What does Obamacare, which is here to stay, mean for us?

[user1234556]

Preventive care takes knowledge, insight and planning

Not everyone has those skills or effort

 

Or time.

 

And THAT won't be changing.

[user1234556]

1. Part of Obamacare will enforce all insurance companies to provide preventative care w/o any charge to the patient, covering prev. care recommended by the US Prev Care task force.

 

And it's particularly interesting how we've already been seeing the "priming" for this in the last few years-- setting the stage for the rationing that will have to occur to accommodate that -- with the task force "amending" current recommendations on these prevention guidelines.. in direct opposition, in some cases, to what groups like the American Cancer Society (for example) recommend. The mammogram issue comes to mind. It was convenient timing that they decided in 2009 that women no longer need to get annual mammograms after age 40. Instead, they should only get them beginning at 50, and only every 2 years. I think the millions of women in this country who were diagnosed with breast cancer during that decade of their life would strongly disagree with this, and I'm thankful that physicians in this country who actually care about their patients have spoken out strongly against it.

[Tonev]

wouldn't increased demand for services mean more jobs at lower wages? I think erveryone in healthcare from the docs on down will take some kind of pay cut. I don't necessarily think that is a bad thing. primary care folks are underpaid. they should make more. specialists are overpaid. they should make less. in England family medicine docs make more than surgeons because they value prevention over intervention there.

 

That's what's happeneing now at my current hospital. Where they use to get $750.00 per test during surgery it has now become $350.00 per test because the insurance company has outlined what tests they will or won't pay for. I currently see a lot of specialty areas being hit hard with this but the general practices seem to be marginally affected by the changes ("Although I do see them advertising to get more patients in now.").

[Tonev]

wouldn't increased demand for services mean more jobs at lower wages? I think erveryone in healthcare from the docs on down will take some kind of pay cut. I don't necessarily think that is a bad thing. primary care folks are underpaid. they should make more. specialists are overpaid. they should make less. in England family medicine docs make more than surgeons because they value prevention over intervention there.

 

That's what's happeneing now at my current hospital. Where they use to get $750.00 per test during surgery it has now become $350.00 per test because the insurance company has outlined what tests they will or won't pay for. I currently see a lot of specialty areas being hit hard with this but the general practices seem to be marginally affected by the changes ("Although I do see them advertising to get more patients in now.").

[Teasip]

And it's particularly interesting how we've already been seeing the "priming" for this in the last few years-- setting the stage for the rationing that will have to occur to accommodate that -- with the task force "amending" current recommendations on these prevention guidelines.. in direct opposition, in some cases, to what groups like the American Cancer Society (for example) recommend. The mammogram issue comes to mind. It was convenient timing that they decided in 2009 that women no longer need to get annual mammograms after age 40. Instead, they should only get them beginning at 50, and only every 2 years. I think the millions of women in this country who were diagnosed with breast cancer during that decade of their life would strongly disagree with this, and I'm thankful that physicians in this country who actually care about their patients have spoken out strongly against it.

 

Be careful about drinking the "cancer screening kool-aid". There IS a reason why USPSTF have the recommendations that they do and why the specialty groups are crying foul. Bottom line, know how to determine NNT and look at all-cause mortality when recommending screening options.

[Teasip]

And it's particularly interesting how we've already been seeing the "priming" for this in the last few years-- setting the stage for the rationing that will have to occur to accommodate that -- with the task force "amending" current recommendations on these prevention guidelines.. in direct opposition, in some cases, to what groups like the American Cancer Society (for example) recommend. The mammogram issue comes to mind. It was convenient timing that they decided in 2009 that women no longer need to get annual mammograms after age 40. Instead, they should only get them beginning at 50, and only every 2 years. I think the millions of women in this country who were diagnosed with breast cancer during that decade of their life would strongly disagree with this, and I'm thankful that physicians in this country who actually care about their patients have spoken out strongly against it.

 

Be careful about drinking the "cancer screening kool-aid". There IS a reason why USPSTF have the recommendations that they do and why the specialty groups are crying foul. Bottom line, know how to determine NNT and look at all-cause mortality when recommending screening options.

[drholmes]

Patient education is the correct next step in the evolution of health care delivery. The focus however, is communicating that our patients can trust the system of health care delivery as well as the trained professionals caring for them. Savvy business models and a re-tooling of how we communicate with our patients is what the providers/their offices can do. The same model will hold true for ACO's and other large conglomerates of health care services. They don't care how much we know; until they know how much we care. The adage is old but true. You will not get everybody to play by the rules. But hopefully, with increased patient understanding, comes increased patient compliance for appropriately managed levels of care.

 

The other thing we need to get absolutely away from is third-party mentality when it comes to payment systems. As a provider, I would rather a patient/their family contract with me/my office for the services they want me to provide for them. For patients with shallow financial income streams, let the medical community encourage local co-ops to increase buying power and have an influence on cost savings. The uncompensated employer-managed access model has not proven to be as effective as was hoped. Let's keep the financial decision making at the same level as the medical decision making. The third party (read: centrally-controlling) system has created the horizon of "one-payor" system that we are facing. If we continue down the road of taking medical and financial decision making away from the providers of the service and the ones seeking such service then our health care delivery system will morph into a corrupted social system with only the elites controlling access and/or getting the services as advertised.

 

I realize the SCOTUS has decreed that health care is some wildly imagined human right. Such declaration doesn't make the concept correct! Also, why is it correct that someone other than your medical practitioner (faceless insurance co, faceless government agency) gets to determine what is best for you or your health care provider? But, since the ACA is now law; the medical community should present more effective and efficient alternatives to take back some of the control of our system. If the medical community and other smart folks band together and propose models where quality outcomes (EBM) and other such benchmarks are the goals of the system; then maybe we can back away from some of the control issues and decentralize some of this.

 

Just some thoughts...

[drholmes]

Patient education is the correct next step in the evolution of health care delivery. The focus however, is communicating that our patients can trust the system of health care delivery as well as the trained professionals caring for them. Savvy business models and a re-tooling of how we communicate with our patients is what the providers/their offices can do. The same model will hold true for ACO's and other large conglomerates of health care services. They don't care how much we know; until they know how much we care. The adage is old but true. You will not get everybody to play by the rules. But hopefully, with increased patient understanding, comes increased patient compliance for appropriately managed levels of care.

 

The other thing we need to get absolutely away from is third-party mentality when it comes to payment systems. As a provider, I would rather a patient/their family contract with me/my office for the services they want me to provide for them. For patients with shallow financial income streams, let the medical community encourage local co-ops to increase buying power and have an influence on cost savings. The uncompensated employer-managed access model has not proven to be as effective as was hoped. Let's keep the financial decision making at the same level as the medical decision making. The third party (read: centrally-controlling) system has created the horizon of "one-payor" system that we are facing. If we continue down the road of taking medical and financial decision making away from the providers of the service and the ones seeking such service then our health care delivery system will morph into a corrupted social system with only the elites controlling access and/or getting the services as advertised.

 

I realize the SCOTUS has decreed that health care is some wildly imagined human right. Such declaration doesn't make the concept correct! Also, why is it correct that someone other than your medical practitioner (faceless insurance co, faceless government agency) gets to determine what is best for you or your health care provider? But, since the ACA is now law; the medical community should present more effective and efficient alternatives to take back some of the control of our system. If the medical community and other smart folks band together and propose models where quality outcomes (EBM) and other such benchmarks are the goals of the system; then maybe we can back away from some of the control issues and decentralize some of this.

 

Just some thoughts...