Monday, December 31, 2007
What does Jay have up his sleeve?
Keep your eye on this guy...If you live in NYC, keep your eye on property in or around Union Square, Soho, the West Village, or the Flatiron District. Something revolutionary will begin to take shape. Think the Apple Store, FedEx, Toyota Lean, Eugene Debs, 1984, The Fountainhead, Experience Design, continuous quality improvement, iPhones, video chats on your mobile phone or computer, IMs, emails, text messages from your doctor designed to respect your time that say “Your appointment is in 20 minutes, please make your way to the office and enter room 3,” evidence-based medicine, cost-consciousness, free generic medications, and a powerhouse of some of the most talented thinkers, businessmen, marketers, programmers, software architects, graphic designers, graphic user interface specialists, interior designers, architects, and some of the best physicians the world can offer all smiling in triumphant admiration.
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How to Care for the World's Poor
"If we train village health workers, and make sure they're compensated," he said, "then the resources intended for the world's poorest--from vaccines, to bed nets, to prenatal care, and to care for chronic diseases like AIDS and tuberculosis--would reach the intended beneficiaries."Thats right, compensate the care givers!
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Sunday, December 30, 2007
Near & Dear To My Heart
At Graham's request, I'll change subjects for a moment to something near and dear to my heart, Down Syndrome. If you're looking for a good cause to support, try buying a book for the young ones in your life.
When Stephen wrote this book he was 11 years old. William was 6 years old and the very best bro anyone could ever have. Stephen and William lived with their parents, 1 dog, 1 cat, 1 bunny and 1 bird in Loma Linda, California. Stephen died from cancer when he was 13 years old. Before he died he asked that a fund be set up from the sale of this book so he could continue to support his brother after he died.
Posted by JoshMD |
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Consumers Holding Down Health Care Inflation
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The Curse of Knowledge
(hat tip: Jay Parkinson MD)
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Death By A Thousand Cuts
A recent HANYS analysis of hospital financial data found that more than half of the state's hospitals lost money or recorded margins of less than 1% in 2006.(hat tip: More than Medicine)
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Volume. Volume. Volume.
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Friday, December 28, 2007
Aetna to End Payment for a Drug in Colonoscopies
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Unstoppable Market Forces
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Top 12 Trends for Physicians in 2008
6. Physician Empowerment - Doctors are re-awakening to the reality they hold the key to effective, efficient, and safe healthcare. They’re asserting themselves through legislative efforts to reduce malpractice costs, state medical societies curtailing health plan abuses, social online networking in sites like Sermo, and health care practices offering prompt same-day access and more efficient and friendly care.
Posted by JoshMD |
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Retired Doc is Beginning to Believe
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Paying for Arnoldcare
CHA leadership has apparently convinced itself that the same bureaucrats who crippled California hospitals by underfunding Medi-Cal are going to change their stripes under Arnoldcare. They actually seem to believe that all of the revenue generated by the tax (and federal matching funds as well) will be set aside by the bureaucrats for payments to providers.
Posted by JoshMD |
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Thursday, December 27, 2007
Courts Overturns Key Part of San Fransisco's Universal Coverage
Judge White ruled that the employer assessment violates the federal ERISA law (Employee Retirement Income Security Act of 1974) which, among other things, prohibits state and local governments from mandating that employers must provide health insurance to their workers. ERISA was the federal law cited by Maryland and New York federal courts in overturning so-called Wal-Mart laws passed last year to require very large employers to cover their workers or pay a tax.
Posted by JoshMD |
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FAQ: Won't Retainer Medicine Exacerbate Physician Shortages?
- Retention of older physicians who no longer wish to participate in the hamster wheel of high volume practices.
- Recruitment of medical students into primary care when they realize the potential for optimal job satisfaction, reimbursement and work load.
- Reduction in the need for physicians if the trend towards decreased hospitalization by even a small margin.
