I'm not sure what you're asking here. HMOs have played a major role in Medicaid in Michigan for over 20 years, and now pretty much dominate the sector. Michigan's ACA-related Medicaid expansion became effective only on April 1, so I'm sure there is no data yet on how that has worked. There is a lot of data on MA in Michigan in general, available here (and elsewhere) See http://www.mahp.org/resources/whitepapers/FY 14 White Paper Ready for Print 2-26-13.pdf From a quick perusal, it appears enrollees in MA HMOs do visit the ER more often than non-MA HMO enrollees (the data is for all HMOs, not just HOMs that serve both MA and commercial enrollees), but there is not strong trend, maybe a little upward. Rx usage used to quite a bit higher for MA than for non-MA HMO enrolless, but MA usage has declined relatively and the two are now about equal. Hospital utilization is mixed; compared to commercial HMO-enrolleess, MA HMO enrollees are spend more days in the hospital overall, but stay for fewer days per visit. The MA enrollees are more likely obese and smoke more.
I hate ACA! ObamaCare Sucks!
- Thread starter southerndoc
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Sorry, my point was more addressing the expansion of Medicaid being pooled into the "successful" signup numbers being argued. Should new MA enrollees be regarded as a success? When there's no price transparency, how is overutilization fixed?
I know in Oregon they saw some minor mental health benefits but saw a 40% increase in ED utilization. Despite thinking they were in better health, patients didn't see any significant improvements in chronic disease or other markers of physical health.
http://www.nber.org/oregon/
You're addressing an issue different from the one I was previously discussing. You're questioning whether MA improved health in Oregon, and, by extension, whether the ACA's expansion of MA across the US would do so. I was discussing whether MA-HMOs are the functional equivalent of insurance in the one state I am most familiar with. In Michigan, the MA HMOs are pretty much the functional equivalent of the non-MA HMOs (and sometimes they are one and the same, with a single HMO using a single set of provider contracts, a single set of treatment protocols, etc., providing coverage to both MA and non MA)
I'm not familiar with Oregon's MA program, and don't know whether MA enrollees have significantly limited access to providers in Oregon or whether providers treat MA patients significantly different from non-MA patients. Since states differ so dramatically in how they implement MA, I'd be careful about generalizing from one state to another. As a further example, in Arkansas and Iowa (and maybe Penn), the ACA-related MA expansion works thru the ACA exchanges, so MA patients will presumably get the same care as the non-MA enrollees in the same plans. See http://kff.org/health-reform/fact-s...5-demonstration-waiver-applications-compared/
As for the cited study, I'd say the reduction of "observed rates of depression by 30%" is more than a "minor" mental health benefit, but that's just opinion. This article discusses the study from a technical point of view, and points out, for example, that "there were only 280 people with hypertension who got Medicaid, and who could be studied for this outcome. Further, those people had a baseline average blood pressure of 130/83. That’s remarkably well controlled! So there’s not nearly the room for improvement that you might assume ... This same discussion holds for the other metrics." http://theincidentaleconomist.com/wordpress/oregon-medicaid-power-problems-are-important/ This article compares the statistical power of the recent Massachusetts mortality study to a hypothetical Oregon mortality study, as a way of illustrating the margins of error/confidence intervals involved with the sample sizes. http://theincidentaleconomist.com/w...mortality-study-to-the-oregon-medicaid-study/ Interesting stuff. I'm sure health economists will be churning out studies over the next couple of years as outcomes data comes in.
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Here's an interesting article on Obamacare.
My interpretation: An anti-Obamacare conservative takes Obamacare money to get an Obamacare waiver, to instead expand his state's own market-driven healthcare solution, to paradoxically accomplish the goals of Obamacare.
Making lemonade out of lemons?
Hmmm...
http://m.washingtonpost.com/opinion...e33bbe-dfa1-11e3-8dcc-d6b7fede081a_story.html
"Dana Milbank: Indiana Gov. Mike Pence is taking Obamacare money and running with it
For the first time since Obamacare split the country in two, the conditions for a cease-fire have begun to appear.
