Whether applied to policymaking for individuals, large populations, or administration of health services nationwide, it is imperative regulatory decisions be anchored to empirical evidence. The official MACRA rule has now been released. (continue reading →)
Independent physicians are at the beginning of a challenging movement as we fight to stay relevant and solvent during the transition of health care from independence to “regulation without representation”. In 1773, (continue reading →)
Recently I wrote about empowerment and the importance of letting patients make their own health care decisions. Our job is to make sure patients are given information and then allowed to choose (continue reading →)
I recently contacted her mother to inquire if she wanted her daughters’ medical chart. She said it was a gift to see her daughter through the eyes of her physician, who was there every step of the way. Medical records are more than metadata on a computer screen; they are a sacred chronicle of our enduring connection with our patients in life, and even in death. When an EMR can do that, I will be thrilled to embark on a digital journey. Until then, give me paper or give me death.
Estimates suggest that a primary care physician would spend 21.7 hours per day to provide all recommended acute, chronic, and preventive care for a panel of 2,500 patients. An average workday of 8 hours extrapolates to an ideal panel of 909 patients; let us make it an even 1000 to simplify. A primary care physician could easily meet acute, chronic, and preventative needs of 1000 patients, thereby improving access.
Government and insurance companies should stop wasting dollars and cents chasing visions of value, rather use common sense and give physician outcomes the attention they deserve. Healthcare will be on better footing now and into the future.
As the reality of MACRA (Medicare Access and CHIP Reauthorization Act of 2015) looms, the pressure is on small practices to survive. CMS plans to penalize 87% of solo physicians and reward bonuses to 81% of practices with more than 100 physicians. It is time for passive resistance, defined as protesting against a law using peaceful methods such as refusing to obey or refusing to leave a building. I vehemently refuse to leave the building.
My county with a population of 260,000 has NO psychiatrist. Not one. Many states all over are experiencing the same provider shortages. Can you grow psychiatrists somewhere at an accelerated rate, like that clone army in Star Wars, and drop them randomly by plane throughout the United States? That would be a good start. They could be raised to believe indentured servitude is their destiny.
In my humble opinion, that type of communication provides tremendous value. Paying more to a physician who provides services that benefit patients directly is a metric worth tracking. If physician and patient can work together by rowing in sync on the same boat, maybe we could get those in control of the healthcare system on board with us after all. Medicine is not a one-way road. You are spot on about that.
Above is a picture of Garrett with me at my wedding (I am clearly more excited about it than he is!) My relationship with this young man, his sister, father, and especially his mother are the foundation of why I became a pediatrician in the first place. Filled with doubt in my darkest moments, his story of triumph always brings me comfort and hope. It reminds me there will be losses and saves, but the life-long, enduring R-E-L-A-T-I-O-N-S-H-I-P is what makes it all worthwhile.
