Stephen C Schimpff's Blog Posts Tagged 'primary' (11)

There are just a few key reasons why Medicare has become inordinately expensive. There is no end in sight for cost escalation. But there are some obvious solutions and they all begin with chronic illnesses. 

Chronic illness – diabetes, heart failure, cancer, chronic lung disease, etc. – are increasing at exponential rates; are caused largely by lifestyle behaviors; and…

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Primary care physicians (PCPs) have been marginalized by Medicare for decades with low reimbursement rates for routine office visits which has led to the 15-20 minute office visit with 10-12 minutes of actual “face time” and a panel of patients that well exceeds 2000. 

Is there a good solution to the Medicare cost and quality issues? Setting aside either the…

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Medicare is complicated. And expensive to government and individuals. My last post was the beginning of a primer on Medicare. It is not simple but can be understood. Medicare covers about 50 million older Americans for general health care and covers about 75% of covered services or 50% of total health care costs of these seniors. Medicare, as the largest single insurer, sets the standard for reimbursement rates across all insurers. It tends to pay slightly less than costs, leading hospitals…

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Our care is generally good in the United States but not as good as it could be nor as good as it should be. There are multiple problems to consider. 

First, ours is a medical care system not a health care system. We focus on disease once it has occurred but give relatively little attention to maintaining health and developing wellness. 

Clearly there is a need for greater attention to disease prevention and health promotion.  Second, our sytem developed over many decades to…

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There are many misconceptions about health care and medical care. This includes the discussions over the last few years about healthcare reform but is not limited to those discussions. I plan to write about these over the coming days and weeks in some detail. Here is the first one. “American has the best healthcare system in the world.”

 

One of the first problems with this statement is that we really have a medical system in America not a healthcare system. We focus on…

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Medical care is organized to treat acute conditions but the need today is to prevent, diagnose and treat chronic illnesses. Unfortunately, we are sorely lacking in a good chronic care management system. this will be the first in a series of six posts on this issue.

 

Our medical care system has developed over decades and even centuries around diagnosing and treating acute illnesses such as pneumonia, a gall bladder attack or appendicitis. The internist gives an antibiotic for…

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Today we mostly have prepaid medical care insurance with some co-pays and deductibles – both with commercial insurance and with Medicare. In other words, our insurance covers essentially everything from basic and routine care to the catastrophic. And the insurance pays out based on units of care – a visit, a test, a procedure, a hospitalization, a prescription. This creates a system in which providers (physicians, hospitals, drug and device companies, others) get paid for a unit of activity –… Continue

Whether we have commercial insurance through our employer or Medicare, the incentives are poorly aligned to lower costs and improve quality. In fact, they actually encourage greater and greater expenditures. In most instances, our insurance covers everything from prevention to basic routine care to complex care of serious illness. Coverage may not be all that good for some things like preventive care and our primary care physician feels underpaid for routine visits but nevertheless we basically… Continue

Generally we prefer calm seas but often they don’t get us anywhere. We need disruptions, transformations to make the changes necessary for real progress in medicine. Sometimes it is a new technology; sometimes a cultural change. But then a refinement may occur. The refinement may not seem like a “disruption” but indeed it can be because the refinement may create a demand for change. Here a few more disruptive changes or refinements that are leading to disruptions of the old ways.… Continue

The following was posted by me at Harvard Business Review yesterday. http://blogs.hbr.org/cs/2010/04/teamwork_can_help_avert_the_pe.html



Most health care money in the United States goes largely for the care of people with complex chronic illnesses such as diabetes, heart failure, cancer, lung disease, and the like. We will soon see many more individuals with these illnesses because of two factors: the… Continue

Two major reasons for cost escalation are lack of good care coordination of those with complex chronic illnesses and inadequate attention to prevention and screening. PCPs are key to both of these but they have too little time per patient and are not paid for either activity. About 5% of all healthcare expenditures go to PCPs but they can have a major impact on the other 95%, especially with good care coordination of chronic illness and with a focus on prevention.



To fix this, PCPs… Continue