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Getbig Main Boards => Politics and Political Issues Board => Topic started by: Soul Crusher on March 14, 2013, 07:05:06 AM
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The Obamacare Revolt: Physicians Fight Back Against the Bureaucratization of Health Care
Jim Epstein|Mar. 13, 2013 9:00 am
Dr. Ryan Neuhofel, 31, offers a rare glimpse at what it would be like to go to the doctor without massive government interference in health care. Dr. Neuhofel, based in the college town of Lawrence, Kansas, charges for his services according to an online price list that's as straightforward as a restaurant menu. A drained abscess runs $30, a pap smear, $40, a 30-minute house call, $100. Strep cultures, glucose tolerance tests, and pregnancy tests are on the house. Neuhofel doesn't accept insurance. He even barters on occasion with cash-strapped locals. One patient pays with fresh eggs and another with homemade cheese and goat's milk. Credit: Tara Higgins/Fosse Photography
"Direct primary care," which is the industry term for Neuhofel's business model, does away with the bureaucratic hassle of insurance, which translates into much lower prices. "What people don't realize is that most doctors employ an army of people for coding, billing, and gathering payment," says Neuhofel. "That means you have to charge $200 to remove an ingrown toenail." Neuhofel charges $50.
He consults with his patients over email and Skype in exchange for a monthly membership fee of $20-30. "I realized people would come in for visits with the simplest questions and I'd wonder, why can't they just email me?" says Neuhofel. Traditional doctors have no way to get paid when they consult with patients over the phone or by email because insurance companies only pay for office visits.
Why did he choose this course? Neuhofel’s answer: “I didn’t want to waste my career being frustrated.”
This model is growing in popularity. Leading practitioners of direct primary care include Seattle, Washington-based Qliance, which has raised venture capital funding from Jeff Bezos, Michael Dell, and comedian (and Reason Foundation Trustee) Drew Carey; MedLion, which is about to expand its business to five states; and AMG Medical Group, which operates several offices in New York City. Popular health care blogger Dr. Rob Lamberts has written at length about his decision to dump his traditional practice in favor of this model.
"Since I started my practice, I seem to hear about another doctor or clinic doing direct primary care every other week." says Neuhofel.
Direct primary care is part of a larger trend of physician-entrepreneurs all across the country fighting to bring transparent prices and market forces back to health care. This is happening just as the federal government is poised to interfere with the health care market in many new and profoundly destructive ways.
Obamacare, which takes full effect in 2014, will drive up costs and erode quality—and Americans will increasingly seek out alternatives. That could bring hordes of new business to practitioners like Neuhofel, potentially offering a countervailing force to Obamacare. (One example, the Surgery Center of Oklahoma's Dr. Keith Smith, profiled for Reason TV in September, is doing big business offering cash pricing for outpatient surgery at prices about 80 percent less than at traditional hospitals.)
Health "insurance" is more than just insurance; it's also "a payment plan for routine expenses," as University of Chicago business school economist John Cochrane puts it in a superb recent paper. The late free-market economist Milton Friedman pointed out that we insure our houses against fire and our cars against major damage, but we don't also insure ourselves against cutting the lawn and buying gas. That's the main reason innovation almost never makes health care cheaper. Most patients never see the bill for an ingrown toenail removal or a glucose tolerance test, so doctors have little incentive to seek ways to offer their services for less. For simple consultations, why bother with Skype when insurance will pay full price for an office visit.
Insurance plans that cover everything, a situation that came about largely because of a quirk in our tax code, have also led to the "bureaucratization of medical care," Friedman wrote in a 2001 essay, in which "the caregiver has become, in effect, an employee of the insurance company or...the government."
Dr. Lisa Davidson had 8 years of frustration while running a successful traditional practice in Denver, Colorado. She had 6,000 patients when she decided to stop taking insurance and adopt the same business model as Neuhofel. Her patient list has dropped to about 2,000. She used to spend about 15 minutes with each patient and now it's more like 45 minutes. "We're on track to make more money and take better care of our patients," says Davidson. "It's a win-win all around."
Before adopting direct primary care, Davidson was unhappy working at the practice she had built because the insurance system imposed a way of doing business that resembled an assembly line. "It's true that in 2014, many more people will have insurance, so there will be a profound need for primary care doctors," says Davidson. "You might say I've done a disservice by dramatically cutting the size of my practice. However, if we make it desirable again to be a primary care physician more people will want to do it."
Under Obamacare, more and more doctors are becoming employees of large hospitals, where there will be more control over how they practice medicine. Hoover Institution Senior Fellow Dr. Scott Atlas fears this will cause a brain drain in medicine. "Really smart people want autonomy, and when you take that away it's naive to think you're going to get really bright people becoming doctors," says Atlas. "The best doctors could excel at any profession, so why go into medicine if they won't have the opportunity to be their best?"
When she was operating a traditional practice, Davidson witnessed firsthand how our "payment plans for routine expenses" drive up prices and block innovation. She recalls that one insurance company paid $118 for a routine PSA test. Now that her patients pay the bill directly the cost is $18. Insurance used to pay $128 for a bag of IV fluid. Now Davidson doesn't bother passing on the cost of IV bags because they run $1.50 each.
Dr. Eric Bricker is the medical director at Compass, a Dallas-based company that helps individuals with high-deductible insurance plans. In a previous job, Bricker was a finance consultant for hospitals, giving him firsthand knowledge of how health insurance drives up prices. "When insurance companies and hospitals negotiate," says Bricker, "it's an exercise in horse trading." For example, an insurance company might let a hospital get away with charging $2,000 for an MRI, says Bricker. In exchange, the hospital agrees to charge the bargain price of $2,000 to deliver a baby. "You do that mixing and matching," says Bricker, "and at the end of the day it works out about even."
According to Bricker, this horse-trading method provides an opportunity for hospitals to earn windfall profits: If the hospital gets $2,000 for MRIs, it will start encouraging patients to get more MRIs.
Given how prices are set, it's no mystery why in health care high costs often correlate with low quality. Bricker cites one facility in Dallas, where a 3-tesla MRI (the more teslas, the higher the resolution) can be had for $860, while a nearby facility offers a 1.5-tesla MRI for $2,500. The former facility stays in business only because many of its customers don't know the difference. They pay the same $20 co-pay wherever they go for an MRI.
So Bricker co-founded Compass, which works with about 1,200 firms to guide their employees to those doctors and testing facilities that offer both high quality and low prices. These employees have an incentive to seek out value because they're responsible for paying a large portion of their own routine medical costs before their insurance coverage kicks in.
High-threshold plans are exploding in popularity, which is a promising trend. According to a 2012 report by the Kaiser Family Foundation, about 31 percent of firms now offer health plans in which patients pay most routine costs out of pocket, like a Health Savings Account (HSA) or Health Reimbursement Arrangement (HRA), and 19 percent of covered workers have one of these plans. High-deductible plans go a long way towards unbundling our "payment plans for routine expenses" from the catastrophic coverage that should be the sole function of health insurance.
"These plans offer hope," says Scott Atlas, "because they drive patients to care about what things cost. High deductible policies also eliminate much of the administrative cost of insurance because there's no need to file claims for routine charges."
Obamacare imposes new mandates on high-deductible plans, but it doesn't outlaw them. "The most devastating thing Obamacare could have done is to say it's illegal to have a deductible of more than $200," says Bricker. "So within the existing confines we can still have a successful business and help people."
Americans with high-deductible policies still have the misfortune of shopping for services in a health care market dominated by traditional health insurance. Since insurance companies and the government still pay the vast majority of medical bills, it's nearly impossible to find doctors who offer competitive and transparent prices.
A Houston-based start up called Snap Health is trying to remedy that by signing up doctors to list their prices on its website. Currently, there are 290 tests and about 100 doctors to choose from. You can buy an EKG (about $35), have a kidney stone analyzed ($250), or get a heart check up (about $400). Patients choose the procedure they want, pay online with a credit card, and then show up for their appointments. Snap Health's CEO and Co-founder Dr. David Wong says the biggest obstacle to building up a menu of offerings is that doctors accustomed to getting paid by insurance companies have no idea how to price their services for direct-paying clients.
