There is agreement among most healthcare officials and experts that the most important and challenging issue facing the future of the industry is the disintegration of primary care. The field has become underpaid, overworked, and has had some serious issues with recruiting its own next generation; the latter partly due to the former. Aside from the lack of medical students pursuing primary care, our current batch are bailing out of the field or opening boutique/alternative practices to keep the bills paid. It has become cliche to talk about "once the baby boomers start getting sick, forget it," but I personally repeat this to everyone I speak to about healthcare.
In the first days of of my first year of medical school I remember the professors taking a poll of who wanted to enter what specialty. Literally, I saw two hands go up for primary/family medicine and surely my school is not alone in these kinds of figures. I don't blame students for having the desire to earn more and its not just that, what we as students hear of primary care makes us cringe. Of course we want to help people (at least most of us) but who wants to spend half of their career on the phone dealing with managed care or insurance companies. We want to spend our time taking care of people, doing what we will be trained to do, and deal with less beauracracy. My point is this, we have a huge problem, and the problem lies within the system not within the physicians or students.
The discussion and debate rages on. Obviously politics and elections plays a big role, but aside from Obama's election and its affect on these issues there have been pushes from all sides to reform if nothing else how we deal with primary care. There needs to be incentive to go into the field and there needs to be reimbursement changes. Lots of good ideas are proposed, and again there needs to be a compromise as a change in payments has affects across the professional board. This is evident by the recent uprising of specialists toward the Baucus healthcare reform legislation. The specialists are insiting that this reform unfairly cuts their salaries to pay primary care doctors more. Surely this is a valid argument, any profession would be against legislation that literally cuts their salary the moment it is signed. So we need to do this carefully, patiently yet swiftly, and we need to compromise. But above all something needs to be done or the backbone of the system will start crumbling, or rather imploding.
Check out the NEJM debate on this issue HERE.
Monday, November 17, 2008
Monday, October 6, 2008
Pay-For-Performance, Setting Patients up for Higher Bills?
The letters to the editor, in response to the Times article I wrote about previously, viciously point out the inherent problems with a PFP reimbursement approach. You can read some of them HERE. A good point: "If hospitals are forced to provide free corrective treatment to victim patients, those costs will become part of hospital overhead, which we will all pay for anyway." Is that all that PFP does, skips the bill so that both providers and patients are left with the difference?
Another question we have to ask when debating PFP is whether this system demands no errors in an industry that cannot exist without some errors. Although we would love to avoid every preventable accident in medicine, it may be dangerous to punish an industry that relies on risk/benefit ratios, experimental treatments, and other efforts to treat diesease. From one of the letters:
Another question we have to ask when debating PFP is whether this system demands no errors in an industry that cannot exist without some errors. Although we would love to avoid every preventable accident in medicine, it may be dangerous to punish an industry that relies on risk/benefit ratios, experimental treatments, and other efforts to treat diesease. From one of the letters:
"It is important to understand the context in which medical events like catheter-related urinary tract infections and pressure ulcers occur in hospitalized patients.
These patients have multiple chronic medical problems and are often immobile and institutionalized, having lost the ability to care for themselves because of diseases like Alzheimer’s or severe stroke. Others are in intensive care units suffering from multisystem organ failure and on the verge of death.
Therefore the analogy to use should not be one of an auto mechanic accidentally breaking the windshield while repairing the engine. Rather, it should be of the mechanic who is required to perfectly repair a vehicle that arrived at the shop totaled."
Wednesday, October 1, 2008
One Step Closer to Pay-For-Performance Medicine
There is a current running through healthcare policy think-tanks, insurance company board rooms, and government offices. Pay-for-Performance (PFP) is coming and coming fast. Not a soul is selling PFP as a key to medical utopia, but it is a decisive movement toward broad reform of medical reimbursement. PFP restructures reimbursement of providers from the current quantity-driven method to a what is supposed to be a quality, error-minimizing way. It does this not only by providing incentives for positive outcomes but also withholding payment when treatment is due to a "reasonably preventable" error. Its proposed benefits to the system are financial incentives toward quality control and minimizing preventable accidents, infections, and injury by providers. Its critics however have a decent leg to stand on. They claim that under these plans physicians begin cherry-picking low-risk patients, for instance for cardiac bypass surgery. This way, their successful outcomes looks very high upon analysis by medicare or an insurance company, and they recieve bonuses and/or high recommendations by what would be a public rating system of doctors and hospitals.