Posted by JoshMD |
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90% Reduction in Hospital Admissions
MDVIP is the largest and most organized company practice wide scale retainer medicine today. Their business model is fee for non-covered services, which basically means that the retainer fee is for additional care, not covered by CMS, but Medicare is still billed when appropriate.One of the common arguments against direct medical practices is the belief that if all doctors converted, then this would greatly exacerbate the physicians shortage, thus doing more harm than good. A reasonable concern. However, analysis of the MDVIP hospital admission rates tells a different story.
(State Reported Data Jan 1 Jun 30, 2005)
Now, I appreciate that in general the population of MDVIP might be more affluent than your typical medicare patient. However, it is logical that when doctors spend vastly more time with their patients, clinical improvements are bound to result. (pay for performance anyone?) Perhaps the numbers would change if more doctors practiced this model, but the trend would likely remain the same.Such a reduction in admissions would go a long way in decreasing the burden of a physician shortage.
Posted by JoshMD |
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Retainer Medicine: Ethical or Not?
Some might argue that these “highly ethical physicians” aren’t so highly ethical by practicing retainer medicine. One ethical framework would suggest if all physicians just practiced retainer medicine, there would not be nearly enough physicians to go around. In that framework, retainer medicine would be viewed as unethical.
Counterpoint:
If retainer physicians are unethical, then what about physicians who quit seeing patients entirely and enter medical administration. What about any variety of subspecialists?Upon further reflection we should learn from this ongoing entrepreneurial experiment. Why are patients choosing to spend moneys on retainer medicine? I believe patients are smart. They are tired of the relative inattention that most physicians can provide.
Posted by JoshMD |
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Wednesday, December 26, 2007
Dr. Chris Ewin: Fee-for-Care
Dr. Ewin, the former president of SIMPD discusses different business models for health care.Feel free to check out his site and see how he has set up his practice...
Posted by JoshMD |
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Simpd: The Society For Innovative Practice Design
Please take a moment and read some of the material available at SIMPD. Then I would like to invite you to challenge the model of direct medical care as passionately as you can in the comments section to encourage meaningful dialogue.
Posted by JoshMD |
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Defending Innovative Practice Models
DB asks those knee-jerking nay-sayers to stop and ask themselves why would they object to a win-win model for patients and physicians.I urge these authors and their ideological colleagues to look beyond the trappings. I urge them to perform a thought experiment. Why are patients increasingly willing to pay? Why are highly ethical physicians opting for this style of practice? If they are honest, they will find some truths that knee jerk opposition obscures.
Posted by JoshMD |
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Insurance = Prevention
So fantastic is insurance at heart attack prevention that the researchers of this important trial never even had to consult a single health record to verify their claims. Not one. From the studies "limitations" section:"Our study relied on self-reported health measures rather than data from medical records. Although our measure of adverse cardiovascular outcomes summarized related items selected for their face validity, this scale has not been formally evaluated as a measure of cardiovascular disease severity."
Posted by JoshMD |
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What is Consumer-Directed Health Care?
Dr. Jay Parkinson, who has moved his blog, calls our attention to an excellent article summarizing CDHC...Would physicians practice medicine differently if they were paid differently? There is ample evidence that the answer is yes. Unlike other forms of surgery, the typical cosmetic surgery patient can find a package price in advance covering all services and facilities, compare prices prior to the surgery, and pay a price that is lower in real terms than the price charged a decade ago for comparable procedures—despite considerable technological innovations in the interim.
Posted by JoshMD |
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Is Your Doctor Working for Big Pharm?
(hat tip: Book of Joe)
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Medical Myths
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Why Men are Funnier than Women
Apparently it has a lot to do with testosterone...
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Nuns Leave Their Brains to Science
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Tuesday, December 25, 2007
How did we get in this mess?
As long as people will accept crap, it will be financially profitable to dispense it.--Dick Cavett
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Grand Rounds is up at Medgadget
Nicholas Genes has another wonderful Christmas themed Grand Rounds up over at Medgadget.Happy Holidays!
