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Should Doctors Be Paid To Communicate With Patients?

I often hear from physicians that they would do a better job communicating with patients if they were adequately reimbursed for the time it took to do so. Given that certain types of physician-patient communications (patient education, care planning, etc.) can have quantifiable, therapeutic benefits for patients, I can see their point.

I have no problem with physicians asking to be adequately reimbursed for services they provide, as long as they are high quality and add value. For example, teaching chronic disease patients how to care for themselves at home takes time and is critical to effective patient self care. In this role, physicians are called upon to be a provider of necessary information as well as a coach to encourage and support patients.

But as evidence suggests, many physicians don’t communicate effectively enough with patients, chronic or otherwise, to seem to merit additional reimbursement. Read more »

*This blog post was originally published at Mind The Gap*

Despite Medicare, Primary Care Doctors Were Paid More In 2009

The Senate has further tweaked its doc fix legislation to restore the extension to six months (from June 1 through Nov. 30) and the pay raise to 2.2 percent, reports a Senate Finance Committee Republican advisor. In Northern Michigan, the doc fix can’t come soon enough, as yet more physicians contemplate not accepting any more Medicare patients. The legislation continues to see revisions in the Senate, following the U.S. House refusal to consider the doc fix as a stand-alone bill. (TwitDoc, WWTV/WWUP-TV News)

But primary care physicians saw a 2.8 percent median compensation increase in 2009, according to a Medical Group Management Association survey. MGMA attributed the rise to employers’ and payers’ increased commitment to primary care, but noted threats to Medicare payments still exist. Read more »

*This blog post was originally published at ACP Internist*

Electronic Medical Records: What Is “Meaningful Use?”

Quiz:  What does the term “meaningful use” mean?

A.  Using something in a way that gives life purpose and leads to carefree days of glee.

B.  It depends on your definition of the word “term.”

C.  It’s not mean. It’s really nice.

D.  A large number of rules created by the government to assess a practice’s use of electronic medical records (EMRs) so that they can spur adoption, give criteria for incentive rewards, and have physicians in a place where care can be measured.

E.  Job security for those making money off of health IT.

The answer, of course, is D and E. Read more »

*This blog post was originally published at Musings of a Distractible Mind*

The “Medical Home” In Ontario: The Poor Left Behind Again

In a recent blog posting, I described Group Health’s medical home for 8,000 patients. It proved to be a boon for primary care physicians, who were able to reduce the size of their patient panels, see fewer patients per day, refer more patients to specialists, and maintain or increase their incomes.

Patients liked it, too. And Group Health was happy because expenditures per patient were 2 percent lower. But poor patients had trouble getting through the front door of the medical home, so based on demographic differences alone, expenditures should have been lower by 10 percent or more. Nonetheless, they declared victory.

Now news filters south from Ontario’s eight-year experiment with medical homes for 8,000,000 patients, and the news is similar. Participation is skewed to healthier and wealthier patients who, in the absence of risk adjustment, yield profitable capitation for primary care physicians. Incomes have soared an average of 25 percent. Read more »

*This blog post was originally published at PHYSICIANS and HEALTH CARE REFORM Commentaries and Controversies*

Saving Primary Care: What Will It Take?

“Bold changes are needed in how the United States delivers and pays for primary care if the key goals of national health reform are to be achieved,” according to the health policy journal Health Affairs, which has released a thematic issue devoted entirely to the crisis in primary care.

(The complete articles are available only to subscribers, but Health Affairs’ blog has a good summary.)

I have spent much of the day reading the journal — 47 articles, and a combined 300 pages of text. Here are my “take-home” messages from the articles. Read more »

*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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