An architect of this detente — although he denies any such intent — is Mike Pence, who as a conservative Republican congressman in 2010 fought bitterly against the law and who as governor of Indiana refused to implement it.
But Pence, after intensive negotiations with the Obama administration, just announced his intent to take the money Obamacare provides for Medicaid expansion and to use it on his own terms to broaden health-care coverage for the working poor.
For Pence, a happy warrior for conservatism and a possible 2016 presidential contender, the reason is pragmatic: If he could get money under an Obamacare waiver to enlarge a market-driven health-care program in his state, there would be no point in cutting off his nose to spite his face.
“When it comes to the issue of health care, I believe that people in my party need to be solutions conservatives, offering real alternatives to the big-government answers,” he lectured Monday at the American Enterprise Institute, a center-right think tank, on a visit to Washington. Conservatives, he said, “need to ensure that the safety net is well-designed and strong enough to provide a firm basis for those starting out on life’s ladder.”
Dana Milbank offers a few answers for the reasons, as he characterizes it, that the Kenyan born Muslim raised in a madrassa president somehow attracts lies and rumors that are far from the truth. As for the rumors themselves, we have compiled a list that aren't the most outrageous but have a surprising base of believers.
Win McNamee /Getty Images
That was an implicit rebuke of his former House colleagues who have a “repeal and replace” slogan but have not offered much of a substitute for Obamacare while at the same time attempting to cut food stamps and other parts of the safety net.
Pence, a former head of the conservative Republican Study Committee in the House, was a tea party Republican before there was a tea party. But running a state has given him an elevated perspective.
“Debates that happen in Washington, D.C., pretty easily get far afield of the real-world impacts on real people,” he told me in an interview Monday afternoon. “It will not be enough for new Republican majorities in the Congress and a Republican president to cut government spending,” he added, calling instead for money to be sent to the states so they can “solve the intractable problems.”
Pence isn’t about to admit it, but Obamacare does that.
He thinks he has a conservative alternative to the new law’s expansion of Medicaid: He wants to broaden the “Healthy Indiana” plan started by his predecessor Mitch Daniels (R) by using financial incentives to get the working poor to contribute to their health coverage under a private alternative to Medicaid. The Obama administration appears likely to grant Indiana a waiver for the experiment — and if it works, other states will be free to follow the example.
Starting in 2017, states will be able to experiment further, securing exemptions from problematic provisions of the law such as the individual mandate, the employer mandate and the health-care exchanges. If Republican governors don’t like Obamacare’s requirements, all they have to do is come up with an alternative that provides comparable care and coverage.
Pence declined to speculate about whether he might seek a waiver exempting Indiana from Obamacare overall. He continues to support the law’s repeal, and he spent a good chunk of his AEI speech bemoaning its flaws.
He has to do that if he wants to compete in Republican presidential primaries. Although not usually mentioned in the top tier, Pence is well positioned at a time when the party’s strongest candidates are governors. He has a better record than New Jersey’s Chris Christie, is smarter than Texas’s Rick Perry, is not as divisive as Wisconsin’s Scott Walker and is more conservative than former Florida governor Jeb Bush. He speaks the language of Christian conservatives — twice in his AEI speech he wove in biblical passages from Luke without citation — and his Medicaid experiment should earn him some moral authority.
While other GOP governors continue to refuse the Medicaid expansion money — a decision that inevitably means lost lives — Pence reminds them, and everyone, that “we’re talking about real people, working people who deserve a better way.” He made it his administration’s job to help the “proud Hoosiers” — people “who find themselves essentially, for all intents and purposes, caught in that gap where their income simply doesn’t give them the ability to purchase health insurance for themselves or for their families.”
This, of course, is what Obamacare is all about. As more conservatives realize that the law they hate allows them to implement policies they like, they may have trouble recalling what all the fuss was about.
Read more from Dana Milbank’s archive, follow him on Twitter or subscribe to his updates on Facebook."
My interpretation: An anti-Obamacare conservative takes Obamacare money to get an Obamacare waiver, to instead expand his state's own market-driven healthcare solution, to paradoxically accomplish the goals of Obamacare.
Making lemonade out of lemons?
