April 1st, 2011 by Stanley Feld, M.D. in Health Policy, Opinion
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The larger the bureaucracy the more inefficient a system becomes. Several things can happen in the decision making process.
1. The decision making process can become opaque rather than transparent.
2. Decisions are made by a committee by consensus.
3. Consensus committee decisions might not sharply define the original goals.
4. Blame for errors gets dissipated.
5. Decisions are only as good as the information that is gathered.
6. Changing a wrong decision can be difficult and costly.
President Obama’s healthcare reform law is creating 256 new agencies to gather information and recommend decisions for other agencies to write regulations.
The following decision is being made by an agency in Washington state. It is not only the wrong decision, but is a decision that will set back the care of Type 2 Diabetes Mellitus 15 or 20 years. It is a decision being made using the wrong information. Read more »
*This blog post was originally published at Repairing the Healthcare System*
March 23rd, 2011 by RyanDuBosar in Health Policy, News
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Academic faculty physicians in primary and specialty care reported slight pay increases, according to the Medical Group Management Association.
The organization’s Academic Practice Compensation and Production Survey for Faculty and Management: 2011 Report Based on 2010 Data, annual compensation for internal medicine primary care faculty physicians increased by 6.84% since 2009, and increased 4.46% between 2008 and 2009.
Median compensation for all primary care faculty physicians was $163,704, an increase of 3.47% since 2009, and median compensation for specialty care faculty was $241,959, an increase of 2.7% since 2009.
Department chairs and chiefs received the greatest compensation, $292,243 for primary care faculty and $482,293 for specialty care faculty. Primary care professors received $190,815 in compensation and specialty care professors received $268,786. Read more »
*This blog post was originally published at ACP Internist*
March 19th, 2011 by BobDoherty in Health Policy, Opinion
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A few days ago I received an email from a general internist about my posts about concierge practices. I have known this physician for over 20 years, and he has great insight into the challenges facing health care. This email was no exception; he had this to say how his group took the “middle way” of pursuing private funding for the Patient-Centered Medical Home (PCMH):
“My practice includes 3 primary care physicians and has invested heavily in IT infrastructure. We have re-engineered our workflows and have achieved benchmark levels of quality and service. We have won NCQA certification for our PCMH. Yet so far no payer has stepped up to underwrite our investment. So we have joined Privia Health in forming a ‘membership practice.’ Patients are asked to pay a small monthly membership fee. In return they receive some special attention . . . Plan sponsors and payers are invited to pay the fee on behalf of their employees. . . Patients like having same day access. They like secure email communication with their doctor. They like having a personal health record. They like having a case manager helping them navigate the system. And they like going online in the evening to make their own appointments. ACP policy supports the medical home but is silent on the question of what a medical home is to do before local payment realities catch up. I owe my patients my efforts to assure that when I retire an eager young internist will welcome the opportunity to take over my practice. Absent public or private funding for the medical home that is just not going to happen.” Read more »
*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*
March 16th, 2011 by StevenWilkinsMPH in Opinion, Research
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Is anyone else tired of hearing about how important empathy is in the doctor-patient relationship? Every other day it seems a new study is talking about the therapeutic value of empathy. Enough already!
It’s not that I don’t believe that empathy is important — I do. I also believe the data that links physician empathy with improved patient outcomes, increased satisfaction, and better patient experiences.
A recent study released in Academic Medicine reported that “patients of physicians with high empathy scores were significantly more likely to have good control over their blood sugar as well as cholesterol, while the inverse was true for patients of physicians with low scores.”
Findings from this study by Hojat, et al. are consistent with a 2009 study by Rakel, et al. which found that among patients with the common cold, those with physicians displaying high empathy had a significantly shorter duration of illness and trend toward lesser severity of illness and higher levels of immune response compared to those patients whose physician displayed less empathy. Read more »
*This blog post was originally published at Mind The Gap*
March 16th, 2011 by RyanDuBosar in Better Health Network, Research
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Obesity contributes to cardiovascular risk no matter where a person carries the weight, concluded researchers after looking at outcomes for nearly a quarter-million people worldwide.
Body mass index, (BMI) waist circumference, and waist-to-hip ratio do not predict cardiovascular disease risk any better when physicians recorded systolic blood pressure, history of diabetes and cholesterol levels, researchers reported in The Lancet.
The research group used individual records from 58 prospective studies with at least one year of follow up. In each study, participants were not selected on the basis of having previous vascular disease. Each study provided baseline for weight, height, and waist and hip circumference. Cause-specific mortality or vascular morbidity were recorded according to well defined criteria.
Individual records included 221,934 people in 17 countries. In people with BMI of 20 kg/m2 or higher, hazard ratios for cardiovascular disease were 1.23 (95 percent CI, 1.17 to 1.29) with BMI, 1.27 (95 percent CI, 1.20 to 1.33) with waist circumference, and 1.25 (95 percent CI, 1.19 to 1.31) with waist-to-hip ratio, after adjustment for age, sex, and smoking status. After adjusting for baseline systolic blood pressure, history of diabetes, and total and HDL cholesterol, corresponding hazard rations were 1.07 (95 percent CI, 1.03 to 1.11) with BMI, 1.10 (95 percent CI, 1.05 to 1.14) with waist circumference, and 1.12 (95 percent CI, 1.08 to 1.15) with waist-to-hip ratio.
BMI, waist circumference, or waist-to-hip ratio did not importantly improve risk discrimination or predicted 10-year risk, and the findings remained the same when adiposity — the carrying of adipose tissue (fat) — measures were considered. Read more »
*This blog post was originally published at ACP Internist*
