Comments on: The egg-timer office visit http://www.kevinmd.com/blog/2006/09/egg-timer-office-visit.html medical blog Sun, 22 Nov 2009 19:59:44 -0500 http://wordpress.org/?v=2.8.4 hourly 1 By: anonymous http://www.kevinmd.com/blog/2006/09/egg-timer-office-visit.html/comment-page-1#comment-67439 anonymous Thu, 28 Sep 2006 01:19:00 +0000 http://clients.emmense.com/kevinmd/2006/09/the-egg-timer-office-visit.html#comment-67439 Unionization is not the answer. Larger practices with market power to match that of the insurance companies and economies of scale are what is needed. Insurance companies are so large that they exercise market power, and in any other sphere of enterprise would be potentially subject to antitrust regulation. That said, be aware that Medicare is the ultimate monopoly, and private payors following Medicare extend this monopoly power. Good luck bringing an antitrust action against the federal government! Unionization is not the answer. Larger practices with market power to match that of the insurance companies and economies of scale are what is needed. Insurance companies are so large that they exercise market power, and in any other sphere of enterprise would be potentially subject to antitrust regulation. That said, be aware that Medicare is the ultimate monopoly, and private payors following Medicare extend this monopoly power. Good luck bringing an antitrust action against the federal government!

]]> By: Anirban http://www.kevinmd.com/blog/2006/09/egg-timer-office-visit.html/comment-page-1#comment-67409 Anirban Wed, 27 Sep 2006 05:46:00 +0000 http://clients.emmense.com/kevinmd/2006/09/the-egg-timer-office-visit.html#comment-67409 the best way is physicians should unionize and collectively get out of the plans, what ever that is . A concierge pratice at an affordable rate would be a better idea , but it will require big solidarity among physicians in primary care. With years of HMO experimentation the hard facts that we have learned that they will never put the money where the mouth is , and only enrich the CEOs . What ever the condition of the HMO the CEO compensation never goes down. It will be far better to expunge all the third parties from the whole process. It is sad that primary care providers have never been allowed to unionize and collectively bargain for the rates ,courtsey the washington lobbyists and ACP-ASIM and Pundits in RWJF always dishing out the politically correct craps , to the detriment of the physicians ,I think PCPs better wake up and smell the coffea,and get a better leadership or just perish . there is no way out. the best way is physicians should unionize and collectively get out of the plans, what ever that is . A concierge pratice at an affordable rate would be a better idea , but it will require big solidarity among physicians in primary care. With years of HMO experimentation the hard facts that we have learned that they will never put the money where the mouth is , and only enrich the CEOs . What ever the condition of the HMO the CEO compensation never goes down. It will be far better to expunge all the third parties from the whole process. It is sad that primary care providers have never been allowed to unionize and collectively bargain for the rates ,courtsey the washington lobbyists and ACP-ASIM and Pundits in RWJF always dishing out the politically correct craps , to the detriment of the physicians ,I think PCPs better wake up and smell the coffea,and get a better leadership or just perish . there is no way out.

]]> By: anonymous http://www.kevinmd.com/blog/2006/09/egg-timer-office-visit.html/comment-page-1#comment-67400 anonymous Wed, 27 Sep 2006 00:00:00 +0000 http://clients.emmense.com/kevinmd/2006/09/the-egg-timer-office-visit.html#comment-67400 I'm sure our troops in Iraq or Afghanistan would graciously accept your care, and that suing you would be the last thing on their minds. There are a lot of Saddamites, but they will just lop your head off you make a mistake. I’m sure our troops in Iraq or Afghanistan would graciously accept your care, and that suing you would be the last thing on their minds. There are a lot of Saddamites, but they will just lop your head off you make a mistake.

]]> By: CJD http://www.kevinmd.com/blog/2006/09/egg-timer-office-visit.html/comment-page-1#comment-67395 CJD Tue, 26 Sep 2006 14:00:00 +0000 http://clients.emmense.com/kevinmd/2006/09/the-egg-timer-office-visit.html#comment-67395 I thought you were going to Europe or Canada or something? Or was it getting out of medicine altogether? Your stories are hard to keep straight. I thought you were going to Europe or Canada or something? Or was it getting out of medicine altogether? Your stories are hard to keep straight.

