Some say that health outcomes are not keeping pace with the costs of healthcare while this system is by design, more “disease care” than healthcare and prevention. What can be done about an entrenched healthcare system? Dr. Pamela Ross, a featured physician in the movie documentary Escape Fire: The Fight to Rescue American Healthcare, gives an inspiring take on lessons learned.  The program was presented on June 12, 2013 and was moderated by SSV President Sue Liberman.

[display_podcast]

Pamela A. Ross, MD, FACEP, is an associate professor of Emergency Medicine and Pediatrics at the University of Virginia Health System, and founding CEO of Holistic Medical Consultants. She bases her holistic medical principles and practice on the belief that there is an unbreakable connection between the mind, body and spirit.

A native of rural Decatur, Tennessee, and her parent’s oldest child, Dr. Ross’ exceptional perceptive skills and mental capabilities were realized at an early age. By the time she reached the fourth grade, she was engaged in various public speaking opportunities through 4-H Club, the nation’s largest youth development organization. Public speaking was a skill that Dr. Ross evidently mastered early, but it was her mother’s illness that sparked her interest and curiosity in the study of medicine. Determined to aid in her mother’s care, Dr. Ross focused her education and career goals on becoming a physician.

Dr. Ross received her BA in Chemistry from the University of Tennessee at Chattanooga, and her MD from Emory University School of Medicine. Her distinguished career is filled with notable highlights including receiving an invitation from President Barack Obama to be present in the White House Rose Garden when he presented “Doctors for Healthcare Reform” to the nation – an event that galvanized the eventual passage of the Affordable Care Act by the United States Congress. Most recently, she is a featured doctor in Escape Fire: The Fight To Rescue American Healthcare, a 2012 Sundance premiere movie documentary that tackles the pressing issue of a badly broken healthcare system.

In her 16+ year tenure at the University of Virginia Health System, Dr. Ross has worn many hats. She has served as division director of the Pediatric Emergency Department, director of the Child Abuse Program, director of the Sexual Assault Nurse Examiner’s Program and director of Quality Improvement. Currently, she serves as ambassador for Sisters Conquering Cancer, a local community grass roots cancer survivor-ship organization; chair of the UVA Cancer Center Minority Recruitment Task Force; and a member of the UVA Compassionate Care Initiative, grounded in compassionate action and empathic leadership. She is also the UVA School of Medicine curriculum thread leader for Complimentary and Alternative Methods (CAM.)

Dr. Ross spends her spare time nurturing her own mental, physical and spiritual well being through reading, meditation, laughter, dance and fellowship in various settings with family and friends.

Program Summary

The intriguing topic addressed by Dr. Pamela Ross was entitled, “Escape Fires & Healthcare Leadership: Lessons I’ve Learned.” Dr. Ross is an associate professor of Emergency Medicine and Pediatrics at the University of Virginia Health System, and founding CEO of Holistic Medical Consultants. Two central themes are that we don’t have a health care system in this country–we have a disease management system, and to maintain a continuous dialogue on health care is essential. In her remarks she incorporated perspectives from a family practice doctor, patients, and that of herself, an emergency department doctor. Due to her mother’s illnesses, she decided at 11 years of age to become a doctor. Her experiences in medical school led to her specialty in emergency medicine. Emergency medicine represents the health care safety net and the only specialty mandated by law to provide health care to people regardless of their ability to pay.

During the course of her remarks, Dr. Ross cited five leadership lessons she has learned: (1) follow your gut and your dream; (2) the Serenity Prayer; (3) never judge a designated leader until you’ve walked a mile in their shoes; (4) the mantra “no money, no mission” should be completely reversed to “no mission, no money”; (5) “I returned, and I saw under the sun, that the race is not to the swift, nor the battle to the strong, neither yet bread to the wise, nor yet riches to men of understanding, nor yet favour to men of skill; but time and chance happens to them all” (Ecclesiastics chapter 9 verse 11).

