Monday, July 16, 2018

Physicians

Physicians
The doctor is in ...

The Myth of Doctors Getting Overwhelmed by E-mail

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”Email is the killer app of patient portals.”

I heard a variation of that quote when interviewing people for the patient-provider communication chapter of the book I co-wrote (HIMSS 2014 Book of the Year –Engage! Transforming Healthcare Through Digital Patient Engagement). For the organizations who’ve pushed patient portals the furthest into their patient base, email has always been the foundation. In other words, email is the gateway drug for patient engagement which Leonard Kish called the blockbuster “drug” of the century.

Physicians are understandably concerned about being overwhelmed by emails if they provide an option for secure messaging. As healthcare transforms, financial incentives have a big effect on the willingness to take on what many perceive to be “more unpaid work” (forgetting the fact that playing voicemail tag is also unpaid and frustratingly inefficient). Interestingly, the physicians who have given out their phone number or enabled secure email (without remuneration) haven’t found they are overwhelmed by any means. In the case of the groundbreaking Open Notes study, many of the doctors just heard crickets.

Focusing on Primary Care for Better Health

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Screen Shot 2016-07-07 at 2.30.28 PMIn the United States, we have historically invested far more in treating sickness than we do in maintaining health. The result of this imbalance is not only poorer health, but more money spent in institutions, hospitals, and nursing homes.

The road to a better health care system means correcting this imbalance. We should reinvest in what we value — primary care — as a practice, as a profession, and as an abundant resource for patients. In recent years, we have begun taking a number of meaningful steps to begin this reinvestment process. Today, we are proposing significant actions to improve how we pay primary care physicians, mental health specialists, geriatricians, and other clinicians. By better valuing primary care and care coordination, we help beneficiaries access the services they need to stay well. In addition to keeping people healthy, health care costs are lower when people have a primary care provider and team of doctors and clinicians overseeing and coordinating their care.

Fixing America’s Health Care Reimbursement System

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A tempest is brewing in physician circles over how doctors are paid. But calming it will require more than just the action of physicians. It will demand the attention and influence of businesses and patient advocates who, outside the health industrial complex, bear the brunt of the nation’s skyrocketing health care costs.

Much responsibility for America’s inequitable health care payment system and its cost crisis is embedded in the informal but symbiotic relationship between the Centers for Medicare and Medicaid Services and the American Medical Association’s Relative Value System Update Committee — also known as the RUC. For two decades, the RUC, a specialist-dominated panel, has encouraged national health care reimbursement policy that financially undervalues the challenges associated with primary care’s management of complicated patients, while favoring often unnecessarily complex, costly and excessive medical services. For its part, CMS has provided mostly rubber-stamp acceptance of the RUC’s recommendations. If America’s primary care societies noisily left the RUC, they would de-legitimize the panel’s role in driving the American health system’s immense waste and pave the way for a more fair and enlightened approach to reimbursement.

As it is, though, unnecessary health care costs are sucking the life out of the American economy. Over the past 11 years, health care premium inflation has risen nearly four times as fast as the rest of the economy. Health care costs nearly double those in other developed nations have put U.S. corporations at a severe competitive disadvantage in the global marketplace.

Why Your Culture Does Not Matter To Me

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flying cadeuciiI am a student in a health care profession. I see many different people every day that come to seek treatment at my school. Most patients are local to our area, but many come to our school’s clinic from different countries, cultures, and backgrounds. Our curriculum has recently been updated in accordance with the board of accreditation that our state mandates for professional schools. This curriculum includes a course entitled ‘Cultural Awareness.’ The goals of the course, as stated by the syllabus and our professor, is to:

  1. Emphasize, illustrate and analyze how patient’s background, culture, beliefs and norms may impact health and health outcomes;
  2. Enhance understanding of legal boundaries and provider’s responsibilities in the delivery of care;
  3. Enhance the students understanding of cultural, various societal values and traditions that must be considered during the delivery of care, doctor-patient interactions and treatment outcomes;
  4. Increase awareness of the challenges and mechanisms for providing services to special populations. Except for the second objective, I am not interested in learning about any of these. I am going to illustrate to you why classes like these are a farce, a waste of our time as professionals, and demeaning to every intelligent culture.

