Showing posts from December, 2011

Flexible Fails and Permanent Primary Care Prevented

The United States has a health policy construct that actually prevents recovery of primary care. Primary care revenue support is insufficient to keep up with the increasing cost of delivering primary care. New types of costs burden primary care practices further. Meanwhile the rewards for non-primary care choices have increased. The rewards are greater for primary care graduates that depart primary care. The rewards are greater for employers who receive more revenue when graduates convert from primary care.
Prevention of Primary Care Recovery By Design

Accelerating cycles of primary care deficits are the result of US policy. The cycle starts with primary care deficits. Innovative academicians create new sources of primary care. The designs are generic to workforce needs and are not specific to primary care or most needed primary care. Despite more sources and increased graduates in each source, there is less primary care result per primary care graduate. Studies contribute to the confus…

Shared Savings Equals Cost Cutting By Design

Medicare needs to cut costs. It has chosen methods to cut costs that will damage the basic health care services needed by most Medicare patients. And instead of calling this cost cutting, it uses terms such as "shared savings." Even worse, the “shared savings” will result in even less health spending in United States locations that already have lowest health spending. Innovative designs are not the problem. The problem is that Medicare designers need to understand the basic health needs of most Medicare patients left behind by design. Medicare and Medicaid face significant challenges. Spending will continue to rise with more patients covered such as the doubling of the elderly from 2010 to 2030. The United States has continued to add more drugs, treatments, drug coverage, reasons for hospitalization, and technologies that are most costly. Politicians shout Death Squad rhetoric for any attempt to limit services. Meanwhile those needing basic services such as primary care are l…

Number One Two Three in Health Access

Solutions for health access primary care workforce Enter primary care practices at highest proportions after training Stay in primary care practice at highest proportions in the years after graduation Have the longest health professional career lengths Remain active in practice during a career at the highest percentages Deliver the highest volume of primary care when active in primary care delivery. Are most likely to be found in 30,000 zip codes with 200 million Americans and only 25% of total workforce (Practice Locations Outside of Concentrations) and Are least likely to be found in 1000 zip codes with only 11% of the population and 50% of the workforce (Super Center Concentrations). Only family medicine residency graduates meet all of these criteria for graduates past, present, and future. Only family medicine residents have not been increased beyond the 3000 annual graduates first reached in 1980. The US primary care design has also not changed for primary care numbers since 1980 while …

Rural Rearrangements of the Deck Chairs

Comprehensive Rural Programs Are Not Enough to Overcome US Maldistribution By Design There is no evidence that Rural Programs in Medical Schools actually increase rural workforce when considering the outcomes of the parent schools. Even with expansions of annual graduates in the parent schools, there has been no improvement. There is nothing wrong with rural programming. It is possible that health access outcomes could decline without rural programming or it might be possible to demonstrate problems resulting from inadequate preparation for the demands of rural practice. The fact is that rural programming has not been able to overcome overall changes in the US health design. Rural programming has not been able to keep up with population changes that increase demand such as increases in elderly, poor, and lower income patients. Lack of health spending for rural populations is the likely reason why rural programming or generic expansions are unable to improve rural access to care. In som…

Piddle Twiddle and Resolve Not One Damn Thing Do They Solve

In the play 1776 there are any number of wonderful allusions to Congress then and now. Former President Nixon thought so too. He requested and received an edited version regarding Cool Cool Considerate Men as he felt they too closely resembled conservatives of the time. Cool Considerate (calm, calculating, conservative?) Men are still very evident, but do they still lead well or wisely or with sufficient understanding of the daily lives of most Americans?
Congress today is a divisive Congress just as presented in 1776. Is Congress today working together affirmatively for the nation. The most basic areas important to most Americans appear to be low priority. The current physician fee crisis is a great example of Piddle Twiddle and Resolve without a solution.
It has taken years for the Medicare Physician Payment Advisory Commission, stacked with landed gentry benefiting from the designs they set, to recognize its past errors and to recommend some protection of primary care fees as compa…