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Primary care crisis is HERE

I recently heard from a UCSF physician who was flabbergasted when he sought an
appointment in our general medicine practice and was told it was “closed.” Turns out we’re not alone: there are also no new PCP slots available at Mass General. The primary care crisis has truly arrived.

I’ve written about the roots of the problem previously, and won’t restate the sad tale of woe. But I hope you’ll take the time to listen to two very powerful NPR reports on the topic – the first, a WBUR special by healthcare journalist Rachel Gotbaum called “The Doctor Can’t See You Now,” is the best reporting on this looming disaster I’ve heard (here is the MP3 and the show’s website). The piece is long (50 minutes), so I’ll summarize a few of its moments that really hit home.

First, it is true – MGH is not accepting any new primary care patients. Like UCSF, therefore, getting “a regular doctor” at MGH now takes the combination of cajoling, pleading, and knowing somebody generally referred to as “working the system.” In other words, the process of finding a primary care doc is now like getting a great table in a trendy restaurant. Obviously, this is horrible for patients, but it is also no fun for doctors. For example, in the NPR special, MGH’s director of Emergency Medicine laments:

“If you really want to give me heartburn, you can say, excuse me but I know you work at Mass General and I would like a primary care physician please.”

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Determination of need rule only goes partway

I usually spend some time throughout the year visiting with accounts, physicians, hospitals, and brokers (among others), just to hear what’s up and what’s going on.  Earlier this week, I was out visiting the leadership at a community hospital in Massachusetts, and asked them if they appreciated the MA Department of Public Health’s (DPH) decision to require academic medical centers to prove they weren’t duplicating existing clinical services in the community when they opened new operations in the suburbs around Boston.

For the uninitiated, this issue has been percolating in Massachusetts for the past couple of years, as a number of well known teaching hospitals have broken ground on some pretty big outpatient facilities in the suburbs around Boston. The service suite in these places varies, but it’s basically day surgery, cancer treatment, cardiac care, high-end radiology, and assorted other high-margin outpatient services that many community hospitals in Massachusetts argue they were already doing, and may now lose to these new facilities.

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Around the Web in 60 Seconds (Or Less)

USA Today: Examines individual health policies and concludes they leave many behind.

USA Today: A record number of babies were born in the USA in 2007. Is this the next baby boom?

CNN: Teen pregnancies up for first time in 15 years.

NY TIMES: Paul Krugman predicts the doldrum economy to last many years and targets lack of universal health care as a reason.NY TIMES: David Brooks says we’re entering an era of "epic legislation" and health care is one of the areas where policy makers will redefine the landscape for future generations.

REUTERS: Family planning groups object to a Bush administration memo that
proposes to redefine abortion to include several types of
contraception, including birth control pills and intrauterine devices.

CNN: FDA lifts the safety ban on tomatoes.

WSJ Health Blog: California rulings against insurance rescissions could spread across the country.

HEALTHNEWSREVIEW: Journalistic hype of health news never stops, says Gary Schwitzer critiques as he critiques ABC’s claims about a "miracle drug" for Alzheimer’s. disease.

Is Meaningful Health Care (Or Any Other Kind Of) Reform Possible?

Those who wait, ever hopefully, for real health reform might want to take a deep breath and take stock of a few realities.First, think about the fact that when the Democrats retook Congress, they tweaked but did not fundamentally change the lobbying rules that trade money for influence over policy. In fact, most contributors have now adjusted their contributions to favor the current, rather than the past, majority party. As it turns out, Democrats, like Republicans, are only too eager to allow special interests to trump the common interest, so long as the transactions fetch a good price.

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Commonwealth puts the boot in, again

Veteran THCB readers shouldn’t need too much reminding about this, so I’ll spare you the blow by blow documented here over the years. Here’s the bottom line. Any time you do a trans-national study on health care, you find that the U.S. spends way too much and gets way too little in terms of quality and outcomes.

In doing these studies the Commonwealth Fund has become the bete noir of the political right.

Why? Well it starts with data first and then draws conclusions, rather than the opposite approach followed by most on the right. And whatever way you look at the data they’ve produced over the years, it’s clear that things aren’t going well.

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War on terror becomes a war on the desperate

I don’t go off topic on THCB much these days, but I do so after reading about the arrests of illegal immigrants at a meat-packing plant in Iowa and the treatment of those arrested.

The “war on drugs” was ramped up in 1986 after a basketball star allegedly died from a cocaine overdose and has since been perverted into a budget-busting bonanza, going largely after marijuana users who are doing little harm to themselves or anyone else. But they are still being arrested in their hundreds of thousands, and contributing massively to the budgets of law enforcement and prisons nationwide.

It was entirely predictable that the same thing would happen to the “war on terror.” In order to justify the huge and growing budget of the Department of Homeland Security’s biggest agency, the Immigration and Customs Enforcement (ICE), illiterate illegal immigrants who are doing nothing more than trying to support their families are now being charged and jailed for laughable offenses using legislation put on the books to stop terrorists. The “war on terror” is now taking on the vital stronghold of rural Guatemala, via Postville, Iowa. The aim is clearly to justify ICE’s budget by pretending that illegal immigrants are serious criminals.

Just in case you thought the callous indifference of this Administration couldn’t get much worse, you should read the whole account from the interpreter who was at the court cases at Postville, Iowa. Hundreds of immigrants are being jailed for up to 5 months — at your and my expense — on the insistence of the DOJ and the ICE.

Here’s the whole account from interpreter Erik Camayd-Freixas, and I urge you to read it.

Around the Web in 60 Seconds (Or Less)

WASH POST: Pioneering heart surgeon, Michael E. DeBakey, 99, dies.

WASH POST: AMA apologizes for historical racism.

NY TIMES: Docs Medicare payment problem persists.

NY TIMES: The hilarities and health benefits of dancing.

WSJ: Lessons from Massachusetts health reform.

WSJ: Medicare auditors recover $700 million in overpayments.

AP: Can rising gas prices save lives?

WASH POST: Japanese dying from too much work.

CANADIAN MEDICINE: Advanced Access scheduling causes headaches.

HELP WANTED: Zimmerman seeks revenue consultant

Zimmerman research and consulting firm seeks a self-motivated and goal-oriented revenue cycle consultant to join its team in providing best practice installation/consulting services to hospitals nationally.

Qualified individuals should have a 3 to 5 years experience working in the hospital and healthy system setting as well as a bachelor’s or master’s degree in health care administration or finance. The position requires extensive travel and includes a lucrative compensation package.

View the full job description here. Please send your resume and cover letter including salary requirements to ts***@**********cm.com

Healthcare Unbound, and HHS Genomics Workshop

There’s lots of activity coming up next week. Matthew Holt will be at a star-studded workshop about personal genomics put on by HHS in Washington DC Monday afternoon. Details are here and if you can’t get there you can see the webcast.

Meanwhile, the Healthcare Unbound Conference is having a session on Monday afternoon in San Francisco about Health 2.0. David Kibbe is the moderator, and our very own Indu Subaiya is on the panel with Adam Bosworth (ex-Google, now with Keas) and Cris Ross from CVS MinuteClinic.

assetto corsa mods