The Affordable Care Act Guarantees Coverage for Millions, Falls Short on Physician Availability

Successful implementation of the Affordable Care Act will provide tens of millions of previously uninsured Americans with healthcare coverage.  However, when these individuals seek medical care outside the emergency room or charity clinic setting will there be practitioners to serve them? The answer is clearly no (J Am Med Assoc, Sept 2009). The facts are that this surge in demand for primary care, will markedly exacerbate the already problematic geographic maldistribution of number and type of physician practice across the United States.

According to the American Association for Family Practice (June 2013), there is presently one family practitioner for every 1470 rural residents compared to one physician for every 1190 residents of urban areas. This projects to a deficit of 2,000-3,000 physicians that will be needed by 2020. Even these numbers belie the supply vs demand mismatch.  In addition to comparative deficiency by population density, there are well-served and underserved populations primarily determined by market forces of family income and education.

Pundits from the Robert Graham Center and the Health Resources Administration provide three part strategy to encourage a more equal distribution of healthcare professionals and resources.

  1. Target future physicians who would commit to working in underserved communities at the time of selection and education of medical students.
  2. Incentivize present practitioners to relocate with financial rewards (“carrots”) and regulatory measures (“sticks”).
  3. Accept a lower staffing level for these populations, but focus on improved productivity by increased utilization of physician extenders, technology such as telemedicine, and air transport of providers to more centralized outreach facilities.

But these are the sterile pontifications of the ivory tower. You can not debunk the general suggestions to pay doctors more and give them more resources to provide care; however, the devil is in the details. What is lacking is a canvassing of those already in the arena to find out what specifically it would take to relocate their practice. The battles are being fought by those of us actually on the frontlines. We hope that opening a dialogue in this forum can be productive as this issue will not go away. Better that physician input be focused constructively and proactively rather than centered on impeding externally imposed change.

By Norman Silverman, MD, with Ryan McKennon, DO and Ren Carlton

Cutting Healthcare Spending - Big Data, Hospital Costs, and Outcomes

According to the federal Agency for Healthcare Research and Quality (AHRQ), inpatient hospital costs account for nearly 30% of healthcare spending in the United States and are increasing by about 2% per year over inflation. This cost issue is a focus of the Affordable Care Act, which is accelerating the move away from fee-for-service to a single, diagnosis-related comprehensive payment, similar to Medicare reimbursement. Such payment systems punish unnecessary testing, prolonged hospitalization, and readmissions.

Is Medical Science Dead? - Art, Science, and Quackery

On April 8, 1966, Time Magazine caused a national commotion when the issue’s cover was emblazoned with the question, “Is God Dead?” The Time article was a measured consideration of how society was adapting to the diminishing role of religion in an age of stunning scientific advances. The writer posited that people would no longer believe things out of received doctrine, but faith would steadily succumb to the scientific method as mankind unraveled the truths of the physical world at the expense of the myths of the metaphysical.

IMPACT OF ICD-10 - Increases Billing Accuracy, Headache for MDs and Patients

I strongly suggest that a pledge to read a synopsis of the philosophy of the 13th century Franciscan William of Ockham on a weekly basis be inserted in the oath of office taken by every government employee. Clearly highlighted should be his nominalist doctrine, Ockham’s razor, which avows that the best solution to a problem is usually the simplest. Pare to a minimum the number of confounding variables.

How do we treat pain? - Unrealistic Goals Leading to Opioid Addiction

In the weekend review from ACEP, two articles caught my attention. The first one was on new guidelines from the American Society of Addictive Medicine on the use of prescription medication to treat opioid addiction. These guidelines were created soon after the Centers for Disease Control and Prevention (CDCP) declared opioid use and resultant death as an epidemic. The second article refers to a study showing that pain is underdiagnosed and undertreated in the ED. This is the challenging dichotomy we live and work in.

Drowning in the Fountain of Youth - Genetic Predisposition

Recently I read in a New York Times magazine article that the 130th richest man in the United States wants to match his age with his Forbes magazine wealth ranking. His riches have not bought him a unique, scientifically-formulated elixir for immortality; nor is he a wacky proponent of perpetual hyperbaric oxygen chambers or cryogenics.

Yelp May Not Help

Concomitant with the metamorphosis of the practice of medicine into the business of healthcare delivery, patients have been transformed into customers. Healthcare providers compete not only on the basis of outcomes, best practices, centers of excellence, advanced technology and cost, but also on customer service

Find and Replace: Genetic Engineering in Science and Medicine

Shakespeare’s Hamlet proclaimed, “What a piece of work is a man,” but now, almost half a millennium later, this could be amended to what a set of sequences is man. The nobility, reason, infinite faculty and admirable form can be attributed to the 20,000 or so genes that contain the chemical code for specific protein formation

HIPAA Protects Millions with Unintended Consequences

The Health Insurance Portability and Accountability Act (HIPAA) was endorsed by Congress in 1996 and was the last significant legislative legacy of Senator Ted Kennedy. It is enforced by the Office for Civil Rights and mandates nationally recognized regulations for use and/or disclosure of an individual's health information by a “covered entity”. Such an entity is a health plan, healthcare clearinghouse or healthcare provider.

Studies Prove Communication and Teambuilding Training a MUST for Surgical And Hospital Staff

Although individual judgment and technical dexterity are obviously important, best surgical outcomes, particularly for complex procedures, reflect the performance of many medical providers before, during and after an operation. Professionalism and a competitive business environment both stimulate medical centers to continuously focus on quality assurance programs, and to improve patient safety.

Death Rates Plunge Due to Following Protocols, Not New Technology

We are regaled in the lay press about new medical breakthroughs a novel cholesterol-lowering drug mimics the effects of a genetic mutation and improves lipid profiles when conventional treatment is ineffective; new cancer therapies are tailored medications designed to specifically attack tumor cells without the nonspecific toxicity of conventional chemotherapy; hepatitis C can be cured by short-term oral agents, not prolonged courses of parenteral infusions; mitral valves can be repaired percutaneously without the potential risks of extracorporeal circulation.

How to Grow Your Medical Practice Online

Here at Michigan Physicians Society, we’re dedicated to the financial betterment of physicians by providing continuing education and technology, along with an extensive network of other like-minded professionals in our space....
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