Posted on 06/27/2009 10:29:32 AM PDT by newbie2008
The primary-care doctor is gaining new respect in Washington. Battles may be breaking out left and right over the various health-care bills emerging from Congress, but reformers on both sides agree that general practitioners should be given a central role in uniting the fragmented U.S. medical system.
This vision has a name: the "patient-centered medical home." The "home" is the office of a primary-care doctor where patients would go for most of their medical needs. The general practitioner would oversee everything from flu shots to chronic disease management to weight loss, and coordinate care with nurses, pharmacists, and specialists. A 2004 study estimated that if every patient had such a home, the resulting efficiencies might reduce U.S. health-care costs by 5.6%, a savings of $67 billion a year.
Instead, most patients today get a scant seven minutes with a general practitioner, who has time to do little more than ask cursory questions and focus on the problem at hand. The patient rushes to specialists for chronic conditions that could be managed by a regular doctor. (Today, these different physicians rarely coordinate.) Last-minute appointments are almost unheard of -- one reason patients with minor complaints flock to already crowded hospital emergency rooms.
(Excerpt) Read more at businessweek.com ...
Imagine that.
I have a “medical home” and a good doctor. However, he doesn’t know everything. The good thing is that he realizes this and is willing to send his patients to specialists who know more than he does. The notion that the use of specialists is wasteful is a dangerous one.
The key thing about specialists is that they see the condition over and over and know how to tweak the treatment. Instead of the cookie-cutter approach, they adjust the treatment to the patient based on their experience. That produces much better outcomes.
The Obama approach, where we’d have “evidence-based medicine” with best practices defined by the Federal government, is the opposite of that. It would lead to medical treatment based on the median rather than based on the actual patient’s situation.
Their belief is that if we just have evidence-based medicine then your primary care doc could look up on the web what the best treatment is, apply it, and everything’s hunky dory, with no need for one of those specialists. Of course if your condition isn’t the average, but a bit up the bell curve, you’re going to suffer needlessly because you didn’t get to see a specialist who knows all the nuances.
This is BS.....Most people ALREADY do this. And if they don't whose business is it anyway. If their insurance allows them to go directly to the specialist they need, so be it. It might even be cheaper since the primary care Dr. bills are eliminated (efficiency).
Most of these costs are private anyway, and much of the reason for high costs have legal roots, not medical. I'd support legal reform before I'd support healthcare reform.
They don't even want to control costs to illegals, etc. These are the people who get care they are not even entitled to receive. But to make it look like a crisis, they are included in the "40 million with no health insurance" number.
OK—what about lab and Xray? This daydream breaks down very quickly.
Not only that, but will be some kind of legal protection in following the protocol, or the protocol breaks down. That means your doc is safer with the protocol...allthough you may not be.
If O manages to drag down doctor income, there will be huge pressure for tort reform or the docs will simply quit, retire early, whatever...but it'll mean decreasing availability of care.
Only 5 decades ago, the fed govt. authorized a gatekeeper board for the purpose of granting the existence and legitimacy of all medical boards...a new board, the Family Practice Specialty Board was distilled from the general practice arena and Family Practice specialists were allowed to have hospital privileges. All remaining general practitioners, some of whom practiced surgery, were gradually eliminated from having hospital privileges and continued on with office practice only. The general practitioners sought a board of their own for decades so as to regain their former privileges, to no avail...they were excluded, marginalized and continue to die off. The govt, thru the ‘board’ defined the specialties as it and corporate America wanted them defined, and as they exist today. Governments role has been present in healthcare extensively since just after WWII.
Now, some are recalling the usefulness of the ole’ family doc, and the wide ranging roles played by them far exceeding the limits of the Family Practice specialty. They played community roles as independent physicians which none are allowed to play today by corporate hospital structures.
Aside from a handful of GPs existing today, all specialists who are not salaried by hospitals will be directly impacted by the ‘public option’ Obamacare refers to...draconianly lower physician reimbursement to those in independent, private practice will cause many of them to close their doors. No one is making an estimate of what percentage of MDs in practice will stop practicing as the costs of practice are not met. Few part-time doctors can remain in practice if any reduction in reimbursement is imposed. Forcing doctors out of practice financially while adding tens of millions to the ‘Insured’ population is a prescription for extensive reduction of care and rationing.
