Sunday, July 6, 2008

Medicare Fee Schedule Cuts, Private Fee For Service, the AMA and Hand Gestures

The Disease Management Care Blog thought Karen Ignagni had cornered the hand gesture market. Ms. Ignagni’s classic two-handed chops, sweeps and grabs in her speeches not only help emphasize her points, but remind the DMCB of a martial artist's kata. Observe Ms. Ignagni’s interview here (once the initial question is over) and this classic kung-fu exercise and see if you can tell the difference.

Well stand back, because Nancy Nielsen, MD, President of the AMA has her own repertoire of jabs, pokes and pushes that accentuate her organization's considerable annoyance at the U.S. Senate’s recent failure to cancel a scheduled 10.6% fee schedule cut by transferring the necessary funding from the private fee for service (PFFS) Medicare plans. Dr. Nielsen and Ms. Ignagni obviously stand on opposite sides on this issue, and the DMCB recommends someone get these two experts together not only for what would be a hugely educational discussion but for an equally entertaining hand gesture smack-down.

Want to learn more about this Republican-Democrat health care kerfuffle? In the opinion of the DMCB, the best summary can be found here at the Health Affairs blog site.

But the DMCB wanted to learn more about hand gestures. This is an excellent article from Scientific American that explains speech and hand gestures are hard wired together in humans. For example, babies who have not yet learned to speak use gestures, while persons with damage to the brain’s ‘speech centers’ lose their ability to interpret gestures. In addition, humans (and primates) are vicariously endowed with ‘mirror neurons’ that are not only activated when we perform a movement but when we observe another person performing the same movement. Numerous studies that have shown speech plus gestures results in far better communication than speech alone.

In fact, this hand-speech connection may be so hardwired, that having your mouth say one thing and your hands do another can be a telling clue to an audience that something is amiss. Unsurprisingly, the best medium for observing this mismatch can be found in politics. Not getting this right can make all the difference in a contender’s career, which is why considerable time and effort may be needed to tie a speech and the movements ‘naturally’ together.

In the meantime, the DMCB has trouble understanding what the Medicare physician fee schedule has to with Medicare PFFS. It has to admit, however, that tying them together and forcing the PFFS supporters to vote ‘against physicians’ was a stroke of partisan genius. Too bad it’s also another example of the manipulative gamesmanship that can get in the way of real health care reform. To the folks in Congress, here’s a gesture from the DMCB to all of you.

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