Trump

A Vote For Trumpcare

The world is not going to end.  We witnessed a revolution earlier this week.  The people have spoken and they chose the anti-establishment, street smart, government shrinking candidate who bucks the status quo.  We find ourselves in uncharted territory, with an unpredictable President-elect, who has unclear plans for healthcare.  Here is what we do know.  Mr. Trump is a successful entrepreneur.  Forbes describes the entrepreneurship pathway as having no clear story line, but a “sense of chaos, hectic decision making, and moments of great fear and doubt.” Improving our broken healthcare system will involve decision making in the face of great uncertainty.  Mr. Trump has a well-developed tolerance for this sort of ambiguity and is likely the right man for the job.  

Mr. Trump won over the white working-class individuals in small rural areas.  Sluggish economic recovery in these areas played a significant role in his unanticipated victory.  It is these disenchanted individuals watching the American Dream slip through their fingers who voted for Mr. Trump.   Those same people want the freedom to buy the insurance they need, and not what the bloated government shoves down their throats.  25% of the population lives in rural areas yet only 10% of the physicians practice in there.  Physicians are leaving the system in droves, closing their patient panels, and not keeping up with demand, thereby threatening patient access in these isolated locales. 

Independent practices have a better chance of survival than they did just a few short days ago.  Do not sit idle.  My son, who is in the second grade, was asked to write down his thoughts on this election. “If Hilary Clinton is elected, I will die.”  His teacher insisted he use facts to back up his dramatic statement.  “If Hilary Clinton becomes President, she will close my mom’s clinic, we will not have enough money for food, and I will die.”  While this is not exactly the conversation that took place over family dinner, my son did understand healthcare would change dramatically following this election.  You should have seen him on election night when the network called Pennsylvania for Trump, but that is another story for another day.  Private practice physicians must seize this opportunity to be involved in the “make things great again” conversation.  

Hillarycare was a known entity with a foregone conclusion. Trumpcare remains a bit of an unknown.  His “plan” for healthcare was revealed a little more than a week ago, ironically, at Valley Forge.  It encompasses dropping the insurance mandate and allowing purchase across state lines,  making health savings accounts accessible, price transparency, Medicaid block grants to the states (which has certainly worked well for Head Start) to encourage policy innovation, and protecting coverage for those with pre-existing conditions.  The blank canvas is full of possibilities, which is markedly better than the universal health care plan we could have been facing had the outcome of the election been different.   

Every clever “fix” for healthcare so far has had unforeseen adverse consequences.   Providing marketplaces for consumers to shop for insurance did not improve health; instead, it padded the pockets of insurance company CEO’s, lobbyists, and administrators with special interests.  The statistics on rising insurance premiums could not have been released at a better time to facilitate a Trump victory.  I am overjoyed at the possibility disingenuous CMS employees and lobbyists for the American College of Physicians could be out of jobs.  As for MACRA, I hope it goes down with the Affordable Care Act ship altogether.  Physicians want to practice at the top of their skill set, without needless oversight by administrators telling us what is “best practice.”  

The system Mr. Trump is inheriting is full of obstacles.  Patients are disgruntled about paying exorbitant premiums they can ill afford.  Even Bill Clinton chimed in, “The costs are going up, coverage is going down, it’s the craziest thing in the world.”  Maybe not the craziest thing.  I say a man getting elected to the White House without having any previous political or military experience while most of the polls were predicting his loss is fairly extraordinary.  

Admittedly, there are no easy solutions.  My best advice is for him to familiarize himself with the game, the players, the field, and the score, and then develop his own blueprint for healthcare.  Most importantly, get back to the basics.  One hundred years ago healthcare started with fundamentals:  the physician, the patient, a stethoscope, and a conversation.  People were arguably as healthy then as they are today give or take a few communicable diseases.  Additional thoughts are below:

  1. Invest and innovate, especially in primary care.  We are cost-effective and knowledgeable.
  2. Stop penalizing physicians who do not use Electronic Health Records.  Physicians are doing two hours of paperwork for every one hour of patient care and hiring ancillary staff to support this unnecessary infrastructure.   Let me care for my patients and do my job.  Give me control.
  3. Shrink or Decentralize the Centers for Medicare and Medicaid bureaucracy.  None of these people are practicing health care providers.  Why are they in charge of 18% of the GDP, when they know little of practice on the front lines?
  4. Encourage innovation and competition amongst insurance companies.  If you want a low deductible, your children covered until they are 26, and exemption from pre-existing conditions, then pay for it.  If you want only catastrophic coverage, and pay for routine maintenance as you go, then pay less and save the extra money to go on a cruise.
  5. Redefine high “quality.”  Reward physicians when they spend more time with patients, are more accessible, and able to prevent expensive hospital admissions and readmissions.  Eliminate patient satisfaction scores, immunization rate scores, and outdated HEDIS measure goals.
  6. Require Medicaid recipients to contribute to their health insurance, on a sliding income-based scale.  Require small copays for insurance plans including Medicare and Medicaid.  Even a small personal investment ($3) for a visit has been shown to increase value in the eyes of the consumer.
  7. Allow Medicare to negotiate with drug companies.  Pharmaceutical companies have been getting fat and happy while Americans have just been getting fatter and more ill. 

Our problems in health care have little to do with the patients or the physicians; rather it has to do with corruption of our administrators and nonessential healthcare players.   Beware of the snake oil salesmen touting their latest “solution” for the health care conundrum; instead, look to physicians with boots on the ground caring for real patients to provide tangible answers. 

Niran al-Agba is a physician in Washington State.

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Keith McCallinJohn IrvineSteve2William Palmer MD Recent comment authors
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Keith McCallin
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Keith McCallin

“Give me control.”

That was a funny line in this article.

“Give me control, for I am a doctor, damn it.”

That would have been a more entertaining collection of words for that moment.

You have no say in your professional life. Talk to the Medical Assistants. They will feel your pain. While the RNs laugh.

Pipe down and get back to work. I think I see someone from the American College of Hospital Executives coming.

Allan
Member
Allan

Gregg, you write, “dis-organized medicine failed”. Did it really fail or was it wildly successful, so successful that we ended up curing and treating more and more patients which caused unexpected budgetary problems? If those patients had died like they did before , those budgetary problems would not exist. From my vantage point what you call dis-organized medicine initially escaped much of the bureaucracy and created all these things you talk about including the replacement of human parts, diagnostic testing that didn’t require cutting the patient open, cures for some cancers control of others, less and less invasive cardiac procedures… Read more »

Member

Oh my! Where to start on the TrumpCare ‘faith based’ hologram which you seem to have swallowed in whole? ‘Mr. Trump is a successful entrepreneur.’ Really? I suppose if serial bankruptcies and forced bailouts including a record near billion dollar annual operating loss constitutes ‘success’. Had he not ‘owned’ the banks, his failing roll of the dice real estate house of cards would have erased his entire net worth. Gulp! Some successful entrepreneur, and that’s before TrumpU, AirTrump and a line of failed extensions of his brand. Who knows what other stories might be revealed by his allegedly ‘under audit’… Read more »

Niran Al-Agba
Member

Yep. Bankruptcies do not disqualify one from being a successful entrepreneur. His tolerance for ambiguity is one of his best assets, no matter which side of the aisle you are on. The risk does NOT require everyone buys in and participates. We have survived for many generations without that. You have clearly swallowed that idea of the left, hook, line and sinker. You had me interested until you went the Adelade route. Mostashari has no idea what those of us on the front lines are doing. Look, my bias is that I am the owner of a private practice in… Read more »

Member

Sorry! No intent to offend. I’ve been in direct delivery of care, though not as a clinician since the mid 70s after graduating from UCLA School of Public Health with and MPH in behavioral sciences and community health – which the rest of the country is just now catching up with in 2016 due to the triple aim and population health narrative. I wholly agree the ‘healthcare conundrum’ we’ve ‘co-created’, and yes I mean all of us from the AMA to ABMS, the litany of member specialty societies, state medical boards and the economic turf carved out via the credentialing… Read more »

Niran Al-Agba
Member

Gregg, you are correct physicians have been too passive when it came to driving change in healthcare. It is time we stand up, fight, and be the change we wish to see. Not every idea is going to work, but the larger point is clinicians actually practicing medicine with real patients should be involved since we are greatly affected.