Credit: Brad OttosenWong says he launched his business partly on the belief that Obamacare will drive up health care costs, causing more and more companies and individuals to drop out and start paying their own health care bills. Neuhofel agrees that Obamacare could be good for business. "I expect some real unintended consequences after Obamacare is implemented. There could be more uninsured people."
Lisa Davidson plans to enter the state-based exchanges that Obamacare will put in place. She cites a provision in the Affordable Care Act that explicitly allows direct primary care practitioners to marry their services with a catastrophic plan and enter the exchanges, although the details of what will be permitted under the law haven't been hammered out yet.
Eric Bricker also sees opportunity to work within the Affordable Care Act. "Compass is trying to make lemonade out of lemons," he says. "I think you can incrementally make improvements within Obamacare, and the situation will change over time."
The efforts of these doctors and others will undoubtedly help constrain exploding health care costs and improve care. But it's hard to fathom how within the legal constraints of Obamacare we'll see the sort of innovations that could solve the very problems that, ironically, were used to justify Obamacare's passage. As economist John Cochrane puts it, without government meddling, health insurance would be "individual, portable, life‐long, guaranteed‐renewable, transferrable, [and] competitive." And going to the doctor would be as simple and straightforward as eating out. What needs to be done to get there is painfully obvious.
http://reason.com/archives/2013/03/13/the-obamacare-revolt-physician-fight-bac/print
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i know several revolting doctors.
that's why I dont use them.
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Other stances from Reason
Climate changeThe Reason Foundation for many years denied climate change was being caused by human beings. But in 2005, Reason magazine's science writer Ronald Bailey wrote a column declaring that climate change is both real and man-made. He wrote, "Anyone still holding onto the idea that there is no global warming ought to hang it up. All data sets—satellite, surface, and balloon—have been pointing to rising global temperatures."[26]
In 2006, Bailey wrote an article titled "Confessions of an Alleged ExxonMobil Whore: Actually no one paid me to be wrong about global warming. Or anything else."[27] In the article Bailey explains how and why he changed his mind on climate change.
War in IraqThe Reason Foundation has been critical of the cost of the war in Iraq. Reason magazine's May 2008 cover story "Trillion Dollar War"[28] discussed the dubious ways in which the war in Iraq and Afghanistan have been funded by Congress and the Bush administration. The majority of Reason magazine's staffers opposed the war, but a few—notably the Beirut-based contributing editor Michael Young—endorsed it.[29]
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This is a Doctor Owned Medical Group. Second biggest Medical Group in California
HealthCare Partners Medical Group to Participate as Medicare Pioneer Accountable Care Organization
Robert Klein 310.630.4126
Monday, December 19, 2011
Torrance, CA, December 19, 2011 – HealthCare Partners Medical Group today announced it has been selected to participate in the Pioneer Accountable Care Organization (ACO) Model, a transformative new initiative sponsored by the Centers for Medicare & Medicaid Services (CMS) Innovation Center.
Through the Pioneer ACO Model, HealthCare Partners Medical Group will work with CMS to provide Medicare beneficiaries with higher quality care, while reducing growth in Medicare expenditures through enhanced care coordination.
“We are pleased to be part of such an important initiative,” said Robert Margolis, MD, HealthCare Partners chairman and chief executive officer. “Since HealthCare Partners Medical Group was founded in 1992, we have been focused on supporting our physicians to provide coordinated healthcare for patients in Los Angeles and Orange counties to improve health outcomes while controlling costs. Coordinated care can improve patient health through intensive patient and family education and earlier treatment of chronic conditions to help prevent complications. We have particularly strong experience in caring for older adults and patients with complex health conditions, and participating in the Pioneer ACO will allow us to partner with other like-minded healthcare organizations to demonstrate how a coordinated care approach allows physicians to help transform the way healthcare is delivered.”
The Pioneer ACO Model is designed to encourage the development of ACOs, which are groups of doctors and other healthcare providers who work together to provide high quality care for their patients. As one in a diverse group of leading-edge health care organizations from around the country, HealthCare Partners Medical Group was chosen specifically by the Innovation Center to test the effectiveness of several models of payment in helping organizations make a rapid transition to higher quality care at a lower cost to Medicare.
“These Pioneer ACOs represent our nation’s leaders in health systems innovation, providing highly coordinated care for patients at lower costs,” said Marilyn Tavenner, Acting Administrator of CMS. “HealthCare Partners Medical Group has demonstrated significant experience in providing high quality, coordinated care, and we are excited to partner with them,” Tavenner said.
Under the Pioneer ACO Model, CMS will provide incentives for participating healthcare providers who form an organization to coordinate care for patients. Providers who band together through this model will be required to meet quality standards based upon, among other measures, patient outcomes and care coordination among the provider team.
CMS will use robust quality measures and other criteria to reward ACOs for providing beneficiaries with a positive patient experience and better health outcomes, while also rewarding HealthCare Partners Medical Group for reducing growth in Medicare expenditures for the same patient population.
Unlike a managed care plan, Medicare beneficiaries will not be locked into a restricted panel of providers. The Pioneer ACO Model is not a health plan or managed care plan. Under the Pioneer ACO Model, beneficiaries seeing doctors participating in an ACO will maintain the ability to see any doctor or healthcare provider, as well as the full benefits associated with traditional Medicare.
Today’s announcement was the culmination of a competitive selection process that began in May with the national release of a Request for Applications from CMS. HealthCare Partners Medical Group was selected based on its demonstrated capabilities to offer high quality, coordinated care.
The Pioneer ACO Model is one of a number of initiatives developed by the new Innovation Center. The Innovation Center was created by the Affordable Care Act to test new models of health care delivery and payment.
About HealthCare Partners
HealthCare Partners Medical Group has been named a top-performer for eight years in a row by the Integrated Healthcare Association (IHA), and has been recognized by health plans and business groups for medical leadership, the high quality of medical care delivered, operational effectiveness, and high rates of patient satisfaction. The HealthCare Partners physician network cares for nearly 580,000 managed care patients and hundreds of thousands of fee-for-service and PPO patients in the areas of Los Angeles, Long Beach, South Bay, Pasadena/San Gabriel Valley, San Fernando and Santa Clarita Valleys, and Orange County, with more than 1,200 employed and affiliated primary care physicians and more than 3,000 employed and contracted specialists. In addition to primary care doctors’ offices, HealthCare Partners provides medical services through urgent care centers and ambulatory surgery centers. For more information, please visit
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LOL at Option FAIL defending obamacare. Fucking clown
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LOL at Option FAIL defending obamacare. Fucking clown
HealthcarePartners Medical Group. Look it up
Its a Doctor Owned Medical group... they are for it... oh yeah.. did it mention... its doctor owned
See... thats real world.. real money... not bullshit actors posing for pictures with signs..
Cmon on 3333 i know you like to troll and sometimes i ignore it.. but today i just feel like destroying you... so.. thats where were at now
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HealthcarePartners Medical Group. Look it up
Its a Doctor Owned Medical group... they are for it... oh yeah.. did it mention... its doctor owned
See... thats real world.. real money... not bullshit actors posing for pictures with signs..
Cmon on 3333 i know you like to troll and sometimes i ignore it.. but today i just feel like destroying you... so.. thats where were at now
LOL. Sad bro - sad - the clown you love so much destroyed your chosen profession and you still kneepad him.
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LOL. Sad bro - sad - the clown you love so much destroyed your chosen profession and you still kneepad him.
LOL... just keep on ignoring it.. that should work out for you..
you keep spouting opinion and ill keep slapping you with facts.
HealthcarePartners is a medical group.. a very successful medical group. Rated as a top company to work for in California. And it is physican owned medical group...
Torrance, CA, December 19, 2011 – HealthCare Partners Medical Group today announced it has been selected to participate in the Pioneer Accountable Care Organization (ACO) Model, a transformative new initiative sponsored by the Centers for Medicare & Medicaid Services (CMS) Innovation Center.
Through the Pioneer ACO Model, HealthCare Partners Medical Group will work with CMS to provide Medicare beneficiaries with higher quality care, while reducing growth in Medicare expenditures through enhanced care coordination.
