Basic Health Access

Cherry picking has become essential for those who provide or insure health care. Choose the easiest route will capture more dollars with less cost of delivery - and this will earn more bonuses and assure no penalties. Changes since 2010 will reward those already doing well and will penalize those already behind. Cherry picking has apparently moved to top importance for those who promote digital solutions. The digital leaders continue to present A Beautiful Day in the Neighborhood or Community as you will see. But which community, theirs or ours?  Leaders are c herr y picking the information to present, when they promote further digitalization and ignore the consequences such as: The massive additional cost of digitalization is a factor contributing to a 1 percentage point increase in health care costs from July to August of this year alone. The clock is now ticking to determine future reimbursement based on the next 3 years of outcomes. Health care entities are trying ...

Since 1999 the United States has been led on a wild chase to pursue ever more costly solutions for "medical errors." Ever greater promises have been made since To Err is Human regarding the ability of technologies to Cross the Quality Chasm . Hundreds of thousands of lives each year were supposed to be saved. Year after year the nation awaits change. Health spending has more than doubled from 1.3 to 3 trillion dollars. In recent years administrative and non-delivery costs have accelerated. It is time to burst this wasteful and distracting bubble. We have been through enough boom and bust cycles to see that all newly develop technologies have consequences as they are implemented widely. The technologies can be applied safely with proper attention to the limitations. The limitations are often not fully known - in the technology or in the people impacted. In the case of health care the limitations of technology are significant in areas such as cost, productivity, and dis...

Most family physicians face discrimination, but not as bad as the patients and communities that we serve. This is not so much about FM as it is about the distribution of family physicians - the broadest generalists remaining despite an aberrant payment design. Family physicians are the only specialty remaining that has equitable population based distribution. The payment design has long chased other specialties away. They layer out with top concentrations of specialties clustered together and tapering down to few. Family medicine is quite different remaining at 30 per 100,000 even in the lower income, lesser educated, lowest resource, lowest workforce areas.  Geographic categories are a way of examining this and are not too difficult to picture. There are just a few counties in each state with top concentrations. The rest are behind with lower to lowest concentrations. In the 2621 counties with lowest physician concentrations with 40% of the population, about 36% of family phys...