In U.S. Elderly Medicare Patients Get Less Attention

Washington Post

Want an appointment with kidney specialist Adam Weinstein of Easton, Md.? If you’re a senior covered by Medicare, the wait is eight weeks.

How about a checkup from geriatric specialist Michael Trahos? Expect to see him every six months: The Alexandria-based doctor has been limiting most of his Medicare patients to twice yearly rather than the quarterly checkups he considers ideal for the elderly. Still, at least he’ll see you. Top-ranked primary care doctor Linda Yau is one of three physicians with the District’s Foxhall Internists group who recently announced they will no longer be accepting Medicare patients.

“It’s not easy. But you realize you either do this or you don’t stay in business,” she said.

Doctors across the country describe similar decisions, complaining that they’ve been forced to shift away from Medicare toward higher-paying, privately insured or self-paying patients in response to years of penny-pinching by Congress.

And that’s not even taking into account a long-postponed rate-setting method that is on track to slash Medicare’s payment rates to doctors by 23 percent Dec. 1. Known as the Sustainable Growth Rate and adopted by Congress in 1997, it was intended to keep Medicare spending on doctors in line with the economy’s overall growth rate. But after the SGR formula led to a 4.8 percent cut in doctors’ pay rates in 2002, Congress has chosen to put off the ever steeper cuts called for by the formula ever since.

This month, the Senate passed its fourth stopgap fix this year – a one-month postponement that expires Jan. 1. The House is likely to follow suit when it reconvenes next week, and physicians have already been running print ads, passing out fliers to patients and flooding Capitol Hill with phone calls to convince Congress to suspend the 25 percent rate cut that the SGR method will require next year.

Such temporary reprieves have increased the potential pain down the road, compounding not only the eventual cut but the cost of doing away with it for good, now estimated in the tens of billions.

The lobbying blitz by doctors also comes amid concern in Washington that Medicare spending is spiraling up so fast the nation can’t afford to boost it further by significantly raising doctors’ pay. And government analysts and independent experts suggest that although doctors could not absorb a 25 percent fee cut, the claim that they have been inadequately compensated by Medicare until now is wildly exaggerated.

Among the top points of contention is the complaint by doctors that Medicare’s payment rate has not kept pace with the growing cost of running a medical practice. As measured by the government’s Medicare Economic Index, those expenses rose 18 percent from 2000 to 2008. During the same period, Medicare’s physician fees rose 5 percent.

“Physicians are having to make really gut-wrenching decisions about whether they can afford to see as many Medicare patients,” said Cecil Wilson, president of the American Medical Association.

But statistics also suggest many doctors have more than made up for the erosion in the value of their Medicare fees by dramatically increasing the volume of services they provide – performing not just a greater number of tests and procedures, but also more complex versions that allow them to charge Medicare more money.

From 2000 to 2008, the volume of services per Medicare patient rose 42 percent. Some of this was because of the increasing availability of sophisticated treatments that undoubtedly save lives. Some was because of doctors practicing “defensive medicine” – ordering every conceivable test to shield themselves from malpractice lawsuits down the line.

“Then you have doctors who order an MRI for an unremarkable headache or at the first sign of back pain,” said Robert Berenson, a Commissioner of the Medicare Payment Advisory Commission, an independent congressional agency. “It’s pretty well documented that it doesn’t help patients to have those scans done in these cases. But if you have the machine in your office … why not?”

Whatever the cause, the explosion in the volume of services provided helps explain why Medicare’s total payments to doctors per patient rose 51 percent from 2000 to 2008.

A review of physicians’ incomes suggests that specialists – who have more opportunities to increase the volume of the services they offer than primary-care doctors – reaped most of the benefit.

On average, primary-care doctors make about $190,000 a year, kidney specialists $300,000, and radiologists close to $500,000, figures that reflect the income doctors receive from both Medicare and non-Medicare patients. The disparity has prompted concern that Medicare is contributing to a growing shortage of primary doctors.

Still, even if primary-care doctors had to rely exclusively on Medicare’s lower payment rates their incomes would only drop about 9 percent, according to a recent study co-authored by Berenson, who is also a fellow at the non-partisan Urban Institute.

“The argument that doctors literally can’t afford to feed their kids [if they take Medicare’s rates] is absurd,” said Berenson. “It’s just that doctors have gotten used to a certain income and lifestyle.”

Regardless of their motivation, if doctors skew their patient base away from Medicare too drastically seniors’ access to medical care could be limited.

Is that happening? Again, opinions vary. Based on its studies as well as those done by others others, the Medicare Payment Advisory Commission has concluded the share of affected seniors has been small, and perhaps most significantly, lower than the share of privately insured patients ages 50 to 64 who also report access problems.

But the American Medical Association cites a recent online survey that it commissioned in which nearly one-third of primary-care doctors said they are currently restricting the number of Medicare patients in their practice.

For Michael Trahos, the geriatric specialist in Alexandria, that has meant spacing out routine visits by his Medicare patients such that their share of his weekly appointments has dropped from about half to less than one-third. Trahos said that if a Medicare patient has a serious condition, he will see the person more frequently. But Trahos said it makes him uneasy to push even apparently healthy elderly patients back to twice yearly visits.

“Is it the proper thing to do? Probably not,” he said. “These are patients who should be scheduled for proper maintenance every three months.”