After engaging in the full practice of medicine for several years, she noticed trends going on in medicine that made her uncomfortable. Patients were losing trust in their doctors, and that she was just a small part of a huge system that is out of control. Decisions made by administrators, policy makers and insurance companies put more distance between the doctor and patient. She learned in a health care marketing class a three-word answer to her question, and it was “follow the money.” For example with investors in pharmaceuticals, if you’re making profits from disease, then what is the motivation to get you to a point where you don’t have to take a whole bunch of pills? The system doesn’t want you to get completely cured, because if you’re completely cured you have no further need of the system.

The above just barely scratches the surface of the points covered by Dr. Ross. To learn how the concept of “escape fire” fits into this discussion on health care, you can listen to the entire presentation via the podcast link above.

Saunders Midyette, vice-president and national sales director for the St. Clair Group, Inc., presented an overview of the Patient Protection and Affordability Act. Jim Haden, president and chief executive officer at Martha Jefferson Health Services and Hospital, and Carol Craig, government relations specialist at the University of Virginia Medical Center,  addressed how cost and access for Virginians will be affected by the Act.

The panelists spoke at the September 8, 2010 meeting of the Senior Statesmen of Virginia. The meeting was held at The Charlottesville Senior Center. Following the presentation, questions were taken from the audience. The program was moderated by SSV board member and secretary Bill Davis.

Standard Podcast [1:27m]

Since 1998, Saunders Midyette has served as vice president and national sales director for the St. Clair Group, Inc., and President, Jackson Group, L.L.C., in Charlottesville. In the three decades previous to that he held the positions of vice president and chief financial officer with the Sisters of Providence Health System in Springfield, Massachusetts (1996-1997); senior associate with The Hunter Group in St. Petersburg (1995-1996); vice president and chief operating officer for the Greater Southeast Healthcare System in Washington, DC (1994-1995); chief operating officer with the University of Virginia Medical Center (1991-1994); associate director and administrator with the University of Michigan Hospitals (1987-1991); associate director and chief financial officer with the University of Michigan Hospitals (1979-1987); associate administrator and chief financial officer with the University of Utah Hospital in Salt Lake City (1976-1979); and controller and chief financial officer with the Hospital of University of Pennsylvania (1966-1976).
Mr. Saunders received his BA from the University of North Carolina, and his MBA from the Wharton Graduate School, University of Pennsylvania. He is a member and past fellow of the Healthcare Financial Management Association, and a past fellow of the American College of Healthcare Executives.

Mr. Saunders and his wife Shirley of 47 years moved to Charlottesville from Ann Arbor Michigan in 1991. Shirley serves as an interpreter at Monticello and when Saunders is not being called upon to present his wisdom and knowledge, he is an avid reader, tennis player, sports and classical music enthusiast.

James E. Haden was named president and chief executive officer of Martha Jefferson Health Services in 1993. Mr. Haden received a master’s degree in Public Health/Health Services Management from UCLA in 1971. He completed his administrative residency at Scripps Hospital in LaJolla, California, and received the 1988 Alumni of the Year Award from the UCLA Health Services Management Alumni Association. Mr. Haden served as president / CEO of Queen of the Valley Health Services in West Covina, California (1986-1993). Prior to that, he served as chief operating officer of Hoag Memorial Hospital Presbyterian in Newport Beach, California (1978-1986). He served as associate administrator at Huntington Memorial Hospital in Pasadena, California (1976-1978). In 1992, Mr. Haden was chairperson of the California Association of Catholic Hospitals and was a member of the Hospital Council of Southern California (1988-1993).

Mr. Haden served as a board member on the Federal Reserve Board of Richmond from (1998-2003). He is a former board member of the Charlottesville United Way, the Piedmont Virginia Community College Foundation and Charlottesville Chamber of Commerce. He is currently a board member of the Optima Health Plans of Virginia Beach; a board member of Virginia National Bank; a board member of Voluntary Hospitals of America – (VHA) Central Atlantic; and, in 2008 and 2009 he served as chair of the United Way Excellence in Non-Profit Leadership Award Committee. Mr. Haden is a member of the Senior Statesmen of Virginia.

