James J. Dignam has been named the new Group Statistician for the Radiation Therapy Oncology Group and will lead the efforts of RTOG's Statistics and Data Management Center. Dignam is an associate professor of Biostatistics in the Department of Health Studies at the University of Chicago and an investigator in the University of Chicago Cancer Research Center. RTOG is a National Cancer Institute-funded national clinical trials group and is administered by the American College of Radiology.

There's word out of Congress that the most contentious provision of the Employee Free Choice Act that would have made organizing workers far, far easier will be whittled from the bill. The New York Times  reported on Friday that moderate Senate Democrats dropped the so-called "card-check provision" from EFCA as a means of securing a filibuster-proof 60 votes for the rest of the package.

Card check would have required employers to recognize unions as soon as a majority of employees signed cards saying they wanted to organize, effectively eliminating the secret ballot. The unions love it. Management hates it, and both sides lobbied ferociously for their cause.

Before you make party balloons out of surgical gloves and form conga lines in the C-suite, remember that the card check provision is only one—albeit key—component of EFCA, the most labor-friendly legislation under consideration in Washington in years. Instead of card check, unnamed Senate and labor officials told the Times that the revised bill would mandate shorter unionization campaigns and faster elections, which will give management less time to react to a union threat.

"A lot of people are confused. When they say EFCA is dead, it's the card check provision that may be in question," says James G. Trivisonno, president of Detroit-based IRI Consultants. "The House may feel differently, so I wouldn't count it out completely. But, clearly there is going to be some kind of reform and it is going to impact employers. The time is now to start looking at employee relations policies and practices."

The federal government's view of the labor-management paradigm has shifted remarkably in the few months since President George W. Bush left the White House. One of the most business-friendly presidents in recent history was replaced by the very union-friendly President Barack Obama, who is an unabashed supporter of card check. Obama has strong ties to Andy Stern of the Service Employees International Union. They meet regularly at the White House.

Democratic appointees also will control three of the five seats on the National Labor Relations Board, which holds great leeway in setting the rules and adjusting the goal posts. And before she was appointed NLRB general counsel this spring, Julia Clark held the same post for the International Federation of Professional and Technical Engineers.

"Nothing precludes the NLRB through their rule making authority from potentially shortening the time frame (for unionization votes) and maybe even ruling on card check," Trivisonno says. "A lot of folks are focused on the single issue of card check but there is so much out there legislatively and the unions' ability to influence the administration is incredible. They've got access. They are going to use it."

In other words, keep your guard up. Organized labor is making an aggressive push to grow its membership and SEIU—which already represents more than one million healthcare workers—has specifically targeted the healthcare sector. Whatever shape EFCA takes when it comes out of Congress, President Obama will quickly sign it, and the NLRB will enforce it, all to the benefit of organized labor.

It's going to happen, so Trivisonno says management needs to prepare. Employees need to hear the case against organized labor. "It's very important to articulate and not be afraid of discussing with your employees your position," he says. "Some employers feel that if they mention the "U" word it is going to help the union. Nothing could be further from the truth. Make sure that people are clear on your position early on."

I am not taking sides on this issue. While organized labor can be justifiably criticized on many, many fronts, critics must also concede that unions helped build the middle class in this nation by pushing for fair wages, better working conditions, the 40-hour work week, overtime pay, and countless other contributions that have improved the lives of tens of millions of men, women, and children, most of whom have reaped the benefit despite never having been in a union. When it comes to organized labor, I subscribe to a simple dictum: Management gets the union it deserves.

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The past few weeks have seen a flurry of activity as health stakeholder groups have taken sides on health reform legislation.

The American College of Physicians, which represents 129,000 internists across the country, said the Democrats' so-called "Tri-Committee" health reform proposal, H.R. 3200, "is closely aligned" with its policies.

The bill includes "policies on coverage, workforce, payment and delivery system reform, primary care, comparative effectiveness research, and administrative simplification that are strongly supported by the College," ACP president Joseph Stubbs, MD, said last week.

However, the Pharmaceutical Research and Manufacturers Association (PhRMA), which represents drug and biotech companies, is opposed.

"We cannot support the Tri-Committee bill," said PhRMA Senior Vice President Ken Johnson, because it fails to encourage biomedical research and innovation. In addition, changes to Medicare Part D would "constitute a tax increase on seniors because of the resulting increase in their monthly premiums as projected by the Congressional Budget Office under similar proposals," he added.

The American Nurses Association, representing 2.9 million nurses in the U.S., supports a public option, but has not said whether it favors the Senate Health Committee proposal or the Tri-Committee alternative.

