Whatever comes from the brain carries the hue of the place it came from
“and whatever comes from the heart carries the heat and color of its birthplace.”

In spite of this festive time of year that is designed to warm the heart, conflicts continue to arise—many of them internal, representing a metaphorical battle between the heart and the head, as the American poet Oliver Wendell Holmes, Sr. suggests.

One area that could have formerly posed internal conflict for physicians is their financial relationships with industry that have become increasingly external through the state and federal government’s push for transparency.

Most recently, Sen. Chuck Grassley, R-Iowa, sent letters to 33 medical organizations, including the American Heart Association and the American Medical Association, to probe their potential conflicts of interest with pharmaceutical companies and medical device makers. As the ranking member of the Senate Finance Committee, he is requesting very detailed information about how much the groups have received since 2006, for what purposes and specifically how much funding the groups’ directors have received.

Meanwhile, the attorney general of New Jersey has become the latest to make recommendations for physicians licensed in the state to disclose any financial payments or gifts received from industry. If these recommendations are accepted, the onus would be on N.J. doctors to disclose any consulting fees of $200 or more, or any gifts or incentives of equal value.

One area that has garnered a great deal of cantankerous conflict is the current Medicare physician payment system, under which the contentious sustainable growth rate (SGR) formula falls. However, the ongoing healthcare reform debate has prohibited any in-depth discussions on the matter, forcing the House to pass a separate, standalone bill (H.R. 3961, the Medicare Physician Payment Act) in November, altering the way Medicare pays physicians and preventing a scheduled 21.2 percent rate decrease set to take effect on Jan. 1, 2010.

Unfortunately, the Senate, due to its preoccupation with healthcare reform, has yet to act on that bill, and the House decided to temporarily delay the rate decrease until March 2010, as part of the larger defense appropriations legislation yesterday. The Senate is expected to vote on this bill by tomorrow.

Due to this flurry of activity in the concluding weeks of the calendar year, the festivities could serve as a welcome distraction. As Holmes said, in speaking of the hues of the heart and the brain, the brain is the palest of all the internal organs, and the heart the reddest—hopefully, you and yours are surrounded by warm hearts during the holidays.

On these topics, or any others, please feel free to contact me.

Justine Cadet