See The Article: Why? What can we do about it?

[CAAdmission]

4 hours ago, jmj11 said:

There are some great ideas expressed here, but I'm pessimistic that the American government has any hopes of making things better.

Anyone who thinks that the government will be able to step in, increase regulation, and improve things has not been watching the government function for the last 50 years.

[iconic]

American Government is corrupt beyond belief. I actually had a hard time believing it until recently. I have absolutely no hope they will change anything for the better. In fact I will most likely be looking at moving back to Europe at some point in the future. I do feel bad for Americans for the government that we have 

Edited February 5, 2023 by iconic

[Boatswain2PA]

11 hours ago, Reality Check 2 said:

For profit medical insurance is an oxymoron in the most moronic meaning of the word.

Disagree.  We have just perverted the meaning of health insurance.

"Insurance" is supposed to be a tool to reduce risk.  Like a hedge fund.  Insurance isn't supposed to be there to pay for your annual physical or birth control, it's supposed to be a way to protect you from catastrophic costs.  Unfortunately catastrophic coverage policies were outlawed, and now insurance companies are required to provide birth control to people who are incapable of becoming pregnant.

11 hours ago, Reality Check 2 said:

No one should profit from "health" except the patient. There should not be reward for NOT using healthcare

The only one who profits from "health" IS the patient.  However, all of us "profit" from providing "health CARE".

 

11 hours ago, Reality Check 2 said:

We have degraded Public Health into a resume padding position on a town or county council by nonmedical people who want a hand in "politics".

Again I disagree my friend.  We have degraded "public health" by forcing it into every aspect of our personal and collective lives, at the expense of focusing on the true "public" domain.

Example - CDC focused for years on things like diet, poverty, and housing (and now "systemic racism")...meanwhile we have had communities (Flint) who have lost their supply of safe drinking water (a public health necessity discovered by the FATHER of Public Health John Snow).

11 hours ago, Reality Check 2 said:

Medicine and science are not political - they are science.

But when the polis (the people) are paying the bills for the provision of health CARE to people, then it by definition becomes political.

And when the polis (the people) pay for so much science (via government funding), then science too becomes political.

11 hours ago, Reality Check 2 said:

Until or unless the US as a whole chooses to accept science as a science

Nobody should ever "accept" science, as REAL science is always open to change.

Only people (politicians, media, etc) who try to control you will say things like "the science is settled".  

Even E=MC(squared) is up for debate among people who understand what science really is.

11 hours ago, Reality Check 2 said:

Insurance CEOs will continue with 7 figure "bonuses" and care will be rationed based on money not logic.

Healthcare will only be rationed on logic in a utopia...which never exists.  

Healthcare will always be rationed.  Either by personal economic means, by insurance policies, or government policies.  The only one of those where logic will apply is by means.

 

 

[Boatswain2PA]

10 hours ago, SedRate said:

although billing for time may help change this

Isn't that just a way to cap income?  There are only so many minutes in a day to bill...

 

10 hours ago, SedRate said:

Sadly, medicine and science have become political in terms of where NIH funding comes from (taxpayers) and who funds academia (local governments wanting to boost their own agenda or personal interests because a family member was sick). Academia also have less rigorous requirements than private research entities as well as more pressure to publish (to attain or retain tenure because the Dean promotes/incentivizes quantity over quality) which leads to bad science.

How do we make this required reading?

[SedRate]

10 hours ago, Boatswain2PA said:

Isn't that just a way to cap income?  There are only so many minutes in a day to bill...

 

How do we make this required reading?

Ah interesting point... Never thought of that. I do believe we can still choose to bill by MDM, though, so that would prevent the cap seen in only billing for time. 

[ventana]

14 hours ago, Boatswain2PA said:

Isn't that just a way to cap income?  There are only so many minutes in a day to bill...