“We are pleased to be part of such an important initiative,” said Robert Margolis, MD, HealthCare Partners chairman and chief executive officer. “Since HealthCare Partners Medical Group was founded in 1992, we have been focused on supporting our physicians to provide coordinated healthcare for patients in Los Angeles and Orange counties to improve health outcomes while controlling costs. Coordinated care can improve patient health through intensive patient and family education and earlier treatment of chronic conditions to help prevent complications. We have particularly strong experience in caring for older adults and patients with complex health conditions, and participating in the Pioneer ACO will allow us to partner with other like-minded healthcare organizations to demonstrate how a coordinated care approach allows physicians to help transform the way healthcare is delivered.”
The Pioneer ACO Model is designed to encourage the development of ACOs, which are groups of doctors and other healthcare providers who work together to provide high quality care for their patients. As one in a diverse group of leading-edge health care organizations from around the country, HealthCare Partners Medical Group was chosen specifically by the Innovation Center to test the effectiveness of several models of payment in helping organizations make a rapid transition to higher quality care at a lower cost to Medicare.
“These Pioneer ACOs represent our nation’s leaders in health systems innovation, providing highly coordinated care for patients at lower costs,” said Marilyn Tavenner, Acting Administrator of CMS. “HealthCare Partners Medical Group has demonstrated significant experience in providing high quality, coordinated care, and we are excited to partner with them,” Tavenner said.
Under the Pioneer ACO Model, CMS will provide incentives for participating healthcare providers who form an organization to coordinate care for patients. Providers who band together through this model will be required to meet quality standards based upon, among other measures, patient outcomes and care coordination among the provider team.
CMS will use robust quality measures and other criteria to reward ACOs for providing beneficiaries with a positive patient experience and better health outcomes, while also rewarding HealthCare Partners Medical Group for reducing growth in Medicare expenditures for the same patient population.
Unlike a managed care plan, Medicare beneficiaries will not be locked into a restricted panel of providers. The Pioneer ACO Model is not a health plan or managed care plan. Under the Pioneer ACO Model, beneficiaries seeing doctors participating in an ACO will maintain the ability to see any doctor or healthcare provider, as well as the full benefits associated with traditional Medicare.
Today’s announcement was the culmination of a competitive selection process that began in May with the national release of a Request for Applications from CMS. HealthCare Partners Medical Group was selected based on its demonstrated capabilities to offer high quality, coordinated care.
The Pioneer ACO Model is one of a number of initiatives developed by the new Innovation Center. The Innovation Center was created by the Affordable Care Act to test new models of health care delivery and payment.
About HealthCare Partners
HealthCare Partners Medical Group has been named a top-performer for eight years in a row by the Integrated Healthcare Association (IHA), and has been recognized by health plans and business groups for medical leadership, the high quality of medical care delivered, operational effectiveness, and high rates of patient satisfaction. The HealthCare Partners physician network cares for nearly 580,000 managed care patients and hundreds of thousands of fee-for-service and PPO patients in the areas of Los Angeles, Long Beach, South Bay, Pasadena/San Gabriel Valley, San Fernando and Santa Clarita Valleys, and Orange County, with more than 1,200 employed and affiliated primary care physicians and more than 3,000 employed and contracted specialists. In addition to primary care doctors’ offices, HealthCare Partners provides medical services through urgent care centers and ambulatory surgery centers. For more information, please visit
www.healthcarepartners.c om
.
Helpful Links
For more information about the Pioneer ACO Model, visit the Pioneer ACO website at
www.innovations.cms.gov/areas-of-focus/seamless-and-coordinated-care-models/pioneer-aco/
.
The Pioneer ACO Model is one of several initiatives underway at CMS designed to encourage the formation of ACOs. For more information, visit
www.cms.gov/aco
. For more information about the Innovation Center, visit innovations.cms.gov.
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LOL - O-SHITHEAD just announced today he is cutting medicare funding for that.
Keep worshipping this asshole because he is black - makes you look like a complete idiot
http://cnsnews.com/news/article/obama-administration-plans-cut-medicare-advantage-reimbursements
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LOL - O-SHITHEAD just announced today he is cutting medicare funding for that.
Keep worshipping this asshole because he is black - makes you look like a complete idiot
http://cnsnews.com/news/article/obama-administration-plans-cut-medicare-advantage-reimbursements
Soooooo... the Doctor owned Medical group, whose ceo makes insane amounts of money...and is also a doctor..... is wrong
33333 the internet guy is right.... Gotcha
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Soooooo... the Doctor owned Medical group, whose ceo makes insane amounts of money...and is also a doctor..... is wrong
33333 the internet guy is right.... Gotcha
After your revolution I'm gonna need to see you for some pain in my lower back.
In all seriousness, do you expect your real wages to decrease when Obamacare is in full effect?
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After your revolution I'm gonna need to see you for some pain in my lower back.
In all seriousness, do you expect your real wages to decrease when Obamacare is in full effect?
Of course not. In fact, he expects to triple his take home pay because Obama said it would. And if he doesn't, its because of Dick Cheney.
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After your revolution I'm gonna need to see you for some pain in my lower back.
In all seriousness, do you expect your real wages to decrease when Obamacare is in full effect?
It hasnt... but im new on the scene so i havent been able to compare it to anything...
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It hasnt... but im new on the scene so i havent been able to compare it to anything...
If Barry O'Malley were a white GOP politician who did this health law you would be livid.
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The Obamacare Revolt: Physicians Fight Back Against the Bureaucratization of Health Care
Jim Epstein|Mar. 13, 2013 9:00 am
Dr. Ryan Neuhofel, 31, offers a rare glimpse at what it would be like to go to the doctor without massive government interference in health care. Dr. Neuhofel, based in the college town of Lawrence, Kansas, charges for his services according to an online price list that's as straightforward as a restaurant menu. A drained abscess runs $30, a pap smear, $40, a 30-minute house call, $100. Strep cultures, glucose tolerance tests, and pregnancy tests are on the house. Neuhofel doesn't accept insurance. He even barters on occasion with cash-strapped locals. One patient pays with fresh eggs and another with homemade cheese and goat's milk. Credit: Tara Higgins/Fosse Photography
"Direct primary care," which is the industry term for Neuhofel's business model, does away with the bureaucratic hassle of insurance, which translates into much lower prices. "What people don't realize is that most doctors employ an army of people for coding, billing, and gathering payment," says Neuhofel. "That means you have to charge $200 to remove an ingrown toenail." Neuhofel charges $50.
He consults with his patients over email and Skype in exchange for a monthly membership fee of $20-30. "I realized people would come in for visits with the simplest questions and I'd wonder, why can't they just email me?" says Neuhofel. Traditional doctors have no way to get paid when they consult with patients over the phone or by email because insurance companies only pay for office visits.
Why did he choose this course? Neuhofel’s answer: “I didn’t want to waste my career being frustrated.”
This model is growing in popularity. Leading practitioners of direct primary care include Seattle, Washington-based Qliance, which has raised venture capital funding from Jeff Bezos, Michael Dell, and comedian (and Reason Foundation Trustee) Drew Carey; MedLion, which is about to expand its business to five states; and AMG Medical Group, which operates several offices in New York City. Popular health care blogger Dr. Rob Lamberts has written at length about his decision to dump his traditional practice in favor of this model.
"Since I started my practice, I seem to hear about another doctor or clinic doing direct primary care every other week." says Neuhofel.
Direct primary care is part of a larger trend of physician-entrepreneurs all across the country fighting to bring transparent prices and market forces back to health care. This is happening just as the federal government is poised to interfere with the health care market in many new and profoundly destructive ways.
Obamacare, which takes full effect in 2014, will drive up costs and erode quality—and Americans will increasingly seek out alternatives. That could bring hordes of new business to practitioners like Neuhofel, potentially offering a countervailing force to Obamacare. (One example, the Surgery Center of Oklahoma's Dr. Keith Smith, profiled for Reason TV in September, is doing big business offering cash pricing for outpatient surgery at prices about 80 percent less than at traditional hospitals.)
