(06-11-2015 09:57 AM)maximus Wrote:  

(06-11-2015 07:33 AM)EverRespect Wrote:  

(06-10-2015 10:14 PM)dfarr Wrote:  I don't see how telemedicine has a role in my office and we see patients from roughly a 6 hospital area. Hard to check a prostate via the interwebs.

It won't have a role for specialists. It does reduce costs for primary care. Common colds and flus, infections, poison ivy, coughs, vomiting, allergies etc can be diagnosed and a prescription written for free (at least my company offers it for free) over the phone as opposed to having to take time off work and spend $100+ (if you have deductibles and no copays) to visit a PCP or doc in the box. Our program started in January and I haven't had to use it yet, but have heard good things from coworkers. The other alternative would be to open up the market a bit and make some of these drugs available OTC.

There a few models

The one your employer offers doesn't include specialists but other models do and will.

Curious what vendor your company uses.

Meritain Health Teladoc

(06-11-2015 07:33 AM)EverRespect Wrote:  

(06-10-2015 10:14 PM)dfarr Wrote:  I don't see how telemedicine has a role in my office and we see patients from roughly a 6 hospital area. Hard to check a prostate via the interwebs.

It won't have a role for specialists. It does reduce costs for primary care. Common colds and flus, infections, poison ivy, coughs, vomiting, allergies etc can be diagnosed and a prescription written for free (at least my company offers it for free) over the phone as opposed to having to take time off work and spend $100+ (if you have deductibles and no copays) to visit a PCP or doc in the box. Our program started in January and I haven't had to use it yet, but have heard good things from coworkers. The other alternative would be to open up the market a bit and make some of these drugs available OTC.

Pedantic correction... sorry... We use and I favor telemed where appropriate... but (and this is a HUGE part of what I do) it is important not to overstate what telemed can and can't do.

It doesn't reduce the cost of primary care like well-checks or physicals or anything involving a lab or culture. As you note, it MAY reduce the cost TO BUSINESS of people taking time off between 8-5 rather than seeing a virtual doc in a different time zone for minor ailments, but it doesn't reduce the doctor's costs. There still has to be an office where he can refer you to for testing and then he has to interpret those results. The reason this matters is that well-checks and physicals are covered by exchange policies... but office visits are subject to deductibles and copays. You can't 'turn your head and cough' via telemed.

The BIGGEST area where telemed can reduce costs is in small, remote, rural areas. As an example, in some of my rural hospitals, I have 1 doc in the ER but no doc on the floor. We telemed the floor doc from my other facilities and use the onsite ER doc if someone needs to 'touch' the patient. Of course, under the law (so it's not really subject to debate) we have by definition reduced the level of care for those patients... or in the ER when the ER doc is called away. That way I can have 2 er docs and 1 floor doc on 24/7 at 2 facilities as opposed to 2 er docs and 2 floor docs.

Of course, how do YOU feel if you are in a hospital and you never actually see your doctor?

Now, where telemed could REALLY make a difference is in skilled nursing facilities..... but you have to understand the economics of a SNF to understand the problems... Because people in a SNF need 24 hour care, a physician is required to be on call 24/7/365... However, if the patient is residential, you can only get PAID to see them once a month... between $60 and $140. If the patient is rehab, it's generally once a week, maybe twice... again, at about the same level. When you start doing the math and considering the 24/7 nature... it is VERY hard for a doctor to justify this business model, unless you have one doctor covering a facility with literally hundreds of beds. I don't know how many SNF's you've seen, but lots of them are <100 beds.... and of course, NONE of them have to worry about the uninsured. Lots of them don't take Medicaid... though some states pay extra to get them to.

Telemed isn't yet fully approved for that to qualify... meaning the docs can telemed to augment their care, but they still must eventually put hands on the patient to bill for them.

I meant it reduces the cost to me as an individual. It is provided by my company and cost me $0, which is significantly lower than having to go to a PCP or doc in the box and pay $100 for the visit. I don't know what the company pays for the service, but I am glad they provide it. I am speaking more on an individual level then having hospitals use a teledoc service. I don't think that is a good idea. If someone is at the hospital, they need to be seen, IMO.

If you utilize this app for minor issues you eliminate a visit to your PCP. Wouldn't that help with the back log? Your PCP would see you on a regular basis but there is no need to go in for every little thing.

(06-11-2015 09:57 AM)maximus Wrote:  The one your employer offers doesn't include specialists but other models do and will.

I don't really see how a specialist can treat a patient via telemed... Of you need a specialist, they probably have to run tests or otherwise touch the patient.

(06-11-2015 04:36 PM)dawgitall Wrote:  If you utilize this app for minor issues you eliminate a visit to your PCP. Wouldn't that help with the back log? Your PCP would see you on a regular basis but there is no need to go in for every little thing.

