Posts Tagged ‘payment’

Wanted: Primary Care Physicians

August 10, 2009

Let’s talk Healthcare Reform.

Don’t get discouraged, and please don’t leave. We’re going to stay away from the Red vs. Blue rhetoric, and (hopefully) neither side will be called a bunch of loons. Since we’re friends, you and I, we’re just going to take a look at something we really need. If we don’t fix this problem, any healthcare system could come crashing down like a house of cards.

Most of the plans being discussed formally establish a “Medical Home” for patients. We can go see any doctor we choose, but the Medical Home system would establish a Primary Care doctor as our automatic first stop – we see him/her first. If we need specialized care, they’ll refer us to a specialist. Chronically ill patients need a primary care doctor anyway; I write often about finding a good Cardiologist, and that is important, but life happens. CHDers turn ankles and slice our fingers while chopping onions just like everyone else. We need a Primary Care doctor for those times when the problem isn’t heart related.

Problem is, for the Medical Home plan to work, we need more Primary Care doctors. We’ve got a shortage on our hands now, so much so that older doctors can’t retire. They aren’t paid as much, so more doctors choose to be specialists. The Primary Care docs we have are already being asked to work harder and harder; some of them are choosing to relocate to facilities where the pace isn’t so frantic. One of the reasons the Universal Healthcare system introduced in Massachusetts is in such trouble is the shortage of Primary Care doctors. The system is simply being overwhelmed.

Even if we could somehow make Primary Care the most attractive job in the world, we’d still need six years or more before the number of new doctors would begin to climb. One way to deal with the problem now is to expand the role of Nurse Practitioners. NP’s are nurses, but they have had extra training and often have Masters degrees. Some states already allow a Nurse Practicioner to diagnose and treat patients; they can even prescribe medication. Some states don’t.

We need Federal legislation to get all the states on the same page, with a national standard of care. Then we can talk about Universal Coverage, insurance, coverage, and who pays. But let’s fix the doctor shortage problem first.

For these links we give thanks

November 26, 2008

Just in case you didn’t know, helicopters don’t glide very well. There have been a rash of medical helicopter crashes lately, which makes some people wonder if they are used too often. This issue is being investigated, and the use of air ambulances is down. So either the number of serious illness and injuries are down (doubtful) or the choppers are flying less. Hmm… why would anyone call for an airlift when it wasn’t needed?

Don’t go here for your medical information, they’ll scare you half to death. And don’t always believe these guys. And if you are looking for drug information, don’t look here. Check out Medscape instead. It’s FREE, and Medscape has a much better drug reference page.

Dr. Wes’ brother asks “Hey, you wanna see an operation?” If you want to see an operation (double bypass heart surgery) click this link. WARNING: The blood is real, and the bone saw is pretty loud.

Laurie smells a familiar smell on a subway car and it takes her back… to an unpleasant place.

Got Heart Failure? Then work it, baby!

I think I know why he is the Happy Hospitalist… he leaves all his frustrations on his blog. Here, Happy tells the story of the guy who thinks that free = more. I’ll take an eye exam, and a rotator cuff repair, with a side order of dental. Oh, and clean out my earwax, too; someone else is paying for it! The costs add up – an implantable defibrillator costs almost as much as some people make in a year. And when you consider this, you realize that our financial situation is just going to get worse. Pay off those credit cards, folks!

Maybe they’ll let us use a spider as payment.

Sometimes though, especially around the holidays, what we really need is a friend.

It’s almost Thanksgiving Day, and I’m spending Thursday with the family. Friday, a friend and I were supposed to just have lunch together, but she has the entire day off! So I’ll be away most of Friday, too. Have a safe, happy, and wonderful Thanksgiving; and remember to be kind to your fellow man and your four legged friends.

And don’t forget, Saturday is Red and Blue Day!

Always yours;


The Funky Heart

“The Wrong Place to be Chronically Ill”

November 19, 2008

We’ve got problems.

I think anyone can agree with that, but this editorial in the New York Times reports the results of a study published by The Commonwealth Fund shows we’ve got BIG problems. Chronically ill adults from eight industrial countries were surveyed, and in the United States: (Read or download a .pdf file of the report HERE.)

* 54% of Americans did not receive care or fill a prescription because of cost;

* 34% say that their care was delayed because of “lack of coordination”… in other words, the results of a test or procedure not being available when needed;

*34% also said they had fallen prey to some type of medical error.

That’s shameful. Congenital Heart Defect survivors are living proof that the United States provides the best medical care in the world… And this report proves that not everyone can take afford to take advantage of it.

So what’s the answer?

My answer, I hate to say, will scare you: “I don’t know.” I don’t think that Universal Health Care is the answer. Chronic Illnesses already cost Americans a LOT of money. How much? Did the recent 700 BILLION dollar bailout give you a chill? We already pay two bailouts each year just to cover the costs of Chronic Illnesses. And we need more Primary Care doctors.

The head of the Massachusetts Group Insurance Commission recently said that insurers can help to keep costs down by limiting patients to just the cheapest and best hospitals. The problem is, we don’t think like that. People believe that bigger hospital + better reputation = better results. That’s not always true – but you’ll gladly pay for it.

So what to do? If you read Funky Heart, you’ve already read The Happy Hospitalist’s rant about the cost and effectiveness of drugs vs. spending the time and effort to imporve yourself. It’s obvious that we’re going to contiune to need our drugs, our physical exams, and occasionally surgery, but we can help ourselves.  Follow Happy’s advice and get down to the gym. Go for a walk. (And I’m talking to myself here, I positively HATE cold weather, especially since I am taking bloodthinners. But it has to be done!) Take a dip in the pool. It doesn’t matter what you do, get active.

As my dad like to say, “Off your seat and on your feet!”