America's Health Insurance Plans, which represents 1,300 organizations providing coverage to 200 million Americans, said an expanded government-run plan would be tantamount to a "death spiral" for providers. That's because the healthcare system, especially hospitals, would be paid at Medicare rates plus 10%, an amount that doesn't come close to covering costs, said a statement from AHIP spokesman Robert Zirkelbach.

If employees now covered by commercial health insurance plans gravitate toward the public option, those left in private insurance would have to pay a lot more to cover the underpayments from the government plan. "And there would be fewer people with private insurance to offset these costs, causing premiums to increase even further," AHIP said in a statement.

The American Hospital Association favors health reform, and national health insurance for people who don't get it through their employer or qualify for other programs. But the organization has "serious concerns…about establishing a new public plan that could exacerbate the underpayment of providers by paying rates at Medicare or Medicaid levels."

The AHA points to a Medicare Payment Advisory Commission projection that hospitals will have a negative 6.9% Medicare margin in 2009, down from a positive 6.2% Medicare margin in 1999 "the lowest level in more than a decade."

Nationally, treating Medicaid patients resulted in a $10.4 billion shortfall in 2007.

The American Medical Association last week reversed its position opposing a public option, saying that it supports H.R. 3200 and urges its passage. "This legislation includes a broad range of provisions that are key to effective, comprehensive health system reform," said AMA president James Rohack, MD.

Though groups have begun taking sides, more details are expected for each of the plans and the Senate Finance Committee plans to release its bipartisan bill in the next two weeks. That should change the healthcare reform landscape even more.

What a difference a day makes—especially on Capitol Hill with the House Tri-Committee's health reform legislation (HR 3200).

Late on Friday, hours after two House committees—Ways and Means and Education and Labor—approved reform legislation, the Congressional Budget Office (CBO) had bad news: HR 3200 would result in a net increase in deficit spending of $239 billion during the next 10 years, according to its analysis. But House leadership immediately challenged the findings—and CBO changed its tune hours later.

The House bill, CBO said, was able to target key areas for savings. However, a key trigger in increasing Medicare spending occurred when the existing annual "sustainable growth rate" (SGR) in the Medicare physician fee schedule (with a 21% reduction in payment rates scheduled for 2010) was replaced with an inflation-based update.

In following years, rates would reflect separate updates for "evaluation and management" and other services. CBO estimated that those changes in the physician payment rates ultimately would add up to $245 billion in changed physician rates between 2010 and 2019.

So, did that create a deficit? Not exactly, said Peter Orszag, director of the Office of Management and Budget (and former CBO director). "The only reason that the bill shows a deficit" is because of the "payments to physicians...once you take that part out, the bill is deficit neutral," Orszag told Fox News on Sunday.

Those reformed Medicare physician payment costs, however, should not have been included in CBO's net calculations, according to a release from the three House committee leaders issued on Saturday. Instead, they will be absorbed under the upcoming statutory "pay-as-you-go" budgetary legislation that currently is pending in the House. (With so-called "paygo," the federal government cannot launch new tax cuts or entitlement programs without finding a way to pay for them.) This would make HR 3200 deficit neutral over the 10 year budget window—and even produces a $6 billion surplus.

It also would create Medicare and Medicaid savings of $465 billion, coupled with the $583 billion revenue package reported by the Ways and Means Committee on Friday. It would "fully finance" the previously estimated $1.042 trillion cost of reform, which will provide healthcare coverage for 97% of Americans by 2019, the House committee leadership said. About 17 million nonelderly residents would be left uninsured (about half of whom would be unauthorized immigrants).

CBO and the Joint Committee on Taxation said that approximately $583 billion would be obtained through increasing federal revenue by methods such as issuing a surtax on higher incomes, which was approved by Ways and Means on Friday. Another $219 billion (plus physician payments) would be saved by Medicare and Medicaid by:

• Making permanent reductions in the annual updates to Medicare’s payment rates for most services in the fee for service sector (excluding physicians’ services)—yielding budgetary savings of $196 billion over 10 years
• Setting payment rates in the Medicare Advantage program based on per capita Medicare spending in the fee for service sector—providing savings of approximately $156 billion over the 2010 2019 period.
• Changes to the Medicare Part D program to establish a new prescription drug rebate program for those eligible for both Medicaid and Medicare.

"This fulfills the strong commitment of the President and House leadership to enact health reform on a deficit neutral basis," said the release signed by House Committee Chairmen Henry Waxman (D-CA), Charles Rangel (D-NY), and George Miller (D-CA).

President Obama has previously said that he would not sign healthcare reform legislation that was not budget neutral.