Hmmm...
http://m.washingtonpost.com/opinion...e33bbe-dfa1-11e3-8dcc-d6b7fede081a_story.html
"Dana Milbank: Indiana Gov. Mike Pence is taking Obamacare money and running with it
For the first time since Obamacare split the country in two, the conditions for a cease-fire have begun to appear.
An architect of this detente — although he denies any such intent — is Mike Pence, who as a conservative Republican congressman in 2010 fought bitterly against the law and who as governor of Indiana refused to implement it.
But Pence, after intensive negotiations with the Obama administration, just announced his intent to take the money Obamacare provides for Medicaid expansion and to use it on his own terms to broaden health-care coverage for the working poor.
For Pence, a happy warrior for conservatism and a possible 2016 presidential contender, the reason is pragmatic: If he could get money under an Obamacare waiver to enlarge a market-driven health-care program in his state, there would be no point in cutting off his nose to spite his face.
“When it comes to the issue of health care, I believe that people in my party need to be solutions conservatives, offering real alternatives to the big-government answers,” he lectured Monday at the American Enterprise Institute, a center-right think tank, on a visit to Washington. Conservatives, he said, “need to ensure that the safety net is well-designed and strong enough to provide a firm basis for those starting out on life’s ladder.”
Dana Milbank offers a few answers for the reasons, as he characterizes it, that the Kenyan born Muslim raised in a madrassa president somehow attracts lies and rumors that are far from the truth. As for the rumors themselves, we have compiled a list that aren't the most outrageous but have a surprising base of believers.
Win McNamee /Getty Images
That was an implicit rebuke of his former House colleagues who have a “repeal and replace” slogan but have not offered much of a substitute for Obamacare while at the same time attempting to cut food stamps and other parts of the safety net.
Pence, a former head of the conservative Republican Study Committee in the House, was a tea party Republican before there was a tea party. But running a state has given him an elevated perspective.
“Debates that happen in Washington, D.C., pretty easily get far afield of the real-world impacts on real people,” he told me in an interview Monday afternoon. “It will not be enough for new Republican majorities in the Congress and a Republican president to cut government spending,” he added, calling instead for money to be sent to the states so they can “solve the intractable problems.”
Pence isn’t about to admit it, but Obamacare does that.
He thinks he has a conservative alternative to the new law’s expansion of Medicaid: He wants to broaden the “Healthy Indiana” plan started by his predecessor Mitch Daniels (R) by using financial incentives to get the working poor to contribute to their health coverage under a private alternative to Medicaid. The Obama administration appears likely to grant Indiana a waiver for the experiment — and if it works, other states will be free to follow the example.
Starting in 2017, states will be able to experiment further, securing exemptions from problematic provisions of the law such as the individual mandate, the employer mandate and the health-care exchanges. If Republican governors don’t like Obamacare’s requirements, all they have to do is come up with an alternative that provides comparable care and coverage.
Pence declined to speculate about whether he might seek a waiver exempting Indiana from Obamacare overall. He continues to support the law’s repeal, and he spent a good chunk of his AEI speech bemoaning its flaws.
He has to do that if he wants to compete in Republican presidential primaries. Although not usually mentioned in the top tier, Pence is well positioned at a time when the party’s strongest candidates are governors. He has a better record than New Jersey’s Chris Christie, is smarter than Texas’s Rick Perry, is not as divisive as Wisconsin’s Scott Walker and is more conservative than former Florida governor Jeb Bush. He speaks the language of Christian conservatives — twice in his AEI speech he wove in biblical passages from Luke without citation — and his Medicaid experiment should earn him some moral authority.
While other GOP governors continue to refuse the Medicaid expansion money — a decision that inevitably means lost lives — Pence reminds them, and everyone, that “we’re talking about real people, working people who deserve a better way.” He made it his administration’s job to help the “proud Hoosiers” — people “who find themselves essentially, for all intents and purposes, caught in that gap where their income simply doesn’t give them the ability to purchase health insurance for themselves or for their families.”
This, of course, is what Obamacare is all about. As more conservatives realize that the law they hate allows them to implement policies they like, they may have trouble recalling what all the fuss was about.