How does it help the backlog? It doesn't take any less of the doctor's time to look at you on a screen than to look at you in an office. It CAN address some location issues as I mentioned... but once again, it doesn't increase the 'supply' of care available. Well, unless we somehow use doctors in other countries.

Think about what a doctor does. In about 90% of situations, someone must touch you. draw blood, palpitate the skin... take your temperature. Iy sounds trite but you'd be amazed at how unreliable 'home drawn' temperatures can be... especially by the sick and elderly. It might be a nurse rather than a doctor... but someone must touch you. In those situations where nobody has to touch you... you aren't really sick and don't need to be going to a doctor in the first place.

I don't know how to say this because there are so many 'buts and ifs' if all someone wants to do is nit=pick and example... ... But if someone presents to the teledoc with what looks like the sniffles and it IS the sniffles, you just wasted the doctor's time. Most mothers, 90% of pharmacists and ANY RN could have diagnosed that... and if you present to the teledoc with what looks like the sniffles and it ISN'T the sniffles, there is no way, short of a nurse touching that patient that you would know... perhaps until after it is too late... or at least until things are far more expensive to cure now than they needed to be. Heck, in some countries the whole reason why they queue you for care is because if you aren't really sick, you'll get over it before your appointment.... and if you're REALLY sick, there's the ER

In other words... Telemed isn't the answer for the vast majority of primary care issues.... Letting PAs and NPs and RNs be 'primary care physicians' is.... and we didn't need the ACA to make that happen as it has been happening for more than a decade now. All we really needed was for Medicaid to say it is ok (that they would pay) for an NP or PA or RN to write the note in that situation rather than requiring the physician to do it.

Simple example for those of you that aren't in the industry. 96365 (off the top of my head) is the icd-9 code for an intravenous transfusion... like blood for someone with chronic anemia... Although a nurse does 99% of the work, a physician must personally see that patient, oversee the procedure, and write a progress note. Frankly, that ten minutes he takes to write that note is a waste, because he really doesn't do anything, but if he doesn't, Medicare and thus insurers won't pay for the procedure. This is a waste of the limited physician resources and costs us $120/hr or so rather than paying an RN more like $50.

Now I understand that the ACA does some of this... but as I've said, we've been doing this more and more for more than a decade. We didn't need the ACA to do it... and the ACA doesn't do it any better than it was being done before.

In the simplest example there, if you weren't insured and went to the doctor for a physical, they followed the exact same protocols as if you had medicaid or medicare or BCBS.... The primary solution to lower the cost of this service doesn't have to do with you having insurance... It has to do with letting NPs or PAs or RNs (as appropriate) rather than MDs do it.

THAT is why I am against the ACA... Again, best way I can say it is that 'what it does' wouldn't take thousands of pages of legislation... but only a small number... The thousands of pages are things that most Americans (including most liberals) wouldn't want... but rather than do what we want, we are told that the only way to get those few pages of good is to accept the thousands of pages of 'what almost nobody wants'. This is a lie... and as I said, the evidence is that all of those things (like NPs and PAs and 'urgent care' centers) were happening long before Obamacare.... as was government subsidized healthcare insurance.

(06-11-2015 09:46 PM)Hambone10 Wrote:  

(06-11-2015 09:57 AM)maximus Wrote:  The one your employer offers doesn't include specialists but other models do and will.

I don't really see how a specialist can treat a patient via telemed... Of you need a specialist, they probably have to run tests or otherwise touch the patient.

(06-11-2015 04:36 PM)dawgitall Wrote:  If you utilize this app for minor issues you eliminate a visit to your PCP. Wouldn't that help with the back log? Your PCP would see you on a regular basis but there is no need to go in for every little thing.

How does it help the backlog? It doesn't take any less of the doctor's time to look at you on a screen than to look at you in an office. It CAN address some location issues as I mentioned... but once again, it doesn't increase the 'supply' of care available. Well, unless we somehow use doctors in other countries.

Think about what a doctor does. In about 90% of situations, someone must touch you. draw blood, palpitate the skin... take your temperature. Iy sounds trite but you'd be amazed at how unreliable 'home drawn' temperatures can be... especially by the sick and elderly. It might be a nurse rather than a doctor... but someone must touch you. In those situations where nobody has to touch you... you aren't really sick and don't need to be going to a doctor in the first place.