Health "insurance" is more than just insurance; it's also "a payment plan for routine expenses," as University of Chicago business school economist John Cochrane puts it in a superb recent paper. The late free-market economist Milton Friedman pointed out that we insure our houses against fire and our cars against major damage, but we don't also insure ourselves against cutting the lawn and buying gas. That's the main reason innovation almost never makes health care cheaper. Most patients never see the bill for an ingrown toenail removal or a glucose tolerance test, so doctors have little incentive to seek ways to offer their services for less. For simple consultations, why bother with Skype when insurance will pay full price for an office visit.
Insurance plans that cover everything, a situation that came about largely because of a quirk in our tax code, have also led to the "bureaucratization of medical care," Friedman wrote in a 2001 essay, in which "the caregiver has become, in effect, an employee of the insurance company or...the government."
Dr. Lisa Davidson had 8 years of frustration while running a successful traditional practice in Denver, Colorado. She had 6,000 patients when she decided to stop taking insurance and adopt the same business model as Neuhofel. Her patient list has dropped to about 2,000. She used to spend about 15 minutes with each patient and now it's more like 45 minutes. "We're on track to make more money and take better care of our patients," says Davidson. "It's a win-win all around."
Before adopting direct primary care, Davidson was unhappy working at the practice she had built because the insurance system imposed a way of doing business that resembled an assembly line. "It's true that in 2014, many more people will have insurance, so there will be a profound need for primary care doctors," says Davidson. "You might say I've done a disservice by dramatically cutting the size of my practice. However, if we make it desirable again to be a primary care physician more people will want to do it."
Under Obamacare, more and more doctors are becoming employees of large hospitals, where there will be more control over how they practice medicine. Hoover Institution Senior Fellow Dr. Scott Atlas fears this will cause a brain drain in medicine. "Really smart people want autonomy, and when you take that away it's naive to think you're going to get really bright people becoming doctors," says Atlas. "The best doctors could excel at any profession, so why go into medicine if they won't have the opportunity to be their best?"
When she was operating a traditional practice, Davidson witnessed firsthand how our "payment plans for routine expenses" drive up prices and block innovation. She recalls that one insurance company paid $118 for a routine PSA test. Now that her patients pay the bill directly the cost is $18. Insurance used to pay $128 for a bag of IV fluid. Now Davidson doesn't bother passing on the cost of IV bags because they run $1.50 each.
Dr. Eric Bricker is the medical director at Compass, a Dallas-based company that helps individuals with high-deductible insurance plans. In a previous job, Bricker was a finance consultant for hospitals, giving him firsthand knowledge of how health insurance drives up prices. "When insurance companies and hospitals negotiate," says Bricker, "it's an exercise in horse trading." For example, an insurance company might let a hospital get away with charging $2,000 for an MRI, says Bricker. In exchange, the hospital agrees to charge the bargain price of $2,000 to deliver a baby. "You do that mixing and matching," says Bricker, "and at the end of the day it works out about even."
According to Bricker, this horse-trading method provides an opportunity for hospitals to earn windfall profits: If the hospital gets $2,000 for MRIs, it will start encouraging patients to get more MRIs.
Given how prices are set, it's no mystery why in health care high costs often correlate with low quality. Bricker cites one facility in Dallas, where a 3-tesla MRI (the more teslas, the higher the resolution) can be had for $860, while a nearby facility offers a 1.5-tesla MRI for $2,500. The former facility stays in business only because many of its customers don't know the difference. They pay the same $20 co-pay wherever they go for an MRI.
So Bricker co-founded Compass, which works with about 1,200 firms to guide their employees to those doctors and testing facilities that offer both high quality and low prices. These employees have an incentive to seek out value because they're responsible for paying a large portion of their own routine medical costs before their insurance coverage kicks in.
High-threshold plans are exploding in popularity, which is a promising trend. According to a 2012 report by the Kaiser Family Foundation, about 31 percent of firms now offer health plans in which patients pay most routine costs out of pocket, like a Health Savings Account (HSA) or Health Reimbursement Arrangement (HRA), and 19 percent of covered workers have one of these plans. High-deductible plans go a long way towards unbundling our "payment plans for routine expenses" from the catastrophic coverage that should be the sole function of health insurance.
"These plans offer hope," says Scott Atlas, "because they drive patients to care about what things cost. High deductible policies also eliminate much of the administrative cost of insurance because there's no need to file claims for routine charges."
Obamacare imposes new mandates on high-deductible plans, but it doesn't outlaw them. "The most devastating thing Obamacare could have done is to say it's illegal to have a deductible of more than $200," says Bricker. "So within the existing confines we can still have a successful business and help people."
Americans with high-deductible policies still have the misfortune of shopping for services in a health care market dominated by traditional health insurance. Since insurance companies and the government still pay the vast majority of medical bills, it's nearly impossible to find doctors who offer competitive and transparent prices.
A Houston-based start up called Snap Health is trying to remedy that by signing up doctors to list their prices on its website. Currently, there are 290 tests and about 100 doctors to choose from. You can buy an EKG (about $35), have a kidney stone analyzed ($250), or get a heart check up (about $400). Patients choose the procedure they want, pay online with a credit card, and then show up for their appointments. Snap Health's CEO and Co-founder Dr. David Wong says the biggest obstacle to building up a menu of offerings is that doctors accustomed to getting paid by insurance companies have no idea how to price their services for direct-paying clients.
Credit: Brad OttosenWong says he launched his business partly on the belief that Obamacare will drive up health care costs, causing more and more companies and individuals to drop out and start paying their own health care bills. Neuhofel agrees that Obamacare could be good for business. "I expect some real unintended consequences after Obamacare is implemented. There could be more uninsured people."
Lisa Davidson plans to enter the state-based exchanges that Obamacare will put in place. She cites a provision in the Affordable Care Act that explicitly allows direct primary care practitioners to marry their services with a catastrophic plan and enter the exchanges, although the details of what will be permitted under the law haven't been hammered out yet.
Eric Bricker also sees opportunity to work within the Affordable Care Act. "Compass is trying to make lemonade out of lemons," he says. "I think you can incrementally make improvements within Obamacare, and the situation will change over time."
The efforts of these doctors and others will undoubtedly help constrain exploding health care costs and improve care. But it's hard to fathom how within the legal constraints of Obamacare we'll see the sort of innovations that could solve the very problems that, ironically, were used to justify Obamacare's passage. As economist John Cochrane puts it, without government meddling, health insurance would be "individual, portable, life‐long, guaranteed‐renewable, transferrable, [and] competitive." And going to the doctor would be as simple and straightforward as eating out. What needs to be done to get there is painfully obvious.
http://reason.com/archives/2013/03/13/the-obamacare-revolt-physician-fight-bac/print
Did you notice this part?
This is the healthcare that I have been touting all along. No Insurance. No Republican wants that. No Democrat wants that. I can only think of Bernie Sanders who wants that and that is it.
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Republicans should love ObamaCare. Its the same thing Bob Dole proposed with Insurance Companies at the forefront.
Can anyone tell me which Republican supports dismantling the Health Insurance Industry? ??? ??? ???
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The Obamacare Revolt: Physicians Fight Back Against the Bureaucratization of Health Care
Jim Epstein|Mar. 13, 2013 9:00 am
Dr. Ryan Neuhofel, 31, offers a rare glimpse at what it would be like to go to the doctor without massive government interference in health care. Dr. Neuhofel, based in the college town of Lawrence, Kansas, charges for his services according to an online price list that's as straightforward as a restaurant menu. A drained abscess runs $30, a pap smear, $40, a 30-minute house call, $100. Strep cultures, glucose tolerance tests, and pregnancy tests are on the house. Neuhofel doesn't accept insurance. He even barters on occasion with cash-strapped locals. One patient pays with fresh eggs and another with homemade cheese and goat's milk. Credit: Tara Higgins/Fosse Photography
"Direct primary care," which is the industry term for Neuhofel's business model, does away with the bureaucratic hassle of insurance, which translates into much lower prices. "What people don't realize is that most doctors employ an army of people for coding, billing, and gathering payment," says Neuhofel. "That means you have to charge $200 to remove an ingrown toenail." Neuhofel charges $50.