The most recent and apparent shift toward PFP is medicare's plan to withhold reimbursement for medical errors. This is the beginning, as most insurance companies will follow medicare as they normally do. This New York Times article lays out the new plan by medicare. What I found interesting was that although this is supposed to be a money-saver for these insurers, studies and experiments have shown little if any savings. The article points out that:
"The real money, many health economists believe, may come from reorienting the payment system to encourage prevention and chronic disease management and to discourage unnecessary procedures."
This astonished me. Have insurers and the government finally realized that investing in these preventable and manageable diseases now, you will have a healthier and thus cheaper patient population later? Who knows, and beyond that question, we don't know if this reimbursement plan will even redirect the medical community's attention to these issues. Time will tell, but now we know that PFP is on its way, whether physicians like it or not. I think it is now our responsibility to educate ourselves about it, so that we can make informed decisions in our future as physicians.
The most recent and apparent shift toward PFP is medicare's plan to withhold reimbursement for medical errors. This is the beginning, as most insurance companies will follow medicare as they normally do. This New York Times article lays out the new plan by medicare. What I found interesting was that although this is supposed to be a money-saver for these insurers, studies and experiments have shown little if any savings. The article points out that:
"The real money, many health economists believe, may come from reorienting the payment system to encourage prevention and chronic disease management and to discourage unnecessary procedures."
This astonished me. Have insurers and the government finally realized that investing in these preventable and manageable diseases now, you will have a healthier and thus cheaper patient population later? Who knows, and beyond that question, we don't know if this reimbursement plan will even redirect the medical community's attention to these issues. Time will tell, but now we know that PFP is on its way, whether physicians like it or not. I think it is now our responsibility to educate ourselves about it, so that we can make informed decisions in our future as physicians.
Wednesday, September 24, 2008
Green Medicine?
Thought this was interesting. The concept of health care professionals practicing as environmentally safe as possible doesn't seem like that profound of a concept. After all, we should be promoting "health" any way we can. It seems that responsible doctors and business people have begun a transforming movement in the industry.
Check out this ARTICLE.
Check out this ARTICLE.
Friday, September 19, 2008
PNHP: Healthy Americans Act is the "Wrong Model"
Well, it comes as no surprise that not everyone would agree on this broad reform proposition. The PNHP has posted an article extremely critical of the Healthy Americans Act. It states that: "the bill depends on the 'mandate' model of private insurance." This is truly a core issue in health care reform, mandating insurance. Through a social lens, a mandate whether private or for a federal plan, resembles how we deal with car insurance. If you drive a car you MUST purchase insurance, however there are differences in this scenario since your personal health does not have as direct affects on those around you (unlike running over a pedestrian in your hummer.) Mandating people to purchase private health insurance is tricky. The issue of compliance and enforcement is an obvious talking point for the critics. A national health plan provides a mandate, but a mandate for government to cover all individuals. As we know there is strong conservative opposition to government fitting the bill for everyone's healthcare. They believe that centralizing and growing the so-called beauracracy limits an efficiently run health care system. So this issue is of primary concern when trying to reform the system. It seems the idea of this bill is to pull away from employer based insurance but to stay in a private market for insurances to compete for this new pool of health care consumers.
The bill also provides a framework of 3 risk pools and government subsidies are to support the lowest (medicaid) of them. It assumes that the problem with medicaid is not that the program is not comprehensive, just that it is underfunded, it underreimburses providers and therefore is limited in where it is accepted. Further subsidies would be provided to those plans so as to increase where medicaid and the like would be accepted. This seems like a simple thing to write in a bill, but not easy to execute in reality. The idea however, is a concrete solution to the lack of acceptance of medicaid.
The article in PNHP went on to attack two more principles of the act:
"healthy behavior to promote personal responsibility by giving premium discounts for controlling your blood pressure or diabetes (hard to imagine the kind of gaming that occurs here), and the Republican favorite - market forces, based on transparency in prices and quality and individuals presumably shopping around for cheaper and better care."
