To be a great internist you have to be great at blood gas interpretation. And you have to be able to do it quickly and efficiently. You have to understand what all the numbers mean and you have to get a good clinical sense of how to interpret them and how to change management based on their result. And you have to be able to do it without pulling out your formula books. In six years as a hospitalist I have never calculated what the compensatory responses should be. I just know.
Sometimes blood gases change your management or your medical opinion on what’s happening. Take for example my patient with advanced MS. She presented through the emergency department with “oropharyngeal bleeding of unclear etiology”. Her original BMP:
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*This blog post was originally published at A Happy Hospitalist*
I heard an interview with T.R.Reid and can’t wait to read his book The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care. He traveled the world and compared how developed countries manage health care. He makes the point that all other developed countries have universal coverage. No-one is left out.
He found four basic systems (some named after their founders):
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*This blog post was originally published at EverythingHealth*
It’s the holy grail of physician payment reform: ending fee-for-service payments to doctors and, instead, pay doctors based on the quality of care they perform. Remarkably, Congress feels they’ve found the answer:
Thus, the new language in the Senate Finance bill would finally connect Medicare reimbursements to quality, as opposed to volume.
The measure gives the secretary of Health and Human Services, working with the Centers for Medicare and Medicaid Services, the power to develop quality measurements and a payment structure that would be based on quality of care relative to the cost of care. The secretary would have to account for variables that include geographic variations, demographic characteristics of a region, and the baseline health status of a given provider’s Medicare beneficiaries.
The secretary would also be required to account for special conditions of providers in rural and underserved communities.
Additionally, the quality assessments would be done on a group-practice level, as opposed to a statewide level. Thus, the amendment would reward physicians who deliver quality health care even if they are in a relatively low quality region.
The secretary of Health and Human Services would begin to implement the new payment structure in 2015. By 2017, all physician payments would need to be based on quality.
Wow. That sounds great! But there’s just one problem…
… how do we define “quality?”
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*This blog post was originally published at Dr. Wes*
A Keynote Address To The American Telemedicine Association September 25, 2009
The following is a summary of Alan Dappen, MD, keynote address at the mid-year meeting of the American Telemedicine Association (ATA). His keynote, billed as “Private Practice And Telemedicine: A Success Story” discusses how Dr. Dappen’s practice, DocTalker Family Medicine, which is a fee-for-service practice that deploys telemedicine for over 50% of its patients needs, has enjoyed growth and has received numerous awards and media attention. You can check out Dr. Dappen’s full address on the site.
On to the highlights of Dr. Dappen’s talk:
“This is my third visit to an American Telemedicine Association (ATA) event. I’ve been a proud member for seven years. Two years ago I presented the fundamentals my medical practice DocTalker, where the doctor is chief cook and bottle washer.
“Our practice mirrors the recommendations outlined by the Institutes of Medicine’s book
Crossing the Quality Chasm and those purporting the ‘medical home’ model. Read more »
Ever wonder why your physician only spends 5-10 rushed minutes with you during your office visit? You may think it’s because there are simply too many patients vying for her time, but that’s not the real reason. The root cause is that health insurance companies are stealing time from your visit by requiring excessive documentation from your doctor. She can’t give you the time you need, because doing so would put her out of business.
In a special report on the administrative burden of healthcare, MedPage Today revealed that PCPs spend about one third of their income on documentation required by health insurers. Because they run a business with thin margins, they must increase the volume of patients they treat in order to cover the salaries of the staff required to manage this “paper weight.”
About 49% of all physicians have said that they are considering retiring or quitting medicine in the next two years (the rate is lower for specialists), largely because of increasing documentation requirements and decreasing reimbursement. Read more »