He consults with his patients over email and Skype in exchange for a monthly membership fee of $20-30. "I realized people would come in for visits with the simplest questions and I'd wonder, why can't they just email me?" says Neuhofel. Traditional doctors have no way to get paid when they consult with patients over the phone or by email because insurance companies only pay for office visits.
Why did he choose this course? Neuhofel’s answer: “I didn’t want to waste my career being frustrated.”
This model is growing in popularity. Leading practitioners of direct primary care include Seattle, Washington-based Qliance, which has raised venture capital funding from Jeff Bezos, Michael Dell, and comedian (and Reason Foundation Trustee) Drew Carey; MedLion, which is about to expand its business to five states; and AMG Medical Group, which operates several offices in New York City. Popular health care blogger Dr. Rob Lamberts has written at length about his decision to dump his traditional practice in favor of this model.
"Since I started my practice, I seem to hear about another doctor or clinic doing direct primary care every other week." says Neuhofel.
Direct primary care is part of a larger trend of physician-entrepreneurs all across the country fighting to bring transparent prices and market forces back to health care. This is happening just as the federal government is poised to interfere with the health care market in many new and profoundly destructive ways.
Obamacare, which takes full effect in 2014, will drive up costs and erode quality—and Americans will increasingly seek out alternatives. That could bring hordes of new business to practitioners like Neuhofel, potentially offering a countervailing force to Obamacare. (One example, the Surgery Center of Oklahoma's Dr. Keith Smith, profiled for Reason TV in September, is doing big business offering cash pricing for outpatient surgery at prices about 80 percent less than at traditional hospitals.)
Health "insurance" is more than just insurance; it's also "a payment plan for routine expenses," as University of Chicago business school economist John Cochrane puts it in a superb recent paper. The late free-market economist Milton Friedman pointed out that we insure our houses against fire and our cars against major damage, but we don't also insure ourselves against cutting the lawn and buying gas. That's the main reason innovation almost never makes health care cheaper. Most patients never see the bill for an ingrown toenail removal or a glucose tolerance test, so doctors have little incentive to seek ways to offer their services for less. For simple consultations, why bother with Skype when insurance will pay full price for an office visit.
Insurance plans that cover everything, a situation that came about largely because of a quirk in our tax code, have also led to the "bureaucratization of medical care," Friedman wrote in a 2001 essay, in which "the caregiver has become, in effect, an employee of the insurance company or...the government."
Dr. Lisa Davidson had 8 years of frustration while running a successful traditional practice in Denver, Colorado. She had 6,000 patients when she decided to stop taking insurance and adopt the same business model as Neuhofel. Her patient list has dropped to about 2,000. She used to spend about 15 minutes with each patient and now it's more like 45 minutes. "We're on track to make more money and take better care of our patients," says Davidson. "It's a win-win all around."
Before adopting direct primary care, Davidson was unhappy working at the practice she had built because the insurance system imposed a way of doing business that resembled an assembly line. "It's true that in 2014, many more people will have insurance, so there will be a profound need for primary care doctors," says Davidson. "You might say I've done a disservice by dramatically cutting the size of my practice. However, if we make it desirable again to be a primary care physician more people will want to do it."
Under Obamacare, more and more doctors are becoming employees of large hospitals, where there will be more control over how they practice medicine. Hoover Institution Senior Fellow Dr. Scott Atlas fears this will cause a brain drain in medicine. "Really smart people want autonomy, and when you take that away it's naive to think you're going to get really bright people becoming doctors," says Atlas. "The best doctors could excel at any profession, so why go into medicine if they won't have the opportunity to be their best?"
When she was operating a traditional practice, Davidson witnessed firsthand how our "payment plans for routine expenses" drive up prices and block innovation. She recalls that one insurance company paid $118 for a routine PSA test. Now that her patients pay the bill directly the cost is $18. Insurance used to pay $128 for a bag of IV fluid. Now Davidson doesn't bother passing on the cost of IV bags because they run $1.50 each.
Dr. Eric Bricker is the medical director at Compass, a Dallas-based company that helps individuals with high-deductible insurance plans. In a previous job, Bricker was a finance consultant for hospitals, giving him firsthand knowledge of how health insurance drives up prices. "When insurance companies and hospitals negotiate," says Bricker, "it's an exercise in horse trading." For example, an insurance company might let a hospital get away with charging $2,000 for an MRI, says Bricker. In exchange, the hospital agrees to charge the bargain price of $2,000 to deliver a baby. "You do that mixing and matching," says Bricker, "and at the end of the day it works out about even."
According to Bricker, this horse-trading method provides an opportunity for hospitals to earn windfall profits: If the hospital gets $2,000 for MRIs, it will start encouraging patients to get more MRIs.
Given how prices are set, it's no mystery why in health care high costs often correlate with low quality. Bricker cites one facility in Dallas, where a 3-tesla MRI (the more teslas, the higher the resolution) can be had for $860, while a nearby facility offers a 1.5-tesla MRI for $2,500. The former facility stays in business only because many of its customers don't know the difference. They pay the same $20 co-pay wherever they go for an MRI.
So Bricker co-founded Compass, which works with about 1,200 firms to guide their employees to those doctors and testing facilities that offer both high quality and low prices. These employees have an incentive to seek out value because they're responsible for paying a large portion of their own routine medical costs before their insurance coverage kicks in.
High-threshold plans are exploding in popularity, which is a promising trend. According to a 2012 report by the Kaiser Family Foundation, about 31 percent of firms now offer health plans in which patients pay most routine costs out of pocket, like a Health Savings Account (HSA) or Health Reimbursement Arrangement (HRA), and 19 percent of covered workers have one of these plans. High-deductible plans go a long way towards unbundling our "payment plans for routine expenses" from the catastrophic coverage that should be the sole function of health insurance.
"These plans offer hope," says Scott Atlas, "because they drive patients to care about what things cost. High deductible policies also eliminate much of the administrative cost of insurance because there's no need to file claims for routine charges."
Obamacare imposes new mandates on high-deductible plans, but it doesn't outlaw them. "The most devastating thing Obamacare could have done is to say it's illegal to have a deductible of more than $200," says Bricker. "So within the existing confines we can still have a successful business and help people."
Americans with high-deductible policies still have the misfortune of shopping for services in a health care market dominated by traditional health insurance. Since insurance companies and the government still pay the vast majority of medical bills, it's nearly impossible to find doctors who offer competitive and transparent prices.
A Houston-based start up called Snap Health is trying to remedy that by signing up doctors to list their prices on its website. Currently, there are 290 tests and about 100 doctors to choose from. You can buy an EKG (about $35), have a kidney stone analyzed ($250), or get a heart check up (about $400). Patients choose the procedure they want, pay online with a credit card, and then show up for their appointments. Snap Health's CEO and Co-founder Dr. David Wong says the biggest obstacle to building up a menu of offerings is that doctors accustomed to getting paid by insurance companies have no idea how to price their services for direct-paying clients.
Credit: Brad OttosenWong says he launched his business partly on the belief that Obamacare will drive up health care costs, causing more and more companies and individuals to drop out and start paying their own health care bills. Neuhofel agrees that Obamacare could be good for business. "I expect some real unintended consequences after Obamacare is implemented. There could be more uninsured people."
Lisa Davidson plans to enter the state-based exchanges that Obamacare will put in place. She cites a provision in the Affordable Care Act that explicitly allows direct primary care practitioners to marry their services with a catastrophic plan and enter the exchanges, although the details of what will be permitted under the law haven't been hammered out yet.
Eric Bricker also sees opportunity to work within the Affordable Care Act. "Compass is trying to make lemonade out of lemons," he says. "I think you can incrementally make improvements within Obamacare, and the situation will change over time."
The efforts of these doctors and others will undoubtedly help constrain exploding health care costs and improve care. But it's hard to fathom how within the legal constraints of Obamacare we'll see the sort of innovations that could solve the very problems that, ironically, were used to justify Obamacare's passage. As economist John Cochrane puts it, without government meddling, health insurance would be "individual, portable, life‐long, guaranteed‐renewable, transferrable, [and] competitive." And going to the doctor would be as simple and straightforward as eating out. What needs to be done to get there is painfully obvious.
http://reason.com/archives/2013/03/13/the-obamacare-revolt-physician-fight-bac/print
This article demonstrates well why we need to do away with the Private Health Insurance Companies. Take out the Middleman.
