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Why Giving Free Care To The Uninsured Is Good Business

Walgreens made some headlines with their program to give free acute care services to those who are unemployed.

Before you think that they’re doing this out of the goodness of their hearts,

Doctors rarely would drop patients who have recently gone on Medicaid, or worse, lost their health insurance altogether. Why? As Dr. Sidorov writes, “Today’s patients with no or non-remunerative insurance were not only yesterday’s richly insured but tomorrow’s also. These providers know that when the economy eventually turns around, these patients are going to join the ranks of the employed/insured.”

Walgreens is applying the same principle. Today’s uninsured patients will, more likely that not, have insurance in the future, and will repay Walgreens back for helping them out during these tough times.

So, rather than patting Walgreens on the back for their kindness, you should be noting their business shrewdness instead.

Once You Reach Medicare Age, Good Luck Finding A Primary Care Physician

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**

US Radiologists: Jobs Outsourced To India

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.**

Why You’re More Likely To Die On Saturdays and Sundays

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**

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