tag:blogger.com,1999:blog-383419782853014025.post6125436378458401041..comments2024-01-01T17:57:22.956-08:00Comments on Dr. Brenner's Thoughts on Healthcare: Medicare Reform Part 3 - New Model For ReimbursementDr. Bhttp://www.blogger.com/profile/15728720514638220172noreply@blogger.comBlogger11125tag:blogger.com,1999:blog-383419782853014025.post-69261688682270457512021-05-07T02:37:45.357-07:002021-05-07T02:37:45.357-07:00Having said this, research does show that breastfe...Having said this, research does show that breastfeeding, avoiding early introduction of solid foods and other factors might play a role in lowering the risk of developing the disease. <a href="https://www.diabetesiq.com/panera-bread-for-people-with-diabetes-everything-you-need-to-know-vfkrtw" rel="nofollow">diabetic panera</a><br /><br />Seo Leenahttps://www.blogger.com/profile/17490936196427284120noreply@blogger.comtag:blogger.com,1999:blog-383419782853014025.post-50770182819791742692021-05-02T03:00:21.055-07:002021-05-02T03:00:21.055-07:00The level of education and support is important, s...The level of education and support is important, so that a woman knows exactly what is happening with her body and she'll also know what her options are and why those options are the best for her particular situation. <a href="http://www.bestamericanhealthcareuni.com/course/online-cna-program-certified-nurse-assistant" rel="nofollow">online cna programs</a><br /><br />leena pearlhttps://www.blogger.com/profile/15854192249550587703noreply@blogger.comtag:blogger.com,1999:blog-383419782853014025.post-25620588884953672732020-09-21T23:11:08.953-07:002020-09-21T23:11:08.953-07:00One of the primary questions about Congress' m...One of the primary questions about Congress' moves towards healthcare reform is how they are planning to pay for it. <a href="https://mymedicare.network/" rel="nofollow">Part A</a>leena pearlhttps://www.blogger.com/profile/03305485723792061529noreply@blogger.comtag:blogger.com,1999:blog-383419782853014025.post-77153745537889742492020-03-15T22:57:53.557-07:002020-03-15T22:57:53.557-07:00I'm happy to see the considerable subtle eleme...I'm happy to see the considerable subtle element here!. <a href="https://scoopposts.com/" rel="nofollow">scoopposts</a>I am blogger 14https://www.blogger.com/profile/14171395171042255476noreply@blogger.comtag:blogger.com,1999:blog-383419782853014025.post-67245996276373205912009-08-05T10:24:11.704-07:002009-08-05T10:24:11.704-07:00Vance thank you for your comments. The point of th...Vance thank you for your comments. The point of this was just as you said, starting a discourse. I see over and over docs saying I don't want salary, fee-for-service is bad, etc...But I don't see people thinking of solutions and discussing them.<br /><br />I had a feeling some primary care doc would be offended by the perception that primary care isn't as "interesting" as a specialty...that's why there are so many different fields - "there's a cover for every pot" my HS teacher used to say.<br /><br />Re: your comments about over generalizations and missing out on complex patients. It was impossible (and would be unreadable) if I listed every situation that would garner an increased complexity.<br /><br />Basically, if you spend more time with a patient bc they are suicidal, you get paid for your time. If you counsel a rape victim, you get paid for your time. But if that suicidal patient also has high blood pressure and diabetes and requires more time dealing with that on a "mental level" as you accurately pointed out does not get its due appreciation in the payment system, then there would be an additional complexity multiplier.<br /><br />My system is inherently simple as the more time a pt requires, the more time a pt gets. And the more medically complex they are, the more per hour the doctor gets for using their brain power. <br /><br />The computer algorithm is just for the billing determination: your doctor base rate adjusted on a yearly basis, muliplied by a complexity number based on age and number of complicating medical problems. Also, it is useful for compiling graphics that assess if docs are charging appropriate amounts of time compared to their colleagues for similar situations - with the outliers getting paid on an average basis.<br /><br />I welcome all opinions to this discussion. I wish there were more discussion beyond the I hate this but I have nothing better to offer that most docs are spewing.<br /><br />Thank you for taking the time to comment.Dr. Bhttps://www.blogger.com/profile/15728720514638220172noreply@blogger.comtag:blogger.com,1999:blog-383419782853014025.post-19523879100653279112009-08-05T09:20:44.516-07:002009-08-05T09:20:44.516-07:00Interesting stuff here:
My thoughts:
1)I'm a...Interesting stuff here:<br /><br />My thoughts:<br /><br />1)I'm a Family Physician (Midwest, small town, I do everything from deliveries and c-sections to inpatient care of severe medical illnesses and cover ER call frequently). I work 12 hour days or more and I don't get paid a fraction of most specialists. I graduated from med school only 5 years ago, and I CHOSE family medicine because I want to make a difference, use my brain, and not become suicidal from doing boring assembly-line specialty care medicine. I made this choice NOT because I want to be wealthy. <br /><br />So I do this instead of making a mint doing factory work like so many specialists do. Does somebody out there really think that specializing (doing just one thing all day) is somehow more exciting than what I do? Is that person really serious? REALLY?<br /><br />Of course increased primary care reimbursement would increase primary care as a choice of new physicians. Always follow the money, and you'll find interest.