I Just Fired my Primary Care Doctor. Before the Appointment Even Happened.

I sighed and slumped into a chair. The office was straight out of the 90’s: clunky desktop computer, paper forms attached to a clipboard. 15 minutes after my appointment should have started, a cagey Latino gentleman ambled behind the desk and asked for my ID and insurance card. I handed them over and watched as he proceeded to fire up a printer in an attached room, print off the registration and history forms I’d sent through ZocDoc, and make copies of my information.  I craned halfheartedly to count the number of shelves before I stopped caring. I felt uncomfortable all of a sudden. The dinginess of the cramped office seemed to amplify a sense of entropy, an oppressive, disheveled dysfunctionality. The stacked tower of dusty magazines. Two dying plants, leaves dried yellow and curling. A slightly off-center, sun-faded print: Monet. Reams of manilla folders so ancient that they literally had holes in them. Literally. I don’t want this anachronistic nightmare of a place to become the bottleneck to my ability to access my own health information (or is it even really mine?) Especially not if or inevitably when I become medically vulnerable. Consumer Me can protect Patient Me by being impatient.

Patients now expect physicians to be experts in technology and business acumen.  It is o longer acceptable to be  dependent upon fax machines, when electronic health records and secure digital documents are more efficient and cost effective.

The waiting room and shenanigans in this vignette do not breed comfort or a sense of competence for a patient. Perhaps calling a patient a consumer (anathema to we physicians) can be a good thing. It gives the patient consumer power. ie follow the money. Sad as I am losing the old 'cottage medicine flavor' I see the benefits of the decade  of revolution.

Many physicians embraced the changes adapting EHR, some  aspects of health reform, while most resisted and bridled at changing their ways.

Medical Front Office of the 90s

Reception Area of 2016

I walked with my feet  to another doctor's office:

This morning’s experience combined some of the best consumer-grade tools (Shout out to Zocdoc: Crushing it! Quick, accurate search with no log-in/account required → confirmation code sent via SMS → second text to my phone with a secured link that prompted my phone’s camera to pop up, so I could snap a picture of my insurance card, front and back, for ease of all future transactions. Magic! Love it.), with some of the worst (see above.)

I voted with my feet today. I left behind an unseen doctor whose clinical adeptness was rendered useless by his business ineptness,   

I Just Fired my Primary Care Doctor. Before the Appointment Even Happened.

Let My Doctor Practice

I hope you will find time to watch and listen to this video.  It synthesizes the thoughts of most physicians.  While watching the video take some  notes to discuss with your friends, doctors and your representatives.

Here are the time markers of  high  points in the video:

:04

:22

:36

;50

1:20

1:50

2:13

2:30

3:16

3:27  The Story of Esther

4:46  Let my doctor practice (the summit)

5:40  Professional practice in the United States is in progressive decline

www.letmydoctorpractice.org

www.docs4pcfoundation.org

I hope you will share this important information widely.  Please comment.

To receive up to the minute information and follow "Let my doctor practice"  Subscribe   to receive email updates.

Own your health care !

Cystic Fibrosis | The Mighty

A 'Mighty' message for those and their families with Cystic Fibrosis

Real People. Real Stories.

We face disability, disease and mental illness together.
Stories and information about Cystic Fibrosis

Learn about Cystic Fibrosis

Cystic Fibrosis Foundation

Cystic Fibrosis | The Mighty

These are the healthiest and unhealthiest states in the country

Hawaii is the healthiest state in the country for the fifth consecutive year, according to an annual state-by-state health ranking report. 

The 2016 America's Health Rankings highlight some long-term improvements in overall health across the country and some disturbing new trends. 

While smoking among U.S. adults decreased by 41% since the start of the report in 1990, and the percentage of the population that is uninsured decreased by 35% in the past five years, for the first time in the report’s history, cardiovascular deaths increased over the past year. Even more disturbing, over the past two years, the rate of premature death has also increased, according to Reed Tuckson, external clinical advisor United Health Foundation, a not-for-profit foundation, that sponsors the report. 

“We are still living longer, but sicker, and getting sicker sooner,” Reed said. "People are experiencing obesity and related consequences earlier in life which is also a problem.”  Obesity, poor eating habits and the explosion of diabetes related complications offset many improvements in health during the past two decades.

The report also found that drug deaths increased 9% over the past five years. Tuckson said the report highlights that the nation is at a health crossroads, with positive health changes like a decrease in smoking and more insured people as wins, but troubling levels of obesity, diabetes, high blood pressure and sedentary behavior diminishing the positive steps. 

"We have to remember that we have to put the fight for promoting health and prevent disease much higher on the agenda," Tuckson said. "If we don’t, we as a nation will see further slippage and see those fearful trends of premature death, people dying from cardiovascular disease at higher rates than years before." 

According to the report, Hawaii ranked first in overall health, with a low percentage of uninsured people, low rates of obesity and a low prevalence of obesity. But it's not all beachy in paradise, according to the report, which notes Hawaii scores above the national average for excessive drinking.