As a professional healthcare worker, I am bound by a code of ethics. In fact, this code is a defining aspect of the culture found among healthcare professionals. This code includes virtues like veracity, nonmaleficence, justice, beneficence, and patient autonomy. These virtues lay the groundwork for almost every aspect of clinical decision-making in healthcare. It is a defining aspect of healthcare culture. This code is well recognized by people within and without the healthcare system as it is the basis for the credibility patients give to their doctors, nurses, dentists, optometrists, etc.

Until Death (or Recertification) Do Us Part

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By RICHARD DUSZAK, MD 

The online membership forum of the Society of Interventional Radiology (SIR) blew up this week in response to an email announcement by the American Board of Radiology (ABR) that it will effectively be doing away with lifetime diagnostic radiology certificates for interventionalists whose original certificates pre-dated the introduction of time-limited certificates. Interventionalists were given two choices:

1.     You can keep your lifetime diagnostic certificate if you give up your (earned) interventional subspecialty certification, or

2.     You can keep your interventional certification, if you give up your lifetime diagnostic certification.

Talk about choice.

Help the Doctor

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Jack CochranIn recent weeks and months a number of articles have delved into the issue with a sense of seriousness and purpose that the doctor crisis deserves. Progress on reducing unnecessary pressures on physicians is painfully slow, but the broadest possible recognition of the problem is an important step toward dealing with it effectively.

We hold a basic belief about the future of health care: Solving the doctor crisis is a prerequisite to transforming our delivery system to improve access, equity, quality, and affordability. How can we possibly achieve the overall excellence and affordability in health care if large numbers of doctors are alienated and burned out?

Let’s be very clear: This is not about coddling doctors.

It is about preserving the ideals of the physician as healer and enhancing the professional experience – essential elements to optimizing care for patients and families. It is about acknowledging an honorable profession whose members deserve an environment in which they can serve patients to the best of their ability; an environment in which physicians can aspire to continuous improvement as engaged learners who embrace their role as active members of the Learning Coalition.

Traced Back to Medical School

The problem begins as early as medical school. Richard Gunderman, MD, recently authored an article in the Atlantic arguing that medical students:

are suffering from high rates of emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment. College students choose careers in medicine because they care, because people matter to them, and because they want to make a difference. What is happening to the nearly 80,000 U.S. medical students to produce such high rates of burnout?

Dr. Gunderman argues that we “need to understand not only the changes taking place in medicine’s external landscape but the internal transformations taking place in minds and hearts. … In what ways are we bringing out the best elements in their character — courage, compassion, and wisdom — as opposed to merely exacerbating their worst impulses — envy, fear, and destructive competitiveness?”

Check Your 2015 Open Payments Data

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The Centers for Medicare & Medicaid Services’ continues to publish data from applicable manufacturers and group purchasing organizations (GPOs) about payments they make to physicians and teaching hospitals on its website. We’re pleased that the public has searched Open Payments data more than 6.3 million times. Doctors, teaching hospitals and others receiving payments or other transfers of value that are sent to us from reporting entities, should take steps to ensure that this information about you, your related research, ownership, and other financial concerns are accurate.

Doctors and teaching hospitals have the chance to review and dispute the information shared about them before we post the new and updated Open Payments data on June 30, 2016. The data we post on June 30th is now available for review through May 15, 2016. Since April 1, this is the only chance for these health care providers to dispute inaccurate or incomplete data before we post it. After that they only have until the end of the year that this financial data is published to review and dispute any payment records and how it was attributed from GPOs, drug and device manufacturers.

Any doctor or teaching hospital that wants to look at the financial information reported on them by manufacturers and GPOs can register on the Open Payments website to create an account or log if they already have an account. Visit our website for instructions and quick tips.

