Physicians writing on KevinMD about the primary care shortage, the fifteen-minute visit, panel size, what primary care is paid against procedural specialties, continuity, and the administrative load that has grown around the work. Four maintained records draw on this archive: Primary care: what physicians say, in their own words, Direct primary care: what physicians say, in their own words, Prior authorization: what physicians say, in their own words, and Scope of practice: what physicians, nurse practitioners, and PAs say, in their own words.
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You the patient are really not the customer of the physician. Since the insurer will determine whether and how much the physician will be paid for attending to your needs, you are largely a bystander in the relationship. The doctor’s customer has become the insurer.
Our system of care is definitely not customer-focused. Doctors truly believe that they have the patient’s best interests in mind and they …
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The doctor’s customer has become the insurer
There’s that line about art, “good artists copy, great artists steal.” There’s some debate about if Picasso said it first, but most of us geeks know it from Steve Jobs.
Often, I see things from companies and industries outside of health care — processes, products, best practices — which inspire me. I like these little inspirations because they often aren’t rocket science, but nonetheless fuel some creative thoughts about their applicability …
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What can health care learn from Amazon?
How does a working mom and physician keep practicing medicine when her husband’s career brings her halfway around the globe? For me, it was an adventure. While it can be challenging, I encourage other physicians to experience the world with their families while still practicing medicine.
As a 14 year family practitioner from Ohio, I suddenly found myself in Qatar with two young children because of my husband’s job. Qatar is …
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Tips for expats working in health care
Daylight saving time is approaching again. At first glance, it might seem enough to just remember to spring forward. But do you realize daylight saving time is one of the grandest social engineering experiments in America?
Almost the entire country moves their schedule up one hour. Every meeting, romantic dinner, and heart transplant occurs one hour later. Every business, court appointment and movie showing is one hour later. In virtual lockstep, …
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Daylight saving time means different things to different folks
As a nation, we are constantly monitoring and appraising the economy and our financial health. We gather a tremendous amount of information to assess this. The Census Bureau randomly selects 60,000 households each month, unleashing a swarm of 2,000 field representatives to track down the selected participants and assess their employment status. The Bureau of Labor Statistics surveys 500,000 businesses to estimate job creation. Approximately 5,000 “consumers” are surveyed each …
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Well-being of a population is both measurable and consequential
Comcast recently announced it is merging with Time Warner, the 2nd largest cable company in the US. Together, this deal nets Comcast an estimated 57% of the cable subscriber marketplace and heralds a new oligarchy in US media and entertainment. It’s big news for Comcast, but aren’t as excited.
Why?
Because both Comcast and Time Warner have been consistently rated the worst providers of customer service in the cable industry. Now as they …
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The consolidation of health care: 5 questions to ask
If you’re a practicing provider, chances are you still feel some anxiety about several issues related to the ICD-10 transition that are critical for maintaining the health of your practice. These probably include reimbursement, documentation workflows, potential audits, and claims denial.
As a family medicine provider, what I hope to see develop is the opportunity for providers to encourage payers to be more transparent about topics like the level of coding …
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Why ICD-10 concerns me deeply
There are over 58 million references to “patient engagement” if one conducts a Google search. The term has been diluted and changed in the past couple of years and has become a buzz phrase, used more from a business than clinical benefit perspective.
The Center for Advancing Health defines patient engagement as “actions individuals must take to obtain the greatest benefit from the health care services available to them.” …
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5 ways to engage your patients in the office
The past few months I have joined thousands of individuals hoping to match into a residency program in 2014. I have had interviews all over the country and spent way too much time living out of a suitcase.
For many students, residency interview season is exciting. For others, it’s stressful and exhausting. But for me, more than anything else, the interview trail was inspiring.
I am currently applying to internal medicine-primary care …
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The bottleneck in ensuring sufficient primary care physicians
As an internist (yes, I am a specialist, just not a subspecialist), I do no procedures. Patients pay me (albeit mostly indirectly) for my cognitive skills. But we live in a culture that seemingly rewards procedures more that pure cognition. Now I understand that procedures are not mindless. Physicians doing procedures must think prior to the procedure, during the procedure and after the procedure. But cognition without procedures seems undervalued.
The …
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Solving the physician income disparity
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We have a real paradox in American health care. On the one hand we have exceptionally well educated and well trained providers who are committed to our care. We are the envy of the world for our biomedical research prowess, funded largely by the National Institutes of Health and conducted across the county in universities and medical schools. The pharmaceutical and biotechnology industries continuously bring forth …
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The real paradox in American health care
A few months ago, I spent 15 minutes filling out a detailed health data form at the doctor’s office. The paper form contained multiple questions about my health, family history, medications and basic demographic information. I assumed that an administrative specialist would code it into the practice’s electronic medical record (EMR) to be put to use. So it came as a surprise when I spent another 5 minutes reviewing the …
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Incorporate patient-generated health data into the EMR
When you go shopping, everything has a price tag. Buying a new car is challenging, but ignoring dealership costs may result in sticker shock when you receive the first payment notice three weeks later. Few of us would ignore costs this way.
In actuality, this happens everyday in health care as we interact with medical professionals, have an examination, and are given treatment without knowing the price.
Headlines alert us how health …
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What is the price of that medical test?
There is a disconcerting myth about single mothers that has been circulating in our society for some time. It was popularized in the Reagan Era as a denunciation of US social welfare policy and resulted in a pointed caricature of a woman on welfare, forever to be known as the “welfare queen” or the entitled single mother.
The narrative of such a woman goes something like this: Not only is she …
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The myth of the entitled single mother remains as relevant as ever
Rob got a cat bite. Then a swollen hand. He goes to the ER, gets antibiotics, then develops itching. So he calls me for advice.
A few days later, I get this email: “The itching from the antibiotics went away as you said it would. But what is NOT poised to go away is the $624 bill from the ER for talking …
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How to save hundreds of dollars on your medical bills
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There is and will be a need for many more primary care physicians (PCPs).
Why?
There is a shortage now and it will be exacerbated in the coming years for at least three reasons. The population is growing, the population is aging and there will be more individuals with health care coverage as a result of the Affordable Care Act (“Obamacare”).
I believe that the need will be much …
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Lack of listening is the core care problem in American health care
Merrill Markoe’s reports that she was fired by her doctor in her article, “My Doctor, the Concierge,” which was both sarcastically entertaining and painfully true. She writes a powerful commentary on the divide caused by insurance companies between doctors and patients. She is shocked at the rapidly growing trend of an access fee to see concierge doctor and yearns for the Hippocratic Oath’s “May I long experience the joy …
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Don’t blame doctors for going concierge
“Just start work half an hour earlier.”
This is what the head of the care coordination committee for our patient-centered medical home executive committee work group recommended when we talked about our struggle getting the team together for early-morning pre-clinic huddles.
She suggested that if we started our usual practice morning at 8 o’clock we should just have everybody come in at 7:30 to load the dashboards for the morning session …
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Huddling in the medical home: Sounds good on paper