Mr. Haden served as a preceptor at UCLA Health Services Management Program (1981-1987) and has served as a preceptor for VCU’s Masters Program in Health Care Administration. In 2003 Mr. Haden was the recipient of the American Heart Association, Charlottesville Chapter, “Billy” Gitchell Award. In 2006 Mr. Haden was the recipient of the National Multiple Schlerosis Society Blue Ridge Chapter Silver Hope Award. Mr. Haden is the 2008 recipient of the Beta Kappa Chapter, Sigma Theta Tau, UVa School of Nursing Community Service Award. Mr. Haden is married to Sue Haden and they have three children.

Carol Huston Craig was appointed government relations specialist at the University of Virginia Medical Center in April 2010. In this position she is responsible for tracking state and federal legislation impacting the Medical Center; preparing advice statements on legislative and regulatory issues impacting the Medical Center; planning and organizing on-site educational programs for legislative guests and off-site visits to legislators; assisting in the preparation and submission of COPN applications; and assisting in the review of Medical Center policies.

Prior to joining the UVa Medical Center, Ms. Craig served as university counsel at the University of Maryland Baltimore (2000-2004), and previously as assistant university counsel (1997-2000). She was associate legal advisor at the Medical College of Georgia in Augusta, Georgia (1995-1996), and an assistant legal advisor (1990-1995). She was assistant general counsel at Baylor University in Waco, Texas (1987-1990), and staff attorney (1986-1987); and an associate in private practice in New Orleans, Louisiana (1984-1985).

Ms. Craig received her B.S. in Marketing at Louisiana State University in Baton Rouge, attended Loyola University School of Law in New Orleans, and received her J.D. from the University of Virginia School of Law.

She and her husband, Stewart, have two children, Mary Grace and Colin, ages 15 and 12, respectively. Although working and raising her children leaves little time for leisure activities, she enjoys reading, fine dining, attending UVa sporting events, traveling, and helping others.

Program Summary

Mr. Midyette outlined the objectives of the PPAA as: (1) increase access to health insurance by providing coverage to millions of uninsured persons; (2) change insurance rules to protect individuals from arbitrary health coverage limits and exclusions by insurers; (3) build on existing “employer and government sponsored” insurance programs; and (4) accomplish these health act reforms with a phased implementation schedule. A number of mandates on insurers become effective in 2010 including no lifetime benefits limits on coverage; no denial of coverage to children with pre-existing conditions; no cancellation of coverage for individuals if they get sick; dependent children up to age 26 can remain on their parents’ plans; rebates will be provided to policyholders under certain conditions; and the temporary use of state and/or federal high-risk insurance pools. Medicare mandates begin with a $250 rebate when the pharmacy “doughnut-hole” is reached and increase until 2020 when the doughnut-hole is eliminated entirely. Mandates on individuals begin in 2013 when families with incomes above $250,000 will pay an additional 3.8% tax on investment income and will also have to contribute more in payroll taxes. All US citizens and legal residents will be required to carry health insurance in 2014 or pay a federal penalty. Beginning in 2010 small businesses (maximum of 50 employees) can receive tax credits to provide coverage.

Ms. Craig compared what the federal government sees as the impact of PPAA with that of the National Center for Policy Analysis. The latter says that the cut over the next decade in Medicare will force 1 in 7 health care facilities out of business, and by 2050, 40% of existing health care facilities will be forced to close. The wait will be longer and there will be insufficient doctors and nurses to handle the increased number of patients. She covered a number of access, cost, and legal issues stemming from the extension of coverage to 32 million uninsured (yet with still 23 million to remain uninsured, one-third of those may be undocumented migrants). Although the act makes more money available to finance the medical education of primary care physicians and surgeons, there could be more medical school graduates than residency slots if the number of residency slots continues to be capped.

Mr. Haden commented that the bill is almost 2,000 pages in length, and the regulations could easily become 30 times that, and the provisions of the bill will be phased in over a very long time. The Medicare plan will be fine, but access will become a challenge with more people covered at the same time as doctors are retiring. One thing he doesn’t see enough of in the in plan is an emphasis on individual responsibility; the population is becoming less healthy and there is a large population of obese. It is also likely that some businesses will choose to take the penalty for not offering coverage because it would cost them less. At this time there is probably more unknown than known about the bill and a lot of it is still to be played out.