]]> By: lawyersux http://www.kevinmd.com/blog/2006/09/egg-timer-office-visit.html/comment-page-1#comment-67394 lawyersux Tue, 26 Sep 2006 08:46:00 +0000 http://clients.emmense.com/kevinmd/2006/09/the-egg-timer-office-visit.html#comment-67394 "My experience in primary care was 3 years in the military.<br/><br/>I was thinking of applying for a job at a military base or VA hospital. I heard that protects you from the sodomites. Does anybody know if it's true you can't be sued if you work at a V.A> or for the military? “My experience in primary care was 3 years in the military.

I was thinking of applying for a job at a military base or VA hospital. I heard that protects you from the sodomites. Does anybody know if it’s true you can’t be sued if you work at a V.A> or for the military?

]]> By: anonymous http://www.kevinmd.com/blog/2006/09/egg-timer-office-visit.html/comment-page-1#comment-67393 anonymous Tue, 26 Sep 2006 05:13:00 +0000 http://clients.emmense.com/kevinmd/2006/09/the-egg-timer-office-visit.html#comment-67393 Realistically my family spends as much on auto associated costs per year as health care, and my mechanic gets paid cash at the time of service. There are no discounts and my mechanic does not accept insurance; he sets his own prices. My mechanic drives a Mercedes-Benz. There is no call or provision for emergencies. If my battery dies I will just have to wait until the shop opens. I love and trust my mechanic nonetheless, and he has earned the AAA seal of approval.<br/><br/>You are right! Maybe physicians should be more like mechanics. Realistically my family spends as much on auto associated costs per year as health care, and my mechanic gets paid cash at the time of service. There are no discounts and my mechanic does not accept insurance; he sets his own prices. My mechanic drives a Mercedes-Benz. There is no call or provision for emergencies. If my battery dies I will just have to wait until the shop opens. I love and trust my mechanic nonetheless, and he has earned the AAA seal of approval.

You are right! Maybe physicians should be more like mechanics.

]]> By: chucky http://www.kevinmd.com/blog/2006/09/egg-timer-office-visit.html/comment-page-1#comment-67392 chucky Tue, 26 Sep 2006 04:46:00 +0000 http://clients.emmense.com/kevinmd/2006/09/the-egg-timer-office-visit.html#comment-67392 My experience in primary care was 3 years in the military. Retirees would come to their 15 minute appointment with a years list of medical complaints and concerns. The spouse, who didn't have an appointment, also had a list and wanted those addressed "because I am here". What finally did it was when I was woke up one sunday morning by a patient who apparently got my number through base information and wanted to know the results of their cholesterol test. <br/><br/>No more primary care for me. My experience in primary care was 3 years in the military. Retirees would come to their 15 minute appointment with a years list of medical complaints and concerns. The spouse, who didn’t have an appointment, also had a list and wanted those addressed “because I am here”. What finally did it was when I was woke up one sunday morning by a patient who apparently got my number through base information and wanted to know the results of their cholesterol test.

No more primary care for me.

]]> By: Criminallopath http://www.kevinmd.com/blog/2006/09/egg-timer-office-visit.html/comment-page-1#comment-67391 Criminallopath Tue, 26 Sep 2006 04:42:00 +0000 http://clients.emmense.com/kevinmd/2006/09/the-egg-timer-office-visit.html#comment-67391 Yet another example supporting the contention that more medical schools should be opened - free of the limiting restrictions of the CME. This form of behavior would never be tolerated in any other profession as the consumers would quickly put the offending service provider out of business by leaving en masse to the horde of providers waiting down the street. Can you imagine if your auto mechanic tried this? How quickly would you find yourself at the next mechanic down the street? The healthcare market needs more competition amongst the providers such that the providers are begging for patients, and not the current system. In any event, this is the system that the sheeple have allowed to be imposed upon them. They should just shut up and take what the providers dish uot to them. Yet another example supporting the contention that more medical schools should be opened – free of the limiting restrictions of the CME. This form of behavior would never be tolerated in any other profession as the consumers would quickly put the offending service provider out of business by leaving en masse to the horde of providers waiting down the street. Can you imagine if your auto mechanic tried this? How quickly would you find yourself at the next mechanic down the street? The healthcare market needs more competition amongst the providers such that the providers are begging for patients, and not the current system. In any event, this is the system that the sheeple have allowed to be imposed upon them. They should just shut up and take what the providers dish uot to them.

