Primary Care

Pay primary care by the hour

The physician/author, Robin Cook, explores this idea in the NY Times:

As it is now, insurance companies “” following Medicare’s lead “” pay primary care doctors according to the number of patients they see. Each patient visit is generally reimbursed at a flat rate of slightly more than $50. The payment is the same whether the patient is a healthy, young person with a runny nose or an elderly …

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A union is angry that colon cancer screening is withheld for the elderly

They are up in arms about this leaked memo:

Richard Thomason, the policy director for SEIU United Healthcare Workers West, which is based in Oakland, said a leaked memo indicates that the physicians group, which is based in Walnut Creek, may be in violation of state and federal laws and regulations and of its own stated policies.

Thomason said the memo, which is dated March 6, 2006, says “primary …

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Classic post: Spectrum of waiting

May 2005 – What kind of physician do you want, one who runs on time, or one who spends the time? You can’t have both:

A typical visit to a primary care physician’s office is allotted 15 minutes. Each physician session lasts 4 hours. Think about that. If the doctor merely spends 5 “extra” minutes with each patient, the last patient of the session will be over 1 …

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News flash: Many ER visits are not emergencies

Better primary care could have prevented almost half of ER visits:

Nearly half of emergency room visits in New Jersey by people who were not sick enough to be admitted to the hospital might have been avoided with primary care, a Rutgers researcher said Wednesday.

Derek DeLia of the Rutgers Center for State Health Policy also found that 31 percent of hospital admissions made through the emergency department were …

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Expect more of this in the future

A primary care practice goes bankrupt in Miami but its affiliated concierge practice remains open:

Even though the university expected Merino’s office to lose $50,000 to $80,000 a year, in the past 12 months it was almost $250,000 in the red, said Jerry Broderick, assistant chairman of the university’s department of medicine.

“The loss was far greater than what we’d planned for,” Broderick said. “Professional fees and patient revenues …

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Arguing against hospitalists

This writer wants life to go back to the old (pre-hospitalist) days:

Somewhat reduced length of hospital stays and lower costs are touted by the hospital and health insurance industries–but hospitalists with subspecialties actually raise costs, and I am aware of no studies of overall costs or number of readmissions after the initial hospital stay.

In-house hospitalist programs do not typically pay their own way, and we needn’t …

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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 who …

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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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