No Republican supports that. They support the Dictator Market of Private Health Insurance companies. This article is not an argument for Republican Policy whatsoever.
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Neuhofel strongly believes in continuity of care and believes his system will allow for a long-lasting doctor-patient relationship despite job, insurance or health conditions. That’s because he doesn’t accept any third party health plans.
Neuhofel said he has seen patients who had diabetes but hadn’t been to a doctor in five years because they changed jobs and lost insurance.
“That’s the silliest thing in the world,” he said. “It shouldn’t be expensive or difficult for people to do that.”
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Neuhofel knows his novel idea isn’t going to be an easy-sell.
“The big challenge in selling this idea is the concept of health insurance and health care have become synonymous. People don’t make a distinction,” he said. “People need to think about health care instead of health insurance to get health care.”
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This is from his Website-
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I thuink most health insurance is a scam.
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I thuink most health insurance is a scam.
I agree, but you support the Private Health Insurance Industry as do all Republicans and Democrats. This is the problem. I don`t see any Republicans solution other than going right along with Obamacare or establishing something nearly the same. Either way, Private Insurance stays at the dictatorial position, controlling the entire medical "industry".
Republicans don`t want to cut away the middleman any more than the Democrats. Both are the problem and if you support either one on their effort, then you become part of the problem as well.
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I agree, but you support the Private Health Insurance Industry as do all Republicans and Democrats. This is the problem. I don`t see any Republicans solution other than going right along with Obamacare or establishing something nearly the same. Either way, Private Insurance stays at the dictatorial position, controlling the entire medical "industry".
Republicans don`t want to cut away the middleman any more than the Democrats. Both are the problem and if you support either one on their effort, then you become part of the problem as well.
The only type of insurance I would support is some type of catastrophic hospitalization or something like that. Other than that - its a rip off.
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The only type of insurance I would support is some type of catastrophic hospitalization or something like that. Other than that - its a rip off.
Agreed, but why is this not represented in Washington by anyone except Bernie Sanders and the former Congressman Anthony Wiener?
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Agreed, but why is this not represented in Washington by anyone except Bernie Sanders and the former Congressman Anthony Wiener?
Because they all get $$$$$ and control the way it is.
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Because they all get $$$$$ and control the way it is.
I think we are fucked for years to come.
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I think we are fucked for years to come.
Correct unless the system hopefully implodes and we can have a chance at a do over.
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Correct unless the system hopefully implodes and we can have a chance at a do over.
As long as Obamacare remains, Private Health Insurance will only grow- Too Big to Fail (it already is at this point) will be engraved in granite.
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As long as Obamacare remains, Private Health Insurance will only grow- Too Big to Fail (it already is at this point) will be engraved in granite.
ObamaCare is the worst possible thing that could have come about - a private mandate to buy an insurance package that requires all sorts of shit you will never use w no price control whatsoever.
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Republicans should love ObamaCare. Its the same thing Bob Dole proposed with Insurance Companies at the forefront.
Can anyone tell me which Republican supports dismantling the Health Insurance Industry? ??? ??? ???
TA. Sometimes i think youre one of the smartest men on this board.
I just dont know when your goofing around or serious at times.
But you are right. The healthcare mandate is not a Doctor problem unless you listen to the complete bullshit from the other side. The doctors and healthcare professionals (money people) love the mandate, and medical groups here in California are scrambling to try to enroll the prospective new members. Is it shitty for the pt.. yes... but this whole "doctors will suffer " is insane
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TA. Sometimes i think youre one of the smartest men on this board.
I just dont know when your goofing around or serious at times.
But you are right. The healthcare mandate is not a Doctor problem unless you listen to the complete bullshit from the other side. The doctors and healthcare professionals (money people) love the mandate, and medical groups here in California are scrambling to try to enroll the prospective new members. Is it shitty for the pt.. yes... but this whole "doctors will suffer " is insane
Doctors are not bereft of greed, especially when they are part of a large health conglomerate ran as a corporation. They love having the middle man around because its guaranteed income. Moreso now with a government mandate in place.
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Doctors are not bereft of greed, especially when they are part of a large health conglomerate ran as a corporation. They love having the middle man around because its guaranteed income. Moreso now with a government mandate in place.
Bingo. If they had to negotiate w patients directly like most other people have things would be a hell of a lot different.
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Bingo. If they had to negotiate w patients directly like most other people have things would be a hell of a lot different.
dude.. you were just saying that doctors are going to the poor house before.. .what the fuck are you talking about now?
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Bingo. If they had to negotiate w patients directly like most other people have things would be a hell of a lot different.
Bingo?...bingo what... this goes against everything youve been saying you fucking shapeshifter
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Doctors are not bereft of greed, especially when they are part of a large health conglomerate ran as a corporation. They love having the middle man around because its guaranteed income. Moreso now with a government mandate in place.
Ive said this for 2 years now.. this Mandate just made ensured the Physicans are well stocked with patients.
Ive said that the Obamacare was pure shit because it didnt fix the root of the problem, as its not "universal" Its making medical groups rich
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http://online.wsj.com/article/SB10001424127887323628804578346614033833092.html?mod=WSJ_Opinion_LEADTop
Good job supporting ObamaCare solely because Obama is black you stupid fuck.
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Neuhofel strongly believes in continuity of care and believes his system will allow for a long-lasting doctor-patient relationship despite job, insurance or health conditions. That’s because he doesn’t accept any third party health plans.
Neuhofel said he has seen patients who had diabetes but hadn’t been to a doctor in five years because they changed jobs and lost insurance.
“That’s the silliest thing in the world,” he said. “It shouldn’t be expensive or difficult for people to do that.”
Still haven't learned math, I see.
He's charging far less than insurance or premiums would cost.
Nationalization of healthcare will definitely create shortages. The real questions are: What demographic will be hurt the most? And how high will taxes be raised so the govt can compensate its own victims?
Everyone is already guessing at how long indentured servitude will be for physicians but I haven't seen a single projection or discussion on preventing FMGs from exercising the nuclear option.
Also, I've yet to see/read anything about the legality of declaring a healthcare state of emergency and forcing doctors to treat patients.
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Still haven't learned math, I see.
He's charging far less than insurance or premiums would cost.
Nationalization of healthcare will definitely create shortages. The real questions are: What demographic will be hurt the most? And how high will taxes be raised so the govt can compensate its own victims?
Everyone is already guessing at how long indentured servitude will be for physicians but I haven't seen a single projection or discussion on preventing FMGs from exercising the nuclear option.
Also, I've yet to see/read anything about the legality of declaring a healthcare state of emergency and forcing doctors to treat patients.
What the hell are you talking about? I don`t support Obamacare and the article posted has NOTHING to do with Obamacare.
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Was a joke, TA.
Democrats steal your sense of humor?
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Was a joke, TA.
Democrats steal your sense of humor?
Yes! They have stolen all humor, mine included, because at the present, they are the biggest joke in town.
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Yes! They have stolen all humor, mine included, because at the present, they are the biggest joke in town.
FWIW,
There are things people just need to find out the hard way. Not trusting politicians is one of them
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It hasnt... but im new on the scene so i havent been able to compare it to anything...
No, and I wouldn't expect it to be felt immediately. But as more doctors are pushed to treating people on Medicaid, either your wages are going down, premiums are going up, or some combination (the latter most likely, IMO).
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Agreed, but why is this not represented in Washington by anyone except Bernie Sanders and the former Congressman Anthony Wiener?
I'd be interested in knowing what "grandpa's" position is on this matter.
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I'd be interested in knowing what "grandpa's" position is on this matter.
gramps would have you in chains where you belong.
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http://online.wsj.com/article/SB10001424127887323628804578346614033833092.html?mod=WSJ_Opinion_LEADTop
Good job supporting ObamaCare solely because Obama is black you stupid fuck.
Lol you're retarded. I said I don't support Obamacare. I'm just destroying your dumbass baseless argument. So....from that and disregarding the fact that I have repeated many times, " I'm not a fan of Obama care" you deduce " you are for Obama care cuz he's black"......and you wonder why republicans are accused of living Ina bubble. You hear and read what you want.
