Category: Healthcare Reform

A Time for Doctors to Shine???

Check this out. What you will see is a physician author describing physicians as going through Kubler-Ross’s five stages of grief in terms of their professional autonomy and compensation. Over the last couple of decades, doctors have increasingly been forced to cede their power, and much of their incomes, to stronger forces. Insurance companies, medical systems, etc. Early on, we saw doctors in the first stage of grief. Denial. Doctors denied that their lives were being tampered with, and they stayed silent. Mentions of physician “unions” were rebuffed. 

Over subsequent years, the doctors predictably marched through the other stages of grief. So now they are where they are. Interestingly, as COVID-19 looked like it was passing off into history, doctors believed that this would be an ideal time for them to recapture their pre-grief former lives. Not so fast! Many of our citizens are facing difficult financial times as a result of the pandemic. Small businesses are struggling to stay open. AND. Many Americans are mindful that among developed countries, the US has the least cost-effective healthcare system on earth. Not a great time for doctors to be asking for more money and more autonomy.

Bottom Line. SO. Dr. Pearl is suggesting that American physicians move on to the last stage of grief. Acceptance.  No, not acceptance of the fact that our healthcare, and doctors’ lives, will continue to get worse and that there is nothing to be done about that.  Nope. Acceptance of the realization of what is broken, e.g., an uncoordinated fee for service system. And making the commitment to fix the problems. 

Then, and only then, will physicians and patients be able to stop grieving!

Healthcare Reforms That Might Actually Work???

The guy pictured above, Bob Laszewski, blogs about healthcare policy and related political issues. In this post, he opines that only three of the Democratic candidates for president (Biden, Bloomberg and Buttigieg) have reform proposals on the table that actually might be voted into law. Warren and Sanders, he believes, have programs that are “politically unrealistic.” How, he wonders out loud, will “their paying providers Medicare rates for everything not bankrupt hospitals and doctors?”

My readers know that I don’t spend a lot of time thinking, much less talking, about politics. It sort of gives me a headache. BUT. As professionals in the healthcare marketing vertical and as just plain citizens, we need to pay special attention to the fact that health care is once again going to be a, if not the, major issue in the upcoming presidential election. Moreover, plans that are being bandied about differ widely in terms of their likely impact on patients, on our provider customers and therefore on us. Can we really depend on Bob’s perspective that the really iffy ones won’t pass in Congress to protect us?

Bottom Line. We  need to keep our eyes on this one, and to be able to discuss this issue knowledgably.  It matters!

4,000 Patients, One School Nurse

School nurse Here is one most people don’t spend a lot of time thinking about. I do, only because I am married to Casey, an RN who spent 17 years of her life practicing as a school nurse. She also has a Master’s degree in school nursing, so she “gets” the picture here from many angles. Check out this article. What you will see is a discussion of a two-part question. First, what does a school nurse actually do? Although there is plenty of the bloody nose and skinned knee stuff that is described in this article, there is also the day-to-day management of the medications for chronic/serious illnesses like asthma and diabetes. There is also education, and screening and … The second and related question is how many kids can one RN handle? Here is where things really get dicey. The American Academy of Pediatrics used to say 750. Now they say that there should be one RN in each school. What happens if there isn’t? The article shares the same kinds of horror stories Casey has told me. Absent an RN, some schools have school secretaries in charge of supervising kids’ medications. Really? Yes, really! Bottom Line. So, what’s the point here? Did I go off on this riff because Casey was a school nurse? Nope. Having thought about this a lot, it has become obvious to me that if there is a setting in which we can meaningfully educate and train people to manage their own health, it is in the school. By the time we get to the 35-year-old, 275-pound couch potato, it is a little late to be talking about healthy eating habits, exercise and drug compliance. But the budgets aren’t there in most districts to support even the nursing coverage for the basic functions, let alone thinking about a more holistic view of what “School Nurses” should really be doing.    As we go about “Health Care Reform,” maybe we should give this a little thought!

How Much of What a Doctor Does Is Actually Good for Patients???

Michael Kirsch The Doc pictured above is a practicing Gastroenterologist who fancies himself as a “Whistleblower.” He gets to see what is actually going on behind the scenes in medicine and to report it out for all to see. Check out this post of his. In it, he asks a different question than we usually hear. You know, the one about what percentage of a doctor’s time is spent in direct patient care. We all know the answer to that question. Not enough!!! Here he asks how much of what he does really benefits patients. He stipulates that some time spent on medical records and other ancillary activities DOES benefit the patient, but wonders out loud how many of the hoops he is made to jump through are really for the patient’s good. Bottom Line. Sort of the same question as historically been asked, but it also is sort of different. More realistic in 2017. When I was constructing topical guides and questionnaires, I learned the importance of properly “framing” a question. Proper framing is now probably more important than ever. I think Dr. Kirsh’s question is the right one.  Think about it!