Read more from Dana Milbank’s archive, follow him on Twitter or subscribe to his updates on Facebook."
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it's modern day robin hood.....steal from the rich (legally by jacking up your deductible/plan) to pay for the poor because let's face it everyone. the govt's broke. the war costs us billions and the only way ombamacare is going to happen is to attempt to put a cap on someone's income. have you guys seen the 2014 tax plan? a little extra taken away if you make over 200,000?
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"The Obama administration has quietly adjusted key provisions of its signature healthcare law to potentially make billions of additional taxpayer dollars available to the insurance industry if companies providing coverage through the Affordable Care Act lose money.
The move was buried in hundreds of pages of new regulations issued late last week. It comes as part of an intensive administration effort to hold down premium increases for next year, a top priority for the White House as the rates will be announced ahead of this fall's congressional elections."
http://www.latimes.com/nation/la-na-insurance-bailout-20140521-story.html#page=1
The move was buried in hundreds of pages of new regulations issued late last week. It comes as part of an intensive administration effort to hold down premium increases for next year, a top priority for the White House as the rates will be announced ahead of this fall's congressional elections."
http://www.latimes.com/nation/la-na-insurance-bailout-20140521-story.html#page=1
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I'm also confused as to why the journalists have given a pass on counting Medicaid signups as people getting "coverage". It is not coverage, as you have to go to a charity clinic or ER for care. Just try to get into an ENT, ortho, or GI doc with Medicaid. You won't even get past the receptionist.
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Can someone dumb down all the technical details so an 18 year old can understand this? What does Obamacare mean for the future of Medicine? I am completely clueless when it comes to insurance issues and what their consequences for doctors are........
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Simple. The end result is single-payer, government-run health insurance. That may be 5-10 years down the road, or even longer, but it is inevitable. The people who support single-payer are zealous, and will work tirelessly towards that goal, while those of us who are against it are fragmented and will lose in the end. What it means is government rationing, price controls and "death panels" for 80% of the U.S. population, and expensive, state-of-the-art concierge medicine for the 20% who can afford it.
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What makes you think we'll have true "single" payer? To get that, all other methods need to be banned. Even many euro-socialist systems allow people to opt out and pay cash or buy private insurance.
I personally don't think we'll ever have only a single payer. We'll have multiple tiers, in my opinion, probably at least 3 or 4.
Cash pay (upper class)
Private pay, quality insurance (for the upper middle class.)
Inadequate government insurance (the medicaid/medicare's) low/middle class.
Uninsured (small percentage refusing to buy insurance and paying fine or in between insurances, who'll lean on EMTALA and the ER for all care)
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Birdstrike, you describe the british system right?
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Which I think is exactly where we're heading. Might take 30 years, but we'll get there.
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So the sky is falling pretty much? Does this mean that EM doctors of the future will be more like FM doctors because patients are coming to the ER with 'bad' coughs and back pain? The whole appeal of EM to me was to deal with trauma, not people with the sniffles.
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This already happens. A lot. And for a myriad of reasons; thus why there have been attempts to screen out low acuity patients, institute copays for the same group, or (in the case of Washington state) not pay EPs for this care.
But, the cornerstone of EM is dispo, and that requires an a priori viewpoint shift towards life threats. To say EM will transform into FM, consequently, is short sighted as there are fundamental differences towards evaluation & management.
-d
PS - trauma's not all that it's cracked up to be. Mostly boring crap, IMHO, and the fun stuff gets sucked up by surgery. If you want to do trauma, then do a surgical residency with a trauma fellowship.
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Okay, so are you saying that you would not go into EM if you could do it over again? Trauma Surgery sounds like the most interesting/prestigious program for sure, but I don't know if I could stand with doing 6-7 years AFTER Medical school. Part of the interest in EM was for their( from what I've read) predictable hours; that's also why I'm considering dentistry. The dentist I shadowed said to just go dental because there is too much of a mess with insurance companies in medicine......maybe he's right, but saving someone's life on a surgical table seems cooler than fixing teeth. Anyways, it's fun to hangout in the attending forums to get the opinions of the people who have been there, done that.