Mississippi fell from 49th to 50th this year, according to the report, which uses data from the Centers for Disease Control and Prevention, American Medical Association, Census Bureau and even the FBI. It looks at a slew of measures of health, including tobacco and alcohol abuse, exercise, infectious diseases, crime rates, public health funding, access to immunizations, premature birth rates and cancer and heart disease rates.

Mississippi has a high prevalence of smoking, low birthweight and a high percentage of children living in poverty, according to the report. But while Mississippi has the most room for improvement, the state does have a low prevalence of excessive drinking and drug-related deaths. 

Here's a look at the top five healthiest states: 

1. Hawaii

2. Massachusetts

3. Connecticut

4. Minnesota

5. Vermont

States with the most room for improvement: 

50. Mississippi 

49. Louisiana

48. Arkansas

47. Alabama 

46. Oklahoma

45. Kentucky 

Where does your state fall?

These are the healthiest and unhealthiest states in the country

Direct Primary Care Conference - Nuts

Physicians are starting new methods of reimbursement, to decrease operating overhead and eliminate much of the bureaucracy involved with billing health insurance plans.

Two  terms which may not be familiar to patients are 'direct pay'  and 'concierge medicine'.  Both eliminate the insurance plan as an intermediary for payment of patient services.

Health insurance as we know it today is not insurance.  It has evolved into a comprehensive health plan(s) governed my medicare and commercial health plans.  Their goal is to  increase and/or maintain profitability in lieu of patient care.  They are designed to provide reimbursement for soup to nuts. This is very inefficient and increases  cost measurably.

Purchasers of health plans no longer have a choice of tier or to opt-out of unneeded coverage. The 50 year old post menopausal woman pays for pregnancy care, and delivery even though she will never use this coverage.

The DPC and Concierge plans are designed for primary care (family practice and some internal medicine and pediatric practices)



The Direct Primary Care conference, is sponsored by 'Doctors for Patient Care' and independent non-profit organization whose mission is to alter the current health care system.

Our Principles

 

Direct Primary Care (DPC) is an innovative alternative payment model for primary care being embraced by patients, physicians, employers,payers and policymakers across the United States.The defining element of DPC is an enduring and trusting relationship between a patient and his or her primary care provider.

Empowering this relationship is the key to achieving superior health outcomes, lower costs and an enhanced patient experience. DPC fosters this relationship by focusing on five key tenets:

1. Service: The hallmark of DPC is adequate time spent between patient and physician, creating an enduring doctor-patient relationship. Supported by unfettered access to care, DPC enables unhurried interactions and frequent discussions to assess lifestyle choices and treatment decisions aimed at longterm health and wellbeing. DPC practices have extended hours, ready access to urgent care, and patient panel sizes small enough to support this commitment to service.

2. Patient Choice: Patients in DPC choose their own personal physician and are reactive partners in their healthcare. Empowered by accurate information at the point of care, patients are fully involved in making their own medical and financial choices. DPC patients have the right to transparent pricing, access, and availability of all services provided.

3. Elimination of Fee-For-Service: DPC eliminates undesired fee-for-service(FFS) incentives in primary care. These incentives distort healthcare decision-making by rewarding volume over value. This undermines the trust that supports the patient-provider relationship and rewards expensive and inappropriate testing, referral, and treatment. DPC replaces FFS with a simple flat monthly fee that covers comprehensive primary care services. Fees must be adequate to allow for appropriately sized patient panels to support this level of care so that DPC providers can resist the numerous other financial incentives that distort care decisions and endanger the doctor-patient relationship.

4. Advocacy: DPC providers are committed advocates for patients within the healthcare system. They have time to make informed, appropriate referrals and support patient needs when they are outside of primary care. DPC providers accept the responsibility to be available to patients serving as patient guides. No matter where patients are in the system, physicians provide them with information about the quality, cost, and patient experience of care.

5. Stewardship: DPC providers believe that healthcare must provide more value to the patient and the system. Healthcare can, and must, be higher-performing, more patient-responsive, less invasive, and less expensive than it is today. The ultimate goal is health and wellbeing, not simply the treatment of disease.

DPC providers are committed to ensuring that American healthcare delivers on these goals.

Tom Price Is Eager to Lead H.H.S., and Reduce Its Clout - The New York Times

Here is the "spin" Depending on your political view (Democratic vs. Republican) Price's appointment is the end of government interference in patient/provider relationships, or it is the end of health care quality and accessibility for our citizens.

I opine it is neither.  Most all practicing physicians agree that some federal and state regulation is necessary, however it is now out of control.  Neither Congress nor  HHS has shown any leadership in controlling costs other than penalties and/or incentives.  The model has been extreme, and cumbersome, with bloated HHS and CMS administration, at times overstepping it's limitations, extending to patient care and not financing.

Regardless of what either side thinks, Price is the ideal selection for the head of HHS. The reasons are:

A long history of patient management, a fluent knowledge of how congress and HHS work, his positions in budgetary matters.

