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You're Killing Us Smalls

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What does it mean when someone says you re killin me Smalls? Line from the movie "The Sandlot," meant to show extreme frustration towards someone's ineptitude or clueless-ness, sometimes both. You're killing meSmalls definition by Urban Dictionary.Nov 27, 2014   Urban Dictionary


Those that design health care are indeed killing us small practices, small hospitals, and small health care - and we let them do it.
The health care financial design is toxic to small practices. Only those with extremes of ineptitude or clueless-ness could do so. Or perhaps they are so dominated by those larger, more organized, and most powerful that they cannot see the damage being done. More confirmation of small health value and neglect
AAFP has no excuse. Half of members are in small practices and have consistently been paid the least for family practice and are paid 15% less where they practice and suffer the most cost of delivery increases. In fact AAFP supports the innovations in the…

Draining the Primary Care Medical Home Swamp

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All three primary care home demonstrations have failed as noted by Kip Sullivan in a recent thehealthcareblog. Kip Sullivan is a voice of reason in an insane policy period. This is only one of many appropriately critical pieces that make sense.

In another sad twist of fate, a major reason for the failure was the promotion by medical associations - including family medicine. Even more important in reading his works, is the discrimination specific to those smaller, where needed, caring for the most complex, and most ignored. Family Medicine has long had the best track record for all of these areas.

Sullivan and Soumerai have noted that these innovations and regulations have taken on a life of their own.  Pay for performance: a dangerous health policy fad that won't die

Others such as Casalino who have noted the value of small practices in some areas such as preventing admissions, have at least implicated that the policies are clearly running over those smaller, independent, rural, …

Another One Bites the Dust - Micromanagement Fails Again

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Another micromanagement has demonstrated costs of micromanagement as much as what might be saved. This is of course what CBO indicated a decade ago about such interventions. This time the CMS Comprehensive Primary Care Initiative failed to demonstrate much - in the practices that survive in the US. 
"The initiative slowed growth in emergency department visits by 2 percent in CPC practices, relative to comparison practices. However, it did not reduce Medicare spending enough to cover care management fees or appreciably improve physician or beneficiary experience or practice performance on a limited set of Medicare claims-based quality measures."


Higher costs without changes in outcomes - this is not value-based. Once again it appears that the personnel used up in micromanagements of costs and of quality could have better been used to address care delivery.


Oregon PCMH Saved 240 million but spent over 250 million
Words like comprehensive and continuity mean little in primary ca…

Innovation Is the Problem Not the Solution for Worsening Health

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Innovation is good. Innovation worship is not good. Innovation application without scientific testing or clinical trials is unethical regarding clinical interventions and should be just as prohibited with regard to health policy. Clinical trials can harm hundreds or thousands. Innovative policies can harm millions.

It takes a reasonable understanding of health care, health care outcomes, social determinants, and the investments that most improve social determinants to understand the consequences arising from the innovative nightmares past, present, and future.

If you review the information sources with a critical eye, you too may find that the innovative policy designs have been disruptive to care, have hurt health care where health care is most needed, have reduced access to care, and have resulted in distortions in the literature. Indeed what is accepted and published in journals seriously lacks consideration of alternative hypothesis, lacks inclusion of many pages of limitations…

Dividing Rather than Supporting Better Health Outcomes

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There are many ways to avoid improving US health outcomes and the United States seems to be best at avoiding.

The Past Contributions To Poor Outcomes

If you understand what was good about the US economy and reductions of disparities 1940s - 1960s, then you can understand what has been bad for health outcomes. Increased spending in a few areas results in decreased spending more specific to the determinants of health outcomes. The areas contributing to declines in outcomes include the contributions of
runaway health care costs, runaway defense spending, runaway prison spending, spending on the debt at high interest rates, maldistributions of health and education by their spending designs that worsen disparities, the consequences of Republican slash and burn (now by both parties Reps and Dems), the consequences of costly Democratic regulation (now by Reps and Dems in health care), autonomous divisions and agencies that can perform in a manner the opposite with regard to improving social d…