Archive for the 'Primary Care in America' Category

Another Sign of the End-Times for the Doctor-Patient Relationship

Wednesday, January 16th, 2008

A feel-good story in the Philadelphia Inquirer does not make DrRich feel good.
The story extols a local (to Philadelphia) start-up company called Verilogue. Verilogue places digital audio recorders in the offices of physicians, and “captures every word” of the doctor-patient encounter. Verilogue then processes these conversations, appropriately scrubbing them of identifiers, and places them into […]

Posted in General Rationing Issues, Primary Care in America | 5 Comments »

On the Transcendant Importance of Retainer Medicine

Friday, January 4th, 2008

For the last week or more, DB has been conducting a lively give-and-take over at DB’s Medical Rants on the topic of retainer medicine. DrRich urges his readers who may have missed this ongoing exchange to take some minutes to acquaint themselves with it.
DB has offered a studied and persuasive apology (in the Platonic sense, […]

Posted in General Rationing Issues, New business models for healthcare, Primary Care in America | 5 Comments »

Patients, Doctors, and Remote Third Parties

Thursday, December 27th, 2007

Why not just eliminate the middleman?
In an interesting posting on EconLog, noted economist Arnold Kling, PhD (in answer to an essay by Richard Dolonar on why it’s important for doctors to individualize clinical decisions) says,
“My own view is that a remote third party probably can use statistical evidence to make good recommendations for a course […]

Posted in General Rationing Issues, Primary Care in America | 6 Comments »

Another Way to Run Afoul of E&M Coding

Wednesday, December 5th, 2007

Last week, DrRich ranted on the E&M coding guidelines, and attempted to demonstrate how this oppressive and uninterpretable set of rules has harmed patient care, and has exposed many if not most doctors to the constant threat of an unpleasant visit from the Office of the Inspector General.
DB took up the call here, and the […]

Posted in Wonkonian Rationing, Primary Care in America | 3 Comments »

E&M Guidelines and Patient Care

Wednesday, November 28th, 2007

The Happy Hospitalist has posted on the mysteries of documenting for Medicare that one deserves reimbursement for delivering medical care to a patient. HH’s description of the documentation hoops through which physicians now must jump is detailed enough that it’s actually difficult to read. Which is the point.
The E&M (”evaluation and management”) guidelines, introduced […]

Posted in Wonkonian Rationing, Primary Care in America | 3 Comments »

A Unique Way to Salvage the Doctor-Patient Relationship

Wednesday, October 31st, 2007

As we have seen, covert healthcare rationing requires destruction of the classic doctor-patient relationship (since a common final pathway for covert rationing is the bedside). The government and private insurers accomplish this task by several mechanisms, but the one that has recently gotten the most attention on this blog is the gambit of severely […]

Posted in General Rationing Issues, Primary Care in America | 4 Comments »

Another Reason For Doctors To Avoid Primary Care Medicine

Monday, October 8th, 2007

As everyone knows, young doctors are avoiding primary care medicine in droves. And while healthcare policy experts feign great puzzlement as to why this might be, the answers seem pretty obvious. The pay (which is not determined by the market, but by Acts of Congress) is low, the hours long, the prestige diminishing. Primary care […]

Posted in Gekkonian Rationing, Primary Care in America | 7 Comments »

The AMA Takes on In-Store Health Clinics

Friday, September 21st, 2007

Despite the fact that covert rationing has systematically separated the interests of doctors from the interests of their patients, thus programmatically destroying the doctor-patient relationship, leaving patients to fend for themselves within a cruel healthcare system, and leaving doctors to wallow in frustration at their loss of autonomy and at the demolition of their once-proud, […]

Posted in General Rationing Issues, Primary Care in America | 3 Comments »

Pay for Performance and Covert Rationing (2)

Friday, September 14th, 2007

In a previous post, DrRich described the most obvious problems with Pay for Performance (P4P) when applied under a system of covert rationing. In the present post he addresses some of the more subtle and insidious aspects of P4P.
Consider, firstly, that the large insurers - and to some extent Medicare - have by now successfully […]

Posted in General Rationing Issues, Primary Care in America | 2 Comments »

Pay for Performance and Covert Rationing (1)

Tuesday, September 11th, 2007

Pay for Performance (P4P) is the latest trend among health insurers and our friends in the government in their never-ending efforts to assure that patients in their charge are receiving top-quality healthcare. At least, that’s what they say.
Under P4P, certain “clinical practice guidelines” are developed by Medicare or private insurers, based on the principles of […]

Posted in Gekkonian Rationing, Wonkonian Rationing, General Rationing Issues, Primary Care in America | 8 Comments »

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