Allan
Member
Allan

“‘Mr. Trump is a successful entrepreneur.’ Really? I suppose if serial bankruptcies…” Bankruptcy laws have changed through the years, but I think it worthwhile to state that Abraham Lincoln could have gone bankrupt if he lived under today’s laws. He kept paying his debts off and to my understanding never fully pain them. But I need not point to an almost bankrupt President when I can point to several others. Jefferson Grant McKinley Not only Presidents were surrounded by debt , industrialists were as well. Henry Ford’s early company went bankrupt. Then again for those of you still members of… Read more »

Peter
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Peter

“One doesn’t create a great company without the risk of failure.”

Definition of “entrepreneur”: a person who organizes and operates a business or businesses, taking on greater than normal financial risks in order to do so.

Definition of Trump:
https://www.bloomberg.com/view/articles/2016-09-26/how-trump-rides-on-waves-of-other-people-s-money

Allan
Member
Allan

Peter we can both say whatever we want, but the proof is provided by those that are willing to continue to invest in projects Donald Trump is involved with. They don’t invest when they think they will lose money. Do you think most businesses are self funded? That is what it sounds like. Businesses fail all the time and investors recognize that though those inexperienced in business don’t. If I remember correctly McDonalds original secretary accepted stock in that hamburger company rather than full payment for services. She owned one of the mega mansions in Palm Beach Florida. You probably… Read more »

Steve2
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Steve2

Sorry. You have Trump. You don’t get to have anything you put on your list. What you will get is some effort to allow sales of insurance across state lines. This is already allowed. In the 6 states that have passed laws encouraging sales across state lines, no insurance companies have come to participate. If you are really a doctor, and if you have ever really run a practice, you should understand why. Next, you will get block grants for Medicaid, which will really just be cuts in Medicaid money, then giving it to the state. You will also get… Read more »

Allan
Member
Allan

“Encourage competition among insurance companies? How old are you? Do you have any idea how naive this is? They don’t want to compete, they want to make money.” I’m sure Niran can answer this herself better than I, but when I read this I wondered how much you understood about the marketplace. In a competitive environment if insurers aren’t competitive they don’t make money. If cost is an issue then insurers competing with one another will attempt to underprice one another. It may not be their choice to compete, but in a competitive market they either compete or die. Competition… Read more »

Steve2
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Steve2

“In a competitive environment ” Sure. Hope you know the old economist joke that ends with “assume a can opener”. You have just assumed one. Most health care markets are dominated by relatively few insurance companies. IF, and that is a big if, we actually had a competitive environment, what you said would be true. In fact, we don’t. In some ideal economic model, you are correct. In reality, not the case. As I noted, states have already tried to encourage insurance companies to enter their state to compete. Has not worked. Glib? Maybe, but mostly I am tired of… Read more »

Allan
Member
Allan

Your comment saying insurers“ don’t want to compete, they want to make money” suggested that Niran was a naive child. I recognize and believe Niran does as well that competition has been reduced by those on the left so I straightened out your thinking process and told you how competition works. One doesn’t get much competition when government sets too many parameters like was done by the ACA. You now agree with the basics of competition something you didn’t understand before or aternativley you worded your statement on competition in a very poor fashion that demonstrates one who doesn’t have… Read more »

Steve2
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Steve2

Nope. They don’t want to compete. Most of our states have been dominated by one, two or three insurers for years. Now, states are eliminating any regulatory barriers that exist, and insurers still aren’t coming. Alternatively, if insurers wanted to compete, they could simply start up in a new state. Hasn’t been happening. The costs involved in starting up are stopping them, not regulations.(Doctors should inherently know this. Most of us give volume discounts to larger insurers. Actually, they just pay us less and we accept it. When a new carrier comes along and they have very few patients we… Read more »

Allan
Member
Allan

“Nope. They don’t want to compete. ” Of course they don’t want to compete and neither does any large company with market share. That is one of the problems with Obama and the ACA. He and the ACA like to deal with large corporations. The ACA reduces competition in all areas including hospitals, insurers and physicians. The left likes to set prices and micro manage. That generally leads to less competition. Under the present rules and regulations it is very hard for new entrants into the ACA’s health insurance realm. If you think that the interference of the ACA is… Read more »

