The quality improvement movement has changed its focus from improving the health of patients to obtaining the greatest return for the investment. Why? Because experience has shown, time and again that the former is beyond our abilities, beyond any 'carrot and stick' approach to patient care, and beyond any contrived incentive realignments. When it comes to lifestyle management, we fail, miserably. For instance, getting people to stop smoking, the only thing that has worked is raising the pric
quality, cost and/or access
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The Bio-Psycho-Social, Collaborative Model of Healthcare "It is possible to screen for and treat depression in the primary care setting. Collaborative care for depression can succeed in diverse settings with a range of staffing combinations, patient demographics, and physical layouts. Centralized data support is essential to drive operational workflows and quality improvement across multiple sites."
Much of the work on health disparities and inequities in access focuses on comparisons between the insured and those without coverage. It should come as no surprise that the uninsured come out wanting and “Uninsurance is associated with mortality.” Furthermore, Uninsured persons have less access to services, suffering worse health outcomes than that of the insured. Breast Cancer patients seem to have a 30-50% higher mortality rate then those without cancer.
A payer judges a physician or a practice organization by the proportion of patients for which the physician adhered to one or more abstract practice measures. Those in quality measurement seem to be attempting to align the clinical quality measures that are relevant to Electronic (EHR) Incentive Programs. Isn't that artificial and once removed from the patient's care?
It's vital to address safety concerns in primary care, especially that which comes from diagnostic errors (i.e., missed, delayed, or incorrect diagnoses). Diagnostic errors are unfortunately all too frequent and they are the largest contributor to "ambulatory malpractice claims (40% in some studies)"; they "cost approximately $300 000 per claim on average."
When patients require specific therapies and an insurance company makes the frail or sickly patients jump thru hoops, denying or delaying care, it's time to move away from the insurance model. How furious should we be when the insurer uses technicalities to refuse coverage, makes patients wait incessantly on the phone, transfers calls to G_d knows now many departments and then, after seemingly hours, the connection breaks, etc.?
Read how "shotgun medicine" can be harmful to your health!
...to generate pieces (Dr. Caldwell Esselstyne, circa mid '60's). Specialists even more than primary care practitioners fractionalize care; that's costly; In the medical home, primary care treats the whole patient. To explain the drastic shift needed to encourage primary care and discourage a further and unjustified overabundance of specialists, know that: 35% of visits for circulatory conditions are to family physicians, 27% of visits for musculoskeletal problems are to family physicians
If you are in a concierge medical practice or you are a specialist, you can stop reading. But, if you aren't and are concerned about the pressure to reduce the costs of care while not compromising accessibility or the quality of care, then understand the incentives matter critically to you; ignore that and you will pay dearly.
The question really is what are you getting for your health care dollar? What's right or not right with the healthcare system, and why? And, what specifically needs to be changed and how will that be accomplished, if at all? The "Bang for the buck" issue is the Medical Loss Ratio. I am revisiting it from a previous publication, "Healthcare Reform Will Fail if We Don’t Reduce Costs!" that had appeared in HCPLive.com