March 31st, 2010 by KevinMD in Better Health Network, Health Policy, Opinion, Primary Care Wednesdays
Tags: Group Medical Practice, Hospital-Owned Practice, Imaging Facilities, Independent Primary Care, Loss Leader, Medical Profit Centers, Medicare, Physician Reimbursement, SGR, Surgical Services, Sustainable Growth Rate
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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 31st, 2010 by SteveSimmonsMD in Better Health Network, Health Policy, Opinion, Primary Care Wednesdays
Tags: Direct Patient Care, DocTalker Family Medicine, Dr. Steve Simmons, Healthcare Policy, Healthcare Reform Bill, HIPAA, Primary Care
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As the period of debate over the Healthcare Reform Bill ends with President Obama penning his signature, one moment from the “debate” at Blair House stands out in my mind. A Republican Congressman sitting behind a copy of the then-current reform bill –- a pile higher than 2,000 pages –- was mocked for using such a prop. It’s complicated to fix healthcare with the laconic response to his theatrics.
Things don’t appear to have grown any simpler as we settle in for a period of discovery to determine exactly what this new law spells out for us in terms of reform. There is no consensus on whether this law will help or hinder, and I’m worried.
I cannot read 2,600 pages written in legalese. I juggle my time now to keep up with the medical literature necessary to adequately do my job and I suspect other physicians struggle similarly. All doctors fight a daily battle with time, trying to care for each patient in the best way possible (this is why many of us walk so fast through hospitals and clinics.) I hope that healthcare reform doesn’t result in less time for direct patient care. Read more »
March 31st, 2010 by RyanDuBosar in Better Health Network, Health Policy, Opinion, Primary Care Wednesdays, True Stories
Tags: ACP, American College Of Physicians, Diagnostics, Dr. Robert Cantor, General Medicine, Healthcare Commerce, Healthcare reform, Internal Medicine, Medical Imaging, Pathology, Patient Behavior, Primary Care, Unnecessary Testing
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Congress controls the nation’s purse strings. It can tell the Executive Branch how to spend money. It can regulate all commerce, and by the way, to Congress everything is “commerce.”
Congressional legislation can incent economic behavior–pay for this, but not for that–but it can’t change personal decisions. A case in point is Dr. Robert Cantor, ACP Member, of Boca Raton, Fla., who says he authorizes the tests that his patients demand. His opinion? “I do the damn test.”
He says there’s little incentive not to order tests and little in healthcare reform to make him and others change their habits. More likely is the idea that, once new medical technology is invented, it will find a use.
Another article compiles a wide spectrum of ideas on how to reduce healthcare spending. Tort reform was one, sure, but many doctors focused on changing patient behavior first.
*This blog post was originally published at ACP Internist*
March 30th, 2010 by Toni Brayer, M.D. in Better Health Network, Health Policy, Health Tips, Opinion, True Stories
Tags: Animals, Big Agriculture, Corn-Fed Beef, Dietitian, Eating Healthy, Farming, Fast Food Nation, Food Inc. Documentary, Grass-Fed Beef, High-Calorie, Inhumane Conditions, Meat, Michael Pollan, Perverted Economics, Processed Foods, Safeway, Slaughterhouse, Sugar-Laden, Whole Foods
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I watched a good documentary called “Food, Inc.” It was nominated for an Academy Award. The promo says “you’ll never look at dinner the same way” and they’re right. Since I’m a fan of Michael Pollan and have read “Fast Food Nation,” I was already a healthy-food fan, but seeing how agriculture and farming has changed over the last 40 years was still a shocker.
There’s no doubt that high-calorie, sugar-laden processed foods are contributing to serious health issues in America. And 10 billion animals are raised on factory farms under inhumane conditions.
So when I went to the grocery store today, I made a conscious choice to ask if Safeway had any grass-fed beef for a healthy stir fry I was making for dinner. The answer was “No,” so I journeyed over to Whole Foods where I bought a pound of grass-fed sirloin. The cost was a whopping $16.43.
I have to ask myself why grass-fed beef should be so much more expensive than corn-fed beef. There’s no way the average family could afford to eat the way we should. The impact on our environment and our health is suffering terribly because of these perverted economics.
*This blog post was originally published at EverythingHealth*
March 30th, 2010 by Shadowfax in Better Health Network, Health Policy, Humor, News, Opinion
Tags: Abortion Drugs, Amendment, ED, Erectile Dysfunction, Federal Funding, General Medicine, HCR, Healthcare Policy, Healthcare reform, Pedophiles, Pharmacology, Primary Care, Sex Offenders, Viagra
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There’s been some buzz on Twitter that the Democrats in the Senate have killed an amendment which would have prohibited federal funding for erectile dysfunction (ED) medications for sex offenders, which means in the upside-down logic of Washington D.C. that the Democrats favor giving Viagra to pedophiles. Right? Well, not exactly.
First, just a point of procedure: Remember, healthcare reform (HCR) is now a law, on the books, signed by the President. But there was this reconciliation sidecar bill which was meant to fix the HCR law as originally passed—it was passed in the House pretty much as soon as the Senate bill was passed. But it had to pass the Senate in the identical form, word for word, in order to go directly to Obama’s desk for signing. If the Senate mucked things up by tacking on amendments, it would have to go back to the House for approval, and given the razor-thin margin in the House, Democrats very much wanted to avoid that. Read more »
*This blog post was originally published at Movin' Meat*