Niran Al-Agba
Member

Steve- I am still working on who the WE is exactly. Insurance companies and drug companies should do it because the government should follow the pathway of other countries and negotiate, negotiate, negotiate. There is no incentive to negotiate right now. Pfizer knows Medicare will pay full price for their drugs right now. What if that was in jeopardy ie if your price does not come down, then we will not cover your drug at all. Neither party understands the inside issues of practicing medicine. This is where the WE comes in and we put together individuals from all backgrounds… Read more »

Niran Al-Agba
Member

Yes, but you do not work in a private clinic, which has vastly different challenges than either of those you face. Encouraging competition in insurance does have a basis in reality. Whether or not those pieces are put into play, depends on what this administration does. As to how we invest in primary care and where the money is going to come from… we negotiate savings in other areas ie insurance companies, government bureaucrats, and negotiation with drug companies to start. There are likely numerous other places to find significant savings. The money saved from a variety of interventions creates… Read more »

Niran Al-Agba
Member

Anyone working for critical access hospital (costs of which are paid by the government) is going to like big government. It literally sustains you. Your bias is exactly opposite to mine. Investing in primary care IS the answer because it avoids other higher expenses in the long run. Allan already handled the market competition issue below quite well. I’m not sure age is an issue, but I am likely younger than you are. I agree with Allan that you sound angry and glib in your comments; the election is over. Accept it and move on. No one is going to… Read more »

William Palmer MD
Member
William Palmer MD

Thanks, Niran, for your thoughtful piece.
I keep thinking that the root cause of all our problems is third party payors.
These cause all of us to believe we are dealing with Santa.
As far as I can see the only ways to get around this problem is to have either have indemnity-type insurance* or to subsidize with Medi-Buck type vouchers.

*Claims money is paid to the patient first and he/she reimburses the provider.

Niran Al-Agba
Member

You know, both of those are intriguing ideas. Tricare Standard works that way with indemnity method if the provider is out of network. Patients just bring in the check and sign it over. It is effective and the consumer understands what “they are spending” so to speak. Anything that encourages ownership of individual health and wellness is a good thing for healthcare overall. Medi-buck type vouchers also helps quantify things more accurately for the consumer. Right now, some Medicaid families tend to over utilize because it is no cost to them. ie, they can email me at night, I will… Read more »

Allan
Member
Allan

Niran, I see early on you were faced with a lot of flak by those who believe bureaucracies provide healthcare and think government bureaucrats are smarter and know more about the needs of the people than the people themselves. How to respond to them while working seems to be a job in itself. I especially like your comment: “ Mr. Trump has a well-developed tolerance for this sort of ambiguity and is likely the right man for the job.” Great comment for those that are so scared they are considering moving to Canada. It also recognizes that the ability to… Read more »

Niran Al-Agba
Member

Allan, yes early on I thought I might be in trouble for writing this article, but figured I would ride it out and stick to the central point, which is the world is not going to end. Moving to Canada does not solve the American Healthcare problem. It is time to roll up our sleeves, get to work, and innovate. I suspect there will be some “outside the box” ideas coming down the pipeline.

Editor

Niran, Nice post. it certainly feels like there’s a measure of hope where there wasn’t any before. The change in conversation when it comes to health care is remarkable. Its good to finally hear health-savings-accounts/ direct primary care being discussed openly on the national stage.

Niran Al-Agba
Member

Exactly my point Anish. There is hope for a different conversation and that is exciting as we go forward.

Peter
Member
Peter

All this complaining about government regs reducing patient care and doc profits.

As I’ve said before – have some backbone and go cash only. You’ll be able to lower your prices (good for patients), reduce your overhead, and manage your own work day. No one is forcing you to work for the government or the insurance companies.

