November 1st, 2010 by EvanFalchukJD in Better Health Network, Health Policy, News, Opinion
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You want to see a doctor? You’re going to have to wait. And I don’t mean like an hour in the office. I mean like 53 days.
It’s not some doomsday story from the future. It’s happening today here in Massachusetts. Massachusetts — the state whose 2006 law was the model for the federal healthcare reform law. Massachusetts — home to some of the world’s best medical centers and doctors. And, as the Boston Globe’s “White Coat Notes” blog reports, Massachusetts — home to doctor shortages and long waits to see a doctor:
When primary care patients do secure an appointment for a non-urgent matter, they have to wait to get in the door, the survey found. The average delay is 29 days to see a family medicine doctor, down from 44 days last year, and 53 days to see an internist, up from 44 days last year.
The report said shortages also exist in dermatology, emergency medicine, general surgery, neurology, orthopedics, psychiatry, urology, and vascular surgery.
But what about costs? If you make sure everyone’s covered, you’ve got the foundation for real cost control, right? Unfortunately, no. Healthcare costs have been booming in Massachusetts:
Costs are rising relentlessly for both families and for the state government. The median annual premium for family plans jumped 10% from 2007 to 2009 to $14,300 — again, that’s a substantial rise on top of an already enormous number. For small businesses, the increase was 12%. In 2006, the state spent around $1 billion on Medicaid, subsidies for medium-to-lower earners, and other health-care programs. Today, the figure is $1.75 billion. The federal government absorbed half of the increase.
So what are the lessons for the future of American healthcare? Read more »
*This blog post was originally published at See First Blog*
November 1st, 2010 by DrRich in Better Health Network, Health Policy, Opinion
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In prior posts, DrRich introduced his readers to Ezekiel Emanuel, M.D., Ph.D., brother of Rahm, eminent medical ethicist, and one of the White House’s chief advisers on healthcare policy. Dr. Emanuel was one of the authors of that recent paper in the Annals of Internal Medicine which admonished American physicians that resistance is futile. He has also famously called upon American physicians to abandon the obsolete medical ethics expressed in the Hippocratic Oath.
The reason the ideas (and pronouncements) of Dr. Emanuel are important is that he presumably will be a major “decider” in determining who will serve on the GOD panels, and how those panels will operate to advance his (and Mr. Obama’s) program of healthcare reform.
So, before we leave Dr. Emanuel to his important duties, let us take one more pass at the views he has expressed, regarding the direction of American healthcare, which we can expect to see manifested in government guidelines and policies in the coming years. In particular, and especially relevant to the subject of this blog, let us view how Dr. Emanuel would direct the rationing of our healthcare. Read more »
*This blog post was originally published at The Covert Rationing Blog*
October 31st, 2010 by DavidHarlow in Better Health Network, Health Policy, News, Opinion
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I [recently] attended the Connected Health Symposium in Boston. I enjoyed many of the sessions (sometimes wished I could have attended two simultaneously, though the livetweeting — #chs10 — helped on that front), and as usual enjoyed the hallway and exhibit floor conversations too. As is often the case at conferences these days, I had the opportunity to meet several online connections in real life for the first time.
(I will not attempt to give a comprehensive report of the symposium here. Please see the livetweeting archive and other reports to get a sense of the rest of the event.)
This year’s exhibit floor included a diverse mix of distance health tools. Most striking from my perspective was the fact that most of these tools do one of two things: Enable patient-clinician videoconferencing, or upload data from in-home monitoring devices. The best of the second category also trigger alerts resulting in emails or PHR/EHR alerts to clinicians if vital signs are out of whack, or phone calls to consumers or their caregivers if, for example, meds aren’t taken on time (one company had a pill bottle with a transmitter in the cap that signals when it’s opened; another had a Pyxis-like auto-dispenser, that looked like you’d need an engineer — or a teenager — to program it). One tool — Intel’s — seemed to combine most of these functions, and more, into one platform, but it’s barely in beta, with only about 1,000 units out in the real world.
The speakers this year seemed to return again and again to several major themes: (1) Is any particular connected health solution scalable? (2) Who will pay for connected health, or mobile health (mHealth)? and (3) Does it work? Read more »
*This blog post was originally published at HealthBlawg :: David Harlow's Health Care Law Blog*
October 28th, 2010 by John Mandrola, M.D. in Better Health Network, Health Policy, Opinion
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As a specialist, one of the saddest truisms about practicing medicine in the private world has always been how little one’s clinical skills determines referrals. Unfortunately, as our present healthcare climate pushes “providers” to consolidate along the lines of major hospital networks this injustice will only worsen.
A decade or so ago when I started private practice it was obvious that referrals came to me because of my association with an established group. This association was essential, as one could have been the next Michael Jordan of electrophysiology, but referrals would still have gone along historic lines, to the favored group. It would have taken a Herculean effort, over years, to encroach upon such long-established referral patterns, etched over the bonds of rituals like Wednesday afternoon golf matches and dinner clubs.
Thus, few specialists start independently. You join an established group, do good work, form relationships and eventually, your quality becomes known. As it should be: Do good work and doctors will trust you with their patients. But yet, even the highest caliber specialists may fall prey to the easily accessible, affable (but unknown and untested) “new guy.” For enhancing referrals, availability and affability trump [actual] skills at least 90 percent of the time. Read more »
*This blog post was originally published at Dr John M*
October 27th, 2010 by KevinMD in Better Health Network, Health Policy, News, Opinion, Research
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Authors of a recent study from the Archives of Internal Medicine are unlikely to endear themselves to specialists. As reported by Reuters, and provocatively titled, Do specialist doctors make too much money?, the study gives a per-hour breakdown of how much doctors make.
I think this is a good approach, since annual salary figures do not account for the number of hours doctors work — and in the case of primary care doctors, this includes uncompensated time doing paperwork and other bureaucratic chores.
Here’s what they found:
… the lowest wages — amounting to $60.48 an hour — [were] paid to primary care physicians.
In other broad categories of practice, surgeons took home the highest average hourly wage of $92. Internal medicine and pediatric docs earned about $85 an hour, the researchers report in the Archives of Internal Medicine.
Looking at salaries among 41 specific subspecialties, however, they found neurologic surgery and radiation oncology to be the most lucrative at $132 and $126 per hour, respectively. These were followed by medical oncologists and plastic surgeons, both making around $114 per hour; immunologists, orthopedic surgeons and dermatologists also took in more than $100 an hour. At the low end of specialist pay, child psychiatrists and infectious disease specialists made around $67 an hour.
Of course, regular readers of [this] blog know that healthcare reform will do little to decrease the disparity. The pay raises that will be coming to primary care will be far too little to change the perception that, in the United States, specialists are more valued by far. Read more »
*This blog post was originally published at KevinMD.com*
