VA Hopeful Dr

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I have two thoughts on that.

Is a 10% increase in medicare rates really that significant? Let's say for a level 3 exam on an established patient you get reimbursed $70. Is $77 really that much better?

Second, am I the only one who questions the idea of a medical home? Maybe I just haven't been paying attention, but I haven't seen any literature that really convinces me that we should all go to this.
 

doc20

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http://www.nytimes.com/2010/03/27/health/27patient.html?hpw

intersting article on what doctors think

Insure Catastrophes Only
"The idea of paying a certain monthly fee for insurance that allows you to have most of your routine care covered doesn't make sense. When you buy auto insurance, you don't insure yourself for every dent and nick — you insure yourself for serious accidents. This is the way the health insurance system should work. Our current insurance model does not encourage patients to take care of themselves. It doesn't reward patients for being healthy, it rewards them for being sick. This isn't good for patients or insurers."
Jacques Moritz, M.D., director of gynecology, St Luke's-Roosevelt Hospital Center, New York
Change Malpractice Law
"Some doctors often order tests to confirm a suspected diagnosis — even when the suspected diagnosis is likely correct with a high degree of certainty — out of concerns regarding the potential for malpractice suits in our current litigious climate. This is a cost of medical care that could be fixed if serious efforts at tort reform were undertaken."
James A. Reiffel, M.D., professor of clinical medicine and director, electrocardiography laboratory, Columbia University Medical Center, New York
NOTE: The new law contains a provision to award five-year grants to selected states to develop alternatives to current tort litigation.
Counsel Nutrition
"In the cardiology arena, adoption of a Mediterranean style diet has been shown to reduce the likelihood of a second heart attack by more than 70 percent — a benefit far in excess of any drug or procedure. Unfortunately, most doctors do not have the training to provide effective nutritional counseling. How much does the health care system — and more importantly, the patient — lose every time a medical encounter does not include attention to nutrition?"
Stephen R. Devries, M.D., preventive cardiologist, Northwestern Memorial Hospital, Chicago
Rely on Evidence...
"I believe that if you do the right thing for the patient, it will ultimately be the right thing for the health care system. That means spending adequate time gathering information and using actual research data to guide judicious ordering of tests and prescribing of treatment. For instance, if an asymptomatic, otherwise healthy, patient comes to me wanting a whole-body CT scan to make sure they do not have something bad hiding inside of them, I would decline and educate him or her that there is no data to show that this test has any significant benefit to offset the potential radiation or other harm and the major medical societies do not recommend this test."
Lisa Bernstein, M.D., internist and associate professor in the department of medicine, Emory University School of Medicine, Atlanta
NOTE: The new law provides for the creation this year of a nonprofit corporation, the Patient-Centered Outcomes Research Institute, which would conduct research comparing the clinical effectiveness of medical treatments. The institute's findings could not be construed as mandates, though, or used to deny coverage.
... But Allow for Expertise
"Government policy often results in a race to the average and mediocre, to the customary and usual, while ignoring the exceptional and extraordinary. And it is this group of patients — the unusual, the outlier, the complex, the group that has failed evidence-based care — that represents the costliest group in any illness category. Such is the case in migraine, where a very small percentage of patients represent 75 percent of the overall costs. These are the patients who must be hospitalized, who attend the emergency department on a regular basis, who develop secondary illness, undergo needless procedures and surgery, and become dependent on narcotics in their desperate search for pain relief. The pursuit of savings by government agencies often misses the point that good care at almost any price is less costly than bad care at almost any savings."
Joel R. Saper, M.D., founder and director, Michigan Head Pain & Neurological Institute, Ann Arbor, Mich.
Use ‘Integrative Medicine'
"Plenty of studies now show that integrative medicine works very well. By that I mean the practice of medicine that reaffirms the importance of the relationship between practitioner and patient, and has a broader scope that includes therapies from conventional bioscientific medicine, as well as newer complementary approaches like acupuncture and chiropractic. For example, a study conducted at Mount Sinai School of Medicine in New York found that when women participated in a hypnosis session before breast surgery, they required less pain medication and experienced less nausea and emotional upset than the control group. Patients in the hypnosis group also cost the hospital $772 less overall. That's an example of how a simple technique can help patients and reduce costs."
Woodson Merrell, M.D., chairman, department of integrative medicine at Beth Israel Medical Center, New York
Pay to Treat Childhood Obesity
"We struggle constantly to get reimbursement for services at my clinic. This is terribly short-sighted. Society could spend one thousand dollars now for comprehensive medical care for an obese child, or it could spend one hundred thousand dollars later for that patient's coronary artery bypass surgery. Every insurance company figures it's not their problem: an obese kid will likely be with a different carrier by the time he or she starts to experience costly health complications."
David Ludwig, M.D., director, Optimal Weight for Life Program, Children's Hospital, Boston
Stop Overtreating
"There are some people who would benefit from more medical care, but there are many more who are getting too much. Excessive intervention is particularly rampant at the two extremes of health: those who are dying, for whom our aggressive care can be inhumane, and those who are well, in whom we feel increasingly compelled to look hard for things to be wrong. There are strong commercial interests in tapping this latter group as a new source of revenue. Screening scans, for instance, find more small cancers and early heart disease. Contracted definitions of what's normal label more people as having disease, such as hypertension and diabetes. And everyday experiences become entirely new diseases: difficulty sleeping becomes a sleep disorder, impaired sex drive becomes sexual dysfunction."
H. Gilbert Welch, M.D., professor of medicine, Dartmouth Institute of Health Policy and Clinical Practice, Lebanon, N.H.
Restore the Humanity
"What's in jeopardy in medicine -- for a host of reasons -- is the human connection between doctor and patient. There are doctors in training now who do not want to do a physical exam; they just want the lab tests and the echo-cardiogram on a heart patient, for example. But the laying on of hands is a powerful tool in establishing trust and in healing. Doctors, patients and insurers alike should work together to recreate the familiarity, the warmth, the trust and the friendly alliances that used to define patient-caregiver relationships. If the health care profession would rediscover the power of the human relationship, we could bring about the kinds of lifestyle changes that would reduce disease big-time."
Edward Hallowell, M.D., a child and adult psychiatrist practicing in New York City and Sudbury, Mass., author of "Married to Distraction" (Ballantine Books, 2010)
 