The physician reimbursement used to be 18% of the Medicare budget, and, if eliminated totally would not save Medicare. After Medicare Part D was added, the physician service ‘imposition’ in Medicare was diluted to only 10%, and if reduced to zero would still not save Medicare, once again. Draconian cuts in physician income are demanded by policymakers with the ‘public option’, and the result will be a big reduction in the no. of doctors in practice.
Govt. promises of ‘you can keep’ your doctor assumes he/she is actually still in practice to be utilized by the choice. The publics’ view that govt. plans regarding healthcare and other agendas are losing legitimacy is growing...competent legislation will only happen if the public continues to educate itself from the means currently available regarding these issues.
Which is not necessarily a bad thing if the function involved is important (ear, eye) or vital (heart).
I have great respect for internists, and think their job is one of the most difficult in all of medicine. Having said that, as we understand more, and things become increasing complex because of what we know now that we didn't know before, it becomes increasingly difficult for one person to know enough to treat a wide spectrum of disease processes. Many patients currently don't get to subspecialists until late in their disease process. As more and more people come into the system to see primary care physicians, more and more people will be referred to specialists. That's because good internists are too busy to read about and manage subspecialty type disease and still have enough volume in the number of patients they see daily to make ends meet financially. I could go on and on, but suffice it to say that dogmatic ideologues are almost always wrong.
The patient rushes to specialists for chronic conditions that could be managed by a regular doctor. (Today, these different physicians rarely coordinate.) Last-minute appointments are almost unheard of — one reason patients with minor complaints flock to already crowded hospital emergency rooms.
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Here we go again. Anyone with half a brain and a chronic illness will see their primary care physician (who does coordinate with the specialist) to save costs once the illness is manageable, saving the specialist visits for the really big stuff. But then, you would have to be savvy about your own health care and desire the freedom to choose - neither of which I think a lot of America can be bothered with on certain days!
We have an excellent family physician who has been caring for our family for almost 30 years.
He is our “go-to” Doc, and as others have said in the thread, knows his limits. The very best thing about him is that he knows who the good specialists are in our area, and cultivates good relationships with these, so he can get us fast referrals when we have a problem that he can’t manage.
He also is honest with us, and tells us what treatments/meds are not worth the cost/side effects. He also keeps track of every specialist being seen, all the meds prescribed, and makes sure, along with our pharmacist, there isn’t any negative interactions.
Since my husband has Parkinson’s and adrenal/kidney problems, has recently broken a hip requiring partial replacement, our family doc is worth everything to us. Dealing with 3 or 4 specialists is very difficult, and he has helped us the most by keeping all of them up to date on what the others are doing/prescribing.
God bless the good family physicians.
Huge, enormous, gargantuan, beyond-belief amounts of money are spent trying not to get sued.
The only way doctors are going to stop ordering CT scans for every lump, bump and twinge is if the CT machine aren't present. If the machines are accessible, they will be filled.
If (and it seems when) your access to care is rationed, thank your local personal injury lawyer and your lawyer-legislators that gave him his license to steal.
Would you pay cash to see him?
A great question!
Among the other things I do, I run a travel clinic for pretravel advice, shots, and prescriptions.
Insurance doesn't pay, for the most part, for this service (Yes, that's idiotic, because they pay $100K for the subsequent hospitalization if you get sick, but nobody said they were smart).
Anyway, we overbook safari visits 5:4 because 20% of the people who have booked $25 000 trips to malaria and yellow fever hot zones walk out when they find out they have to pay $45 for the visit.
Think about that.
Exactly.
I’m an Internist, very classical in structure, but am playing with a retainer structure.
As the above, I have a huge cohort of patients who adore the services I provide, blah, blah, blah. Of course every one of them is detached from the price of my services, save their copayment, as they are all insured.
I can expect 10% of my 1500 patients to stay with me if I go to full-time retainer. Keep in mind - half (let’s say) of them think I’m the best doctor they have ever had, best since sliced bread.
This is why I suggest, as with most big problems in this country, that we are very far away from solving problems — we haven’t even correctly identified the ingredients and the problem. But we’ll love to talk and throw money.
Which candidate in the last presidential election discussed the 100 trillion owed in the next one generation to keep our two biggest entitlements (SS, MCare) afloat? All I heard was the possibility of expanding MCare for those 40 million (another bogus statistic) uninsured - spending MORE money (that we don’t have) at a problem that really is much more complex than advertised.
Thank you for listening to my rant. Mike
And perhaps this as well.
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