What Obamacare Doesn't Do
Started by BLADEMDA
Correct. But paid less than our EM colleagues due to the oversupply of cheaper anesthesia nurses.
D
deleted171991
Read the darn book: http://journals.lww.com/em-news/Documents/The_Rape_of_Emergency_Medicine[1].pdf .
It's more than 20 years old, for God's sake! They've been planning this for a long time.
D
deleted171991
It's not about one specialty. It's about all of them. The question is not if it will ever happen to each, but when and how.
Right, this is not an issue that is only unique to Anesthesiology, or even medical specialties for that matter. Registered Dental Practitioners (RDPs) seem to be gaining traction in a number of states, including NY: http://www.dentalplans.com/dentalhe...al-care-training-for-nurse-practitioners.html
- "Advanced dental hygiene practitioner (ADHP): ADHA's model for a mid-level provider for services from dental hygiene care to simple restorations and extractions without the direct supervision of a dentist."
D
deleted171991
Also known as dentistry for stupid people. The customers, not the providers.
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D
deleted171991
No. I'm just a guy who's got a hint of knowledge about the complicated maxillary mechanics and how bad fillings can destroy occlusion and dental health for many other teeth.
A good general dentist is like a good primary care doc: not only has a unique big perspective about your health, but prevents at least as much as s/he treats. But please keep seeing nurse practitioners, so I don't have to be waitlisted for seeing the good docs.
Radiation Oncologists do not administer radiation therapy; the "radiation therapy technologist" does so. Rather, the MD oversees the treatment process: http://hospitals.jefferson.edu/tests-and-treatments/radiation-therapy/a-team-approach/
Is this not similar to the ACT model?
Is this not similar to the ACT model?
D
deleted171991
No. It's similar to an MD-nurse/tech model, like in most specialties. The MD orders, the nurse/tech executes the order, mostly without any debate.
The ACT model is more akin to a parent-arrogant teenager who knows everything (better) model. CRNAs are as educated as we are, hence we'd better have a good reason for contradicting them. </sarcasm>
In 2014, for example, 35 percent of adults, or 64 million people reported some kind of bill problems or medical debt, compared with 41 percent of the population, or 75 million people in 2012, according to the Commonwealth Fund's survey released Thursday.
Read MoreHealthCare.gov tops 2014 tally
Also in 2014, the number of adults who reported not getting needed care because of cost, including visiting a doctor, filling a prescription or getting specialist care had decreased to 66 million, or 36 percent. In 2012, 80 million people, or 43 percent of the population, reported such issues.
"These declines are remarkable and unprecedented in the survey's more than decade-long history," said Sara Collins, the Commonwealth Fund's vice president for health-care coverage and access and lead author of the study.
"They indicate that the Affordable Care Act is beginning to help people afford the health care they need. We also found sharp declines in the uninsured rate nationwide," Collins said.
The survey suggests there could be continued decreases in the number of people facing health-care financial pressure in coming years, as more people obtain health insurance through elements of the Affordable Care Act, particularly among young and poor adults.
But Commonwealth Fund President Dr. David Blumenthal warned that a Supreme Court case that is attacking one of those major features could undo progress seen in the levels of people strapped by health costs and in number of people who lack insurance.
That case challenges the legality of subsidies given to most customers of the federal Obamacare exchange HealthCare.gov—which sells insurance plans in 37 states—to help them pay for premiums and out-of-pocket health costs.
"I think the Supreme Court decision will have a major effect...if there is a decision in favor of the plaintiffs we would expect, in those states at least in the short term, the situation would revert to the kinds of numbers we saw before the Affordable Care Act," Blumenthal told reporters during a briefing on the survey. A decision in that case is expected in June.
http://www.cnbc.com/id/102338507
Read MoreHealthCare.gov tops 2014 tally
Also in 2014, the number of adults who reported not getting needed care because of cost, including visiting a doctor, filling a prescription or getting specialist care had decreased to 66 million, or 36 percent. In 2012, 80 million people, or 43 percent of the population, reported such issues.
"These declines are remarkable and unprecedented in the survey's more than decade-long history," said Sara Collins, the Commonwealth Fund's vice president for health-care coverage and access and lead author of the study.
