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Above the Fold

On Rural Doctoring: The Generalist’s Mind

Aug 22, 2008• 3

By Theresa Chan

This is the second part of a series that first appeared on the blog Rural Doctoring,
where Theresa Chan writes about her experience working as a family
physician and hospitalist in a rural community in Northern California. Chan
moved from San Francisco to try out rural life.

When I think of rural doctors, I think of family practice. Part of this is training bias, because I am a family doctor, but this bias is supported by surveys which demonstrate that a significant number of rural communities would be medically underserved if it were not for the presence of family physicians.

In this post series, I will emphasize the family practice model of medical training as an approach to preparation for rural practice. I do not mean to imply that other primary care specialties–such as internal medicine, pediatrics or OB/GYN–have no place in rural communities. Quite the opposite, in fact. My job in rural California would be much more difficult if I did not have the support of the other primary care specialties. I hope this post series will be useful to medical students and residents who are training in those specialties as well, even if the content tends to veer towards family practice. I will argue that it is the generalist’s mind, rather than the specialty, which will suit a doctor for rural practice.

Reports on Gardasil study offer varying interprations

Aug 22, 2008

By Sarah Arnquist

Merck’s HPV vaccine, Gardasil, has received significant press in recent days, following a cost-effectiveness study published in the current issue of the New England Journal of Medicine.

Depending on where Americans get their news, they received different summaries and interpretations of the study. No wonder consumers are confused. Here are four examples:

Chastened and More Sober, Harry and Louise Return

Aug 21, 2008• 10

By Brian Klepper

On Tuesday, Ron Pollack of Families USA led a call with bloggers — unfortunately, I couldn’t be on it — to discuss Harry and Louise Return — the new health reform campaign sponsored by five prominent organizations: the American Cancer Society’s Cancer Action Network (ASC CAN), the American Hospital Association (AHA), the Catholic Health Association (ACHA), Families USA and the National Federation of Independent Business (NFIB).

Health Wonk Review

Aug 21, 2008

The biweekly compendium of the best of the health blogs is up over at Worker’s Comp Insider.

Health 2.0 on icyou

Aug 21, 2008• 2

Check out videos from past conferences and learn all about Health 2.0 at our very own channel on icyou, an online source filled with loads of useful health videos!

Personal genetic companies back in service

Aug 20, 2008• 3

By Sarah Arnquist

Two direct-to-consumer genetic testing firms, 23andMe and Navigenics gained approval from California regulators this week to continue providing clients access to and interpretations of their personal DNA.

The NY Times reports this morning that, "The licenses, granted to Navigenics and 23andMe, should help defuse a
controversy that began in June when the California Department of Public
Health sent “cease and desist” letters to the two companies and 11
others that offer genetic testing directly to consumers."

The news sparked a heated summer debate over whether consumers should have unbridled access to their DNA or whether a doctor should lead the process.

On Rural Doctoring: The Landscape

Aug 20, 2008• 2

By Theresa Chan

This is the first part of a series that first appeared on the blog Rural Doctoring, where Theresa Chan writes about her experience working as a family physician and hospitalist in a rural Northern California community.

I’ve been reading the blogs of medical students and residents with some interest lately. Their stories about the trials and tribulations of learning to stay awake night and day and how to deal with cranky attendings and even crankier patients take me back to the bad old days of my own residency.

I’ve also had a few glimpses of the osteopathic medical students (OMS) who are rotating in rural California as they assume their new roles as clinical learners. Hearing about and witnessing these experiences makes me reflect on my own training and the steps I took to become a doctor in a rural community. This post series will examine these steps in more detail, and I hope it will be helpful to trainees who are considering a career in rural health care.

Back-to-school specials at the retail clinic

Aug 20, 2008• 3

By Jane Sarasohn-Kahn

People have begun to ration themselves off of medical visits and prescription drugs, according to the National Association of Insurance Commissioners (NAIC).

One in 5 Americans said they reduced visits to the doctor due to the slowing economy. One in 10 have reduced their prescription drug intake.

The NAIC found that 85 percent of Americans have made a change to their health insurance policy.

In related news, Take Care Clinics, part of Walgreens, is offering school and sports physicals for $25 to patients 18 months of age and older. The clinics will also certify that kids’ immunizations are up-to-date. The launch of this targeted service is well-timed for back-to-school physicals when pediatricians’ offices can be very busy in the weeks leading up to school starts. Take Care’s press release has been quick to point out that, "School and sports physicals at a Take Care Clinic do not take the place of a child’s yearly routine health exam and complete developmental assessment." Take Care has about 200 clinics in 14 states.

Health IT policy: the fur is flying

Aug 19, 2008• 11

By Matthew Holt

Some fur is flying in the rarefied world of health IT policy geeks this morning. Health Affairs has three articles. The first from Markle’s Carol Diamond, writing with Here Comes Everybody author and Internet guru Clay Shirky, more or less says that obsessive attention to rigid standards is not helping and actually may be hindering the IT adoption process. And yes, in case you were wondering they do mean CCHIT and ONCHIT’s current policies and agenda which has been going for four years and which they’re accusing of “magical thinking.” Instead, we need new policies which target desired outcomes measured in improved patient care, instead of assuming that creating new technology standards will get us there. And by policies I think they mean money, and its redirection by current payers. After all, if putting in a RHIO costs hospitals operating revenue in reducing admissions and tests, why would they do it?

Pay Doctors For the Value They Offer Patients

Aug 19, 2008• 12

By MAGGIE MAHAR

When Medicare first created a fee schedule, critics suggested that it was a Marxist invention. Nevertheless, the schedule, which lists what Medicare is willing to pay for some 7,000 procedures, has become the master list for physician reimbursement in our health care system: Most private insurers peg their payments to the Medicare schedule.

The notion of deciding the precise worth of some 7,000 diagnostic and therapeutic procedures is mind-boggling. How exactly does Medicare do it?

The process began in the late 1980s when officials at the Department of Health and Human Services decided that the way Medicare paid doctors should be overhauled. At the time, Medicare was reimbursing physicians based on what was considered “customary, prevailing and reasonable” in a particular market — in other words the “market value” of the service in that region.

Instead, reformers urged Congress to begin paying doctors in a way that reflected the real cost, to the doctor, of providing the service. (This is where Marx comes in: rather than letting the local market decide what a service is worth “the system appears to be based on the Marxist ‘labor theory of value,’” sputtered Susan Mandel in a 1990 piece in the National Review.)