July 19th, 2011 by DrRich in Health Policy, Opinion
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In his last post, DrRich pointed out to his PCP friends that their chosen profession of primary care medicine is dead and buried – with an official obituary and everything – and that it is pointless for PCPs to waste their time worrying about “secret shoppers” and other petty annoyances.
It is time for you PCPs to abandon “primary care” altogether. It is time to move on.
Walking away from primary care should not be a loss, because actually, primary care has long since abandoned you. Whatever “primary care” may have once been, it has now been reduced to strict adherence to “guidelines,” 7.5 minutes per patient “encounter,” placing chits on various “Pay for Performance” checklists, striving to induce high-and-mighty healthcare bureaucrats (who wouldn’t know a sphygmomanometer from a sphincter) to smile benignly at your humble compliance with their dictates, and most recently, competing for business with nurses.
This is not really primary care medicine. It’s not medicine at all. It’s something else. But whatever it is, it’s what has now been designated by law as “primary care,” and anyone the government unleashes to do it (whether doctors, nurses, or high-school graduates with a checklist of questions) now are all officially Primary Care Practitioners.
What generalist physicians (heretofore known as primary care physicians) need to realize is that “primary care” has been dumbed-down to the point where abandoning it is no loss; indeed, it ought to be liberating to walk away from it.
The beauty is that Read more »
*This blog post was originally published at The Covert Rationing Blog*
July 6th, 2011 by BobDoherty in Health Policy
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For physicians, and especially those in primary care, it seems like there is a form for every purpose imaginable—often for purposes that are hard to imagine.
An ACP member in Rhode Island recently gave this example:
“I was just asked by my Medicare Advantage plan to sign a form for [a well-known pharmacy benefit manager]. This form is to be faxed to them in order for them to send me a prior authorization form for a med. So in other words, I had to complete a form in order to get another form. This is nuts!”
Or how about this, from another ACP member in a private internal medicine practice:
“The documentation that is getting to me, is that documentation that the ‘durable medical equipment people want including repetitive- recurrent documentation, whenever we see a patient to document “continued need”. The list of things we have to document, sign, approve or prior authorize, I believe is what makes most physicians think they chose the wrong field. A PBM letter to me about my prescribing practices today nearly did me in! Luckily I just shredded it. If I am kicked out of this business, I am so close to retirement it would be a blessing!”
Or this: Read more »
*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*
May 17th, 2011 by Stanley Feld, M.D. in Health Policy, Opinion
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“The media is the message.” It does not matter if the policy has failed previously. All that is important is the effectiveness of the policy’s presentation and its ability to manipulate the polls.
The government’s purpose is to work for the people who elected it. It does not seem to be working that way at present. Bureaucrats create rules or regulations as they interpret the laws made by congress and the president. Regulations are controlled by the administration’s ideology. Many times the regulations in one area nullify the intended effect in another area.
Regulations and bureaucracy inhibit the use of common sense in policy making for the benefit of the people.
The people did not have an outlet to express their opinions or frustrations until blogging came into its own seven years ago.
Americans do not like President Obama’s healthcare reform act. They also do not like Dr. Don Berwick’s apparent disrespect for their intelligence and his infatuation with the British healthcare system.
“I am romantic about the NHS (British National Health Service); I love it. All I need to do to rediscover the romance is to look at health care in my own country.” Read more »
*This blog post was originally published at Repairing the Healthcare System*
April 25th, 2011 by DrWes in Health Policy, Opinion
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The above graph from the Cato Institute demonstrates the growing complexity of the U.S. tax code over the years. After doing my taxes recently and trying to track the ins and outs of the law for my wife’s private practice, I can attest to the graph’s accuracy.
But then I was reading an interesting editorial in Circulation: Arrhythmia and Electrophysiology by N.A. Mark Estes III, MD and Jonathan Weinstock, MD that reviewed an article by Roos, et al in the same journal that found only 27 of 698 guideline recommendations from the European Society of Cardiology (median 1.2% per guideline [IQR 0.95% to 3.7%]) were correctly referenced as Class I or III Level of Evidence A recommendations, calling into question the accuracy of guideline recommendations. In their editorial, Estes and Weinstock defended the guideline process but also mentioned the following shocking statistic: Read more »
*This blog post was originally published at Dr. Wes*
April 10th, 2011 by Stanley Feld, M.D. in Health Policy, Opinion
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President Obama’s has created an incentive program to encourage physicians to adopt functional Electronic Medical Records. The program’s $27 billion dollars (funded by President Obama’s Economic Stimulus package) will turn out to be a colossal failure and a waste of money.
Twenty seven billion dollars would provide $44,000 for 640,000 physicians. After the bureaucratic infrastructure is built the federal government will be lucky if one third of the money remains for bonuses to physicians.
Only 21,000 of 650,000 (3%) of physicians have applied to date.
Complex bureaucracies and complicated regulations never save money. These bureaucracies create bigger government, inconsistent policies, more complicated regulations and inefficiencies.
The best and cheapest way to create a universally accepted and functional EMR is for the federal government to put the software in the cloud and charge physicians by the click for the use of the Ideal Medical Record.
Upgrades in software to the Ideal Medical Record will be swift , inexpensive and instantly adopted. Read more »
*This blog post was originally published at Repairing the Healthcare System*
