April 8th, 2009 by KevinMD in Better Health Network
1 Comment »
Almost 30 percent of Medicare beneficiaries have trouble finding a new primary care doctor.
Expect that number to rise dramatically in the near future, as the number of Medicare beneficiaries balloons, and the amount of primary care physicians plummets.
The whole scenario is a perfect example of how poor physician access makes medical coverage practically worthless.
Contrary to popular belief, Medicare’s paperwork requirements and pre-authorization obstacles are just an onerous as those of private insurers. Combined with the continuing threat of downward physician reimbursements, and the baseline complexity of a typical Medicare patient, it is no wonder that doctors are dropping Medicare in droves.
This phenomenon with Medicare is likely going to spread nationwide, if the current plans for universal coverage go through without first addressing the primary care shortage.
**This blog post was originally published at KevinMD.com**
March 30th, 2009 by KevinMD in Better Health Network
2 Comments »
More hospitals are resorting to so-called “dayhawk” radiology services to read their x-rays.
It’s modeled after the “nighthawk” model, where radiologists (via Shadowfax), in some cases as far away as India, remotely read films in the middle of the night.
Now, the phenomenon is happening during business hours as well, which according to radiologist Giles W. L. Boland, means that “some radiologists can no longer assume long-term job security because their core value proposition can now be outsourced.”
This trend was entirely foreseeable. Cash-strapped hospitals are finding it cheaper to outsource x-ray readings, and furthermore, it seems that both nighthawks and dayhawks provide better service and more timely interpretations. This adds up to a declining need for an in-house radiology staff.
That’s bad news for some. Radiology departments at smaller hospitals may close, and eventually general radiologist salaries will come under pressure.
The answer? Like everything else in medicine, radiology sub-specialists will increasingly be in demand. Expect procedure-based, interventional radiology to grow, since what they do cannot be outsourced. Health care costs will correspondingly rise.
So, like primary care, don’t be surprised if the days of general radiology are numbered.
**This post was originally published at Dr. Kevin Pho’s blog, KevinMD.**
March 19th, 2009 by KevinMD in Better Health Network
No Comments »
In a surprise, President Obama has signaled a willingness to discuss medical liability as part of the health reform process.
Good for him for standing up to the trial lawyers, a core constituency of the left.
That’s a good sign, as the costs of defensive medicine brought on by the broken malpractice system, should be addressed if there is any hope of reducing health care spending.
Trial lawyers like to say that medical malpractice represents “less than one percent of the cost of health care,” but that fails to account for the substantial sum attributed to defensive medicine doctors practice to avoid the threat of malpractice, estimated to be $210 billion annually.
Furthermore, the argument that malpractice reform will harm patients “by limiting their ability to seek compensation through the courts” doesn’t hold water either.
That’s because the current system does a miserable job of compensating patients for medical errors, where more than 50 cents on every compensated dollar goes to pay lawyers and the courts. Not to mention that a typical malpractice trial may last years before an injured patient receives a single penny.
So, don’t believe the arguments of the trial lawyers, who prefer the financial security of the status quo.
Any alternative system, such as no-fault malpractice, mediation, or health courts, will go a long way both to reduce the cost of medical care, and fairly compensate more patients for medical errors at a significantly more expedient rate.
Lawyers are aware of these facts, and to their credit, are going on a preemptive offensive to head off tort reform. If I were the AMA, I would start pro-actively circulating some of the above talking points, rather than reacting to the trial lawyers.
**This post was originally published at KevinMD**
March 10th, 2009 by KevinMD in Better Health Network
No Comments »
Patients don’t choose the days they get sick.
There are several studies, specifically dealing with heart attacks, showing that the mortality rate increases when a patient visits the hospital during the weekend.
It appears that the same goes for upper GI bleeding. MedPage Today discusses a recent study showing that “patients with nonvariceal upper gastrointestinal hemorrhage had a 22% increased mortality risk on weekends, and those with peptic ulcer-related hemorrhage had an 8% higher risk.”
Staffing issues, leading to delayed endoscopies, appear to be chief culprit. Minutes count in cases of GI bleeding, so the delay is a likely explanation for the higher mortality rates.
Especially in community hospitals, doctors often cover for one another, and in general, there are less physicians available. Short of having more doctors on call, a prospect that faces long odds as hospitals are loathe to pay specialists for additional call, I’m not sure what can be done to rectify this statistic.
One suggestion is to have so-called “bleed teams,” where staff can be quickly mobilized to respond solely to acute GI bleeds. But again, this likely would require more staff, and it’s dubious that hospitals are willing to bear the additional cost.
**This post was originally published at KevinMD.com**