I don't know how to say this because there are so many 'buts and ifs' if all someone wants to do is nit=pick and example... ... But if someone presents to the teledoc with what looks like the sniffles and it IS the sniffles, you just wasted the doctor's time. Most mothers, 90% of pharmacists and ANY RN could have diagnosed that... and if you present to the teledoc with what looks like the sniffles and it ISN'T the sniffles, there is no way, short of a nurse touching that patient that you would know... perhaps until after it is too late... or at least until things are far more expensive to cure now than they needed to be. Heck, in some countries the whole reason why they queue you for care is because if you aren't really sick, you'll get over it before your appointment.... and if you're REALLY sick, there's the ER

In other words... Telemed isn't the answer for the vast majority of primary care issues.... Letting PAs and NPs and RNs be 'primary care physicians' is.... and we didn't need the ACA to make that happen as it has been happening for more than a decade now. All we really needed was for Medicaid to say it is ok (that they would pay) for an NP or PA or RN to write the note in that situation rather than requiring the physician to do it.

Simple example for those of you that aren't in the industry. 96365 (off the top of my head) is the icd-9 code for an intravenous transfusion... like blood for someone with chronic anemia... Although a nurse does 99% of the work, a physician must personally see that patient, oversee the procedure, and write a progress note. Frankly, that ten minutes he takes to write that note is a waste, because he really doesn't do anything, but if he doesn't, Medicare and thus insurers won't pay for the procedure. This is a waste of the limited physician resources and costs us $120/hr or so rather than paying an RN more like $50.

Now I understand that the ACA does some of this... but as I've said, we've been doing this more and more for more than a decade. We didn't need the ACA to do it... and the ACA doesn't do it any better than it was being done before.

In the simplest example there, if you weren't insured and went to the doctor for a physical, they followed the exact same protocols as if you had medicaid or medicare or BCBS.... The primary solution to lower the cost of this service doesn't have to do with you having insurance... It has to do with letting NPs or PAs or RNs (as appropriate) rather than MDs do it.

THAT is why I am against the ACA... Again, best way I can say it is that 'what it does' wouldn't take thousands of pages of legislation... but only a small number... The thousands of pages are things that most Americans (including most liberals) wouldn't want... but rather than do what we want, we are told that the only way to get those few pages of good is to accept the thousands of pages of 'what almost nobody wants'. This is a lie... and as I said, the evidence is that all of those things (like NPs and PAs and 'urgent care' centers) were happening long before Obamacare.... as was government subsidized healthcare insurance.

What did you bring up the ACA? This was just about the PCP shortage. Everything doesn't have to be about the ACA.

As someone with admittedly basic medical training I have a hard time seeing how tele-medicine is going to work on a wholesale level. The vast majority of patients out there either hide or lie about symptoms, and it has been my experience that the vast majority of the time the numbers given by home medical devices are significantly wrong. As someone who by law doesn't diagnose I would have a hard time treating someone that I didn't physically put my hands on and get real physical measurements based upon certified instrumentation. I mean it wasn't too long ago in emergency medicine that we though oxygen was totally harmless. When I first came up in EMS the first thing we did was throw the oxygen to a patient because "It isn't going to hurt them." Then we learned about hyperoxia or oxygen toxicity.

A little off-topic, but I was thrown off by OPs decision to shorten primary care physician to PCP, considering the drug is more well known for that accronym. Oh well.

(06-12-2015 07:39 PM)dawgitall Wrote:  What did you bring up the ACA? This was just about the PCP shortage. Everything doesn't have to be about the ACA.

Actually, everything about healthcare DOES have to be about the ACA, since it's the law with regard to healthcare.

In threads about the ACA, you don't want to talk about how it doesn't address healthcare because it doesn't address the PCP shortage... and in a thread about the PCP shortage you don't want to talk about how the ACA keeps some of these things from being options.

In other words, you don't want to talk about the ways that our current policies on healthcare don't address and in some cases even hinders healthcare... yo just want to talk about meaningless measures of success and 'solutions' that aren't workable under the current guidelines.

Got it.

You know, you're right about one thing....

If we get rid of the ACA, we DO have a chance to solve the PCP shortage. I've never particularly been adamant about repealing it... parts of it for certain but i've been a little ambivalent about its repeal... But you've convinced me

(06-13-2015 11:21 AM)ODUDrunkard13 Wrote:  A little off-topic, but I was thrown off by OPs decision to shorten primary care physician to PCP, considering the drug is more well known for that accronym. Oh well.

Screws me up everytime I see it.

Just read a news story about a guy getting busted with 85 grand worth of heroin (in is car... bright one)then saw this.

Wondered damn, now people are worried about an Angel Dust shortage?!?


Okay, /end thread jack.

(06-13-2015 11:40 AM)Hambone10 Wrote:  

(06-12-2015 07:39 PM)dawgitall Wrote:  What did you bring up the ACA? This was just about the PCP shortage. Everything doesn't have to be about the ACA.

Actually, everything about healthcare DOES have to be about the ACA, since it's the law with regard to healthcare.