The Insurance Companies Did It!!!

Screen Shot 2017-06-20 at 10.50.48 AM Check out this piece. In it, you will read that healthcare became such a mess because of the machinations of insurance companies and, behind them, the political workings of the AMA. You will also see the perspective that Obamacare and the latest Republican attempts at a healthcare bill are doomed to fail because they don’t overturn the insurance company model, but rather attempt to work around it with “jerry rigged” tactics. Bottom Line. Interesting, and rather fatalistic stuff here. One is left to ponder when someone will get the guts to overturn the insurance company model in the U.S., and what the replacement should look like.  

Legislating For Failure

Screen Shot 2016-08-16 at 3.25.59 PM Read this blog post. What you will see is a pediatrician drawing a parallel between No Child Left Behind, that made educators responsible for student progress, and MACRA, which makes health care providers responsible for patient outcomes. Interesting parallel! The blogger rightfully points out that the NCLB and MACRA share the flaw of unfairly placing responsibility on those who do not have final control of the situation. Students leave school at the end of each day to return to their home environments where the amount of effort they put into their schoolwork is up to them. Similarly, patients are notorious for failing to comply once out of sight of their HCP’s. Bottom Line. Is it fair to “dock” educators and HCP’s for poor outcomes under these circumstances? Probably not!!!

Pain Refugees

Pain Refugees Check out this article. What you will see is yet one more indication of the problems that result from the U.S. dealing with much of healthcare at the State level. More specifically, what you see pictured above are people who suffer from chronic pain, and use opioids to cope. BUT. Their home State of Montana makes it very risky for physicians to prescribe opioids, lest they be brought up on charges. Result? Every 90 days, these patients make a pilgrimage to L.A., where they have a doctor who will readily meet their needs in a State where opioid use by chronic patients, NOT addicts, is not stigmatized. Bottom Line. A country in which healthcare is significantly impacted by a hodge podge of State laws is suboptimal.  Lord knows, we have enough challenges at the Federal level. Which leads to a question. Why???

Bottom Up Changes In Health Care

Tat Ming Leung   A simple thought for today. Read this blog post! Bottom Line. What you see in this blogger’s thoughts is a clear expression of the notion that while politicians and others are scrambling around trying to change health care from the top down, meaningful changes will more likely come from the bottom up. I think that is sort of right, and sort of not. If all one does is make changes from the bottom up, there is the risk of winding up with a hodge-podge of little changes that don’t mesh well together. To avoid that outcome, the change agent needs to zoom in and zoom out, look bottom up and top down, to make sure that the changes are appropriate at the tactical level and fit together to form a coherent strategy as well.

ProPublica! Again!!!

ProPublica We’ve talked about ProPublica before. Hell bent to enable patients to research such metrics as how much $ their personal physician has accepted from pharmaceutical companies in the last year, which ones, for what, etc. Here’s a new one. ProPublica has now developed a search engine that will allow a consumer to determine the extent to which a physician, a hospital, a pharmacy, etc. have been cited for HIPAA violations. Bottom Line. Another mixed reaction on my part to this one, folks: On one hand, I again laud ProPublica for providing the public with sunshine drenched views of formerly shadowy areas of health care. On the other hand, I wonder to what uses these pieces of information will be put. Will people choose a practitioner based on a HIPAA violation score? I’m thinking probably not. Will lawyers, yellow journalists, and others interested in raking healthcare practitioners over the coals find these data of interest? I’m betting that the answer to that one is probably yes.

Hopeful Signs

Cape of Good Hope The physician who wrote this blog feels that he spends too much time as the “chronicler of the decline” in health care. Sometimes, I feel much the same way. Thus, it is a pleasure to direct you to one of his posts that deals with five hopeful trends that he sees emerging, and growing, in healthcare. Things like “Direct Pay” practices, where care is bought for cash at retail, but without significant amounts of money being skimmed off for insurance companies and bureaucracies. Interestingly, he also sees medical tourism as a hopeful trend, since it actually reflects people doing something about getting control of their health care. As a middle-aged physician, Dr. Accad lists the rebellion among physicians against goofy recertification requirements as something that is likely to make at least his life in health care a little better. He sees the use of social media in support of healthcare as a positive trend as well. Here’s a new one on me. Last but not least, he discusses “cost sharing ministries,” in which people with something in common (e.g., Amish, other Christian groups) band together to cover each others’ medical expenses without turning over profit to insurance companies and other middlemen. Bottom Line. Dr. Accad freely admits that none of these phenomena, in and of itself, is likely to make healthcare genuinely better. I’m with him, though, in believing that people actually doing something about health care, as each of these rays of hope reflects, is better than people simply moaning about its decay.