Most people probably agree that our health care system should include some kind of incentives for personal responsiblity. That concept is not foreign even to socialized medical systems like the German system. Here is an example of some German social security code regarding health care personal responsibility:
As for the issue of market forces, it has plenty of arguments on both sides. In our system dominated by employer based health insurance, the competition my be limited by the big players purchasing the plans. Competition may not be acting to fully improve the health care provided and the efficiency with which it is run. For instance, costs of insurance company infrastructure have been estimated as enormous percentages of the entire healthcare spending in this country, noone can argue that that is efficent. The insurance companies themselves also rake in huge profits and are really the biggest winners in the system, wheras physicians and other providers struggle to get their share. Also, if the market was maximizing efficiency then our system should prove to be a better medical system than a universal coverage system, but we lag behind many nations' in a plethora of statistical data measuring the effectiveness of our healthcare. The opposing argument is that we cannot write of the market in health care. If the system was weaned off employer based insurance, it could be possible that a higher level of competition would arise from the huge pool of independent consumers looking for private plans. This could lower prices and improve the efficiency of our system. There is obviously something wrong with the way the current insurance/market system is set up. If we are to maintain the private system that we have, it has to be changed so as to encourage improvement.
Regardless, the debate is healthy and going strong. At least if nothing else, we seem to be making something happen. Party players are coming together and working on compromise which is when the country tends to actually move forward. The next blog will continue with this discussion.
The bill also provides a framework of 3 risk pools and government subsidies are to support the lowest (medicaid) of them. It assumes that the problem with medicaid is not that the program is not comprehensive, just that it is underfunded, it underreimburses providers and therefore is limited in where it is accepted. Further subsidies would be provided to those plans so as to increase where medicaid and the like would be accepted. This seems like a simple thing to write in a bill, but not easy to execute in reality. The idea however, is a concrete solution to the lack of acceptance of medicaid.
The article in PNHP went on to attack two more principles of the act:
"healthy behavior to promote personal responsibility by giving premium discounts for controlling your blood pressure or diabetes (hard to imagine the kind of gaming that occurs here), and the Republican favorite - market forces, based on transparency in prices and quality and individuals presumably shopping around for cheaper and better care."
Most people probably agree that our health care system should include some kind of incentives for personal responsiblity. That concept is not foreign even to socialized medical systems like the German system. Here is an example of some German social security code regarding health care personal responsibility:
- Services must only be used insofar as necessary
- Copayments are to be requested where treatment is required as a result of a criminal activity, deliberate self harm, or a "non-medically indicated measure such as cosmetic surgery, a tattoo, or a piercing"
- Financial incentives are to be provided to those taking part in preventive measures, screening, and check-up programmes, those taking part in managed care programmes, or those who do not use general practitioner or hospital services over prescribed periods
- Threshold for copayments of chronically ill and cancer patients are to depend on their compliance with screening and treatment regimens
As for the issue of market forces, it has plenty of arguments on both sides. In our system dominated by employer based health insurance, the competition my be limited by the big players purchasing the plans. Competition may not be acting to fully improve the health care provided and the efficiency with which it is run. For instance, costs of insurance company infrastructure have been estimated as enormous percentages of the entire healthcare spending in this country, noone can argue that that is efficent. The insurance companies themselves also rake in huge profits and are really the biggest winners in the system, wheras physicians and other providers struggle to get their share. Also, if the market was maximizing efficiency then our system should prove to be a better medical system than a universal coverage system, but we lag behind many nations' in a plethora of statistical data measuring the effectiveness of our healthcare. The opposing argument is that we cannot write of the market in health care. If the system was weaned off employer based insurance, it could be possible that a higher level of competition would arise from the huge pool of independent consumers looking for private plans. This could lower prices and improve the efficiency of our system. There is obviously something wrong with the way the current insurance/market system is set up. If we are to maintain the private system that we have, it has to be changed so as to encourage improvement.
Regardless, the debate is healthy and going strong. At least if nothing else, we seem to be making something happen. Party players are coming together and working on compromise which is when the country tends to actually move forward. The next blog will continue with this discussion.
Friday, September 12, 2008
Health Reform On Its Way?
