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Real Health Care Solutions, Not Value Focus

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The Value Based Movement lacks Value. It is important to understand how AAFP, Commonwealth, and others have arrived at their misguided focus about what is value.You will hear the various promotions constantly in journals, policy papers, and in the media. The following are more critical evaluations via Jha, Soumerai, Sullivan, CBO, Annals of IM, and others with my comments, critique, and assumptions regarding the real influences on outcomes.

I still have hope for associations and foundations, but they need new leadership and a return to missions such as health access – real health access.Their staff need to be re-educated regarding the true value of family physicians and others serving in teams on the front lines despite that greater challenges of the value-based focus.



Value, P4P, Performance Based Evidence Is Lacking

Annals of IM 1/17 in a comprehensive review did not indicate value for performance based incentives. Only process was improved.   It is hard to stop a Bandwagon, but a B…

Rachettattating Nurses Physicians and Others Who Deliver the Care

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The corporate takeover of health care is more obvious with each passing day. The power goes with the trillions of health care dollars. Insurance corporations, drug corporations, and largest systems dominate. They can dictate the disposition of dollars. They can effectively prevent reforms, They can design legislation and programs that favor their interests. Generally this marginalizes dollars for patient care, dollars for the support of those who deliver the care, dollars for basic services, and dollars for most Americans most in need of care. In other words, health care has been redirected to care of the corporation.

Sadly much of the rhetoric that guides this transition claims to be focused on the patient and on better outcomes. This is clearly not the case. Journalists are often engaged in some new innovative intervention that has great promise - but that mostly requires more dollars for same or less outcomes. This is can even be termed value-based even when the outcomes stay the …

The CMS Contribution to the Devastation of Rural Health

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Searching on CMS and rural health is revealing. There are regular headlines with regard to reports and proposals and programs. The themes of innovation and quality grab the attention. But there has been a continued lack of progress where it matters most - in Rural Health Care and the Ability to Care
In the last decade even worse has been the case. The next decade seems to have the potential for devastation to rural health.


CMS says rural health needs major improvements in quality, 
but CMS leads the nation to pay too little resulting in half enough generalists and general specialists – those who provide 90% of rural services in the places with limitations of quality, outcomes, workforce, and access.
Quality and outcomes are actually about the situations, conditions, relationships, and environments as well as income, housing, jobs, education, and other social determinants. CMS contributes to lesser social determinants by designs that send 15% less to rural practices and 30% less to rur…

Killing Off Caring Docs That Matter

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By permission from Shane A Avery, MD    August 29, 2018 12:47 PM as posted in AAFP News

I am a rural, solo, self-employed family physician who is practicing with his wife, an NP; in one of the poorest counties in Indiana. I was one of the physicians who reported the first cases of HIV during the historic outbreak in 2015. I lobbied at the state level for a needle exchange program when our governor and state health department said it should not be done. It is quite sobering to have the heads of the HIV division of the CDC sitting in your hospital boardroom. I had fought the opioid epidemic before it was recognized, when JCAHO was telling us to monitor pain as the 6th vital sign. I watched a rural community flounder under an epidemic of death, disease, and disability brought on by opioids with the blessing of the healthcare and pharmaceutic industry. But I am a family physician. I kept seeing patients in the office, providing complex care coordination. I did home visits. I did obstetri…

Go Fund Me and Basic Services for Most Americans

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There are more indications of the punishment of health care costs upon our nation. A recent article in Forbes indicates that GoFundMe accounts are increasingly used to help with overwhelming costs. There are numerous indicators of worsening facing most Americans - the ones that health care designers fail to understand most.
Generally the article is a good review of the increasing costs as out of pocket expenses go up, employers and health insurers move to lesser coverage, and high deductible plans hit hard. Those who have lower income are often forced to go to lower cost high deductible plans - but of course the $10,000 that they have to pay is overwhelming.


The answer to this issue is we need to fix the healthcare system. There is enough spending at over 3 trillion. How the dollars are spent actually makes the situation worse.  There are many solutions that can lower healthcare costs. The author lists some We spend 10% to 20% more in overhead than other countries. This equates to at le…

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…