Make America great again – go cash (or chickens)

Pesto Sauce
Member
Pesto Sauce

As a fellow physician in the trenches, I must congratulate you on speaking the simple unvarnished truth in this great article. Bottom line, government unfunded mandates and absurd/onerous reporting requirements have killed the soul of medicine. I hope they demolish Obamacare and MACRA! and I hope they leave us alone to put the relationship right–one doctor, one patient. I hope we get to witness he elimination of the pharmacy benefit manager, managed care and assorted bureaucrats mooching insurance premiums and dictating care. Buh Bye CMS bureaucrats, YOU’RE FIRED!!! LOL

Niran Al-Agba
Member

Thank you Pesto Sauce! I believe our voice would be better heard if practicing physicians in the trenches would unite and be more vocal. On many social media sites, they are still asking “what is MACRA?” That is a huge problem. We are too bogged down doing our job, seeing patients, documenting and saving lives instead of fighting to make sure it remains #OneDoctorOnePatient. That is better for patients, their families, and our country as a whole. Thank you for reading and commenting.

Barry Carol
Member
Barry Carol

Niran, If you could only pick one item from your list of proposed changes to the ACA and the healthcare system what would it be? As a patient, I was wondering if you could speak in somewhat more detail about the electronics records issue and MACRA in terms of how it affects how you and your colleagues do your job day to day and how many patients you can see each day Specifically, how much more time do you need to spend each day complying with documentation requirements than you had to spend before these rules took effect? My own… Read more »

Pesto Sauce
Member
Pesto Sauce

A recent study– http://annals.org/aim/article/2546704/allocation-physician-time-ambulatory-practice-time-motion-study-4-specialties — for every hour of patient care, there are 2 hours of computer/EMR/EHR work that demands to be done. There are 24 hrs in one day, something has got to give. The electronic records are not interoperable and they do not connect seamlessly with one another, in fact, we were ordered to buy and invest and dream and it has destroyed lives in innumerable ways, both doctors’ and patients’. And we still have to fax the medical records to clinic in Loma Linda. They were not created to be medical documentation, but easy troves for data… Read more »

Niran Al-Agba
Member

Barry- These are great questions. It is difficult to pick just one, but I would eliminate MACRA’s mandate for electronic health records and data collection. Just as “Big Data” predicted Hillary Clinton was going to be the President-elect, data is not foolproof and may not even be helpful. As part of the Transformation of care grant, the largest Medicaid provider compiled “quality measure” statistics on my practice using claims data. Numbers showed we were “above average” for ER visits. I pulled the names and evaluated the top 100 utilizers in my practice. More than 50 had NEVER been patients, yet… Read more »

Barry Carol
Member
Barry Carol

Niran, Thanks very much for taking the time to respond to my questions in detail. I appreciate it very much. I’ve learned a lot about the controversy around electronic records and MACRA (from a pretty low base) during the last several months. While I’m just a retiree now on Medicare who spent my career in the money management business, I’ve had a keen interest in healthcare issues for at least the last ten years or so, partly because of my broad interest in markets and efficient resource allocation and partly because of my considerable experience as a patient dating back… Read more »

Peter
Member
Peter

“Billionaire donors and lobbyists already shaping Trump’s ‘drain the swamp’ administration”

This’ll bring relief to underserved rural America. I can’t wait for my 15% tax reduction.

Maybe a few “uneducated hillbillies” will round out his cabinet. Duck Dynasty anyone?

Allan
Member
Allan

Maybe the donors have learned that their massive donation might yield little reward. I guess the Saudi’s asking Hillary for a refund won’t work and will do more to reduce this type of influence than anything else recently tried. Placing her in jail where she should be might encourage honesty in our politicians. Apparently we have only seen the tip of the iceberg where Hillary is concerned.

Peter
Member
Peter

As usual Allan you look at this with Republican blinders. Trump is being investigated for fraud and has a history of being named in federal lawsuits.

What would you say if a Democrat had said half the things Trump said during the campaign?

560 false things Trump said during the campaign.

https://www.thestar.com/news/world/uselection/2016/11/04/donald-trump-the-unauthorized-database-of-false-things.html

Trumpland: Where hate and ignorance is popular again.

Allan
Member
Allan

There are so many rules and regulations out there that I will bet all or almost all have done something that could be cosidered criminal in their lifetimes. I don’t know of many promotors and builders that havensn’t been investigated. They too frequently have to deal with government officials frequently Democratic so one should expect to be investigated hanging out with those types. Trump actually hung out with Hillary and that scares me because she is the quintessential crook along with being a treasoness liar. By the way I read some of your 560 and I am sure there are… Read more »

Member

“The people have spoken”

25.5% of them for Trump® specifically, vs 25.7% for his opponent — vs the 47% who failed to vote at all.