"They indicate that the Affordable Care Act is beginning to help people afford the health care they need. We also found sharp declines in the uninsured rate nationwide," Collins said.
The survey suggests there could be continued decreases in the number of people facing health-care financial pressure in coming years, as more people obtain health insurance through elements of the Affordable Care Act, particularly among young and poor adults.
But Commonwealth Fund President Dr. David Blumenthal warned that a Supreme Court case that is attacking one of those major features could undo progress seen in the levels of people strapped by health costs and in number of people who lack insurance.
That case challenges the legality of subsidies given to most customers of the federal Obamacare exchange HealthCare.gov—which sells insurance plans in 37 states—to help them pay for premiums and out-of-pocket health costs.
"I think the Supreme Court decision will have a major effect...if there is a decision in favor of the plaintiffs we would expect, in those states at least in the short term, the situation would revert to the kinds of numbers we saw before the Affordable Care Act," Blumenthal told reporters during a briefing on the survey. A decision in that case is expected in June.
http://www.cnbc.com/id/102338507
Still not sure as to how this is so different from RadOnc. I thought that in the ACT model the MD orders the anesthetic after evaluating the patient himself, and the CRNA executes the order. Except for the militant ones, do CRNAs usually argue about the anesthetic plan? And would this be a fire-able offense? How can they argue they know better if the MD is the one who evaluated the patient?
I remember having a class in undergrad where the TA told the whole class she wouldn't mind being seen by a nurse instead of a physician. I am kicking myself right now for not taking a stand.
Why bother? People are free to make their own choices. Just don't try to pin it on someone else if something goes wrong.
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Has anyone read the first three chapters in Miller's? It talks extensively about the future of Anesthesiology regarding ACOs, PSH, ACT, etc.
Some excerpts from the 8th edition:
"The expanding role of anesthesiologists, both within and outside the operating room, presents an opportunity for them to serve as perioperative physicians. 48 49 50 The increasing complexity of patient care related to surgical services has also created a demand for improved coordination of care from preoperative management through outpatient follow-up. Recently, the American Society of Anesthesiologists (ASA) proposed development of the perioperative surgical home (PSH), built in part on the PCMH model of care. 5152 53 The PSH emphasizes clinical management of the patient through the perioperative period, with coordination of care specifically designed to optimize outcomes after surgery and facilitate the transition of the patient back to the primary care provider. Within the PSH, care is coordinated by the anesthesiologist, who works collaboratively with a team of providers to identify evidence-based clinical pathways, improve outcomes, and reduce overall costs of care across the continuum, including postoperative costs such as home care and skilled nursing facilities. As is true for the PCMH, the PSH is designed to be patient focused. This approach requires a reassessment of the entire perioperative experience to ensure that the patient’s needs are an integral part of each element of the perioperative course. Although the PSH concept is currently being implemented for selected patient populations and the outcomes are still being defined, other initiatives that address some of the components of the PSH suggest that this more integrated approach to care (at least for some patient populations) should improve outcomes and patient (and provider) satisfaction while reducing costs. 53 54
The implementation of the PSH model could be a very effective way to optimize perioperative care for selected patient populations. The model may also define some generic strategies that can be implemented for all patients undergoing surgical procedures and new approaches to clinical care and assessment that will benefit patients, providers, and payers.
Conclusion
The changing demographics of hospitalized patients have created significant challenges for hospitals, health systems, and providers. For many hospitals, the percentage of surgical patients continues to grow. Many surgical procedures are performed on patients with underlying comorbidities that not only complicate surgical management and anesthesia care but also require coordinated care of primary care providers, surgeons, anesthesiologists, and other medical specialists. This chapter has defined some of the challenges of coordinating and optimizing perioperative management. Although no single strategy is appropriate for all clinical settings and patient needs, the one critical element in perioperative care is the need to implement a model of care that ensures coordination and transition across the continuum from preoperative assessment and management to postoperative rehabilitation. A number of alternative approaches can be used, and multiple strategies may be required to address the idiosyncrasies of each patient population, surgical procedure, and institutional capabilities. The expanded role for the anesthesiologist in many of these models requires the commitment and skills to acquire and analyze data on outcomes and costs, while also defining ways to optimize clinical care. The PSH is an example of a new creative model that might have significant benefit for selected patient populations, thus aligning patient’s, provider’s, hospital’s and payer’s goals and significantly improving perioperative care by building on the experience and successes of other approaches, including ERAS, the surgical hospitalist model, and the PCMH."