Or you're a retarded troll
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Tags: obamacare | family | physician | shortage Top Doc: Say Bye to Your Family Doctor When Obamacare Hits
Monday, 18 Mar 2013 06:27 PM
By Bill Hoffmann
More ways to share... Mixx Stumbled LinkedIn Vine Buzzflash Reddit Delicious Newstrust Technocrati Share: More . . . A A | Email Us | Print | Forward Article
0
inShare inShare0 Americans may no longer have access to their family doctors because of Obamacare, according to Dr. Scott Gottlieb, a resident fellow at the American Enterprise Institute.
“By next year more than 50 percent of all physicians in the country … will be working either for a hospital or a hospital and health network as a salaried employee,’’ Gottlieb told Newsmax TV’s “The Steve Malzberg Show.’’
“So the idea of the local doctor owning their practice and practicing locally — that’s going away.’’
That’s because incentives in the Affordable Care Act will pay physicians to practice as employees rather than to own their own businesses, Gottlieb explained.
“This is going to have some negative ramifications for our patients,’’ he said.
“They’re going to get more of their care from hospital-owned clinics that aren’t going to have the look and feel of the local doctors’ office.’’
Just as alarming, he added, is that doctors “basically are just working shifts and accountability to the patient could be lost as they get handed off from shift to shift to shift.’’
Editor's Note: ObamaCare Is About to Strike Are You Prepared?
Gottlieb — who also served at the Food and Drug Administration as Deputy Commissioner for Medical and Scientific Affairs — said the concept of Obamacare has already been tested — and has a record of failure.
“We’ve tried this before in the 1990s and it didn’t work when we tried to give hospitals incentives to buy out doctor practices, run these integrated living systems. A few hospitals survived and thrived but most of them didn’t. Most of them failed,’’ he said.
“There’s this naïve notion that if you can just consolidate doctors around a hospital and it’s going to lead to improve in care and better coordination of care. But that’s not what’s happening.’’
Read Latest Breaking News from Newsmax.com http://www.newsmax.com/Newswidget/obamacare-family-physician-shortage/2013/03/18/id/495239?promo_code=11102-1&utm_source=11102Real_Clear_Politics&utm_medium=nmwidget&utm_campaign=widgetphase1#ixzz2O11o21sI
Urgent: Should Obamacare Be Repealed? Vote Here Now!
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Kaiser Health News | 32 Comments
Group Appointments With Doctors: When Three Isn't A Crowd
More doctors are holding appointments with multiple patients, a trend some say may help ease a forecasted shortage of physicians.
By Michelle Andrews, Kaiser Health News
TUESDAY, March 19, 2013 (Kaiser Health News) — When visiting the doctor, there may be strength in numbers.
In recent years, a growing number of doctors have begun holding group appointments — seeing up to a dozen patients with similar medical concerns all at once. Advocates of the approach say such visits allow doctors to treat more patients, spend more time with them (even if not one-on-one), increase appointment availability and improve health outcomes.
Some see group appointments as a way to ease looming physician shortages. According to a study published in December, meeting the country's health-care needs will require nearly 52,000 additional primary-care physicians by 2025. More than 8,000 of that total will be needed for the more than 27 million people newly insured under the Affordable Care Act.
"With Obamacare, we're going to get a lot of previously uninsured people coming into the system, and the question will be 'How are we going to service these people well?' " says Edward guy, who has developed group-visit models and consults with providers on their implementation. With that approach, "doctors can be more efficient and patients can have more time with their doctors."
Some of the most successful shared appointments bring together patients with the same chronic condition, such as diabetes or heart disease. For example, in a diabetes group visit, a doctor might ask everyone to remove their shoes so he can examine their feet for sores or signs of infection, among other things. A typical session lasts up to two hours. In addition to answering questions and examining patients, the doctor often leads a discussion, often assisted by a nurse.
Insurance typically covers a group appointment just as it would an individual appointment; there is no change in the co-pay amount. Insurers generally focus on the level of care provided rather than where it's provided or how many people are in the room, guy says.
Some patients say there are advantages to the group setting. "Patients like the diversity of issues discussed," guy says. "And they like getting 2 hours with their doctor."
Patients sign an agreement promising not to disclose what they discuss at the meeting. Although some patients are initially hesitant about the approach, doctors say their shyness generally evaporates quickly.
"We tell people, 'You don't have to say anything,' " says Edward Shahady, medical director of the Diabetes Master Clinician Program at the Florida Academy of Family Physicians Foundation in Jacksonville. Shahady trains medical residents and physicians to conduct group visits with diabetes patients. "But give them 10 minutes, and they're talking about their sex lives."
Though group appointments may allow doctors to increase the number of patients they see and thereby boost their income, many doctors are uncomfortable with the concept, experts say, because they're used to taking a more authoritative approach with patients rather than facilitating a discussion with them.
According to the American Academy of Family Physicians, 12.7 percent of family physicians conducted group visits in 2010, up from 5.7 percent in 2005.
Some studies have found that group visits can improve health outcomes. In an Italian trial that randomly assigned more than 800 Type 2 diabetes patients to either group or individual care, the group patients had lower blood glucose, blood pressure, cholesterol and BMI levels after four years than the patients receiving individual care.
Doctors say patients may learn more from each other than they do from physicians. "Patients really want to hear what others patients are experiencing, " Shahady says.
Jake Padilla of Westminster, Colo., participated in his first group visit more than a decade ago, shortly after he had heart bypass surgery.
Padilla, now 67, continued to attend group appointments geared to primary-care patients' concerns for years after that at the Kaiser Permanente outpatient clinic near his home. (Kaiser Health News is not affiliated with Kaiser Permanente.) He usually went once a month or so, and the members of the group constantly changed.
One woman who attended the group was 102 years old, he remembers. Fellow patients wanted to know how she managed to live that long. One of her secrets, she said, was deep breathing. Padilla has since used that advice when his blood pressure gets out of control.
But group visits aren't for everyone. Padilla's wife, Tedi, went to one meeting with him and never went back.
"She said she didn't have time to sit there and listen to all those patients," he says.
Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communications organization not affiliated with Kaiser Permanente.
Last Updated: 03/19/2013
| 32 Comments
Read Next
"Cancer Patient " Means Someone Else »
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Tags: obamacare | family | physician | shortage Top Doc: Say Bye to Your Family Doctor When Obamacare Hits
Monday, 18 Mar 2013 06:27 PM
By Bill Hoffmann
More ways to share... Mixx Stumbled LinkedIn Vine Buzzflash Reddit Delicious Newstrust Technocrati Share: More . . . A A | Email Us | Print | Forward Article
0
inShare inShare0 Americans may no longer have access to their family doctors because of Obamacare, according to Dr. Scott Gottlieb, a resident fellow at the American Enterprise Institute.
“By next year more than 50 percent of all physicians in the country … will be working either for a hospital or a hospital and health network as a salaried employee,’’ Gottlieb told Newsmax TV’s “The Steve Malzberg Show.’’
“So the idea of the local doctor owning their practice and practicing locally — that’s going away.’’
That’s because incentives in the Affordable Care Act will pay physicians to practice as employees rather than to own their own businesses, Gottlieb explained.
“This is going to have some negative ramifications for our patients,’’ he said.
“They’re going to get more of their care from hospital-owned clinics that aren’t going to have the look and feel of the local doctors’ office.’’
Just as alarming, he added, is that doctors “basically are just working shifts and accountability to the patient could be lost as they get handed off from shift to shift to shift.’’
Editor's Note: ObamaCare Is About to Strike Are You Prepared?
Gottlieb — who also served at the Food and Drug Administration as Deputy Commissioner for Medical and Scientific Affairs — said the concept of Obamacare has already been tested — and has a record of failure.
“We’ve tried this before in the 1990s and it didn’t work when we tried to give hospitals incentives to buy out doctor practices, run these integrated living systems. A few hospitals survived and thrived but most of them didn’t. Most of them failed,’’ he said.
“There’s this naïve notion that if you can just consolidate doctors around a hospital and it’s going to lead to improve in care and better coordination of care. But that’s not what’s happening.’’
