« December 2009 | Main | February 2010 »

6 posts from January 2010


One Year Later - What Happened to Real Healthcare Reform?

Richard G. Stefanacci, DO, MGH, MBA, AGSF, CMD

Last year, as President Barak Obama addressed Congress, he said, “Let there be no doubt: healthcare reform cannot wait, it must not wait, and it will not wait another year."

A year later we are still without healthcare reform. And in the Jan. 27 State of the Union address, the President changed the focus to health insurance reform. And like big banks, health insurance companies are now being labeled as enemies of the state.

And while the President even promised that patients would be able to keep their doctors, the delay in healthcare reform looks to actually do the opposite for older Americans.

The problem is that there are some major components of healthcare that actually can’t wait any longer to be addressed. One of the most pressing timelines is the one governing physician reimbursement. As it stands today, in just about four weeks, physicians caring for Medicare patients will have a 21 percent cut in their reimbursement. Without congressional action, Medicare beneficiaries are likely to find it increasingly difficult to find a physician who will take their Medicare insurance because many physicians will likely stop seeing Medicare patients. And while Congress has historically acted to pass one year corrections to these Medicare cuts, in the face of massive debt and a focus on deficit reduction, this year might actually see those reimbursement cuts go through.

The question is what will be the effect on Medicare patients?

As a practicing geriatrician and health policy expert, I appreciate the concern of older adults. These fears come out of the concern that a large number of physicians will opt out of Medicare and privately contract with their Medicare patients. Older adults who find their physician has opted out of Medicare can choose to find a physician who does still take Medicare or they can pay privately out of their own pocket for services traditionally covered under Medicare. The delay in health care reform could actually cause a major break in the relationship patients have with their physicians.

Real healthcare reform is possible. It can start with focusing on just a few key issues:

Extend Health Insurance Coverage – providing coverage for the majority of those Americans who are currently uninsured can happen by:
- moving Medicare to 55 (this action would also move pre-retirees out of the work force, opening up opportunities for those currently unemployed)
- lowering the eligibility requirement for Medicaid
- providing tax breaks for those seeking personal insurance
- make mandatory the requirement for health insurance

Develop Efficient & Effective Systems – lower the cost of healthcare through promotion of integrated systems of care rather than the current fragmented silo’ed process.

Expansion of Information Technology – promote the use of electronic health records that are integrated among providers that can reduce unnecessary and ineffective treatments.

Reduce Administrative Burdens – the administrative burden is currently causing great waste and inefficiencies.

Support Primary Care Services – shift the financial incentives from procedures to primary care services.

Reform Malpractice – provide reform that works to eliminate nuisance lawsuits and the need to practice defensive medicine through a specialized court system absent of juries, governed by a skilled judge.

Promote Personal Responsibility – work to promote personal responsibility to reduce obesity, tobacco abuse, and sedentary life styles.

While time will tell the direction of healthcare reform – time is certainly running out at least perhaps on the promise that patients, especially older adults, will be able to keep the relationships they enjoy with their doctors today. Instead of the break of existing patient-doctor relationships perhaps real healthcare reform will happen.

Dr. Richard Stefanacci, Director of the Institute for Geriatric Studies at University of the Sciences. As an internist/geriatrician, Dr. Stefanacci has a longstanding interest and commitment to geriatric health, particularly the frail elderly and long-term care.


iPad Touches Electronic Medical Records Adoption

By Richard G. Stefanacci, DO, MGH, MBA, AGSF, CMD

The most positive news to impact healthcare in quite some time may not have been the words of the President in his State of the Union address but rather the words coming out of Silicon Valley. Yesterday, Jan 27, Apple unveiled its latest product, the iPad. This device may actually have the ability to improve patient care and reduce healthcare costs.

With some $21 billion set aside in the Stimulus Package to provide funds to physicians and hospitals that use electronic health records (EHRs), part of these funds may be used to purchase the new Apple iPad. Already the iPad will enjoy apps that are currently available to the iPhone/iPod Touch and more are in the works. The Mayo Clinic recently announced production of several healthcare apps.

Major electronic health record systems like Epic have already developed electronic health record applications for the smaller devices. The increased screen and key board size of the iPad will make these systems much easier to use.

