January 21st, 2010 by KevinMD in Better Health Network, Health Policy, Opinion
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It’s no secret that without a stronger primary care foundation, the current reform efforts are unlikely to be successful. If anything, it will only delay the inevitable.
I wrote last month that one discussed solution, adding more residency slots, won’t help: it would simply perpetuate the disproportionate specialist:primary care ratio.
A recent op-ed in The New York Times expands on that theme. The authors suggest that not only does primary care need to be promoted, specialist slots should be limited. Simply building more medical schools, or adding more residency slots, without such restrictions will only add to the number of specialists.
Already, many primary care residency slots go unfilled – what’s the point of adding more?
You have to solve the root cause that shifts more students away from primary care: disproportionately low pay, disrespect that starts early in medical training, and poor working conditions where bureaucracy interferes with the doctor-patient relationship.
Until each of those issues are addressed, simply more spending money to produce more doctors simply isn’t going to work.
*This blog post was originally published at KevinMD.com*
January 21st, 2010 by Steve Novella, M.D. in Better Health Network, Research
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The problem with the Western diet is not one of deficiency, but one of excess. We get too much of a good thing – too many calories, too much of the wrong kind of fat, and too much salt. As a result obesity, diabetes, and hypertension are growing health problems.
There also does not appear to be an easy solution – voluntary diets founded primarily on will power are notoriously ineffective in the long term. Add to that is the marketplace of misinformation that makes it challenging for the average person to even know where to apply their (largely ineffective) will power.
It can be argued that this is partly a failure, or an unintended consequence, of market forces. Food products that provide cheap calories and are tasty (sweet, fatty, or salty) sell well and provide market incentives to sell such products. Consumers then get spoiled by the cheap abundance of tempting foods, even to the point that our perspective on appropriate portion sizes have been super-sized. Read more »
*This blog post was originally published at Science-Based Medicine*
January 20th, 2010 by Peggy Polaneczky, M.D. in Better Health Network, Health Policy
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A study published in this week’s Archives of Internal Medicine looked at so-called errors made in consultation code billing by specialists seeing patients at the request of a primary care practice in suburban Chicago. The methodology? Comparing the primary care office referral form with the specialist’s bill.
The author concludes that specialists are greatly overusing consultation codes in situations where a new patient visit would be more appropriate, to the tune of over half a billion dollars a year in Medicare payments, and suggests that it is time to reconsider the use of these codes. (Medicare, of course, has already come to the same conclusion, and beginning January 1 of this year, is no longer paying for consultation codes.)
There may be misuse of consultation codes going on, but this study does not necessarily prove that. The methodology does not include medical record review, the standard by which coding choices are verified or refuted, and relies entirely on the referring physician’s determination of what the specialist should be billing. Read more »
*This blog post was originally published at The Blog that Ate Manhattan*
January 20th, 2010 by AlanDappenMD in Primary Care Wednesdays
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I bristle when my patient-driven, fee-for-service primary practice, DocTalker Family Medicine, gets lumped into the “concierge” movement, as it frequently does. First, veterinarians, accountants, mechanics lawyers and all other service providers in everyday life who work directly for their clients and not as “preferred providers” for the insurance companies are not labeled “concierge.” Secondly, the label “concierge” implies exclusivity, membership, high yearly retainers, and capped patient enrollment. Each of these labels we too reject.
A practice like ours out-competes the traditional model and the “concierge idea” in almost every measurable way: access, convenience, patient control, speed to treatment, quality and finally and maybe most importantly for the sake of the health care debate, price. Our boss is each patient one at a time, and our goal is to provide the most cost effective delivery model achievable. We strive for nothing less than making primary care immediate, high quality, patient controlled and affordable to every American. We deliver a concierge-level service at a price that is much less than even the price-fixing controlled by the insurance-driven model to date. Read more »
January 19th, 2010 by Davis Liu, M.D. in Better Health Network, Health Policy, Opinion
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Even with healthcare reform, Americans will increasingly be burdened with high deductibles, more financial responsibility, and less satisfaction with their health insurance for the foreseeable future. Why? Because the healthcare system is unable to transform its services in a manner that other industries have done to improve quality and service while decreasing costs. The two biggest culprits are the mentality of healthcare providers and the fee for service reimbursement system.
Doctors and patients haven’t altered the way they communicate over the past hundred years. Except for the invention of the telephone, an office visit is unchanged. A doctor and patient converse as the physician scribbles notes in a paper chart. Despite the innovations of cell phones, laptop computers, and other time saving devices, patients still get care through face to face contact even though banking, travel, and business collaboration can be done via the internet, webcams, and sharing of documentation. As Dr. Pauline Chen noted in a recent article, doctors are not willing to use technology to collaborate and to deliver medical care better, more quickly and efficiently. Mostly it is due to culture resistant to change. Partly it is due to lack of reimbursement. Both are unlikely to be addressed or fixed anytime soon. Read more »
*This blog post was originally published at Saving Money and Surviving the Healthcare Crisis*