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Birdstrike, I thought I was describing a British style system where only the upper classes (top 20%) can afford to opt out of the disastrous public system. The best we can hope for is an Aussie style system where everyone gets "free" coverage, but 80% have some sort of supplemental insurance. ED docs do okay there making about 75% of what their U.S counterparts make.
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The sky is not falling. The medical profession is alive and well. Morale may be sh¡tty at the moment, but the sky is by no means falling.
Emergency Medicine already is largely primary care, as it is. That's news to no one.
Trauma was one of the things that drew me to EM also, but I ended up being annoyed by it. Most of it is just ordering tons of X-rays and CTs on people who don't need surgery 95% of the time, as it is.
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In wouldn't say trauma surgery is the "most prestigious" specialty by any stretch, although it's a matter of opinion. A lot of trauma from the surgeon's side is consulting out to various Subspecialty services and babysitting patients until you can find a rehab service to transfer them to. Again, the majority trauma is non-surgical and taking care of patients no one else wants to take care of.
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Yeah, I figured you were headed in that direction. Either way, I'm convinced that as doctors, we are as a group, very smart people and we'll find a way to thrive in any system we're forced to deal with, no matter how non-sensical. We complain like the sky is falling, yet find a way to make make it work. The world depends on us to do so, and we do every time.
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Yeah, I take that prestigious thing back.......that's not the word I was looking for. I think I read some of your postings in the "Things I've learned from my patients" thread......sounds like the ER is an eventful place. I could honestly read all 60 pages of that thread!
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You've read it. I've lived it.
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Predictable hours? In THIS specialty?
Low hours per month, yeah - I'll buy that - but predictable isn't "Morning shift, morning shift, nightshift, nightshift, day off, swing shift, day off, morningshift".
Also; +1 for trauma being little more than "stabilize, send to surgery, do several stacks of paperwork".
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Sorry, I meant predictability in terms of the total amount of hours. I know that EM is shift work and you will have to do night shifts too.
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I would 100% go into EM again... and again... and again.
And no, I'm not codependent. d=)
Trauma is such a small part of what we do, though, and we have little to do with it outside their arrival in the ED that if one wanted to do trauma, you're better served as a surgeon.
As for "predictable hours," well, that's a mixed bag (mine are predictable as I work all nights and my group is structured to allow nocturnalists much more say in their shifts) and *not* a reason to go into EM.
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Agree with RF. EM hours couldn't be less "predictable." Also, there's absolutely no reason to think the amount will be "limited" either. An hour in EM is 1.5 hours doing anything else. 40 hours doing EM, is 60 doing anything else.
It just is.
Don't believe me? Try just randomly staying up all night tonight until 7:30 am, for no good reason at all. Not partying, not ----ing, not studying, just doing....whatever. Then sleep from 8am-10am tomorrow and get up to go to something otherwise enjoyable, smiling, bright eyed and bushy tailed. Try it. It's next to impossible. Then do it the night before a wedding, the night before a barbeque, the night before a romantic dinner, the night before a funeral.
Try it. I'm abso-flippin'-lutely serious.
Do your normal daily routine today. Have dinner. Relax this evening. Then as the whole world is going to bed.....
Just stay up, 'till 7:30. Until you've literally done this, I'd say.....10 times, you have no clue what you're getting into.
Oh...I forgot. One of those 10 days MUST be the day of, or day before a major, major life event.
Rate your mood on a scale of 1-10 the day you start, each day throughout the process, then 2 days after you this experiment ends.
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agreed and would add..
imagine that while you stay up all night trying to wrestle ~25 patients (if you're a resident.. more like 35-60 if an attending) from the cold claws of death (or even worse, the figments of their somatization disorder), calling cardiology to cath someone CTD in cardiogenic shock, having cards refuse because they'll probably die on the table thereby ruining their numbers.. then talking to family..
missing the cut off for the cafeteria closing so you don't eat all night..
going back to the desk, having >10 charts to do, knowing that failing to document some important finding that you probably will forget might end up in a lawsuit going against you.. that young crack-headed looking female patient who came in w/ CP, had a nl EKG/CXR and is now discharged, you notice her initial HR was 80 but the RN took dc vitals and showed a HR of 110, probably sympathetic but now you're worried you blew her off and she had a PE...
