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Showing posts from 2017

It's Still the Economy Stupid

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Once again Americans are rallied to fight against the result (high prices) rather than what caused the high prices. More money is thrown at the diagnosis leaving less remaining for prevention of high health care costs and prices. The process is great for those who write the articles, capture the attention, and enrich themselves. It is also the easy choice. Exposing high health care prices as evil takes no effort at all. The real harm is done by those who promote what seems to be popular as they distract Americans from the real causes of high health care costs.
The Biomedical and Micromanagement Waves that have long shaped runaway health care costs are the result of the same influences that shape higher prices and less for more Americans - by design. Higher costs are the result of advantages of designs that favor those bigger, those most organized, those who prepare to profit from the newest designs or implement them to their advantage, and those in the right locations serving the pop…

Focus on Supportive Designs to Fix Burnout

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While promoting the new well-being efforts at AAFP, the promotional material indicates what AAFP must address to result in improvements in well being for family physicians. "To function at your best in an ineffective system" would first of all require AAFP to lead the nation to address the ineffective system. Top on the AAFP list should be all resources focused upon the grossly insufficient investment in primary care. Also high on the list should be efforts to address insufficient investments in people, families, and communities for best health outcome results. Attending a conference may not work out for well-being as those who attend will return to an ineffective system. 



The following critique is directed at the latest AAFP efforts to address family physician well being by web sites, live chats, and well being conferences.

I learned during my time as an AMA Delegate that association activities were often turned into parties for those most associated with the associatio…

Surviving the Pessimists and Optimists to Deliver Real Health Care

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Pessimists include politicians, micromanagers, insurance payers - those that devalue those who deliver the health care or any that try to hold them accountable.
Optimists sit at home optimizing care on spreadsheets and have difficulty separating assumption from reality but that does not stop their abusive policies and regulations.
Realists are those out there delivering care, constantly adjusting in one on one interactions with patients as always, but they must now adjust to the resource deficits from the pessimists and to the innovative regulatory distractions of the optimists.
For us realists, health care is our life. And we are tired of the abuses of the pessimists and the optimists. Let our people and our patients go. Triple Threat is the enemy of health access.  Pessimistic revenue kept too low. Optimistic tinkering accelerating costs of delivery. Challenging patient complexity made worse by meaningless added practice complexity. Patient complexity addressed is the heart of health ca…

Address Discrimination to Address Burnout

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Where family physicians are most important, payment is less by design, the population is more complex, local colleagues are fewest, and the local support resources are lowest. The outcomes are more likely to be lower because of inherent social, local, and other non-clinical determinants of health - the most powerful influences. Also innovation, regulation, digitalization, and certification costs are higher as are turnover costs.

This is another in a series of posters illustrating that it will take more than words to bring Basic Health Access to half of Americans with low to no access by design.

AAFP must address the needs of members in their most important areas. We work hard at what we do and we need more support. 

We need associations to focus on Triple Threat rather than addressing all of the consequences of Triple Threat. Support for what we do is too low by design, costs of delivering care are accelerating by designs often supported by our associations, and complexity is being m…

Why Not Better Health Access for Most Veterans?

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Most Veterans are located in counties distant from Veterans facilities. Veterans facilities are concentrated in major metro areas where highest concentrations of physicians are found. As a visual representation these are mostly Blue Counties. Most Veterans find it too expensive to live in places with highest concentrations of physicians as the housing is highest cost to buy or rent. Veterans clinic locations have extended to other sites, but the widespread distribution of veterans makes this a ridiculous and costly choice. The design for Veterans health care is a poor fit for health access for most Veterans.



Triple Threat Hurts Access to Veterans More
Veterans are most likely to arise from families, counties, and communities that are average to lower in concentrations. They are most often from lowest concentration counties and they tend to return, and they are joined by Veterans not from these counties. This has to do with housing.

Affordable housing is lacking in highest concentratio…

Sinking Health Care Design After Design

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Those shaping health care have long deserted the top priority focus upon health care delivery. Their efforts from above make it much harder for those delivering care down below. Those delivering care are forced to bail out health care delivery - working harder and harder to keep US health care delivery afloat despite greater challenges from above and from outside of the boat. They are too busy and are too poorly organized to address those largest, most organized, and most distant from health care delivery who continue to shape designs that fit those at the top best while leaving the rest behind. The designers have created more lines of revenue for health care in highest concentrations (training, schools, foundations, research related corporations, management groups). The designers send the highest payments in each line of revenue to highest concentration settings. The designers are selected by a process that involves highest concentration and most exclusive origins, schools, programs, …

Zombie Thinking and Vampire Actions Suck the Life Out of Health Access

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For decades the designers have ignored the consequences of their designs as hundreds of small hospitals, small practices, and practices where needed have fallen prey to revenue too low, costs of delivery accelerating as complexity overwhelms health access. More counties are added and millions more a year are added to those with low or no access - by design. Triple Threat translates to little or no treatment for most Americans. Vampires suck the life blood of health access while zombies design costly and cumbersome innovations.
Fight Zombie Thinking - Stop the Insanity The evidence basis is quite clear. Clinical interventions and especially digital clinical interventions are costly and can only address process - not outcomes (Annals of IM Comprehensive Review, more)Less Datapalooza and more Team Member Support - Team Members cannot celebrate their contributions because digitizers are celebrating.Health Access Care Still Fails Despite 153 Tricky Studies Triple Threat Tricks Destroy the …