<br /><br />2) I wholeheartedly agree that we need to find a way to pay physicians who use their brains in some kind of equitable fashion. I understand your "computer algorithm" thing. I have a couple thoughts about it, though. The first is that it seems complicated, and prone to massive mistakes and over-generalization. There are certain patients who demand or need more time, despite the absence of 12 diagnoses (say a depressed and suicidal patient, or a healthy teen needing counselling due to recent sexual abuse). The second is, that it will give more money to to the doctors who go faster. There is evidence that haste makes waste when it comes to this quality/quantity argument. So your hospitalist and ER doc get paid more when they get dumped on on a particular day, since that's beyond their control, and I get that. However, what about the consiencious doctor who refuses to see more than 20 patients a day. If the algorithm says that since all the other doctors see 25, he must be too slow. No--maybe the others are too fast.<br /><br />This "computer algorithm" has no way of sorting the good from the bad, and might actually incentivize the bad.<br /><br />The more I think about it, I still think we need to get out of this mindset where we have to have a complicated payment system. Instead, I'm getting comfortable thinking that if instead we give some kind of health savings account money to people, and let the market forces sort all this complicated mess out.<br /><br />What I mean, is that if I go slow and do a great job taking care of people, i can charge whatever I want, and my patients can decide if it's worth it. If I'm not worth it, I'll go broke, and will have to adjust my prices accordingly. At the same time, if another doctor can run 40 patients through, but they don't feel that the 2 minutes they got with him or her was worth the bill, he'll feel the heat too. I think the market would sort this out. The problem is how to pay for it.<br /><br />If we have to have a massive gov't giveaway, then just give away catastrophic health coverage and then let the savings accounts pay for the day to day stuff, and let the market sort it out.<br /><br />I know I'm over-simplifying this, but I think our problem could bear some simplification. Thank you for starting this discussion.Vancehttps://www.blogger.com/profile/00621539600041231540noreply@blogger.comtag:blogger.com,1999:blog-383419782853014025.post-70632168600657566092009-07-29T12:00:35.264-07:002009-07-29T12:00:35.264-07:00Dr. Thom, your comments remind me of what I heard ...Dr. Thom, your comments remind me of what I heard 2 different doctors say:<br /><br />Surgeon, "There are only two kinds of doctors, those who are surgeons and those who want to be surgeons."<br /><br />Internist, "There are only two kinds of doctors, surgeons and doctors that think."<br /><br />It all depends on your perspective.Dr. Bhttps://www.blogger.com/profile/15728720514638220172noreply@blogger.comtag:blogger.com,1999:blog-383419782853014025.post-23532316963370318212009-07-29T11:57:15.740-07:002009-07-29T11:57:15.740-07:00Dr. Thom, I am not a primary care doc so while I p...Dr. Thom, I am not a primary care doc so while I personally agree with your interpretation of primary care medicine, I have a number of friends who chose that and really do enjoy it. Many doctors do enjoy that one-on-one contact, getting to know the patient as a person, their family and watching them grow.<br /><br />To say that primary care is less interesting is not fair to the profession, and I imagine a large number of docs would take umbrage with your opinion. That being said, it is your opinion and your right.<br /><br />There will always be students who like procedures and specialties, and others who like old fashioned primary care. However, many are driven to specialty forms of medicine for financial reasons. Do MDs really dream about doing colonoscopies in med school? Or of becoming urologists? Usually it is a lifestyle choice.Dr. Bhttps://www.blogger.com/profile/15728720514638220172noreply@blogger.comtag:blogger.com,1999:blog-383419782853014025.post-41116006723812961422009-07-29T10:29:39.148-07:002009-07-29T10:29:39.148-07:00First, we have got to lose the notion that medical...First, we have got to lose the notion that medical students would actually choose primary care over a specialty with greater frquency if the reimbursements were different.<br /><br />Specialty medicine is interesting and satisfying. Primary care, not so much.Dr. Thomnoreply@blogger.comtag:blogger.com,1999:blog-383419782853014025.post-2204257956036257012009-07-10T17:29:43.078-07:002009-07-10T17:29:43.078-07:00I agree that older docs can sometimes be behind th...I agree that older docs can sometimes be behind the times, and younger docs can be up on the latest. However, medicine is the only field I know of where your experience is not valued at all. And so much about medicine is the art of medicine, not the science. The art takes more time to learn. I am not saying to lower pay for those who start out. But in nearly every other job, you start off lower at first and get raises from year to year. In medicine, it often is the opposite (due to medical malpractice rates increasing with more patients seen) - you make less with more experience, which to me seems perverse. Thank you for sharing your opinion.Dr. Bhttps://www.blogger.com/profile/15728720514638220172noreply@blogger.comtag:blogger.com,1999:blog-383419782853014025.post-67547525532942514092009-07-10T16:14:19.795-07:002009-07-10T16:14:19.795-07:00I have a bit of a bone to pick with the experience...I have a bit of a bone to pick with the experience increase for base pay. There are many physicians who should have long ago retired and are not practicing evidence based medicine. To punish younger physicians just because they have not been around as long, even though they were trained to evaluate the evidence for or against a course of treatment is not fair. I have had patients state that they actually picked a younger physician because they felt I was more familiar with the most recent and up to date treatments. I agree with CME and board certification but time in practice should not be determining factor in your base rate.estaitnoreply@blogger.com