Q&A with: N.H. Medical Society’s Palmer Jones
For 25 years, Palmer Jones has been at the helm of the New Hampshire Medical Society, a physician organization founded by Isaiah Bartlett in 1791 to promote the art and science of medicine that also has kept a close eye on public policy.
Jones, who retires as executive vice president of the society in June, has seen a lot of changes in the industry and has found himself at the center of several important legislative battles.
Q. What has been the biggest change in health care during your tenure?
A. When I came to New Hampshire, a significant amount of health care was done outside of the state. Patients needed to drive to Boston for more specialized care, where there were several teaching hospitals. You don’t need to do that now. People should feel very comfortable with the care they receive within New Hampshire. My wife, Sheila, had triple bypass heart surgery at Concord Hospital. The care was excellent and results very good.
Another significant change is the shift from the independent practices to hospital-owned practices. This is a result of the poor reimbursement policies set by Medicare, Medicaid and the private health plans.
Primary care physicians are struggling because of the complicated federal reimbursements process. Specialists are faced with the economics of the current health-care system as well, but they do fare better because their practices have procedures that get reimbursed at high levels.
Q. What are some of the challenges physicians are facing?
A. One big challenge is the lack of physicians. Medical school enrollments have been stagnant for the last decade. We do not provide enough support for medical schools. This shortage is the biggest issue, especially in primary care.
The government money that was available to help support medical schools has been cut back dramatically. It is so expensive today; most of the doctors who come out of medical school have a debt of $140,000 to $180,000, so when they have that kind of debt, they are reluctant to go into primary care.
They choose a specialty that will help them pay back that loan promptly.
Another change is in the complexity of the paperwork that is required by private insurance. Physicians’ offices and hospitals hire more staff to process insurance paperwork than technical staff.
Q. What is your position on health-care reform in Washington?
A. If I was king for the day, I would focus on insurance reform. There is no reason why people should be denied access to care because they don’t have or can’t afford insurance. Also, why is it that a person who has had insurance for 10 years and then gets sick, the insurance company can put a limit on their coverage?
There should be no limitation for pre-existing conditions.
When I came to New Hampshire there were about 15 insurance companies in this country, we’re down to less than ten now. Consolidation has created monopolies. We have a monopoly in New Hampshire. Anthem, for all intensive purposes, controls what insurance will cost. They are a for-profit business. It is all about profits and, unfortunately, a lot of these profits are leaving the state.
I think they are starting to understand this in Washington., but whatever change occurs is going to be in phases. Whatever happens will only be the first step.
Q. What can physicians do about the substantial number of people living unhealthy lives.
A. The bottom line is that we need to all talk about prevention and wellness. Physicians should have time with patients to discuss this, but they don’t. We need parents knocking on the school door saying something is wrong with the present nutritional system, that everything does not need to be super-sized.
This year there is legislation to consider putting a tax on soft drinks. It’s not going to pass, but it raises awareness. Diabetes in adolescents is growing rapidly, and it is related to our diet and no exercise.
Q. When will food policy be tied to health care?
A. It’s going to take time. It’s a large industry and we need to hold them accountable for the way they process food and the treatment of the animals in the food chain. It is long overdue.
Having Dr. (and New Hampshire First Lady Susan) Lynch and Michelle Obama talking about this issue helps. If you look back at the autopsies of the young men killed in the Second World War, they were walking cardiac arrests. They had hardening of the arteries, pre-cardiac and pre-diabetes issues. It is a huge problem because we didn’t think about what we put into our bodies.
I do ask questions about the source of the food I consume in a restaurant or at the grocery store.
Q. The state Supreme Court sided with you and prevented the state from taking the excess funds from the medical malpractice fund.
A. Physicians financed a fund to provide medical malpractice practice insurance because there were no carriers in the state in 1975. So they created their own little medical malpractice fund with assistance from the state’s Insurance Department. It was very clear from day one – loud and clear – any excess money, like a mutual company, was to be given back to the stakeholders. Right there, black and white.
Some of our legislators are confused about the facts, and that is understandable. The physician and hospital community advised them from day one that we did not believe they had the authority to take those funds, and they’d be challenged legally.
Q. How has the state’s medical malpractice panel worked?
A. Five years ago, the Medical Society worked with a group of legislators to create these panels. This idea was not original – it came from Maine. What we saw was, say you’re an OB/GYN in Portsmouth and you drive across the bridge and practice in Maine, you’ll get your malpractice insurance for one-third less than what you’re paying in New Hampshire from the same company.
Once we showed the legislators the comparisons of the rates, they supported it. The medical malpractice panel is now in place. It includes a retired judge, a lawyer and a doctor of the same specialty. Any liability issues brought against any physician, hospital or other health-care practitioner has to be reviewed by this panel.
The panel can then make recommendations; if the panel is unanimous, that outcome can be introduced in court should the person wish to go on to a jury trial. We think that it has changed the overall culture as to how we deal with medical malpractice. Cases are being settled quicker, and we know when this happens, the system will save funds.
Q. What kind of impact does greater transparency have on health care?
A. Patients, the consumers of health care, are now asking quite rightly: what it is going to cost me? The Insurance Department (nh.gov/insurance) and Hospital Association (nhha.org) are trying to address this. These Web sites provide a lot of information you couldn’t use to get. You can compare some hospitals by location and procedure. People use that to determine where they are going to get their care.
We are in a period of transparency, and people want to understand what it’s going to cost them. What does my insurance cover? We think it's an important component of good health care.
Q. Despite having three doctors as signers of the Declaration of Independence, doctors don’t seem to gravitate toward politics.
A. We’re trying our best to explain how important this is to them. Over the last decade, they’ve realized they have to get involved. When I speak to new groups of physicians, they ask: why should I get involved? I tell them, you’ve gone to an excellent medical school, you practice high-quality medicine, but how you practice is determined in Concord, N.H., and Washington, D.C. If you don’t take the time to roll up your sleeves and get involved, you and your patients are the ones who are going to lose out. I think that has a lot of traction with our physicians.
Q. Looking forward 25 years, what will U.S. health care look like?
A. The approach is going to be different. We are now going into a new era where the medical students and residents want a more structured life for themselves and their family. I don’t believe you’re going to see the physician who is in the hospital 24/7. They want their own personal lives. It’s a healthy balance that they’re looking for.
Q. How has state government changed in the 25 years that you’ve served in this position?
A. It has changed dramatically, I think for the good. Twenty-five years ago everything was done behind the scenes at the Highway Hotel. It doesn’t happen like that anymore. People want transparency in their government, and they are getting it. Today what you do is bring your best people in to put your argument forward and if you do that, you’ll usually get treated very well.
What you talk about in the hallways is to try to answer questions where legislators may be confused. I don’t see us so much as lobbyist, but as advocates, an individual who educates people on these issues. We bring in the experts – the physicians – so the health-care perspective will be understood. No more Highway Hotel deals.