 

 

not really

I have always billed mostly 214 on MDM (not hard to do)

now with time I can bill most visits on time at 14, and if not then MDM gets there

 

8-5pm - 9 hours in clinic

16 patients a day average > 30 min each

30-39 min 14

easy

but the annuals and complex get billed on MDM and typcially 15

Also Advanced care planning, annual wellness, hospital DC/TCM all get billed as well as hospice and VNA cert...

 

 

[jmj11]

On 2/4/2023 at 11:55 AM, SedRate said:

Rather than focus on the powers that be, I think a great start is preventing some of the diseases in the first place. Less sickness and less disease roughly equals less costs and less burden on our healthcare system and society. Or am I missing something? Sadly, preventive medicine won't necessarily help those already afflicted or predisposed except for maybe curbing disease expression and progression. 

While just focusing on the government's role is not the answer as you allude to, they are an important partner in this endeavor. If you look at countries that have done a better job at getting the biggest bang (healthy populace) for the same buck (healthcare expenditures) government policies seem to have made the difference. Short of banning certain unhealthy lifestyle choices, making such choices more expensive is one idea. I just heard from our teachers that vaping in middle school is becoming a huge problem. The vapor industry needs more government regulation, especially marketing and selling to minors.

The government could create financial incentives for medical practices to focus more on health issues that impact outcomes (weight loss for Type II DM, diet and exercise programs for all patients, etc.). Why do procedures get rewarded more than preventative care? Could the government regulate this?

I remember when I owned my own headache clinic, I was advised by several clinic owners (at a dinner at a conference) that for our clinic to survive we had to do a higher percentage of procedures. When I protested, "There is no data to support the use of procedure x, y, or z, they responded, "That doesn't matter. If you want to survive, you must do procedures." Something is wrong with that. Why not get rewarded as much as procedures by talking about lifestyle changes?

No, our government is not the answer, alone. But they are an important partner that needs to grow up to adulthood to help us do the heavy lifting of change.

[SedRate]

4 hours ago, jmj11 said:

While just focusing on the government's role is not the answer as you allude to, they are an important partner in this endeavor. If you look at countries that have done a better job at getting the biggest bang (healthy populace) for the same buck (healthcare expenditures) government policies seem to have made the difference. Short of banning certain unhealthy lifestyle choices, making such choices more expensive is one idea. I just heard from our teachers that vaping in middle school is becoming a huge problem. The vapor industry needs more government regulation, especially marketing and selling to minors.

The government could create financial incentives for medical practices to focus more on health issues that impact outcomes (weight loss for Type II DM, diet and exercise programs for all patients, etc.). Why do procedures get rewarded more than preventative care? Could the government regulate this?

I remember when I owned my own headache clinic, I was advised by several clinic owners (at a dinner at a conference) that for our clinic to survive we had to do a higher percentage of procedures. When I protested, "There is no data to support the use of procedure x, y, or z, they responded, "That doesn't matter. If you want to survive, you must do procedures." Something is wrong with that. Why not get rewarded as much as procedures by talking about lifestyle changes?

No, our government is not the answer, alone. But they are an important partner that needs to grow up to adulthood to help us do the heavy lifting of change.

Interesting points.

Unfortunately, with all the food, meat, beer, and dairy industries lobbying and affecting government policies, I gotta think it's unlikely that the government would then go against all that and support healthcare providers to tell pts to stop drinking their soda or beer and eating their corn-fed meat and dairy. But I suppose change starts somewhere! 

Agree that discussing modifiable factors should be weighed more heavily. Perhaps the MDM can be amended to a higher billing and I do believe we can code for counseling as a part of billing by time. It's too bad it's not included in higher levels of MDM. However, is telling a pt they should eat better and exercise more really on par with a procedure? This is probably a stupid question and I don't feel like searching it right now, but is there any EBM out there to support that lifestyle counseling actually works long-term and reverses disease? We're all taught it but I'm more interested in whether our 15-min counseling sessions actually change human behavior and result in a positive endpoint. 

[EMEDPA]

15 hours ago, SedRate said:

We're all taught it but I'm more interested in whether our 15-min counseling sessions actually change human behavior and result in a positive endpoint. 

