April 7th, 2010 by KevinMD in Better Health Network, Health Policy, Opinion, Primary Care Wednesdays
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Overuse of the emergency department is commonly discussed during the healthcare conversation, especially with the lack of primary care access shunting patients with seemingly routine symptoms to the ER. But is this a myth? That’s what two emergency physicians contend in a piece from Slate.
The emergency department is functioning just fine, they say: “Just 12 percent of ER visits are not urgent. People also tend to think ER visits cost far more than primary care, but even this is disputable. In fact, the marginal cost of treating less acute patients in the ER is lower than paying off-hours primary care doctors, as ERs are already open 24/7 to handle life-threatening emergencies.” Read more »
*This blog post was originally published at KevinMD.com*
April 5th, 2010 by KevinMD in Better Health Network, Health Policy, News, Opinion
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One of the points of contention in healthcare reform is whether it will do enough to control costs. Forget about the Congressional Budget Office’s optimistic outlook, as it discounts the Medicare “doc fix,” which, when factored in, will erase any supposed deficit reduction.
Reform doesn’t do very much to change the underlying structure of our health system, which continues to pay more for quantity of medical services, rather than shift the focus to value and quality.
Sharon Begley, writing in Newsweek, offers some sensible suggestions on what we can do control costs. Better incorporating the best clinical evidence into their medical decisions would help. She cites the continued, and possibly unnecessary, use of back surgery, knee surgery, vertebroplasties, and angioplasties, despite mounting evidence that they’re being overused. Read more »
*This blog post was originally published at KevinMD.com*
March 31st, 2010 by KevinMD in Better Health Network, Health Policy, Opinion, Primary Care Wednesdays
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Medicare’s sustainable growth rate, or SGR, has been the bane of doctors for years now. To encapsulate, this is the reason for Medicare’s annual threat to cut doctors’ fees by 20% or more, only to be staved off at the last minute.
Emergency physician Shadowfax has a nice take on it, explaining why it has devastated primary care:
Primary care has many fixed expenses in addition to those we bear: they pay rent, nurses and techs and secretaries, healthcare costs for their employees, equipment, scheduling software, etc etc. The fixed costs portion of a typical office practice can be much higher, consuming 60-80% of gross revenue. Worse, many of these “fixed costs” for primary care are not truly fixed, but increase annually consistent with inflation.
I wrote several years ago that primary care is the “cheap DVD” of the medical profession — a loss leader to bring people in the door for more lucrative services. Shadowfax agrees, arguing that it’s unlikely there will be any independent primary care practices in the near future:
I predict that, if nothing else changes in the overall model of physician reimbursement, within a decade there will be almost no independent primary care left in existence — they will all have been subsumed into hospital-owned or group practices to serve as “loss leaders,” existing solely to drive referrals to profit centers like surgical services and imaging facilities.
Bingo.
*This blog post was originally published at KevinMD.com*
March 30th, 2010 by KevinMD in Better Health Network, Health Tips, News, Opinion
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Is the tide finally turning on PSA screening for prostate cancer? There’s no definitive data that PSA screening saves lives from prostate cancer, and it indeed can lead to further, invasive, tests that can cause men significant discomfort. Medical societies are divided on the issue. Primary care groups like the U.S. Preventive Services Task Force (USPSTF) recommend against it for older men, while the American Urological Association (AUA) continues to recommend screening.
In a strongly worded op-ed in the New York Times, Richard Ablin, also known as the founder of the PSA test, bemoans how our healthcare system has twisted its use. “The test’s popularity has led to a hugely expensive public health disaster,” he writes. Read more »
*This blog post was originally published at KevinMD.com*
March 29th, 2010 by KevinMD in Better Health Network, Health Policy, News, Opinion
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A personal health record (PHR) has been touted as a way for patients to better keep track of their health information. Google Health and Microsoft HealthVault lead the way. But what happens if the company storing your data gets bought, goes bankrupt, or simply decides to discontinue their system?
Well, those who stored their data with Revolution Health are finding out first hand. The troubled company, which started off with so much fanfare yet died in a whimper, recently announced they’re shutting down their personal health record service. According to American Medical News: “Industry insiders say Revolution joins a long list of vendors who launched PHRs with a big splash, only to find little interest from consumers.”
Most of my patients don’t use a personal health record, and prefer that I enter the data in myself, or export it from from my electronic record system. The problem is: a) there isn’t enough time in a 15-minute patient visit to help patients enter in their data (apart from what I already do in my own system), and b) many online personal health record sites aren’t compatible with the systems doctors are using.
Leaving the data entry to the patient is inefficient, and a sure way to minimize the adoption rate. Indeed, “the most successful PHR-type systems have been created by healthcare organizations and have benefits to patients, such as e-mailing with physicians, online appointment scheduling and the ability to look at information entered by their physicians.”
That means a successful personal health records have to be well-integrated with or designed by existing hospital and physician systems, making it harder for a third-party system, such as the defunct Revolution Health service, to gain traction.
*This blog post was originally published at KevinMD.com*
