The Happy Hospitalist - Latest Comments in Payment Reform Coming Down The Pipe Line

Re: Payment Reform Coming Down The Pipe Line

Robyn — Fri, 02 Oct 2009 21:40:09 -0000

Oh - and to see in the future - read the NHS Doctor Blog. My husband and I - being retired and having some time on our hands from time to time - have on a couple of occasions stopped by the NP in a box at Walgreen's and the like. The people staffing those places know less medicine than we do as retired malpratice lawyers (no offense to Nurse K - I'm sure there are doctors around today who know less than experienced nurses - but the people we've spoken with in drugstores are totally pathetic).

Re: Payment Reform Coming Down The Pipe Line

Robyn — Fri, 02 Oct 2009 13:57:31 -0000

The physicians are revolting. They are avoiding primary care and becoming dermatologists. Many are refusing to accept Medicare patients (most have refused to accept Medicaid patients for a long time). Takes a while for all of this to work its way through the pipeline (Medicare patients didn't have many problems finding primary care docs 10 years ago - today they do). But it is working its way through the pipeline and will get a whole lot worse (remember - the first boomers won't qualify for Medicare for a couple of years - and right now they are upsetting all prior assumptions about Social Security by taking early SS in record numbers).

Re: Payment Reform Coming Down The Pipe Line

Name — Fri, 02 Oct 2009 12:50:23 -0000

I wish you physicians would stand up and revolt.

Re: Payment Reform Coming Down The Pipe Line

Name — Fri, 02 Oct 2009 02:33:38 -0000

I wouldn't support anything written by RJWF. Ugh they give me the shivers.

Re: Payment Reform Coming Down The Pipe Line

Robyn — Thu, 01 Oct 2009 19:44:20 -0000

And FWIW - like I've said before - I have nothing against hospitalists. They handled my FIL during his hospital admissions in terms of checking in on him - adjusting some of his meds if necessary - etc. (there was also an in-house doc from UF at my FIL's SNF - and he pretty much did the same things for all the residents). But could do they do anything about his cancers - no. Ditto with his CHF - except to try to keep it from getting to a crisis point.

Re: Payment Reform Coming Down The Pipe Line

Robyn — Thu, 01 Oct 2009 19:38:43 -0000

As someone who isn't a doctor - I don't know whether or not this is a joke. Can someone in the health care field define "bundled care" to me in 3 sentences or less? How do you bundle care when a patient has - for example - 2 problems. Like say my husband has a hole in his heart valve - and MS (which happens to be the case). Does the neurologist do his echo - or does the cardiologist do his EMG?
And who's going to do basic stuff - like his regular rectal exam (funny - that is something that no one seems to want to do). Or what about another patient with IBS and hypertension (hypothetical patient). When I read stuff like this - I think of a client who has to get his divorce and his slip and fall case "bundled" (a really silly concept IMO). Of course - these are relatively "healthy" patients. When you get to someone like my late FIL - who suffered from CHF - and 2 totally unrelated metastatic cancers - before he died from a stroke - well how do we "bundle" his care? The guy who does his bladder cancer surgery also removes the angiosarcoma on his head? And treats him in the ER when he has a double pneumothorax as well? Finally - does this mean we will all wind up having to get our care at one place (even though most places are really good at some things - and perhaps not so good at others).

Anyway - how does this work in practice - as opposed to theory?