Donna Goings, Robert Graham and David Shreve

Panelists Donna Goings,  Robert Graham and David Shreve examined the problems with today’s health care system, their origins and how they would be addressed by a proposed national health insurance program. The panel included the perspectives of a consumer/patient, a medical professional and an economist. They spoke at the June 10, 2009 meeting of the Senior Statemen of Virginia held at the Charlottesville Senior Center

Donna Goings is a local real estate agent with 23 years of experience, a member of the National Association of Realtors, a Certified Residential Specialist (CRS), and a graduate of the Realtor’s Institute (GRI). Donna served four years on the Board of the Charlottesville Area Association of Realtors including two years as treasurer. Donna received her Bachelor of Science degree in Mathematics from Wake Forest University in 1968. A former teacher of math in the Charlottesville Public School System Donna has served as president of the Charlottesville Education Association and chairperson of the Charlottesville Political Action Committee for Education. Donna has also been active in her community by serving on the Charlottesville Rail Board, on the CHART citizens’ advisory committee on transportation and as an organizer of her Westwood Road area Neighborhood Watch. Donna’s current concern is health care reform.

Robert Graham has, for 10 years, served as director of patient billing for the Department of Ophthalmology at the University of Virginia. During this time, Robert has served on a number of committees at the University of Virginia Health Center dealing with billing issues for both physician and hospital charges. Robert received his Bachelor of Music Degree from Indiana University in 1980 and his Masters Degree from Indiana in 1981. As a trombonist, Robert has performed with the Baton Rouge Symphony, Richmond Symphony, West Virginia Symphony, Lynchburg Symphony and Charlottesville Symphony orchestras. Robert was the adjunct instructor of trombone at the University of Virginia from 1985 through 2001. He has also performed professionally with the Broadway touring production of Annie and with the Cab Calloway orchestra.

David Shreve is a former professor of economic history at the University of Virginia, where he held a joint appointment at the Miller Center of Public Affairs and the Department of History. He was a candidate for the United States Congress in 2008. A specialist in national, state, and local economic policy and 20th century U.S. political history, David also served as a budget analyst for the Louisiana legislature, where he was the legislative analyst responsible for the state Medicaid program, its indigent care hospital system, and all of the Bayou State’s health care departments and agencies. In that capacity, he was also a member of the governor’s health care estimating conference and the legislative representative to the Kellogg-Robert Wood Johnson task force on public health reform. He is the vice president of Advocates for a Sustainable Albemarle Population, a member of the Virginia Organizing Project Tax Reform Committee, the editor and associate editor of seven volumes in W.W. Norton’s Presidential Recordings series, and the author of numerous essays and articles on American political economy and of the forthcoming book, American Promise: Kennedy, Johnson, Nixon, and the Forging of the Modern Economy.

Program Summary

Three panelists addressed the issue: “Health Insurance: the Problem, the Solution.” The primary debate going on in Washington today is the formation of a national health insurance program that has everyone in and no one out. In the early decades of the 20^thcentury, three payment plans sere formed. First was le Cross, a nonprofit. During WW II, when wages were frozen, employers got into the act by providing company paid insurance. Also during this period, Henry J. Kaiser developed the Health Maintenance Organization. Then came Medicare for the elderly, and in the 90’s came Medicare Part D, a drug plan using private insurance companies under government regulation.

Panelist Donna Goings described her experience as a consumer/patient. For 24 years she had paid her own health care premiums with a high deductible. When a skin blemish was diagnosed as cancer, she underwent outpatient surgery, but the cost came to $10,000. She also spoke of a friend who has worked for many years with a company that provides employee health care, but now she is on the verge of reaching the $1 million lifetime benefit limit. Ms. Goings has come to the conclusion that a single payer approach is the solution.

Panelist Robert Graham, a medical professional, provided extensive information comparing Medicare to six major private insurance plans. In every case, the Medicare allowances beat all of the private plans and also the patient copays were less than all of the private plans, and none of the commercial insurances came close to the cost control achieved by Medicare.

Panelist David Shreve, an economist, addressed the question of how to pay for a single payer system. He suggested a small transaction tax on all stock market sales; a roll back of 2003 tax cuts; a 1.45 percent tax on income; and a gain from economic efficiencies.