Adam Weinstein, the kidney specialist in Easton, has taken to supplementing his three-doctor practice by doing medical IT consulting several hours a week. But although the pay is far greater than what he would receive seeing Medicare patients, who make up 70 percent of his practice, the side work means he has less time to serve them. Not only must Weinstein make them wait longer for an appointment, he said, he can no longer afford to answer their phone calls.

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Rockefeller Foundation Presents Anti-Fertility GM Food

Jurriaan Maessen

It seems there is no limit to the Rockefeller Foundation’s ambitions to introduce anti-fertility compounds into either existing “health-services”, such as vaccines, or — as appears to be the case now — average consumer-products.

The 1985 Rockefeller Foundation’s annual report underlined its ongoing dedication towards finding good use for the anti-fertility substance “gossypol”, or C30H30O8 – as the description reads.

Indeed, gossypol, a toxic polyphenol derived from the cotton plant, was identified early on in the Foundation’s research as an effective sterilant. The question was, how to implement or integrate the toxic substance into crops.

“Another long-term interest of the Foundation has been gossypol, a compound that has been shown to have an antifertility effect in men, By the end of 1985, the Foundation had made grants totaling approximately $1.6 million in an effort to support and stimulate scientific investigations on the safety and efficacy of gossypol.”

In the 1986 Rockefeller Foundation annual report, the organization admits funding research into the use of fertility-reducing compounds in relation to food for “widespread use”:

“Male contraceptive studies are focused on gossypol, a natural substance extracted from the cotton plant, and identified by Chinese researchers as having an anti-fertility effect on men. Before widespread use can be recommended, further investigation is needed to see if lowering the dosage can eliminate undesirable side-effects without reducing its effectiveness as a contraceptive. The Foundation supported research on gossypol’s safety, reversibility and efficacy in seven different 1986 grants.”

It seems that the funded scientists have indeed found a way of “lowering the dosage” of gossypol, circumventing the toxicity of the substance, so as to suppress or even eliminate these “undesirable side-effects”, which include:  low blood potassium levels, fatigue, muscle weakness and even paralysis. If these effects could be eliminated without reducing the anti-fertility effects, the Foundation figured, it would be a highly effective and almost undetectable sterilant.

Although overtly, research into and development of gossypol as a anti-fertility compound was abandoned in the late 1990s, the cottonseed containing the substance was especially selected for mass distribution in the beginning of the current decade. Around 2006 a media-campaign was launched, saying the cottonseed could help defeat hunger and poverty.

In 2006, NatureNews reported that RNA interference (or RNAi) was the way to go. On the one hand it would “cut the gossypol content in cottonseeds by 98%, while leaving the chemical defenses of the rest of the plant intact.” Furthermore, the article quoted Dr. Deborah P. Delmer, the Rockefeller Foundation’s associate director of food security, who was quick to bury any concern:

“Deborah Delmer, associate director of the Rockefeller Foundation in New York City and an expert in agricultural food safety, points out that a benefit of using RNAi technology is that it turns off a gene process rather than switching on a novel function. So instead of introducing a new foreign protein, you’re just shutting down one process,” Delmer says. “In that sense, I think that the safety concerns should be far less than other GM technologies.”

A 2006, National Geographic article Toxin-Free Cottonseed Engineered; Could Feed Millions Study Says, quotes the director of the Laboratory for Crop Transformation (Texas A&M Universtity), Keerti Singh Rathore as saying:

“A gossypol-free cottonseed would significantly contribute to human nutrition and health, particularly in developing countries, and help meet the requirements of the predicted 50 percent increase in the world population in the next 50 years.”

“Rathore’s study”, states the article, “represents the first substantiated case where gossypol was reduced via genetic engineering that targets the genes that make the toxin.”

I bring into recollection the statement made by the Rockefeller Foundation in its 1986 annual report, which reads:

Before widespread use can be recommended, further investigation is needed to see if lowering the dosage can eliminate undesirable side-effects without reducing its effectiveness as a contraceptive.

In the 1997 Foundational report, Rathore is mentioned (page 68). A postdoctoral fellowship-grant was given to a certain E. Chandrakanth “for advanced study in plant molecular biology under the direction of Keerti S. Rathore, Laboratory for Crop Transformation, Texas A&M University, College Station, Texas.”

Compromising connections, in other words, for someone who claimed academic objectivity in regards to gossypol and its sterilizing effects. Rathore explained the workings of RNAi in a 2006 issue of the Proceedings of the National Academy of Sciences.

“Cottonseed toxicity due to gossypol is a long-standing problem”, Rathore said, “and people have tried to fix it but haven’t been able to through traditional plant breeding. My area of research is plant transgenics, so I thought about using some molecular approaches to address this problem.”

Rathore also mentioned the desired main funder of his work without actually saying the name:

“we are trying to find some partners and will probably be looking at charitable foundations to help us out in terms of doing all kinds of testing that is required before a genetically engineered plant is approved for food or feed. We are in the very early stages and have a lot of ideas in mind, but we need to pursue those. Hopefully, we can find some sort of partnership that will allow us to do them.”

He also expressed the final adaptation of the cottonseed for widespread use is something of the long term:

“(…) right now there are many hurdles when you are dealing with a genetically modified plant. But I think in the next 15 or 20 years a lot of these regulations that we have to satisfy will be eliminated or reduced substantially.”

The Foundation, as is evident from the statements of Rockefeller’s own Deborah Delmer, is more than interested. Even worse, through the process of readying gossypol for mass-distribution in food, the fulfillment of their longstanding goal of sterilizing the populous into oblivion comes into view.