One of the greatest advantages of the iPad over the use of PC-based EHRs is that it fits better in the work flow of physicians that patients are already comfortable with. One of the largest criticisms by physicians and patients, including my own, is that the use of the PC appears to make the office visit less personal. A tablet device like the iPad could eliminate that distances and actually improve the link between physicians and their patients.

Apple’s iPad improvements could be the link between physicians and their patients combined with the benefits in efficiency through the use of EHRs. The iPad could do what Washington has long promised but has yet to be able to do – improve patient care and reduce the cost of healthcare.

As a practicing geriatrician who has utilized EHRs for more than a decade, this is long welcome positive news.

Dr. Richard Stefanacci, Director of the Institute for Geriatric Studies at University of the Sciences. As an internist/geriatrician, Dr. Stefanacci has a longstanding interest and commitment to geriatric health, particularly the frail elderly and long-term care.


Fighting cancer with light

University of the Sciences researcher are among those using photodynamic therapy to fight cancer. A Philadelphia Inquirer story on Jan. 25 helps to illuminate this hopeful process. Read: http://www.philly.com/philly/health_and_science/82574882.html


What to do the first day of class?

There are three important objectives for the first day of class.  


  1. Establish rapport and a supportive, safe environment for learning. 

Introduce yourself as a human being by talking a little about yourself, your interests and why you love teaching this subject.

Take roll and learn how to pronounce names or nick names they prefer to be called (this can be done in writing)

Find out a little about your students beyond that they are enrolled in your class.  You might ask them to write a little about themselves in addition to contact information.

Show respect and dignity for all students in the class.

Try to learn as many names as possible. Knowing the students by name makes them feel connected to you, to the course and encourages them to try harder in the course.


  1. Explain the mechanics of the course.

Explain how and why you set up the course as you did.

Discuss how students can succeed or get good grades in your class.  This can be quite specific such as how to read the required material for this course or best approaches to studying and mastering the material.  If you have insights from previous students share them.

Clarify grading policies and how they will be assessed. 

If you modified the course as a result of previous feedback form students, let them know that you made these changes because previous students indicated these changes would be helpful.

Allow plenty of time for questions to be answered


  1. Begin the content of the course with the big picture of the material.

Explain the major themes that organize much of the content and discuss how students can use these themes.

Describe how the students should approach the content, the readings and the assignments.

This is a macro view of the content from 5000 feet.

Allow plenty of time for questions to be answered.


Some faculty wonder if they should really spend much time on the first day since the enrollment is still in flux.  Research shows that this day is important to establishing the correct mood and a good perception of the course.  Also we do not have extra time in courses; each class should be worth attending.


These might seem like a tall order and if necessary continue these activities in the second class.  This is very worthwhile time spent.




Working out on the Cheap!

No monthly membership fees.  No uncomfortable feelings of "is everyone watching me?"  Just you & yours getting in shape!

Recently featured on ABC Channel 6, I was interviewed regarding inexpensive exercise equipment: Watch for our two Devils basketball players too! Think quality, enjoyment & space.   Don't go for the dollar store jump rope - splurge on the one from Target or better yet, Dick's Sporting Goods.  Do you even LIKE jumping rope?  If not, choose something else.  Maybe walking is better for you with strength training.  Do you have the space to jump rope indoors? 

Start with a new piece of equipment, try it out and then add on from there.  The last thing you need is a $1500 clothes hanger (aka treadmill).

Start again in 2010! 


Excerpt: "Congratulations and Appreciation!"

Excerpt from The Pharmacists Activist (Dec. 2009): For many years pharmacists ranked first in the annual Gallup polls in which participants were asked to rate individuals in various professions/vocations with respect to honesty and ethical standards. When nurses were added to the professionals being rated, pharmacists have consistently ranked second to nurses. The results of the 2009 Gallup poll have recently been announced. Pharmacists ranked second, following nurses, among the 22 professions/vocations identified in the survey. Approximately two-thirds of respondents rated pharmacists "very high" or "high" when asked about their honesty and ethical standards. Read the full editorial.

Daniel A. Hussar is the Remington Professor of Pharmacy at the Philadelphia College of Pharmacy at the University of the Sciences in Philadelphia. He serves as the author and editor of The Pharmacist Activist newsletter (http://www.pharmacistactivist.com)

© 2011 University of the Sciences in Philadelphia • 600 South 43rd Street • Philadelphia, PA 19104 • 215.596.8800