The most recent legislation with any hope of being passed is a bipartisan supported bill called the "Healthy Americans Act." Click here for a PDF download. Anyone with a future in medicine should be paying very close attention to the progress of this bill. Although it will likely change once a president is elected, the meat of the bill could remain. Whether this will actually come through is another story. As the battle goes with reforming healthcare in this country, it is not so easy. So let's examine what a co-author of the bill says it will do. The next blog I will go into more of the debate and look at other perspectives of this bill.
These are the main concepts of the bill from Senator Bob Bennet's website:
These are the main concepts of the bill from Senator Bob Bennet's website:
The Basic Principles of the Healthy Americans Act
- CHOICE – Gives Americans choice in what type of coverage best suits their individual and family’s needs and a choice in where they receive health care services.
- PORTABILITY – Because the individual will now own their health policy, insurance becomes portable from job to job and individuals will no longer feel tied to their job because of health benefits.
- TAX REFORM – Breaks the link between employment and insurance, giving employees instead of employers the tax benefit, which will strengthen incentives to shop for lower cost plans, as well as improve health care quality.
- HEALTHY BEHAVIOR – Promotes personal responsibility and preventative medicine by creating incentives for individuals to engage in healthy behavior.
- MARKET FORCES – Provides for patient-driven health care through market forces by allowing more transparency and competition, thereby forcing insurance companies to compete on price, benefits, and quality.
Monday, July 28, 2008
Hello Health: Dr. Parkinson Launches in Williamsburg
The MSBA's first speaker was Dr. Jay Parkinson back in April. His patience has paid off as he is finally launching the "storefront" of Hello Health in Williamsburg, Brooklyn. The hip "Racked" blog published a recent post about the new Brooklyn doctor's office - or "hub" as Parkinson would prefer. We would like to congratulate the launch and wish Dr. Parkinson and his associates good luck.
Monday, July 21, 2008
Did the Industry FINALLY Wake Up??
Short term gains, quarterly stock price increases, quick fixes: for years these have been the key reasons for the American health care system downfall. Insurance companies try to please their stockholders, they have consistently achieved this by fighting tooth and nail to pay hospitals and doctors for services rendered. This lowers the quality of our medical care and turns doctors into assembly lines. Our system is essentially a "sick-care" system that offers zero incentive to be a so-called "good doctor." The insurance companies themselves are nurturing their own demise. By avoiding the costs of controlling chronic disease and prevention now, down the road when those diseases manifest themselves it will surely cost exponentially more. Have the insurance companies finally seen the fate they have created for themselves?
Someone with any business knowledge may have finally consulted with the companies and reminded them about investing for FUTURE gain. New plans springing up from Phili to North Carolina have been testing the concept of PAYING PRIMARY CARE DOCTORS MORE, and focusing on prevention and chronic disease management in order to save on more expensive treatment and consults down the road. The New York Times describes these insurance company-backed experiments in their article HERE. To me it seems like some foresight and common sense is finally seeping into these greedy insurance conglomerates. Maybe our "Sick care" can become "health care." If we manage our sickest patients efficiently, focus on prevention, pay primary doctors fairly for what they should be doing (promoting wellness and providing support to their patients) than we ALL benefit.
Someone with any business knowledge may have finally consulted with the companies and reminded them about investing for FUTURE gain. New plans springing up from Phili to North Carolina have been testing the concept of PAYING PRIMARY CARE DOCTORS MORE, and focusing on prevention and chronic disease management in order to save on more expensive treatment and consults down the road. The New York Times describes these insurance company-backed experiments in their article HERE. To me it seems like some foresight and common sense is finally seeping into these greedy insurance conglomerates. Maybe our "Sick care" can become "health care." If we manage our sickest patients efficiently, focus on prevention, pay primary doctors fairly for what they should be doing (promoting wellness and providing support to their patients) than we ALL benefit.
Monday, June 23, 2008
SHOULD DOCTORS BE RATED?
I have been having many discussions with people about the future of medicine lately. A topic, often controversial, that continues to come up is that of rating systems for doctors. As the costs of medicine rise both on the individual and the system, and patient satisfaction across the board is declining, the debate is not only legitimate but I believe absolutely necessary.
