doctors. Dr. Joseph Stubbs, the president of the American College of Physicians:
AX Stubbs (9 seconds): "Physicians are anxious to take care of patients but the rates have to be something that does not actually cost us money to do so."
NARR: Doctors' wishes may go unfulfilled, however. In fact, the entire health reform effort is threatened by Tuesday's Senate election in Massachusetts. Voters are choosing a successor to the late Ted Kennedy, a Democrat and staunch health reform supporter. After early leads of as much as 30 points in the polls for Democrat Martha Coakley, the race is now a dead heat with GOP state Sen. Scott Brown. Brown has said that if he's elected, he'll vote against health reform. That has Democrats scrambling to get the work done before the Massachusetts winner is certified and sworn in to the Senate.
NARR: In Washington, Democrats want to have health reform done in time for the President's State of the Union address. But here's a sign of just how fluid the situation is. The annual speech usually takes place in late January. But with health reform still undone, Congressional leaders STILL haven't scheduled the speech. And that's the Policy & Practice Podcast. I'm Todd Zwillich.
January 11, 2010Audio (MP3)
It's a new year but an old issue. Congress is trying to wrap up health reform. Welcome to Policy & Practice, the weekly podcast of Global Medical News. I'm Todd Zwillich.
NARR: It appears that Republicans are running out of time in their fight against health reform legislation. Mary Ellen Schneider has more.
MARY ELLEN (30 sec): President Obama and Democratic congressional leaders announced last week that they agreed to forego a bipartisan formal House-Senate conference to reconcile the two reform bills. Instead, Democrats are informally going to negotiate amongst themselves. They'll then send the bill to the Senate for a final vote. Not surprisingly, Republicans objected, saying that the public would be left out of witnessing the process on this historic piece of legislation. But Democrats plowed ahead.
NARR: Democrats got some new ammunition for health reform...from a new government report. It showed that the overall rate of growth in health spending slowed in 2008 from the year before. But still health care costs far outpaced the economy's ability to support them. The report found that it's a bad economy...and some of the slowdown was simply because...a million fewer people have health coverage. Visits to physicians also dropped. Susan Dentzer is editor of the journal Health Affairs. She says reforms like the proposed employer mandate and a new health insurance exchanges are designed to tackle health care's vulnerability to the economy.
DENTZER AX (12 sec): "In the future, we wouldn't necessarily get into a situation where because there was a recession and because people lost coverage, the health sector would be hit and people would not be getting the health care they needed."
NARR: The health reform debate appears close to being finished...at least for now. So now experts are trying to decide just how proposed health exchanges would work. Both the House and Senate want to allow for some policies to be sold outside of the exchange, where regulation is much lighter. Insurance companies could still game the system by going outside the exchange and offering bare-bones policies that cater to healthier people...and THAT could leave sicker people inside the exchange, so says Timothy Jost [Yost] of Washington and Lee University. Jon Kingsdale, who runs the health exchange in Massachusetts, said some states don't want exchanges in the first place and will do everything they can to see them fail. And THAT could make the SENATE's plan of having states run the exchanges...problematic.
NARR: Democrats are once again battling the calendar as they seek to complete health reform before the President's State of the Union speech in just a few weeks. Stay tuned to see if they meet this goal and what compromises are struck along the way. And that's the Policy & Practice Podcast. I'm Todd Zwilli