Posted by JoshMD |
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The NHS Song
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Treating the Dead: The Science of Resuscitation
...why can't doctors revive someone who has been dead for an hour? Because once the cells have been without oxygen for more than five minutes, they die when their oxygen supply is resumed. It was that "astounding" discovery, Becker says, that led him to his post as the director of Penn's Center for Resuscitation Science, a newly created research institute operating on one of medicine's newest frontiers: treating the dead.
Posted by JoshMD |
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Monday, December 24, 2007
Charles Dickens Could Have Been A Physician
Dickens has long been recognized as a skillful and accurate chronicler of human behavior. His characters are rendered with a realist’s dedicated, unstinting eye. Physician readers of Dickens’s stories have commented on the precision with which he portrays his characters’ quirks and oddities — many of which are now recognized as disease states. Some of his most memorable characters are virtual case studies of diseases that were not described or understood until long after Dickens’s time.He is credited with the first description of an individual with Progressive supranuclear palsy...
Posted by JoshMD |
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The Governor Praises Qliance!
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Concierge Quality for Low Income Patients
Singh is not your typical patient of a boutique medical practice; he earns about $50 or $60 a day—far less than the CEOs and other wealthy types who tend to pay the monthly, out-of-pocket fees that boutique (or concierge) practices charge for on-demand access to their doctors. That's because Qliance is not your typical boutique service. Indeed, it doesn't even like that term, which it says smacks of elitism.Rather, Qliance's target demographic is the working poor and uninsured. It does not accept insurance, instead charging between $39 and $74 a month for an individual, depending on age. (The older you are, the more you pay.) That fee covers most of what encompasses primary care, including office visits, phone consultations, common X-rays, and some procedures and lab tests. Other tests, including those for cholesterol, diabetes, and blood count, will be offered at close to cost, for $7 to $17.50 each.
Sound too good to be true?
Posted by JoshMD |
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Online Donations for Hospitals?
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Retainer Medicine is Misunderstood
...before he left his former practice, he was delivering a standard of care which troubled him. He was losing his love for medicine and patients.Amen brother.As I asked SP about his typical day, he told me that he physically saw 6-8 patients each day. He spent at least as much time on the phone or answering email as physically seeing patients. At least once each week he makes home visits. He often calls his patients preemptively.
Because of his intense outpatient work, his admission rate is very low. He needs less consultants and orders fewer high ticker imaging studies.
This movement continues to grow. It grows because patients are willing to pay for service. Unfortunately, the Medicare reimbursement system drives what other insurers pay. This illogical, bureaucratic system is destroying outpatient internal medicine. Retainer medicine and cash based practice may save these practices.
Posted by JoshMD |
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Sunday, December 23, 2007
Not Just For the Rich
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Contagious Chin Dimples
Junkfood Science demonstrats absurdity by being absurd...
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Medical Gift Cards
In our current system, a few hundred dollars may barely pay for a month of insurance, but with direct medical practices, it could by unlimited visits (including labs and chest x-rays) to your primary care doctor.
Posted by JoshMD |
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Dad, I Love You
Dr. Wes with a heartwarming reflection on the last year with his Dad...
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Fetal Ultrasounds on Your Ipod
Women can visit the clinic in their lunch hour, have a 40-minute scan and then download the high-definition images to their MP3 player or mobile phone via a secure internet site.
Posted by JoshMD |
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Physicians and Customer Service
The Physician Executive is pleasantly pleased with the health care industry when compared to a few others...
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Should Insurers Cover Organ Transplants?
A sad story of a young girl in need of experimental liver transplant.
Posted by JoshMD |
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Friday, December 21, 2007
Niche Market: Truckers
A new company called Roadside Medical plans to offer quality, accessibly, affordable health care to truckers. Sounds like a recipe for success...
Posted by JoshMD |
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Health Care Reform, From the Ground Up
The answer is simple and reconnects us with the sacred bond of patients and physicians by removing the insurance middle man for primary care.