Quite the “mandate.”

Peter
Member
Peter

It’s the only mandate that counts. The 47% who didn’t vote probably feel neither candidate (or Congress) would have changed their lives to any significance, or they wanted to teach the Dems a lesson for not nominating Bernie – which is like punishing the whole population for the fault of one person. That’ll teach’m.

Niran Al-Agba
Member

Sounds like you are frustrated with our system of representative democracy. True democracy would take popular vote numbers into account, but as I painfully learned in 2000, the country doesn’t work that way. Healthcare must move forward and those of us on the frontlines should get involved this time.

Member

I’m just pointing out some facts. And I know full well that we don’t have a direct popular vote democracy. If we had that, only 9 states would matter (51% of population). But, this “mandate” and “the people have spoken” talk is simplistic.

Niran Al-Agba
Member

The only mandate I mentioned was the misguided EHR requirement. I do not think there has been a mandate for the Republicans since 1984 when I was 10. I remember the entire country was almost completely red. In my mind, a true mandate would be considerably different than the results we saw Tuesday night. As far as “the people have spoken”, (which seems to bother you), those people who showed up and voted have chosen a new leader in accordance with the representative democracy in which we live. Neither you or I can do very much about that. We need… Read more »

Member

As far as “the people have spoken”, (which seems to bother you)
__

Only because it’s BS. ~25% of voters “have spoken” for Trump. Moreover, Clinton’s popular vote plurality continues to grow, and is now reported at about 1.8 million more aggregate votes than The Donald’s. So, it seems that of those who bothered to “speak” at the ballot box, Trump was not their first choice. That he was nonetheless elected owes to structural Constitutional mechanics more than national popular will.

Niran Al-Agba
Member

How is this any different than 2000? I lived with the disappointment my guy lost when “really” he won. Maybe you would prefer “not enough people spoke outside of California and New York for her.” Any way you slice it, this is the result. The electoral college allowed Penn, MI, Ohio, and WI decide this election. Insurance premiums went up by 30% in Penn, maybe that had something to do with his victory? It would be very interesting to superimpose the map of insurance premium increases, over the surprising states that turned red after years of blue. I haven’t seen… Read more »

Member

“How is this any different than 2000?”
__

THIS is how it differs, in terms of consequences:

https://medium.com/@BobbyGvegas/i-alone-can-solve-8a4b5fe1ff47#.go3fweru9

Niran Al-Agba
Member

Bobby- while I was born during the time Nixon was being pardoned, (so not all that knowledgeable) I wholeheartedly agree with the rest of your post after that. In this case, we do not have consequences yet, only perceived ones. Let’s relax and see what happens.

Peter
Member
Peter

Who’s, the exchanges? How much did subsidies go up to compensate? I find it puzzling (but not really) that those speaking the loudest against Obamacare are the ones who don’t have it, need it, and don’t buy through it. This fight is not about what coverage we all need and can afford, but what ideology of failure the right wants. They went up, 1. because premiums were set too low ( optimistic blunder) to reflect that the buy-in enforcement for young/healthy’s would actually work. 2. Because the Obamacare risk group was a group by itself with nothing to blunt the… Read more »

JustSayin
Member
JustSayin

While the author makes an admirable attempt to discuss some of the issues related to healthcare today, he is missing the boat in many areas. First and foremost, just about all of the issues surrounding healthcare today relate to 1 issue: cost. It’s the cost stupid. As the author notes, healthcare consumes 18% of GNP (and rising) — way too high a number. This is unsustainable. Other industrialized countries are doing it for a lot less. Our Rube Goldberg system of healthcare just does not cut it. So any and all discussions about fixing healthcare should focus on cost. I… Read more »

Niran Al-Agba
Member

It looks like we agree on most things except electronic records. I disagree the cost of technology we have today helps drive down cost of healthcare overall. The systems we currently have require more time, staff, and work to maintain than plain old paper. Why can private clinics just keep using what they have?