I believe in a subset of patients that those discussions can make a difference. I told the mother of a friend I was seeing as a patient years ago that her long time smoking would likely result in poor outcomes in the future. This was someone who knew me and respected my opinion. I was very graphic about emphysema, home oxygen, heart and CVA issues, etc. Guess, what? At age 60 after years of smoking she stopped cold turkey and has not smoked in 20 + years. I am sure I improved her health with that brief conversation and I likely saved "the system" quite a bit of money on what her medical care would have been. She said no one had ever explained to her before just how bad smoking was! So is the money saved from that discussion worth more than a lung transplant, stents, stroke rehab, etc? I would like to think so. Ditto convincing someone to lose weight, preventing the onset of T2DM or to stop drinking alcohol and preventing cirrhosis or deaths from DUI accidents, etc

Not everyone will listen. If 10% of your patients do, it will make a difference. Keep throwing it out there. Every day. Every encounter. Some of it is bound to stick. 

As Mel Herbert, EM guru likes to say: What you do every day with your patients matters.  

Another of my favorite EM quotes from Peter Rosen, one of the founders of the specialty: I know my life had value because I worked in the ER

[Boatswain2PA]

2 hours ago, EMEDPA said:

Another of my favorite EM quotes from Peter Rosen, one of the founders of the specialty: I know my life had value because I worked in the ER

Then he sold out and became a paid specialist for med mal plaintiffs, and was censured for ACEP for his terrible testimony against emergency physicians.

 

 

[SedRate]

6 hours ago, EMEDPA said:

I believe in a subset of patients that those discussions can make a difference. I told the mother of a friend I was seeing as a patient years ago that her long time smoking would likely result in poor outcomes in the future. This was someone who knew me and respected my opinion. I was very graphic about emphysema, home oxygen, heart and CVA issues, etc. Guess, what? At age 60 after years of smoking she stopped cold turkey and has not smoked in 20 + years. I am sure I improved her health with that brief conversation and I likely saved "the system" quite a bit of money on what her medical care would have been. She said no one had ever explained to her before just how bad smoking was! So is the money saved from that discussion worth more than a lung transplant, stents, stroke rehab, etc? I would like to think so. Ditto convincing someone to lose weight, preventing the onset of T2DM or to stop drinking alcohol and preventing cirrhosis or deaths from DUI accidents, etc

Not everyone will listen. If 10% of your patients do, it will make a difference. Keep throwing it out there. Every day. Every encounter. Some of it is bound to stick. 

As Mel Herbert, EM guru likes to say: What you do every day with your patients matters.  

Another of my favorite EM quotes from Peter Rosen, one of the founders of the specialty: I know my life had value because I worked in the ER

Great points. I have a similar mentality and hope that my efforts aren't in vain. Thanks for sharing those quotes, too. 

Interestingly, my own parent had a similar, graphic discussion with her PA/PCP that finally got her to quit. All the times as a kid and PA myself couldn't get through to her, so I'm glad someone could. 

[rev ronin]

5 hours ago, SedRate said:

Interestingly, my own parent had a similar, graphic discussion with her PA/PCP that finally got her to quit. All the times as a kid and PA myself couldn't get through to her, so I'm glad someone could. 

"Jesus said to them, 'A prophet is not without honor except in his hometown and among his own relatives and in his own household.'" Mark 6:4

[ventana]

On 2/7/2023 at 4:08 PM, Boatswain2PA said:

Then he sold out and became a paid specialist for med mal plaintiffs, and was censured for ACEP for his terrible testimony against emergency physicians.

 

 

yet another doc that sold out for cold hard cash

 

Anyone else read the article on the two brothers that fueled the opiod epidemic in FL an the doc's (only doc's could write Sch II in FL at that time) that just sold their souls for cold hard cash

 

Then read the Medscape article about the Insurance company doctors that had sold their degree and integrity to an insurance company and no longer had any ethics left....

 

Seems maybe Doctors need supervision more then PA!!!