Basic Health Access

Triple Aim, innovation, regulation, certification, cost cutting, and other changes have widened the gap between small primary care practices and large practices for the past 37 years. The treatment of small practices and those that they serve will some day be recognized as discrimination by design. Revenue and Collections The financial design for primary care has been an issue since the 1980s. Stagnant payments, increasing costs of delivery, and increasing complexity represent the Triple Threat to primary care. This threat is most prevalent in the smaller practices. 15% higher payment are common in large vs small practices for the same office codes (Medicare Data 2011). This translates to about $65,000 less payment per primary care doctor.  This is shaped by a number of different factors such as being small or rural, not being associated with a hospital, being in the wrong state, and being less organized. Large systems and practices often have 5% annual escalati...

A popular video on social media lists 20 areas of improvement around the planet. It lists a 50% decrease in homeless veteran numbers. The rapid declines in Veteran homeless counts in metro areas are not necessarily a positive result. The media has a hard time understanding demographics and this makes it difficult when attempting to report on positive and negative areas. Another popular poster notes that homeless veterans need attention before refugees. The fact of the matter is that many Americans are treated like refugees - as those who do well plan ways to do even better. Their designs continue to leave most Americans behind. The relevant areas to consider for Veteran situations are not immigrants. The relevant areas are declines of veteran benefits, deteriorations involving lower income, disabled, fixed income, and less healthy populations of which Veterans are part. Most important is the consideration of available and affordable housing. Factors Regarding Veteran Homeles...

AAFP News translates what Family Medicine is doing as a movement, but sometimes more important is what it is not being done. Do the "Families" of Family Medicine focus on what can accomplish the most for family physicians and especially for their patients? The one thing that sets family medicine apart is service to all of the various places and populations that are most left behind by health care design - rural, underserved, elderly, Community Health Center, lowest physician concentration counties, etc.  Broadest generalists are the primary means  to the end of health access where needed. FM as a specialty has a 3 to 5 times multiplier effect for care where needed - the elderly, the poor, rural populations, CHCs, frontier, and lowest physician concentration county. This is because only family medicine distributions at 30 per 100,000 across the wide range of populations while other specialties are more concentrated where physicians, income, health resources are mor...

Quality measurement focus has resulted in higher cost, distractions from care, and lower productivity. Articles proposing more quality measure emphasis may be popular but will not move homebound seniors toward the care that they need. An understanding of the situations facing homebound seniors is required.   Based on higher levels of disabled payments, Social Security payments, Medicare patients, Medicaid patients, seniors, obesity, smoking, and sedentary lifestyle at least 45% of homebound seniors are found in 2621 lowest physician concentration counties.   It helps to have access to care and workforce to provide care and local resources and many other areas addressed before more quality measures.   Homebound seniors where care is needed face Lack of mobility - condition, housing Lack of transportation - due to family situations and lesser public transportation Lack of insurance competition Insurers who avoid them due to cost and complexity Provider...