Primary Care

A UK hospital is fined for treating people too quickly

They should be rewarded instead:

Ipswich Hospital, in Suffolk, which is more than £16m in the red, accidentally breached an agreement to ensure all patients had similar waiting times.

Ipswich Hospital agreed with the East Suffolk Primary Care Trusts, which fund treatment, that patients should wait at least four months for treatment.

However, doctors had treated patients inside that time and the trust refused to pay the …

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Primary care in the ER

These two ERs want to put an end to it:

After evaluating patients who come to the emergency room, nurse practitioners or physician’s assistants will inform those with nonurgent symptoms that they can seek treatment at a specific community health clinic.

Patients who insist on staying will have to pay a $150 deposit before being treated in the emergency room or an $80 deposit to be seen in urgent …

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The real reason for the ER crisis

Lack of primary care and outpatient services. It’s only to get worse given the crisis primary care is in:

Instead, the people clogging the ER are the insured who can’t reach their regular doctor. Cunningham found that communities with fewer or busier doctors tended to have higher rates of ER use. It makes sense — ERs are open 24 hours a day, 7 days a week. Unlike at a …

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A doctor has second thoughts about concierge medicine

He opts out of his contract and goes back to the primary care grind:

He knew he would have to part with most of his patients. But it proved much harder than he expected. “When you see the patients and talk with them, and you understand their financial situation and how difficult it was for them to afford [the concierge service]. . . . I had this 90-year-old lady …

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"The cost of business is killing doctors"

More primary care woes:

“The nationwide average income for family physicians is around $120,000, and none of the doctors in my practice were making $100,000. We make less, probably $20,000 to $25,000 a year less than the doctors in other states.”

According to a recent national study by the Center for Studying Health System Change, physicians’ net income from practicing medicine dropped about 7 percent between 1995 and 2003.

(via …

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Primary care cosmetics will soon become the norm

One surefire way to beat cutbacks in reimbursement:

“I think as long as physicians have to work as long and as hard as they do,” says plastic surgeon John D. Newkirk II, “the tendency is to do those things that give maximum revenue with minimal work.”

Medicare is proposing to cut hospital payments

Procedure-based medicine has been disproportionately reimbursed for years. If the cuts are redistributed to primary care and E&M visits, I don’t have a problem with it:

The Bush administration says it plans sweeping changes in Medicare payments to hospitals that could cut payments by 20 percent to 30 percent for many complex treatments and new technologies.

The changes, the biggest since the current payment system was adopted …

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More grim news for primary care

Here are results from a recent survey:

. . . only 37.6 percent said they would choose to enter primary care again if they could start their careers over. Over one-third said they would go into a surgical or diagnostic specialty instead. Meanwhile, 28.6 percent said they would not choose to go into medicine.

(via a reader tip)

Short supply of a narcotic leads to an inhumane death

The drug in question was diamorphine, or heroin:

The former husband of a mother of three says she died in agony from cancer because of a shortage of a painkiller.

Joe Fortescue from Alfreton, Derbyshire wants the government to provide more diamorphine, which has been in short supply since 2004.

He said his 49-year-old ex-wife from Nottingham was screaming in pain in the days before her death …

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More ragging on primary care

Yes, I get it – primary care isn’t glamorous. Maybe that’s why medical students are avoiding the field:

As a patient’s entry point into medical care, primary-care physicians have a far less glamorous job than doctors in other specialties, Leominster pediatrician Terry Callahan said Thursday.

“You’re the one getting called in the middle of the night about the right dosage for Tylenol,” she said. “You get used …

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Patients lose when physician reimbursement is cut

Who cares when you’re making big profits:

Doctors aren’t alone in thinking that something’s wrong when UnitedHealth’s customers can’t afford what the company charges in premiums and doctors can’t stay in business on what it pays in reimbursements. Yet its stockholders are happy and the company’s CEO got paid $1.6 billion in stock options . . .

. . . This is what reduced access to care looks like: …

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There’s hope: Maybe Medicare is getting it

Dr. Centor writes on the possible increased reimbursement for E/M services. This single action, if it goes through, will go a long way in resuscitating primary care.

Shadowfax also writes about how emergency medicine will benefit.

Can they be finally cluing in? One can only hope.

HMOs and Medicare have the wrong target

Instead of targeting PCPs as they have, they should be making big pharma a cost-cutting focus. What HMOs and Medicare have done is virtually destroy primary care in the US:

It remains a mystery why managed care and Medicare have centered their cost reduction efforts for so long on physicians, and particularly on the least well paid physicians, while apparently willingly paying out ever more for pharmaceuticals . …

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About 10 percent of doctors in Ontario are accepting new patients

Primary care is facing the same challenges and deterrents in Canada as well:

Dr. Brian Berger, who has a family practice in Richmond Hill, says many young doctors stay out of family medicine because it’s too time-consuming. He says young doctors have other priorities, like spending time with their families or pursuing other interests.

“More doctors want to do sort of part-time family practice. A lot of people may …

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Primary care continues to get the shaft

Dr. Centor outlines a fundamental reason why medical students are avoiding primary care:

Some would argue that this is really a lifestyle issue. I would argue that money drives lifestyle. Family physicians and general internists have responded to lowered reimbursement by increasing the number of patients they see each day. These increases must decrease quality of care and decrease physician satisfaction.

Insurers are waiving copays for walk-in clinics

It’s all about the cost, forget the physician relationship:

FP Michael J. Morris of Willmar, MN, thinks the insurer’s approach to this issue works against its efforts (and those of other plans) to encourage primary care doctors to manage patients’ overall health. A nurse at a walk-in clinic, he says, isn’t likely to check patients’ cholesterol, make sure they’re up on their immunizations, and talk to them about their weight …

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Obvious news of the day: ERs are overwhelmed

Yes, ERs are in crisis. A favorite topic here. A major part of the problem can be traced to poor primary care access and “defensive medicine”. Let me elaborate:

1) Lack of access
Lack of primary care incentives for medical students and providers = dwindling primary care access = patients going to the ER for “routine” or non-emergent care = ER overcrowding = eventual collapse. Simple.
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This PCP crosses the line in his frustration

He’s doing all of this just to get more Lunesta for his patient? Ridiculous:

When Tufts Health Plan cut a patient’s prescription for the sleep aid Lunesta from 30 pills to 10 pills a month, her physician, Dr. Stephen A. Hoffmann, decided to circumvent state regulations by writing a second prescription in the name of her husband so she could get 10 more pills per month.

Hoffmann …

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Chris Rangel wonders about fast-food outpatient medicine

Welcome to primary care in the USA:

To use the same fast food analogy, imagine a situation where price was no longer an issue (because of insurance) and the hungry masses started demanding the best burgers in the world . . . . but they wanted to wait no longer than they did for the regular “McDonaldized” burger. The problem is that the amount of money that the restaurant gets …

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Foleys for convenience

Perhaps this speaks more for the nursing shortages in the country:

Nearly one in four older hospitalized patients received a urinary catheter without any medical reason for one, and these patients tended to be the ones who would need the most help going to the bathroom if left un-catheterized, said Seth Landefeld, M.D., of the San Francisco Veterans Affairs Medical Center here.

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