Blue Dog

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Is a 10% increase in medicare rates really that significant?
No, but it's a start.

am I the only one who questions the idea of a medical home?
No, but most of the critics that I've talked to don't seem to really know very much about it. They mainly appear resistant to change. Not saying that's you, of course.

There is growing evidence of the PCMH's capacity for improving quality and reducing costs, however.

http://www.pcpcc.net/content/evidence-quality

http://www.pcpcc.net//evaluation-evidence

http://www.mainequalitycounts.org/patient-centered-medical-home/financial-case-for-pcmh/
 

EdibleEgg

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I have two thoughts on that.

Is a 10% increase in medicare rates really that significant? Let's say for a level 3 exam on an established patient you get reimbursed $70. Is $77 really that much better?

Well... it's a heck of a lot better than a 20% decrease. 50% overhead in a primary care office is pretty good, so take home from that patient would go from 35$ to 42$; that's a significant improvement. That's over simplified, and that increased income will all be paid back to the government in increased taxes, but it's a start.
 

VA Hopeful Dr

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No, but it's a start.



No, but most of the critics that I've talked to don't seem to really know very much about it. They mainly appear resistant to change. Not saying that's you, of course.

There is growing evidence of the PCMH's capacity for improving quality and reducing costs, however.

http://www.pcpcc.net/content/evidence-quality

http://www.pcpcc.net//evaluation-evidence

http://www.mainequalitycounts.org/patient-centered-medical-home/financial-case-for-pcmh/
From looking at the websites you've posted, it definitely shows what we all know - a good PCP is both cost-efficient and better for M&M than a bunch of specialists who don't communicate well.

I guess I just don't see the difference between a really good PCP and the medical home. You handle the primary stuff, send them to specialists and keep track of what goes on at those specialists. It kinda sounds to me like lots of this could be accomplished with a VA style EMR nationwide. I might be missing something here though.

All the descriptions are also fairly vague on how they reduce waiting times and provide for appropriate cultural support and so on.
 

Blue Dog

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Blue Dog

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tony montana

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Does anyone know how the whole student loan repayment for people who choose primary care work?


I was reading this right:

Nonetheless, provisions in the new law intended to help address the PCP shortage include increased student loan forgiveness programs, scholarships and bonuses for medical graduates who choose to go into primary care.

Read more: http://www.fiercehealthcare.com/story/health-reform-exposes-need-primary-care-physicians/2010-03-26#ixzz0jR6UZWiE


And so I'm matched in FP so I'm wondering will this help relief my loans or will this be for future physicians only?

Does anyone know? :confused:
 

notinkansas

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Does anyone know how the whole student loan repayment for people who choose primary care work?


I was reading this right:





And so I'm matched in FP so I'm wondering will this help relief my loans or will this be for future physicians only?

Does anyone know? :confused:
I was poking around on the web last night, and from what I saw the new rules will only apply to loans take out in 2014 or after (like many of the provisions in the health care reform bill). So no. And it's not a huge change from the IBR rules now anyway. Sorry I don't have any links, but if you google IBR you should find the info.
 

tony montana

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I was poking around on the web last night, and from what I saw the new rules will only apply to loans take out in 2014 or after (like many of the provisions in the health care reform bill). So no. And it's not a huge change from the IBR rules now anyway. Sorry I don't have any links, but if you google IBR you should find the info.

What you're referring to is Section 2213. Income‐Based Repayment.

I'm talking about a different section: SEC. 340I. LOAN REPAYMENTS.