then 0400 hits, you find a pt w/ a massive SAH who is about to code, call neurosurgery who bitches you out for waking him up and yells in the phone, "I'M NOT GOING TO CLIP SOMEONE WITH A HUNT/HESS of 5 DON'T CALL ME!!", then go back to family and say, "I've discussed with the neurosurgeon and surgery is not an option.."
going home feeling like you got ran over by a mack truck, finally falling asleep at 0830, then at 1000 the doorbell rings, the wife comes home, lawn mowers running outside, tiny rays of sunlight peeking through your black-out curtains terrorizing your retina..
oh yeah and you have to be bright and chipper by 6:30PM cause you do it all over again.
but no big deal cause you only do this 4 times a week so it's an easy lifestyle.
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Oh my god... the LAWNMOWERS ! - for real. I hate the 7 AM lawnmowers after a nightshift. Hate hate hate.
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Okay thanks, you've scared me away from EM. However, after visiting the ER three times as a child, I surely do appreciate what you guys do for us! I think I remember reading something about this EM doctor saying how he basically lived off of Doritos and Coca-Cola during his shifts. Can any of you confess to a diet like this? haha
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Yeah. Lol.
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Doritos and coca cola? No. That might as well be organic gluten free kale salads.
Me?
10 years of chocolate-frosted pop tarts and Gatorade in a can. It's the quickest way humanly possible, to get 500 calories of immediate release carbs down the gullet, at 5:30 am between a shaken baby and rectal disimpaction.
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Doritos and coke? Nah.
When I was a medical student, there was an ice-cream novelty machine tucked away somewhere up and around the corner from... wherever. I made damn sure to bring my quarters every night shift.
As a resident, it was all-day-and-all-night gatorade, and whatever PowerProteinBarLOLZ! I could grab.
Now, I'm a bit better to myself, but all too often I go for the Dr. Pepper because "Oh, its so sugary and effervescent and a;slkdjfa;lkdsfj;akldsfj."
Someone could do a whole thread on this: "What I ate when I was a (student/resident/fellow/attending)."
Bird? I'm lookin' at you, dude.
When I was a medical student, there was an ice-cream novelty machine tucked away somewhere up and around the corner from... wherever. I made damn sure to bring my quarters every night shift.
As a resident, it was all-day-and-all-night gatorade, and whatever PowerProteinBarLOLZ! I could grab.
Now, I'm a bit better to myself, but all too often I go for the Dr. Pepper because "Oh, its so sugary and effervescent and a;slkdjfa;lkdsfj;akldsfj."
Someone could do a whole thread on this: "What I ate when I was a (student/resident/fellow/attending)."
Bird? I'm lookin' at you, dude.
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How come nobody has mentioned coffee? Because it's a diuretic? I don't think I could pull an overnighter with just a Dr. Pepper.......that has like the equivalent amount of caffeine as one shot of espresso.
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Because coffee is a given necessity. We don't mention needing oxygen or gravity to work an overnight either.
On the other hand there are the variables. Some nights are all right and I get to pee whenever I want. Some nights are nice and I get to eat (and drink) something. Some nights are great and I get to go to the cafeteria for fried cheese balls with sauce.
D
deleted109597
Our cafeteria closes at 630pm. Opens at 630am. On nights, I can bring food, or eat from the vending machine. Flaming hot cheetos with lime are good, as well as poptarts. Delivery chinese food, or send a tech to get wings, or hot dogs, or whataburger.
During the day, the cafeteria is like the fair. Fried corn nuggets, fried jalapeno poppers, fried mushrooms, onion rings, fries, chicken nuggets, etc.
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A feast for kings.
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Seriously though, can one of you please start a whole forum for the diet topic? That "What I've learned from my patients" forum has been going strong for 10 years, so I can only imagine what you guys could come up with for a diet one!
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First three rules of residency:
1.) Eat when you can.
2.) Sleep when you can.
3.) Tell no one that you did either.
1.) Eat when you can.
2.) Sleep when you can.
