Next in a series. Primary care physicians (PCPs) have too little time per patient which means too many referrals to specialists, too little time listening and thinking, no time to delve into the stress or emotional causes of many symptoms and substantial frustration by PCP and patient alike. Previously in this continuing series on primary care, I described a patient with a straight forward if unusual symptom who was bounced ...

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First in a series. The primary care physician (PCP) should be the backbone of the American healthcare system. But primary care is in crisis -- a very serious crisis. The first statement is my considered opinion and I will attempt to convince you of its truth. The second sentence is a simple fact. Accounting for only 5% of all health care expenses, the PCP can largely control the “if and ...

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The Affordable Care Act is not so affordable if you own or if you are an employee of a small business. Here is why. Consider the owner of a small service business with one or multiple outlets (e.g., a large restaurant or a small chain of sit down restaurants, a chain of barber shops, a taxi company.) The owner has more than 50 employees but the business is still “small” with ...

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There are just a few key reasons why Medicare has become inordinately expensive. There is no end in sight for cost escalation. But there are some obvious solutions and they all begin with chronic illnesses. Chronic illnesses -- diabetes, heart failure, cancer, chronic lung disease, etc. -- are increasing at exponential rates; are caused largely by lifestyle behaviors; and consume 70-85% of all claims paid. Medicare enrollees tend to have chronic ...

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“An ounce of prevention” we all know is good medicine. An example is colonoscopy. It was time for mine so after some lengthy procrastination I called and set up an appointment which I soon found a perfectly good reason to postpone for a few weeks. A common occurrence. The government wants me (and you) to not procrastinate, at least not because of the cost. The Affordable Care Act (or Obamacare) ...

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Primary care physicians (PCPs) have been marginalized by Medicare for decades with low reimbursement rates for routine office visits which has led to the 15-20 minute office visit with 10-12 minutes of actual “face time” and a panel of patients that well exceeds 2000. Is there a good solution to the Medicare cost and quality issues? Setting aside either the Democrats’ approach to basically enact price controls by ratcheting down reimbursements or ...

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There are distinct advantages for the patient who pays the primary care physician (PCP) directly: higher quality, lower cost and greater satisfaction. The fundamental problem in health care delivery today is a payment system that is highly dysfunctional leading to higher costs, lesser quality and reduced satisfaction. The core problem? The patient is no one’s customer. With employer-based insurance, the physician’s customer is the insurance company that sets the rates, defines the rules and accepts ...

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The Democrats and the Republican parties’ approaches to Medicare are quite different.  Which approach is better? That is the wrong question. Or at least not the most important question. Instead we should consider what could be done now to actually improve patient care quality as a means to reducing costs. Is there a good solution to the Medicare issue? Setting aside either the Democrats’ approach to basically enact price controls by ...

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The two party’s approaches are quite different.  Politicians realize that Medicare will not be able to continue on its current track. Something has to change since the country will simply not be able to afford the inexorable growth and expenditures. But politicians do not like to take away entitlements so proposals generally are couched in vague terms and often with positions that are unrealistic. The Democrats’ plans are contained generally in ...

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Since the nomination of Congressman Paul Ryan as the vice presidential candidate of the Republican Party, Medicare has become front and center in the political discussions. To understand the dialogue requires an understanding of Medicare, how it works, where the money comes from, how it is spent and why there is such concern for its future costs. Here is an overview. Medicare was designed in 1965 to serve as “major medical” ...

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