CBD (Cannabidiol) 101

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By DONNA SHIELDS

 

I’ve been a proponent of marijuana legalization since I heard about it in high school.  I lived in the UK in the 1970s when it was not easily available! So I was a legalization proponent before I’d ever touched the stuff. Nearly four decades later, it’s legal in many states, Canada and Uruguay and most — but by no means all — of the drug war hysteria is recognized for the idiocy it is. But while anyone who’s got stone and had the munchies knows that pot is a good appetite enhancer and antiemetic, there are now a bunch of claims being made about cannabidiol (CBD). So I thought we’d explore them. We’re including a video from ZdoggMD which gives a balanced view of the (appalling lack of) data so far, and an article from Donna Shields, co-founder of the Holistic Cannabis Academy. Donna, as you may guess, thinks it’s pretty useful. And while you think this may still be on the edge, a CBD company called Sagely Naturals won the recent G4A contest held by old world big Pharma company BayerMatthew Holt

 

Understanding CBD

Demystifying CBD Video

It’s come onto the healthcare scene like a rocket yet most people don’t really understand what cannabidiol (CBD) is, how to use it and the results one can expect. Here’s a primer on the basics you need to know.

Do you know about the endocannabinoid system

We all have an endocannabinoid system; a network of receptors throughout the body whose job is to maintain homeostasis and well-being for all our organs. Like a master control system. And while our bodies make their own cannabinoids, life, through stress, toxins, poor diet and illness, has a way of depleting the in-house supply or making those receptors “less receptive”. This is when adding cannabinoids, such as CBD, can be a helpful boost.

Marijuana vs Hemp

The mother plant, called Cannabis sativa, can be cultivated to grow marijuana (the plant containing THC, CBD, and other cannabinoid compounds) or hemp, a crop with many uses from food products to building materials. Hemp also contains CBD (cannabidiol), but less than 0.3% THC. CBD is just one of over 80 different cannabinoid compounds found in both marijuana and hemp. Hemp-derived CBD products are available at retail stores and online; while marijuana-derived CBD products are available cannabis dispensary stores.

How to Avoid Being a Dumb-Ass Doctor, Blog Edition

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Evil Dr Rob Part 2It’s been two years since I first started my new practice.  I have successfully avoided driving my business into the ground because I am a dumb-ass doctor.  Don’t get me wrong: I am not a dumb-ass when it comes to being a doctor. I am pretty comfortable on that, but the future will hold many opportunities to change that verdict.  No, I am talking about being a dumb-ass running the businessbecause I am a doctor.

We doctors are generally really bad at running businesses, and I am no exception.  In my previous practice, I successfully delegated any authority I had as the senior partner so that I didn’t know what was going on in most of the practice.

The culmination of this was when I was greeted by a “Dear Rob” letter from my partners who wanted a divorce from me.  It wasn’t a total shock that this happened, but it wasn’t fun.  My mistake in this was to back off and try to “just be a doctor while others ran the business.”  It’s my business, and I should have known what was happening.  I didn’t, and it is now no longer my business.

This new business was built on the premise that I am a dumb-ass doctor when it comes to business.  I consciously avoided making things too complicated.  I wanted no copays for visits (and hence no need to collect money each visit).  I wanted no long-term contracts (and hence no need to refund money if I or the patient was hit by a meteor or attacked by a yeti).   The goal was to keep things as easy as possible, and this is a very good business policy.

An Alternative Proposal For Certification

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John HalamkaSome have suggested that my comments over the past few months about the Meaningful Use program, MACRA/MIPS, and Certification imply that we should just give up – throw out the baby with the bath water.

That’s not what I’ve written.

Here’s a clarification.

I believe MACRA/MIPS is the right trajectory – create a set of desirable policy outcomes, then enable clinicians to choose technology, quality measures, and process improvements that are relevant to their practice.

Although the current MACRA formula is overly complex, it’s the right idea and I’m confident that CMS will revise the notice of proposed rulemaking appropriately.   My metric for MACRA’s success is simple – can a clinician keep three goals in mind while seeing a patient and be rewarded if successful i.e.:

1. Ensure care is delivered in the most appropriate location in the community (urgent care, home care, rural hospital)

2. Focus on wellness/prevention

3. Avoid redundant and unnecessary testing, medications, and procedures

My issue is that MACRA currently “inherits” the flawed 2015 Certification Rule that is a kitchen sink of immature standards and a black hole for developers.   Overly zealous regulatory ambition resulted in a Rule that has basically stopped industry innovation for 24-36 months since it has listed every use case for every purpose including those unrelated to Meaningful Use and MACRA.