As chairman of the House Budget Committee, he has tried to put a lid on federal spending. As secretary, he would be responsible for more than $1 trillion in spending, a number that will surge as the population ages.

The health secretary has immense discretion to impose, revoke and modify rules. A review of Mr. Price’s record in Congress, including his speeches and legislative proposals, suggests that he would try to reduce the burden of federal regulations on health care providers, especially doctors.

As secretary, he would be responsible for the popular Children’s Health Insurance Program, which insures eight million children at some point each year. In 2007, he opposed expansion of that program because, he said on the House floor, some children with private insurance would become eligible for “government-run socialized medicine.”  This would unnecessarily shift private funding to the tax-payer.

Senate Democrats are sure to challenge many of his positions at his confirmation hearings. Just as they distrust him on health care, he distrusts them.

I do not trust any of them. Most of us are tired of rhetoric during elections and legislative processes. That is how President-elect Trump rose to his present status.  

In 2010, he said on the House floor that he had discovered that “there were more folks in Washington who affected what I could do for and with my patients than anybody I ever met in residency or in medical school.” That, he said, “was wrong.”

Mr. Price often reminds colleagues of a sentence in the original Medicare law, passed in 1965: “Nothing in this title shall be construed to authorize any federal officer or employee to exercise any supervision or control over the practice of medicine.”

Congress has a short memory.  Perhaps that is one reason for funding more research on Alzheimer's disease.

If confirmed, Mr. Price will have a chance to practice what he has preached for decades. He could try to overhaul what he calls the “predatory trial lawyer litigation system.” He could try to stop what he calls “regulatory oppression” by the federal government. And he could eliminate some of the mandates that he calls a “death knell for quality health care.”

Tom Price Is Eager to Lead H.H.S., and Reduce Its Clout - The New York Times

AMA endorsement of Trump health secretary spurs backlash

Liberal MDs are furious after top doctors group backed Trump’s pick for health secretary

When Donald Trump this week tapped a surgeon-turned-congressman to run the Department of Health and Human Services, the nation’s largest physicians group swiftly endorsed the choice.

Liberal doctors peppered the American Medical Association with furious tweets decrying the group’s endorsement of Representative Tom Price as a betrayal of patients and physicians. And by Wednesday night, 500 doctors had signed an online open letter titled “The AMA Does Not Speak For Us” started by the Clinician Action Network, a left-leaning advocacy group.

The AMA does not truly represent grassroot physicians.  A small percentage of physicians are members of the AMA. Formerly state medical societies required membership in the AMA to belong to a state medical society. THIS IS NO LONGER THE CASE.

The outpouring of anger has exposed the bitter political rifts dividing doctors these days. Price is an AMA member, but he also belongs to a conservative doctors’ group that publishes a journal which has advanced discredited theories, such as the notions that abortions cause breast cancer, vaccines cause autism, and HIV does not cause AIDS. The same group shot into the spotlight during the presidential campaign by promoting conspiracy theories about Hillary Clinton’s health, including speculation that she’d had a seizure or a stroke.

These opinions are not true. They should not be attributed to HHS-nominee, Tom Price. Just because he belongs to an alternative medical group he does not ascribe to those statements.  As a congressman he represents all of the people of his district.  It does not mean he promote these ignorant statements.

The outpouring of anger has exposed the bitter political rifts dividing doctors these days. Price is an AMA member, but he also belongs to a conservative doctors’ group that publishes a journal which has advanced discredited theories, such as the notions that abortions cause breast cancer, vaccines cause autism, and HIV does not cause AIDS. The same group shot into the spotlight during the presidential campaign by promoting conspiracy theories about Hillary Clinton’s health, including speculation that she’d had a seizure or a stroke.

 There are left-leaning alternatives to the AMA, too, including one that has long advocated for gun control, pushes physicians to cut all financial ties with drug companies — and expressed dismay that any doctors group would back Price.

The AMA remains by far the biggest and most visible lobbying force representing doctors and medical students. The group spent $15 million just in the first nine months of this year to lobby Congress and the executive branch on everything from marijuana research to opioid prescribing to telemedicine, as well as traditional issues such as reimbursement and billing, according to federal filings.

The AMA reaps profits from insurance companies with advertisements, derives income from copyrights from Current Procedural Codes that are used by insurance companies, medicare, medical, hospitals, and medi-cal.  The lobbying funds do not come from dues. Do the numbers.

“The AMA is generally a force for the status quo in health care, a physicians’ guild in the old-school style of wheeling, dealing, and horse-trading to keep the billing flowing like a mighty stream into MDs’ coffers,” Dr. Zackary Berger, an internist at Johns Hopkins.

The AMA is a dinosaur in today's medical environment.  On the other hand specialty groups are focused on education, and are apolitical.

This article is from STAT, an internet publication about Health and Medicine and is mixed with the author's private opinionls

AMA endorsement of Trump health secretary spurs backlash