Author Archives

cindywilliams

The Kübler-Ross Model of EHR Adoption

Apr 25, 2011• 30

By MARGALIT GUR-ARIE

For over a hundred years the paper chart has been a trusted partner and best friend to many physicians and nurses. The paper chart was born the day a new patient walked into the office, a pristine, crisp and neatly color-coded folder, with just the right markings in carefully shaped calligraphy on its covers. As the years went by, the paper chart grew in size, acquired meaning and wisdom, and like most of us, became a bit tattered around the edges and heftier in the middle. It felt good to hold the elderly paper chart in your hands and its voluminous physical presence inspired confidence and trust. The paper chart is dead. In some places the paper chart’s pages are still turning slowly, but we all know its long, productive life has come to an end and someone should pull the plug and call it. Or do we?

In 1969 Elisabeth Kübler-Ross proposed a 5 stage model for typical grieving behavior. The various reactions from the clinical community to the apparent demise of the paper chart exhibit almost textbook adherence to the Kübler-Ross model, with each clinician advancing through the five stages of grief at his/her own pace*.

Denial – This is a joke. These people don’t understand medicine and this entire Obamacare thing will soon go away and we’ll return to normalcy. My practice is doing just fine on paper and my patients get all this fancy medical home care right here and always had. They actually get better care. Besides, I have patients to see and I am too busy to tinker with these fads that come and go every five years or so.Continue reading…

There Aren’t Enough Rich People To Pay For Medicare And Medicaid

Apr 25, 2011• 80

By ROBERT LASZEWSKI

I hear more and more of my progressive friends arguing, in the context of deficit reduction, that we should be raising taxes before getting aggressive about reducing the cost of Medicare and Medicaid — as well as Social Security.

To a point, I agree.

This country is in such a hole that it is senseless to deny that at least some new taxes will be needed to pay for all of the nation’s bailouts and accumulated debts.

For instance, progressives would like to end the $1 trillion cost over ten years of the Bush tax cuts for those making more than $250,000 a year.

I also believe that ending those tax cuts is necessary.

But if you’re looking to better understand the budget policy choices we face, I highly recommend the March 2011 Congressional Budget Office study, “Reducing the Deficit: Spending and Revenue Options.” The CBO prices out about all of the budget options.Continue reading…

The New Cost-Conscious Doctor

Apr 22, 2011• 28

By JANE SARASOHN-KAHN

Doctors practicing in the U.S. are becoming increasingly conscious of the increasing costs of health care. Most consider themselves cost-conscious, and are considering the impact of their practice patterns — in terms of prescribing medicines, tests, and procedures — on the nation’s health bill. In fact, most physicians feel they have a responsibility to bring down health costs.

This perspective on physicians comes from the survey report, The new cost-conscious doctor: Changing America’s healthcare landscape, from Bain & Company, published in March 2011. Bain spoke with over 300 U.S. physicians to assess their perspectives on managing costs, drug and device usage, and standardized care protocols.

The top-line finding is that, regardless of physician demographic — whether male or female, salaried or productivity-based, specialist or generalized, urban or rural, young or mature, doctors uniformly see that they must change clinical practice patterns to accommodate the realities of health economics.Continue reading…

Are Decision Support Tools Turning Doctors into Idiots?

Apr 21, 2011• 39

By DAVID WILLIAMS

A HealthLeaders article by Gienna Shaw notes that some physicians are reluctant to use computerized decision support (CDS) tools because they fear losing the respect of patients and colleagues. There’s some evidence to support this concern:

In one [study], even tech-savvy undergraduate and graduate computer science students preferred physicians who rely on intuition instead of computer aids.

“Patients object when they ask their doctor a question and then she or he immediately types in the question into their laptop and then reads back the answer. It gives patients the feeling that they just paid a $25 copay to have someone Google something for them,” [study author James] Wolf says.

Shaw argues that this is a transient phenomenon in any case because soon everyone will use CDS as payers demand it and the tools get built in to electronic medical records in a way that’s invisible to patients. She’s probably right, but she’s sparked some interesting thoughts.Continue reading…

IPAB — The New Punching Bag

Apr 21, 2011• 4

By MERRILL GOOZNER

Remember death panels? Politicians have found a new way to use health care reform as a punching bag.

