Basic Health Access

More articles indicate more closures of small hospitals. These articles have been appearing for over 30 years. Washington designers have implement a lethal combination of cost cutting to shrink revenue plus ever higher cost of delivery as shaped by regulation. The margins are low to negative and hope for the future of many hospitals is vanishing. All it takes is lost hope to die. Small practices face much the same decline by design as seen in small hospitals - and for the same reasons. It is hard to tell who to blame – Republicans, Democrats, the media that profits from controversy, or the designers that are so out of touch with basic health care needs for most Americans. The one thing that unifies all who are against small health care is the lack of awareness regarding the situations facing more and more Americans - soon to be half of Americans behind by design. It was quite interesting to see the HRSA impression regarding these closures. In many ways, HRSA was bla...

Four decades of attempts to address overuse have not only failed to rein in overuse, the efforts have contributed to under-utilization and more Americans left behind by design. Overuse has long been 2 to 4 times higher in highest physician concentration counties. Overuse supports too much workforce for few and results in too little for many. Overuse steals the workforce needed elsewhere and makes it appear that there are deficits of workforce with the need for more graduates - when the problem remains overutilization.   Payment Design Plus Profit Motive Plus Political Power Overutilization is largely the result of the payment design and profit motive and political power. The payment design results in too much paid for highly specialized services and too little for the basic services (primary care, mental health, basic specialties).    Profits are best supported by the march to ever more types of procedures and technologies that are paid the most beca...

Recent meetings of family physicians brought up the age old question of expanded scope. Some raised concerns about threats to this scope. As is the usual, what is most important is the context. Where half of Americans are found, there is not a reason to be concerned about scope.    Only in highest concentration settings are family physicians limited - since all specialties other than family medicine concentrate in higher concentration settings.   The competition is less and less of a problem regarding broad scope for family physicians in lowest physician concentration counties. Few of the other specialties remain and many are in decline.    This places more burdens upon the remaining family practice workforce. This comes at a bad time as the practices require more time for documentation and there is less time for expanded scope such as hospital and procedural activities.   As discussed previously in recent blogs, the payment designs ...

Arguably the practices of most value are those with lower cost relative to patients seen or outcomes achieved. Small and rural practices have long been paid the least and cover more complex patients often without access to local resources or other local types of providers. They have demonstrated same or similar outcomes. They are also the most valuable as their existence is often the difference between access to care and no access to care. So how can CMS improve value in practices most valuable. Despite greatest value, CMS apparently sees the need to improve value. One would think that CMS would have the small and rural practices instruct others and the nation about value, but such is not the case. A new grant program has been promoted by CMS and the usual associations to increase value in the most valuable practices.  This latest grant is another in a long series of 100 million dollar CMS grant distractions. Apparently associations such as AAFP will continue to promote this e...

Rapid chaotic change is what foundations and government and payers have promoted most in health care over the last decade. In the attempt to shake up health care and promote value, core values have been disrupted. Cost, quality, and access have not significantly improved. Costs have increased substantially. Outcomes have not improved. Access has not improved where most Americans need access. Even worse, people have been taught that access is about insurance - not much help when workforce is not available. In many ways what has been done via innovation has been distraction from actually addressing cost, quality, and access.  Keeping Perspective During Turbulent Times was a recent post by Commonwealth. It is quite interesting that those who have engineered turbulent times would craft such a post.  The following is a representation from the perspective of basic health access. The Innovation Bandwagon Takes No Prisoners There is no stopping this train as so many ...