3.) Tell no one that you did either.
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Philosophically? Because the people in charge of these changes are Marxists, not Euro-socialists. Elimination of the upper middle and middle classes is the goal. But you can already see these changes in our current system and how it works. If you are a hardworking physician, you are taxed to death during your career to pay for social benefits. But then, when you retire your social benefits are reduced based on your past success...as opposed to a truly socialist system where pensioners stand as equals in front of their rationing boards.
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"Obamacare program may be linked to ER opioid prescriptions"
http://m.washingtonexaminer.com/oba...ed-to-er-opioid-prescriptions/article/2564111
http://m.washingtonexaminer.com/oba...ed-to-er-opioid-prescriptions/article/2564111
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It's going to get worse. Now with the repeal of SGR (good) we've replaced it with Quality measures (bad). CMS will be yet another agency encouraging us to give painkillers to increase "quality" and thereby reimbursement to physician groups and hospitals.
I was also at ACEP-LAC this week, and there's some scary stuff coming down the pipeline from the Feds in the next few year. Essentially individual physician "customery satisfaction" scores will be tracked, and documented publicly on a government website. The cynic in me thinks that hospitals will use this data to hire and fire physicians, as they all want ONLY physicians who are greater than the 90th percentile. What that does to the other 90% of physicians can't be good. Just another pressure on us to prescribe antibiotics, narcs, and perform unnecessary tests and procedures.
I was also at ACEP-LAC this week, and there's some scary stuff coming down the pipeline from the Feds in the next few year. Essentially individual physician "customery satisfaction" scores will be tracked, and documented publicly on a government website. The cynic in me thinks that hospitals will use this data to hire and fire physicians, as they all want ONLY physicians who are greater than the 90th percentile. What that does to the other 90% of physicians can't be good. Just another pressure on us to prescribe antibiotics, narcs, and perform unnecessary tests and procedures.
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They love to look the other way, in regards to the fact that sometimes the most immediately "satisfying" care provided is often not the best, but often the worst. You all know many examples, but another one that should be simple to understand would be obesity and diet counseling by PCPs. There's nothing "satisfying" about being told you are overweight, need to exercise more and eat less delicious, sugary and fatty food and if you don't, you'll die sooner. But it's best practice and right. It's much more "satisfying" for the doctor to smile, ignore the problem and ask how the grandkids are doing. Addiction is another devastating and classic example. It's most "satisfying" always to take true path of least resistance, enable a patient's addiction and write the Rx that fuels their demise all while satisfying them by refusing to confront their denial.
Those elected to supposedly serve and protect us, equate instant gratification with "quality." It's dangerous what our so-called "leaders" are pushing and have codified into law. I used to think it was pathetic incompetence on their part, but they're not stupid. They know exactly what they're doing. It's all about money and power to them and the special interests (hospital corporations, insurance companies, Pharma) that help fund their elections and lifestyles. These interests want "return customers" and doing what's "right" is secondary, especially if the government endorses what's wrong for patients and makes it law. Our country and nation's health will be much, much worse off for it. It's frustrating knowing, that this cancer will have to metastasize, the nation's health will have to worsen, and good doctors be punished for doing the right thing, before it gets better, if it ever does. Considering a large portion of the population is dead set on instant gratification themselves and 100% behind this movement, it will be difficult to ever get support for doing the right thing.
The government has given a hammer to the worst of human nature and empowered it to use that hammer to coerce our prescribing pens and medical decisions to fuel self destructive impulses.
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tl;dr
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I know, my last post was written at least at a fifth grade level, or higher. Here is the condensed Twitter-version in 140 characters or less:
Press Ganey sucks
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^ Birdstrike, I wasn't referring to your post when I said "tl;dr" but rather the entire thread/discussion. I appreciate your input on this forum and I certainly wouldn't post such a rude comment directed at you. It was meant as a lighthearted comment directed towards the entire thread since it's so long now. I realize now it was a useless comment and I withdraw it now! Let it be stricken from the record!
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That's cool, but I wasn't offended. Just wanted to throw some snark out there. Don't delete. It's all good. And some of my posts are long as ****, btw.
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Irony much?
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