Essentially at the core of the debate is the question of whether medicine should be treated like any other consumer service or product. If I am interested in a digital camera, I can search the Canon Powershot S5 on BIZRATE.com and see that a reviewer gave it 5/5 on battery life, features, and picture quality. After a lengthy joy-filled approval of the camera, the reviewer states his grievance: "Although the battery life is really good, I wish it would tell me a little sooner that the batteries are going dead." I can see this same sort of set up for a doctor-rating site: John Doe wants a new primary care doctor, so he checks out the rating site and finds a 9.6 overall rating and reads that the doctor is great at coordinating his prescriptions so that the cost to the patient is the lowest! He is satisfied and is just about to schedule an appointment, when he reads that one patient complained that during a pelvic exam the doctor left the room to answer a page and left the door wide open with her in the stirrups. Uh-oh, maybe this is not the type of doctor John was looking for.... NEXT. Do patients (consumers) have the right to be able to check out a reliable source for physician ratings like this? Many believe so. Some, however, are staunchly fighting what they believe is a slippery slope to bargain, untrustworthy, doctor-shopping.
I do not have the perfect answer to this debate, nor does anyone right now. What I do know is that whether we like it or not, doctor-rating is coming. All the way back in October, the WSJ Health Blog wrote about Zagat's new system for patients of particular health plans to rate their experience with their doctor.
As a future doctor, I know medicine will change drastically by the time I am practicing. The rising concept of patient-consumer education, choice, and freedom will not simply vanish because of the uncompromising resistance of lobby groups. There are endless issues and challenges that we will need to approach clear-minded, and logically. That thought brings me back to the reason that we founded the MSBA, to empower ourselves as future doctors with knowledge of important issues related to the business of practicing medicine.
Essentially at the core of the debate is the question of whether medicine should be treated like any other consumer service or product. If I am interested in a digital camera, I can search the Canon Powershot S5 on BIZRATE.com and see that a reviewer gave it 5/5 on battery life, features, and picture quality. After a lengthy joy-filled approval of the camera, the reviewer states his grievance: "Although the battery life is really good, I wish it would tell me a little sooner that the batteries are going dead." I can see this same sort of set up for a doctor-rating site: John Doe wants a new primary care doctor, so he checks out the rating site and finds a 9.6 overall rating and reads that the doctor is great at coordinating his prescriptions so that the cost to the patient is the lowest! He is satisfied and is just about to schedule an appointment, when he reads that one patient complained that during a pelvic exam the doctor left the room to answer a page and left the door wide open with her in the stirrups. Uh-oh, maybe this is not the type of doctor John was looking for.... NEXT. Do patients (consumers) have the right to be able to check out a reliable source for physician ratings like this? Many believe so. Some, however, are staunchly fighting what they believe is a slippery slope to bargain, untrustworthy, doctor-shopping.
I do not have the perfect answer to this debate, nor does anyone right now. What I do know is that whether we like it or not, doctor-rating is coming. All the way back in October, the WSJ Health Blog wrote about Zagat's new system for patients of particular health plans to rate their experience with their doctor.
As a future doctor, I know medicine will change drastically by the time I am practicing. The rising concept of patient-consumer education, choice, and freedom will not simply vanish because of the uncompromising resistance of lobby groups. There are endless issues and challenges that we will need to approach clear-minded, and logically. That thought brings me back to the reason that we founded the MSBA, to empower ourselves as future doctors with knowledge of important issues related to the business of practicing medicine.
Tuesday, May 6, 2008
SPEAKER #2: Dr. Richard Handelsman
MSBA had the privilege of hosting another innovative speaker yesterday, Dr. Richard Handelsman. As part of the MDVIP network (www.mdvip.com), he has challenged the bureaucracy of managed care through his internal medicine practice.
Instead of treating patients in the assembly line fashion which is dictated by managed care, he treats his patients with the time and attention they deserve from their physician. He is able to do this by charging a $1500 flat annual fee per patient and treating a smaller patient population of approximately 450 people. He also bills the patient's insurance company as an out of network provider.
As a result, he can treat his patients and address their specific needs, rather than treat the disease with a quick diagnosis. Dr. Handelsman now has the time to make house calls, personally consult with the specialists he refers to, do an hour and a half extensive history and physical, advise his patients on nutrition, excercise, and lifestyle, and much more. His patients are very satisfied with his service and according to Dr. Handelsman neither he nor his patients would ever go back to the way he used to practice. This is just one of the innovative ways we can practice medicine without the burden of managed care.