All physicians should ask themselves the following questions:
1) Do you want to have the luxury of time, allowing you to provide superb care to your patients?Did you answer yes to these questions? Then you might be interested in Direct Medical Practices. Over the next several days, I'll answer all your questions, provide countless success stories, and hopefully convince you to join.
2) Do you want to be financially rewarded for your skill, while still saving the patients thousands of dollars?
3) Would you to escape the current beast of billing, ICD-9 codes, high volume, low efficiency practices?
4) Would you like to enjoy medicine again?
Posted by JoshMD |
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DB Explores Retainer Based Practices
Thanks for the uncanny set up Dr. Centor, I'll be talking about retainer practices for the next week or so.How can you disagree with that? If you'd like to fall in love with the practice of medicine, stay tuned....Retainer physicians provide better care. The key to their care is time. We all know that time is important. Some critics of retainer medicine complain that these physicians are unethical, but could practicing internal medicine in 15 minute visits be the true unethical style of practice.
My friend suggested these observations:
1. Because he has enough time with his patients, he orders less imaging studies and less consultations.
2. He now enjoys practicing medicine.
3. His patients are very happy.
4. He and his partner admit fewer patients because they can see patients longer and do more in the office.
Posted by JoshMD |
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Sick & Sicker
Independent film producer Logan Clements (and fellow Rand Fan) is combating Michael Moore's misguided propaganda with his own documentary detailing the massive failings of the Canadian health care system in Sicker & Sicker.
Posted by JoshMD |
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Thursday, December 20, 2007
Can You Help?
Since Kevin has been so kind as to let me borrow his blog for a while, I'd like to ask you all for a favor. Can you help me understand more about "most favored nation" clauses, common to insurance contracts? I'll be meeting with my states legislators soon and I'd like to be well versed.So how about it, any J.D.s and/or M.D.s in the audience? Are they good, bad, or meaningless? Are they the reason that doctors must charge "full" price to cash patients?
Posted by JoshMD |
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Schwarzenegger Passes Spending Bill For Socialized Medicine
1. An individual mandate, with exemptions if premiums are more than 5% of family income
2. Tax subsidies to families <400%>
3. Expansion of Medicaid (including to young adults <250%>
4. Employer pay or play mandate (tax of up to 6.5% on wages if employer doesn’t provide insurance as a benefit)
5. Hospital tax of up to 4% of revenues
6. New cigarette tax of at least $1.50/pack
7. State fund (employer pay + hospital taxes + cig taxes) to fund indigent who cannot afford care
8. Insurance requirement that 85% of premiums go to patient care
9. Kills experience rating and doesn’t allow insurers to refuse coverage because of a pre-existing condition
10. Increase in Medicaid reimbursement, potentially up to Medicare fee schedule
Posted by JoshMD |
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Worst Gift Idea Ever
Altruism is aLaughable.beautiful[emphasis mine] virtue, but it has fallen painfully short of its goal. We must be bold and experiment with offering prospective donors other incentives for giving, not necessarily payment but material reward of some kind — perhaps something as simple as offering donors lifelong Medicare coverage. Or maybe Congress should grant waivers so that states can implement their own creative ways of giving something to donors: tax credits, tuition vouchers or a contribution to a giver’s retirement account.
(hat tip: Healthcare Economist)
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Paul Levy Takes on the US News & World Report
Why not add to your algorithm extra points for those hospitals that voluntarily publish clinical indicators of the degree to which they harm patients? I am not talking about the usual hodgepodge of outdated CMS data, which are available anyway. I am talking about substantive clinical metrics, like central line infections, ventilator associated pneumonia, and the like. Or the ultimate, the hospital standardized mortality rate calculated by the Institute for Healthcare Improvement.Amazingly enough, it worked. Avery quickly responded in the comment section that he will listen to opinions on the issue. Be sure to add your two cents and potentially influence the way hospitals are rated...
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