]]> By: CJD http://www.kevinmd.com/blog/2006/09/egg-timer-office-visit.html/comment-page-1#comment-67390 CJD Tue, 26 Sep 2006 03:04:00 +0000 http://clients.emmense.com/kevinmd/2006/09/the-egg-timer-office-visit.html#comment-67390 Okulus, when will your lobbying entities start putting some legislation up to enact your proposals? Okulus, when will your lobbying entities start putting some legislation up to enact your proposals?

]]> By: anonymous http://www.kevinmd.com/blog/2006/09/egg-timer-office-visit.html/comment-page-1#comment-67386 anonymous Tue, 26 Sep 2006 01:56:00 +0000 http://clients.emmense.com/kevinmd/2006/09/the-egg-timer-office-visit.html#comment-67386 The fact of the matter is that the demand for health care services continues to rise, fueled by new technologies, increasing expectations, increased longevity, and increased disease (diabetes especially). This increased demand equires greater expenditure of resources. <br/><br/>If demand increases as payments per encounter or service decrease, the choices are to be more efficient in some manner or spend less time per encounter. The efficiency of providing medical care is one thing that has not improved. Patients want time to converse with their doctor and have their questions answered. Physicians have more tests to order, procedures to perform, and medications they can prescibe. Add the bureaucratic morass of managed care, verifying insurance, HIPPA forms, documentation requirements, etc. and things become ever less efficient. <br/><br/>The issues for everyone concerned include consideration of how much time and money to spend on health care, how much choice is desired, where to draw the line on services covered by third party payors, and how to improve efficiency in delivery of healthcare. <br/><br/>Reactions to the current situation include the subject of the article. I view such responses in a negative light, but it really all about scarce resources and how to distribute them. Concierge medical practice is another reaction. I think it has its place, but will not deliver speciality care nor care for the masses. Limiting ones scope of practice can produce certain efficiencies of scale and standardize care to an extent. <br/><br/>Old fashioned face-to-face time with a physician is very expensive and with decreased payments by third party payors will become less and less. Instead of physical exams as we know them, maybe we will have asssembly-line exams (height, weight, blood pressure, pap smear, ekg, and plebotomy performed by allied health providers). A report will then be generated by computer with physician review, e-mailed to our homes, and follow-up recommended determined by evidence-based medicine and economic cost/benefit statistics. Further procedures, studies will be done by highly subspecialized providers with standardized and streamlined protocols. Drugs will be prescribed by formulary protocol, not doctor or patient preference. This will be the new government mandated standard of care. For anything else, you must have additional insurance or pay out of pocket. The fact of the matter is that the demand for health care services continues to rise, fueled by new technologies, increasing expectations, increased longevity, and increased disease (diabetes especially). This increased demand equires greater expenditure of resources.

If demand increases as payments per encounter or service decrease, the choices are to be more efficient in some manner or spend less time per encounter. The efficiency of providing medical care is one thing that has not improved. Patients want time to converse with their doctor and have their questions answered. Physicians have more tests to order, procedures to perform, and medications they can prescibe. Add the bureaucratic morass of managed care, verifying insurance, HIPPA forms, documentation requirements, etc. and things become ever less efficient.

The issues for everyone concerned include consideration of how much time and money to spend on health care, how much choice is desired, where to draw the line on services covered by third party payors, and how to improve efficiency in delivery of healthcare.

Reactions to the current situation include the subject of the article. I view such responses in a negative light, but it really all about scarce resources and how to distribute them. Concierge medical practice is another reaction. I think it has its place, but will not deliver speciality care nor care for the masses. Limiting ones scope of practice can produce certain efficiencies of scale and standardize care to an extent.

Old fashioned face-to-face time with a physician is very expensive and with decreased payments by third party payors will become less and less. Instead of physical exams as we know them, maybe we will have asssembly-line exams (height, weight, blood pressure, pap smear, ekg, and plebotomy performed by allied health providers). A report will then be generated by computer with physician review, e-mailed to our homes, and follow-up recommended determined by evidence-based medicine and economic cost/benefit statistics. Further procedures, studies will be done by highly subspecialized providers with standardized and streamlined protocols. Drugs will be prescribed by formulary protocol, not doctor or patient preference. This will be the new government mandated standard of care. For anything else, you must have additional insurance or pay out of pocket.

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