Instead of treating patients in the assembly line fashion which is dictated by managed care, he treats his patients with the time and attention they deserve from their physician. He is able to do this by charging a $1500 flat annual fee per patient and treating a smaller patient population of approximately 450 people. He also bills the patient's insurance company as an out of network provider.
As a result, he can treat his patients and address their specific needs, rather than treat the disease with a quick diagnosis. Dr. Handelsman now has the time to make house calls, personally consult with the specialists he refers to, do an hour and a half extensive history and physical, advise his patients on nutrition, excercise, and lifestyle, and much more. His patients are very satisfied with his service and according to Dr. Handelsman neither he nor his patients would ever go back to the way he used to practice. This is just one of the innovative ways we can practice medicine without the burden of managed care.
New Concepts for Medical Practice
Going on the theme of our latest speaker (Dr. Richard Handelsman - of MDVIP) I want to show you an organization dedicated to innovation of medical practice. The concept of innovation is crucial to a progressive approach to the medical business world. The Organization's name is Society for Innovative Medical Practice Design and you can check out their site HERE.
Friday, May 2, 2008
hellohealth
The website is up and running. Dr. Parkinson told me that the Brooklyn "node" of this mobile practice launches June 1st! We will follow the success of this very closely. Check it out: http://www.myca.com/hello_health/index.html
Dr. Parkinson's Blog: http://blog.jayparkinsonmd.com/
Dr. Parkinson's Blog: http://blog.jayparkinsonmd.com/
Thursday, May 1, 2008
Empower Your Financial Future
MSBA is here not only to encourage students to become business-conscious physicians, we also promote smart decision-making when it comes to personal finance. Check out this recent SDN article on investment ideas for medical students and residents HERE.
Or you can check out all finance related articles up on SDN at this site:
http://studentdoctor.net/blog/category/finance/
Or you can check out all finance related articles up on SDN at this site:
http://studentdoctor.net/blog/category/finance/
Get Involved: StuHE
"Student Healthcare Executive, the NYMC Chapter of the American College of Health Care Executives is a resource as well as a credential for current and aspiring health care executives."
-Nina Luppino (NYMC MPH '09)
StuHE is currently accepting nominations for treasurer and secretary. Contact Nina for information on running for a position or voting: nina_luppino@nymc.edu.
http://www.ache.org/
-Nina Luppino (NYMC MPH '09)
StuHE is currently accepting nominations for treasurer and secretary. Contact Nina for information on running for a position or voting: nina_luppino@nymc.edu.
http://www.ache.org/
Tuesday, April 29, 2008
Bad Timing, but Useful Site
Ok, Taxes must be a sore subject for most right now. Especially those whose refund checks were only enough do buy a coffee at doc's cafe .... This site may be bad timing but could be very helpful for next year's tax season and all throughout residency.
Medical student and resident end of year tax saving strategies
Is this the Future of Medicine?
There are all sorts of concepts being tossed around regarding the future of medicine. With the advancement and lowering costs of genetic testing medicine surely will become more personalized. Technology investment is huge right now in the healthcare field. Most of the current presidential candidates' policies are encouraging integration of technology into all medical practices. This video is a really interesting view at what the future of medicine could be like...this is really exciting stuff!
http://www.youtube.com/watch?v=6F1u36Y-qlE
http://www.youtube.com/watch?v=6F1u36Y-qlE
Monday, April 28, 2008
MSBA's Entrance into the Blogosphere
The MSBA is pleased to introduce our brand new BLOG! We felt that our first speaker went incredibly well. Dr. Parkinson demonstrated his innovative approach to medicine and I believe gave all who were there a healthy perspective change on practicing in this day and age. For those who missed Dr. Parkinson's demo of his new Myca software platform that he will run his new practice "HELLO HEALTH" through, check it out HERE.
Bookmark this blog and we will try our best to update regularly, providing you all the hottest links, articles, debates, legal issues, and ANYTHING else relevant to the medical business world!!
Bookmark this blog and we will try our best to update regularly, providing you all the hottest links, articles, debates, legal issues, and ANYTHING else relevant to the medical business world!!
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