Read Latest Breaking News from Newsmax.com http://www.newsmax.com/Newswidget/obamacare-family-physician-shortage/2013/03/18/id/495239?promo_code=11102-1&utm_source=11102Real_Clear_Politics&utm_medium=nmwidget&utm_campaign=widgetphase1#ixzz2O11o21sI
Urgent: Should Obamacare Be Repealed? Vote Here Now!
lol ....ok...Healthcare partners...Medical group.... Doctor owned. Endorses Obamacare as its good for business according to the doctors.....so..ummm..ye ahhhh
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Most docs are agajnst kenyacare
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lol ....ok...Healthcare partners...Medical group.... Doctor owned. Endorses Obamacare as its good for business according to the doctors.....so..ummm..ye ahhhh
Read it again:
“This is going to have some negative ramifications for our patients,’’ he said.
“They’re going to get more of their care from hospital-owned clinics that aren’t going to have the look and feel of the local doctors’ office.’’
Just as alarming, he added, is that doctors “basically are just working shifts and accountability to the patient could be lost as they get handed off from shift to shift to shift.’’
Editor's Note: ObamaCare Is About to Strike Are You Prepared?
Gottlieb — who also served at the Food and Drug Administration as Deputy Commissioner for Medical and Scientific Affairs — said the concept of Obamacare has already been tested — and has a record of failure.
“We’ve tried this before in the 1990s and it didn’t work when we tried to give hospitals incentives to buy out doctor practices, run these integrated living systems. A few hospitals survived and thrived but most of them didn’t. Most of them failed,’’ he said.
“There’s this naïve notion that if you can just consolidate doctors around a hospital and it’s going to lead to improve in care and better coordination of care. But that’s not what’s happening.’’
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Remember - Mal supports obama because he is black, and that alone trumps all else - who gives a fuck if his profession is destroyed in the process.
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Remember - Mal supports obama because he is black, and that alone trumps all else - who gives a fuck if his profession is destroyed in the process.
Ah, that explains alot.
Well, you have to give them credit. Most blacks stick together through thick and stupid.
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Under Obamacare, more and more doctors are becoming employees of large hospitals, where there will be more control over how they practice medicine. Hoover Institution Senior Fellow Dr. Scott Atlas fears this will cause a brain drain in medicine. "Really smart people want autonomy, and when you take that away it's naive to think you're going to get really bright people becoming doctors," says Atlas. "The best doctors could excel at any profession, so why go into medicine if they won't have the opportunity to be their best?"
Funny, that quote looks like something right out of the book/film Atlas Shrugged, and the guy's name is Atlas. :)
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http://www.theblaze.com/stories/2013/03/20/here-are-two-reminders-that-obamacare-will-be-controlled-by-a-massive-bureaucracy
Unreal. Only a seriously demented person approves of ShitHeadCare
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Remember - Mal supports obama because he is black, and that alone trumps all else - who gives a fuck if his profession is destroyed in the process.
Sooooo..you say "doctors hate Obama care"
Then i show you real world evidence that there is a very successful Medical Group that works with Obama care...
i simply show you proof that your thread might be incorrect...and your counter is
"you like obamacare because hes black"
But then wonder why a GOP heavy hitter named you "the stupid party"...
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Obamacare official: “Let’s just make sure it’s not a third-world experience”
March 22, 2013 | 11:11 am
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Philip Klein
Senior Editorial Writer
The Washington Examiner
With time-running out before the major provisions of President Obama’s health care law are set to be implemented, the official tasked with making sure the law’s key insurance exchanges are up and running is already lowering expectations.
“The time for debating about the size of text on the screen or the color or is it a world-class user experience, that’s what we used to talk about two years ago,” Henry Chao, an official at the Centers for Medicaid and Medicare Services who is overseeing the technology of the exchanges said at a recent conference. “Let’s just make sure it’s not a third-world experience.”
Chao also described himself as “nervous.” His comments, which came at a policy meeting of insurance industry lobbying group America’s Health Insurance Plans, were first reported by CQ Health Beat and picked up by Avik Roy at Forbes.
The idea of regulated insurance exchanges, on which eligible individuals can use government subsidies to purchase insurance coverage, is central to the law. By 2023, the Congressional Budget Office projects that 25 million Americans will obtain coverage through the exchanges.
As originally pitched, the exchanges were to be easy to use — like Expedia or Orbitz for health insurance — allowing users to fill out basic information, have the government database verify their eligibility, and then enable them to choose among competing plans.
But achieving this has been proving to be a huge hurdle. The exchanges are supposed to be available for open enrollment by Oct. 1 and benefits are supposed to kick in on January 1. Also adding to the workload — 26 states have chosen to let the federal government set up their exchanges.
The CQ article also quotes Gary Cohen, director of the federal Center for Consumer Information and Insurance Oversight, as conceding that the exchanges may not be fully functional in all 50 states in time. “I think it’s only prudent to not assume everything is going to work perfectly on day one and to make sure that we’ve got plans in place to address things that may happen,” Cohen said.
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http://www.breitbart.com/Big-Government/2013/03/20/Physician-Entrepreneurs-Revolt-Against-ObamaCare
F Obama! Fng ghetto basehead
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http://www.mcclatchydc.com/2013/11/20/209165/doctors-are-concerned-about-pay.html
:(
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http://www.breitbart.com/Big-Government/2013/03/20/Physician-Entrepreneurs-Revolt-Against-ObamaCare
F Obama! Fng ghetto basehead
Chris, your persistence is admirable but give it a little break will you fella?
GO have a nice coffee with the missus and a lovely early morning walk.
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Chris, your persistence is admirable but give it a little break will you fella?
GO have a nice coffee with the missus and a lovely early morning walk.
Nope - not until this communist coke head is out of office and exposed for the criminal he is
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Nope - not until this communist coke head is out of office and exposed for the criminal he is
2016 dude. You going to keep this up for another 3 years?
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2016 dude. You going to keep this up for another 3 years?
Hopefully not. ;)
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Hopefully not. ;)
That's good pal. People here are concerned about your mental state. Just looking out for you dude. (no homo)
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Nope - not until this communist coke head is out of office and exposed for the criminal he is
You have been trying to get this message out since he got elected.
Too bad people dont give a shit about your opinion, huh ;)
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That's good pal. People here are concerned about your mental state. Just looking out for you dude.
same
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Medicaid Growth Could Aggravate Doctor Shortage
SAN DIEGO — Dr. Ted Mazer is one of the few ear, nose and throat specialists in this region who treat low-income people on Medicaid, so many of his patients travel long distances to see him.
But now, as California’s Medicaid program is preparing for a major expansion under President Obama’s health care law, Dr. Mazer says he cannot accept additional patients under the government insurance program for a simple reason: It does not pay enough.
“It’s a bad situation that is likely to be made worse,” he said.
His view is shared by many doctors around the country. Medicaid for years has struggled with a shortage of doctors willing to accept its low reimbursement rates and red tape, forcing many patients to wait for care, particularly from specialists like Dr. Mazer.
Yet in just five weeks, millions of additional Americans will be covered by the program, many of them older people with an array of health problems. The Congressional Budget Office predicts that nine million people will gain coverage through Medicaid next year alone. In many of the 26 states expanding the program, the newly eligible have been flocking to sign up.
Community clinics, which typically provide primary but not specialty care, have expanded and hired more medical staff members to meet the anticipated wave of new patients. And managed-care companies are recruiting doctors, nurse practitioners and other professionals into their networks, sometimes offering higher pay if they improve care while keeping costs down. But it is far from clear that the demand can be met, experts say.
In California, with the nation’s largest Medicaid population, many doctors say they are already overwhelmed and are unable to take on more low-income patients. Dr. Hector Flores, a primary care doctor in East Los Angeles whose practice has 26,000 patients, more than a third of whom are on Medicaid, said he could accommodate an additional 1,000 Medicaid patients at most.
http://www.nytimes.com/2013/11/29/us/lack-of-doctors-may-worsen-as-millions-join-medicaid-rolls.html?partner=rss&emc=rss&smid=tw-nytimes&_r=0
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Doomed to fail but Sallie Mae will get a lot of love when medical student loans are forgiven.