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Showing posts from October, 2016

Basic Health Access Recent Blog Posts

Biomedical Focus is Ruining US

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More Quality Measures for Homebound Seniors - Not Hardly

Quality measurement focus has resulted in higher cost, distractions from care, and lower productivity. Articles proposing more quality measure emphasis may be popular but will not move homebound seniors toward the care that they need. An understanding of the situations facing homebound seniors is required. Based on higher levels of disabled payments, Social Security payments, Medicare patients, Medicaid patients, seniors, obesity, smoking, and sedentary lifestyle at least 45% of homebound seniors are found in 2621 lowest physician concentration counties. It helps to have access to care and workforce to provide care and local resources and many other areas addressed before more quality measures. Homebound seniors where care is needed face Lack of mobility - condition, housingLack of transportation - due to family situations and lesser public transportationLack of insurance competitionInsurers who avoid them due to cost and complexityProviders who avoid them due to payment too lowLack of a…

What Is Stunning in Primary Care Is No Change By Design

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Health Affairs has another of a long line of interesting articles that point out the potential of nurse practitioners and other interventions regarding primary care, but with stunning failure to document the primary care situation and what is needed to address recovery of basic health access. 

In this stunning Health Affairs article - the usual promotions of nurse practitioners are noted. The article fails to note the limitations such as fewest active, fewest years in NP careers, highest turnover, lack of specificity of primary care training for primary care outcome result, steady departures from primary care - shaped by NP training design and made worse by payments too low for NP and for primary care.
How Long Do We Tolerate Lack of Primary Care Delivery Capacity Increase Despite  Four new sources of primary care with more proposedHuge expansions of new sourcesCountless training interventionsCountless billions for primary care training that yields less and less primary careIn…

Oregon PCMH Saved 240 Million But Spent Over 250 Million

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The latest headlines spout 250 million saved for Oregon in the movement to Primary Care Medical Home. Claims of savings often fail to consider the additional costs of an intervention or the supplemental government or foundation funding required. Based on $105,000 additional cost per primary care physician per year the following table demonstrates $250 million to 1 billion dollars more in cost for primary care medical home across Oregon. It is important to consider not just the savings, but also the higher costs of new models.

Specifics are not given but the impact of the primary care medical home can be estimated across the number of clinics that could participate and the doctors per clinic over a 2 or 3 year period. The number of doctors may be small compared to actual. The high and low levels are shown along with a possible average cost. If studies involved less than 2 years they should not have gained print.

The limitations in new studies with new measurements as measured and analy…