Some excerpts from the 8th edition:
"The expanding role of anesthesiologists, both within and outside the operating room, presents an opportunity for them to serve as perioperative physicians. 48 49 50 The increasing complexity of patient care related to surgical services has also created a demand for improved coordination of care from preoperative management through outpatient follow-up. Recently, the American Society of Anesthesiologists (ASA) proposed development of the perioperative surgical home (PSH), built in part on the PCMH model of care. 5152 53 The PSH emphasizes clinical management of the patient through the perioperative period, with coordination of care specifically designed to optimize outcomes after surgery and facilitate the transition of the patient back to the primary care provider. Within the PSH, care is coordinated by the anesthesiologist, who works collaboratively with a team of providers to identify evidence-based clinical pathways, improve outcomes, and reduce overall costs of care across the continuum, including postoperative costs such as home care and skilled nursing facilities. As is true for the PCMH, the PSH is designed to be patient focused. This approach requires a reassessment of the entire perioperative experience to ensure that the patient’s needs are an integral part of each element of the perioperative course. Although the PSH concept is currently being implemented for selected patient populations and the outcomes are still being defined, other initiatives that address some of the components of the PSH suggest that this more integrated approach to care (at least for some patient populations) should improve outcomes and patient (and provider) satisfaction while reducing costs. 53 54
The implementation of the PSH model could be a very effective way to optimize perioperative care for selected patient populations. The model may also define some generic strategies that can be implemented for all patients undergoing surgical procedures and new approaches to clinical care and assessment that will benefit patients, providers, and payers.
Conclusion
The changing demographics of hospitalized patients have created significant challenges for hospitals, health systems, and providers. For many hospitals, the percentage of surgical patients continues to grow. Many surgical procedures are performed on patients with underlying comorbidities that not only complicate surgical management and anesthesia care but also require coordinated care of primary care providers, surgeons, anesthesiologists, and other medical specialists. This chapter has defined some of the challenges of coordinating and optimizing perioperative management. Although no single strategy is appropriate for all clinical settings and patient needs, the one critical element in perioperative care is the need to implement a model of care that ensures coordination and transition across the continuum from preoperative assessment and management to postoperative rehabilitation. A number of alternative approaches can be used, and multiple strategies may be required to address the idiosyncrasies of each patient population, surgical procedure, and institutional capabilities. The expanded role for the anesthesiologist in many of these models requires the commitment and skills to acquire and analyze data on outcomes and costs, while also defining ways to optimize clinical care. The PSH is an example of a new creative model that might have significant benefit for selected patient populations, thus aligning patient’s, provider’s, hospital’s and payer’s goals and significantly improving perioperative care by building on the experience and successes of other approaches, including ERAS, the surgical hospitalist model, and the PCMH."
D
deleted171991
You'll see how nice it is when a patient comes with a preop "exam" from a NP/PA, which does nothing but basically rehashes the medical record without specifying how optimized each disease is, to finally conclude that the patient is cleared for surgery. A little knowledge is a dangerous thing.
People should be free to choose to spend less money on inferior products, including their health care.
A problem arises however when the sellers are free to lie about their products and pretend that an inferior product is equal or better than another, or when the patient is spending someone else's money.
Somewhere between the ultra-libertarian position of "sell all the snake oil you want because the market will take care of the scammers" and a nanny state is a happy functional medium where truth in advertising laws exist and are enforced.
I have NO problem whatsoever with a patient going to a nurse instead of a doctor and paying that nurse whatever fee they agree on. When the nurse gets an online DNP and gets an ID badge with "doctor" on it, and when the payment is via a third party or government, and when prices are obscured from the patient, and when haggling or comparison shopping isn't allowed or possible ... I have a problem with that.
Also -
We can and should try to help the public understand how healthcare works and help them make good choices.
And if after that, they decide to ignore us and exercise their right to spend more money on inferior products, we are free to mock them for making stupid choices, and maybe we should.