The Independent Payments Advisory Board (IPAB) will be a 15-member expert panel appointed by the president and approved by the Senate that is charged with coming up with ways of cutting Medicare spending when payments grow significantly faster than the rest of the economy.

Last week, President Obama, in his speech outlining his long-term plan for cutting the deficit, upped the ante for IPAB by ratcheting up the level of cuts the board could impose if the senior citizen health care program grew too fast. Congress, under the law, would have to substitute comparable cuts of its own, or the IPAB’s plan would go into effect.

It didn’t take long for the fireworks to start. The New York Times reported this morning that politicians from both sides of the aisle are lining up not only to deep-six the president’s latest IPAB proposal, but to get rid of it entirely. Republicans like Paul Ryan of Wisconsin cried rationing. Democrats like Pete Stark of California said such decisions are better left in the hands of Congress.Continue reading…

Primary Care Revolt: Replace the RUC

Apr 21, 2011• 1

By RICHARD REECE, MD

An under-the-radar revolution is going on out there. It is a revolt of primary care physicians against the AMA and CMS. It is a request for parity with specialists. It is a movement to replace how primary care practitioners are paid.

Why the revolt against the AMA and CMS? Because primary care doctors yearn to correct myths about primary care vis-à-vis specialists, and because they believe, by altering how the AMA and CMS pay doctors, health costs can be brought down, and primary care can be re-invigorated. Health systems with a broad primary care base have lower costs. In the U.S., two-thirds of doctors are specialists, and one-third are in primary care, the reverse of most nations, which have 50% or lower costs.

In the early 1990s, the AMA formed the Relative Value Scale Update Committee (RUC), which specialists now dominate. RUC sets payment codes for doctors. Since RUC’s inception, the payment differential has been growing between primary care doctors and specialists, so much so that the typical primary care doctor now makes only 30% of what an orthopedic surgeon makes. On average, primary care incomes are 50% of those of specialists.Continue reading…

Patient-Driven Care Instead of Patient-Centered Care

Apr 20, 2011• 4

By PAUL LEVY

After being part of a discussion at the Institute for Healthcare Improvement today, I have decided to change my profile, above, from this:

Advocate for patient-centered care, eliminating preventable harm, transparency of clinical outcomes, and front-line driven process improvement.

To this:

Advocate for patient-driven care, eliminating preventable harm, transparency of clinical outcomes, and front-line driven process improvement.

What I am suggesting is that clinicians should do their best to collaborate with patients to understand their needs and desires and to jointly design plans of care that are as consistent as possible with those needs and desires.Continue reading…

Finding A Path Through The Health Insurance Market ‘Gobbledygook’

Apr 20, 2011• 13

By LISA W. DREW

My ZIP code is a black hole for individual health insurance.

That’s what I recently discovered when I tried to find the coverage I want at an affordable price. What hubris I had.

My story started in 2009, when my position as a journalism professor at a small college was eliminated, and I lost my health benefits along with the job. In the ensuing months, as the clock ticked on my COBRA extension, I began to focus on finding a new health plan. I thought it would be a matter of dealing with mild sticker shock and doing comparative shopping. I was wrong.

As an experienced writer and researcher, I am used to making calls, asking questions and digging through hard-to-understand details. But it never occurred to me that the answers I uncovered about Tompkins County, N.Y. — a paradise of farmland, lakes and waterfalls close to the cultural attractions of Ithaca, home for me and Cornell University — would be so frustrating. It turns out it’s one of the state’s worst places to find good individual health coverage.

When I tell people about my dilemma, they get curious — even participatory. “Did you try a professional group?” they ask. “Did you try an online broker?” (Yes and yes.) Maybe they get caught up in my story because, unlike many people with tales of insurance woes, I’m in my fifties and healthy. My story doesn’t involve a medical condition that’s unsolvable or hard to talk about. Or maybe it’s just that my experience lights a path, however convoluted, through the insurance gobbledygook.Continue reading…