JustSayin
Member
JustSayin

EHRs are important for several reasons: Remember that before Meaningful Use, you did not have an EHR, and the system was still broken. Costs were rising incessantly. We cannot go back to that old system of paper records and fee for service — we just cannot afford it. Why is an EHR important? 1) you need it for population health. Example: you want certain patients in your panel to receive a flu shot every year. How could you do that without a database? How would you remind them. Are you going to pull 3,000 charts or would you rather just… Read more »

Niran Al-Agba
Member

The primary care system was arguably less broken than before MU and EHR mandates. We CAN go back to the paper system and fee for service, but maybe that is not where the country is headed. Paper is cheap, efficient, and very effective. Getting a 10 page note for an ear infection seen elsewhere with a bunch of junk on it is not as helpful as my 20 line dictation diagnosing the same thing. In 10 seconds or less, I can glance and see what the exam findings were and what medication was used. That is real efficiency. Fee for… Read more »

Pesto Sauce
Member
Pesto Sauce

Cost isn’t transparent nor available because government sets the rates and changes them every year, and private payers follow suit. The “true cost of healthcare” discussion has failed to have an open accounting to take into account malpractice insurance cost, taxes, employee staffing and training, a myriad of compliance/board certifications/CME/ biohazard rules/OSHA/regulations that cost the provider–this is never spoken of. Bending the cost curve has proven extraordinarily difficult. Bottom line, the heterogeneity of how people take care of themselves isn’t ever accounted for either. LASIK or breast augmentation costs–outside the realm of third party payment– are easily accessible and furnished… Read more »

JustSayin
Member
JustSayin

You are talking about 2 different things. First you talk about govt rates for different episodes of care. These costs are set by CMS and there is a lot of jawboning back and forth about what these rates should be. In general primary care doctors get shafted and specialists do great; mostly based on the strength of their lobbying efforts from what I can tell. I have yet to see a specialist in private practice that does not make a boatload of money. The other costs you mention are the costs of running a practice, which include certain administrative/compliance costs.… Read more »

Peter
Member
Peter

So much wrong with this self serving piece. Trump was never an “entrepreneur”, as he risked “other peoples money” then declared bankruptcy several times – using the tax payer as backstop. “Sluggish economic recovery in these areas played a significant role in his unanticipated victory.” That “sluggish” economy is still a result of the, “don’t need no stinking regulations” financial collapse with the fact that rural economies are always teetering. The other fact is if rural residents want the same income as city folk they need to get an education and leave their county. “Those same people want the freedom… Read more »

Niran Al-Agba
Member

Let’s just agree to disagree. It is important to mention those of us in small rural areas are not uneducated hillbillies. Your statement is appalling. The people living in rural areas are intelligent, hard-working, honest, and have integrity. If you do not have experience with people living in Health Professional Shortage Areas, then at least refrain from insulting them.

Peter
Member
Peter

“It is important to mention those of us in small rural areas are not uneducated hillbillies.” Where did I say that? By the way, what have you got against “hillbillies”? Seems a little presumptive and demeaning. “Trump did best among white voters without a college degree, beating Clinton by the enormous margin of 72 percent to 23 percent. Trump also won among white, non-college women 62 to 34 percent” Not having an education does not necessarily make you stupid, and I see ignorance in well educated people, but lack of an education does however make you less likely to earn… Read more »

Allan
Member
Allan

“Trumpland: Where hate and ignorance is popular again.”

Peter most of the hate I have been hearing seems to come from you.

Pesto Sauce
Member
Pesto Sauce

Uh, no doctor got any subsidy from Ocare. Govt had 8 years to correct the financial meltdown sequalae and craft a healthcare bill. Instead we got a health insurance bill/monstrosity forced down our throats filled with goodies for pharm, insurance companies, etc and when the money ran out they all bailed. Face it, Obama has been a failure top to bottom, and the nation has repudiated his legacy. We the peasants changed the face of the republic. We were sliding towards destruction. Us po’ white trash (I’m really Hispanic and Irish) don’t know nuffin and should go die. You spew… Read more »

Peter
Member
Peter

Pesto maybe you could tell us how you paid for health coverage before the ACA and after the ACA and what you would prefer without it?