On November 7, with a number of amendments from its original form, the health care reform bill was passed with a slim margin of victory. While it is an important step, a number of steps remain before the bill is signed into law. The amended form of the health care bill includes concessions to pro-life democratic congressmen, who would only pledge their signatures after the bill was amended to include no support for abortions under the government-run public option. The passed version of the bill only garnered one vote from a Republican.

The bill now faces an equally rough ride in the Senate. Republicans in the Senate can come up with a number of amendments for the bill and keep it tied up for weeks, a threat that severely impairs the end-of-year deadline set by President Obama. House Republicans have said that the bill would be “dead on arrival” to the Senate floor.

The Senate Majority Leader, Harry Reid, is waiting to receive a cost estimate from the nonpartisan Congressional Budget Office for the Senate version of the legislation before unveiling it. Once that estimate is in, Reid could use a procedural technique known as reconciliation to avoid a Republican filibuster and get the bill passed before the end-of-year deadline. To do so, however, may be politically explosive as it would signal an end to the bipartisan negotiations that President Obama has tried to foster throughout the health care reform debate.

You can read more on the most current developments at CBS News.

Specialists are quietly under fire in the new proposed health care bill. In it, the most highly paid doctors are asked to take a 5% pay cut, which is even more formidable than it sounds since Medicare dollars are worth 83 cents on the private dollar. When these figures are collated, it amounts to a pay cut of roughly 20% for specialists under the new health care bill.

The devil is in the details. According to a recent article in the Wall Street Journal:

    “Beginning in 2015, Medicare would rank doctors against their peers based on how much they cost the program—and then automatically cut all payments by 5% to anyone who falls into the 90th percentile or above.”  The War on Specialists, WSJ October 6th, 2009

This formula automatically penalizes specialists, as it is they that will invariably fall into the 90th percentile of that formula. Specialists become specialists for a variety of reasons, not least of which is the potential for a higher income. If their wages are stripped towards parity with general practitioners, will specialists still want to be specialists?

The common theory running through the health care bill is that the high costs of specialists will be defrayed if patients have better and more frequent access to general practitioners. However, the above formula simply penalizes specialists for doing what they do disregarding any other measures that have been put in place.

In addition, the health care plan goes after diagnostic tests. Echocardiograms and catheterizations have been reduced by 42% and 24% respectively. These diagnostic tests are vital to understanding what is going on with patients and their discouragement through the health care bill is a misplaced effort to trim costs. Cancer doctors are hit especially hard through slices to the CT and MRI pie, both of which are vital tools in cancer diagnosis and treatment. Payments for antitumor radiation therapy will fall off by up to 44%.

While the cuts referenced don’t actually cut any spending, they definitely shift the money from one area to another. In its quest to make the specialist less of a driving force to the patient than the general practitioner, the health care bill is cutting too close to the bone where specialists and their diagnostic equipment are concerned.

In 2008, residency programs were changed to limit residency hours so that residents wouldn’t be made to work shifts that are longer than 16 hours without sleep, and various other changes designed to maintain the health and quality of life of medical residents. However, according to a new study just put out by the New England Journal of Medicine, these changes will cost the health care industry roughly $1.8 billion.

The facts that the study is based on are the costs of hiring replacement workers for those hours. This is good or bad news depending on what side of the industry you are on – if you are in a medical profession, there is bound to be more work for you at the entry level. If you are a health care organization of any kind, you are probably already experiencing the manpower dent that these regulations have made.

There are also debates about patient safety if they are being handed off between doctors and residents. This is an issue that is likely to resolve itself when mandated EHR’s come into existence over the course of the next few years. For the time being, the general consensus is that a patient would prefer a well-rested resident to one who hasn’t had any sleep in the last day.

Quality ratings for hospitals come in two flavors – professional and public. As can be expected, the professional quality ratings are the ones that can be trusted, but they are not as easy to access as the public rating systems. Public rating systems can be skewed towards a positive outcome by advertising, or skewed towards a negative outcome due to one complaint. Professional rating systems are often fairly done through industry reports and surveys, and thus can be more trusted. Patients should be discouraged from using internet healthcare rating systems, even if they are favorable towards your organization. What then are the professional quality ratings that you can trust, and how do they work?

The first thing to note is that even hospital quality rankings that are considered top in the industry can be considered flawed when placed under a microscope, such as the rankings of the US News and World Report, a frequent go-to guide for hospital rankings. These reports are generally meant to be overall rankings and may not take into account representative samples or all statistics that are available. In the end, there is no one way to denote “the best” hospital for a certain surgical procedure. Most hospitals and medical professionals are created equal and while some surgeons and physicians may be considered subject matter experts, there is no guarantee that this expertise will translate into better patient care.

The US News and World Report uses the four following criteria to rank hospitals:

1. Having intensive care units staffed by specially trained doctors

2. Having computerized order-entry systems for medications and other orders with error-prevention measures

3. Performing procedures such as cardiac catheterization and caring for certain high-risk neonatal conditions4. Having practices such as those designed to control hospital-related infections and cut down on medication and treatment errors.

While these are lofty goals, what about overall patient satisfaction surveys, or other criteria that medical professionals and patients alike can start rattling off? The reason is simple – these four are really the only universally measurable criteria for most organizations. Until there is a better source of information, such as the new EHR’s that the Obama administration wants to see in place, the US News and World Report is the best source for quality ratings of health care organizations.

There are a lot of things conspiring against you when you are looking for a job in a bad economy. The trick is to stay positive and upbeat. Potential employers will pick up on this and will probably choose you over other candidates if you can manage to manifest such an attitude in these difficult times. The trick is – how to get there?

1. Give yourself a Grieving Period

Even if your layoff or job that you quit was a few months ago, give yourself a week or two to simply deal with the emotions that the experience produced in you. Many people just throw themselves into looking for a new job thinking that it will solve their problem, when really you can’t find a new job without dealing with the loss of the old one first. A job is a lot like a relationship in that you need to get over the old one in order to be ready for a new one. Wallow, cry, scream, talk to a counselor. Do anything you have to in order to deal with those feelings. Once you feel that you are genuinely over the old experience, start prepping yourself for the new one.

2. Dump The Pessimists

You can probably list them off right now. The people in your life who predict doom and gloom and always care to share their diatribes with you, the downtrodden job seeker. Elect not to answer their calls or attend the same social functions until you can get back on your feet. Share your precious time with people who are just as positive and loving as you want to be.

3. Stay Human

When asked at a job interview about your personal interests and circumstances, don’t put on airs or act like you don’t care. That’s old news. Employers now want to know that they are hiring a human being who will care about their job, not a drone who will simply follow orders. They now want to hear about your family and the fact that you enjoy Ultimate frisbee. Just stay you and you’ll be fine.

4. Take “Me Time”

If you are searching for employment you will quickly find your days filling up with chores, family requests and tasks doled out to you by people who think that you are sitting at home on the couch eating bonbons. All of this can actually add up to a more full-time day than what you were used to. Take a bath, read a book, do whatever you like to do on your own for at least a few minutes every day.

5. Take a Class

Yoga, meditation and fitness classes are something that you may have not partaken in before due to a lack of time. Sign up for them now in order to achieve a healthy balance and keep your attitude positive. Nothing keeps you more upbeat than exercise. Exercise produces the same effects naturally that pharmaceutical antidepressants do artificially.

Most of all, don’t forget that your next job is simply a matter of time. The health care profession is simply not being hit as hard as other sectors in this recession. In fact, stimulus spending is creating new jobs in the health care field. Keep your skills upgraded and your attitude upbeat and you’ll have another position in no time.