Basic Health Access

In the wake of another gun tragedy there have been many calls for change. Trauma experts have asked for better trauma response preparedness. The advocates for change are taking advantage of this narrow window of opportunity,  but their calls for changes will not do much.  How can I be so sure? First of all, c alls for greater preparedness for disasters or traumas have been made for decades. The calls have been made by those logical in their thinking as well as those passionate after disasters. But most importantly, there is no design to support change. The funding designs, training designs, and locations of health care would need to be changed in the opposite ways of the last 30 years. It only takes common sense to understand that responses have become more limited with ER closures, mergers, and movements. The personnel to respond to disaster are fewer and are less linked to ERs than ever. The on call systems that backed up emergency rooms and disaster responses have long

It is a sad day when something can be implemented that is so wrong for health care delivery overall as demonstrated by the evidence and is also so discriminatory across access to care where needed.  MACRA cannot measure and discern performance. MACRA methods are known to punish smaller practices, raise costs of delivery, and distract from care focus. Inability to discern and sloppy methods plus wide variations (between practices, patients, year to year) will result in inaccurate feedback. The impact will likely be greatest to compromise care where needed.  SloppyRisk Adjustment and Attribution is Part I of Kip Sullivan’s MACRA review  “Outside the bubble where Congress and CMS live, there is a widespread recognition that CMS cannot measure physician “performance” accurately.” KS backs this up with evidence from Journals and MedPAC. "CMS’s failure to say a word elsewhere in the rule about the disproportionate punishment meted out to smaller clinics, and CMS’s refus

Do no harm is still considered a top principle in health care - especially for physicians. Physician associations should advocate for their patients and should not advocate policies or practices that cause harm - especially harm to vulnerable populations by commission or omission. Harm can be caused in a number of ways in health care. Harm can be caused by cost too high or by quality problems or by access to care barriers.  MACRA claims to be focused on quality but studies question whether quality can be achieved by clinical interventions. Failure regarding the ability of electronic interventions is already documented. MACRA cannot even discern differences in "quality." CMS agrees that excessive costs due to regulation must be addressed and then minutes later CMS officials promote the burdensome MACRA implementation without possibility of delay MACRA has a focus on cost cutting with no better than break even regarding payment change overall for areas such as primary ca

When a journalist wakes up the the real world, there are great opportunities. But can the journalist manage to capture the perspectives needed to truly understand the reality of health care delivery? I enjoy the variety of information that I allow to access me. Sometimes there is amusement. At other times I see the best of humanity or try to turn off the worst. In the health care area, I am usually frustrated with what rises to the surface, particularly from health care journalists. A few years back I tried to do more work in this area. I found that there was not much interest from the perspectives that I embrace - local care, health access, care where needed, and preparing health professionals for these areas. I thought that the experiences of 30 years of teaching, researching, and delivering health access would be valuable - since the nation has long been drifting away from health access, local, care where needed. It took years for the decades of habits and experiences to peel