Tuesday, January 27, 2015

Family Medicine: Teaching Direct Primary Care to Medical Students

What should a first year medical student know about Direct Primary Care?

Second year medical student?

Third year medical student?

Fourth year medical student?

Let's talk about this.  Comment below or call in to the Dr Synonymous Show on Blog Talk Radio  on Tuesday's from 9:30 - 10:30 PM.

Monday, January 19, 2015

Health Insurance Company Quality Bonuses

Insurance Company Bonuses for Quality from the Care National Blog http://carenational.com/ 

"Just how much money are we talking about? She explained that for a health plan with just 100,000 members being evaluated by HEDIS, each quality measure would mean around $17 million in reimbursements from federal or state agencies. When you consider that there are 20-25 measures directly tied to reimbursement (depending on the health plan and the population served) the math adds up to $340 – $425 million in revenue each year! Now consider what that might look like for larger Managed Care Organizations who have a million or more members enrolled. “You are not talking about a little bit of money. You are talking about what keeps the machine running – literally!” In addition to standard reimbursement, CMS Stars ratings are directly related to the percentage of HEDIS measures met. That also translates to losses or gains in revenue as Stars ratings are something the public is very aware of when shopping for a health plan. Ultimately, if a health plan demonstrates poor performance for 3 or more years, CMS will assess penalties against them, up to and including shutting the organization down. Having key leaders that internalize the monetary value of each measure, and the importance of HEDIS as a whole, generally transforms the whole company’s understanding of the importance of those quality measures, such as preventative care, safety, patient satisfaction, and provider satisfaction. That is the fundamental concept behind any Pay for Performance (P4P) quality initiative."

Saturday, January 17, 2015

Is High Quality Health Care Hazardous To Your Health? Patient Perspective

Here's another guest post by Dave Levingston from the patient perspective.  (See the previous post from his Florida trip.)
I’d like to share a few thoughts about my recent interface with the Medical/Industrial Complex.
A brief recap of what happened to me:
I got sick with what appeared to be the flu. Actually, it was a drug reaction to an antibiotic I was taking for the aftereffects of bronchitis. I was on the next to the last day of a two-week course of the antibiotic, so I didn’t suspect it might be the problem, and I kept taking it for a day after the reaction started. That made me very sick.
I went to the ER where the doctor originally diagnosed me with a “stomach bug” and signed my discharge, saying I’d be fine in a day or two. But he took a second look when he saw that I appeared to be getting worse. At that point he noticed the head-to-toe rash that I had developed and realized it was probably a drug reaction.
Wanting to be sure of the problem, the doctor ordered several tests, leading to a lumbar puncture to look at my spinal fluid because meningitis was a possibility.
I was admitted to the hospital where I spent several days recovering.
I’m now out of the hospital recovering, not from the drug reaction, but rather from the spinal tap. They tell me I will need 3-4 weeks to fully recover. Right now just writing this at my computer is pushing me to the limits of what I’m physically able to do.
If you look that over you will see that everything, except the original lung issue from the bronchitis, was all a result not of disease, but rather a result of medical treatment.
Now, don’t get me wrong. I’m not complaining about the care I received. Far from it. I was very sick, the sickest I’ve ever been, and they cured me. I’m glad.
And I’m not a Luddite. I appreciate modern medical science and the great improvements in the health of nearly everyone as a result of the great health care we enjoy in our country.
Every single person I encountered in the health care system during this misadventure was wonderful, caring and obviously highly skilled.
But, I have to wonder if I might have been better off with care that wasn’t quite so great. If instead of being concerned about other possible problems, what would have happened if I had just been treated for the drug reaction and then watched in the hospital for a day or two in case there were other problems? I don’t know the medical protocols for my situation, but I’m sure the care and diagnostic decisions were proper and intended to make sure something much worse wasn’t going on.
So today I’m still sick…not with any disease, but with the aftereffects of that spinal tap. Let me tell you, those aftereffects are not minor. I suspect that, if I had not had the spinal tap, I would be completely fine today. The effects of the drug reaction would be long past and I’d be back to going about my normal life. Instead I can barely function and it looks like this is going to cost me several weeks of my life. And this is shortening my life not by losing a few weeks at the end with tubes running into me and struggling for every breath. These are several good weeks taken from me now, when I could be out there enjoying life and getting things accomplished.
Maybe in my case the health care was just a little too good. So it goes.