In threads about the ACA, you don't want to talk about how it doesn't address healthcare because it doesn't address the PCP shortage... and in a thread about the PCP shortage you don't want to talk about how the ACA keeps some of these things from being options.

In other words, you don't want to talk about the ways that our current policies on healthcare don't address and in some cases even hinders healthcare... yo just want to talk about meaningless measures of success and 'solutions' that aren't workable under the current guidelines.

Got it.

You know, you're right about one thing....

If we get rid of the ACA, we DO have a chance to solve the PCP shortage. I've never particularly been adamant about repealing it... parts of it for certain but i've been a little ambivalent about its repeal... But you've convinced me

All you want to talk about is how the ACA doesn't address the PCP shortage. We get that. You never seem to be able to get passed it though. The PCP shortage can be addressed without involving the ACA. You've offered several ways to address it and others including myself have added information about doing it as well. But you tend to shoot any ideas others bring into the discussion down as soon as you can though.

(06-13-2015 05:30 PM)dawgitall Wrote:  All you want to talk about is how the ACA doesn't address the PCP shortage.

W R O N G!!

All I want to do is correct a number of the misconceptions that people have and people like you spread. I often talk about is how the ACA isn't affordable, and doesn't provide care. Since that is 2/3rds of the words in the name, I'd say that is important.

Telemed isn't the answer for primary care. (I believe you suggested it was). more loans for med school isn't the answer. More med schools isn't really the answer... at least not without more residents. and BETTER pay for PCPs (encouraging them to be PCPs rather than specialists) AND allowing mid-levels and even RNs to do far more. That's the topic, right? Addressing the PCP shortage? If the ACA doesn't fund more residency slots... doesn't pay for NPs and PAs to do more and pays PCPs less, not more... then why is it a problem for you for me to mention that in a discussion about the problems?

UNC setting up local offices don't come without a price somewhere else in the system... ERs as I said. I mean, it's nice that you don't have to drive as far, but is your convenience worth one person dying?

etc etc etc

Quote: But you tend to shoot any ideas others bring into the discussion down as soon as you can though.

Well yes. You've admitted that I know a lot about this subject and you specifically said you hoped I'd post. So I have... Unfortunately for you, yes... I shoot down bad ideas and correct misconceptions. The problem for you seems to be that I generally agree with all the people in the industry... and disagree with all of those who THINK they understand healthcare because they understand what politicians tell them to believe.... or because they understand their OWN needs, but don't see the big picture.

Having said that, I've specifically told you that EMR is good and that there is a place for telemed.. just not where many think it is... I've also suggested the government allow pushing more primary care to less expensive practitioners as a solution to supply... I've repeatedly called for more residency slots and funding... and 'supported' all sorts of things that others (including you) have mentioned.

If you consider that 'shooting them down', then I don't know how to help you.

Perhaps you should see a doctor. Mental health is covered under the ACA right?

Oops.

(that's meant as an ACA joke... not really suggesting you have mental problems)

People crack me up when they think that electronic medical records somehow link together every doctor in the world. I can't tell you how many patients think that I can pull up labs and notes from other offices like there's a big giant Facebook for healthcare providers that we can all access.

(06-13-2015 10:47 PM)Hambone10 Wrote:  

(06-13-2015 05:30 PM)dawgitall Wrote:  All you want to talk about is how the ACA doesn't address the PCP shortage.

W R O N G!!

All I want to do is correct a number of the misconceptions that people have and people like you spread. I often talk about is how the ACA isn't affordable, and doesn't provide care. Since that is 2/3rds of the words in the name, I'd say that is important.

Telemed isn't the answer for primary care. (I believe you suggested it was). more loans for med school isn't the answer. More med schools isn't really the answer... at least not without more residents. and BETTER pay for PCPs (encouraging them to be PCPs rather than specialists) AND allowing mid-levels and even RNs to do far more. That's the topic, right? Addressing the PCP shortage? If the ACA doesn't fund more residency slots... doesn't pay for NPs and PAs to do more and pays PCPs less, not more... then why is it a problem for you for me to mention that in a discussion about the problems?

UNC setting up local offices don't come without a price somewhere else in the system... ERs as I said. I mean, it's nice that you don't have to drive as far, but is your convenience worth one person dying?

etc etc etc

Quote: But you tend to shoot any ideas others bring into the discussion down as soon as you can though.

Well yes. You've admitted that I know a lot about this subject and you specifically said you hoped I'd post. So I have... Unfortunately for you, yes... I shoot down bad ideas and correct misconceptions. The problem for you seems to be that I generally agree with all the people in the industry... and disagree with all of those who THINK they understand healthcare because they understand what politicians tell them to believe.... or because they understand their OWN needs, but don't see the big picture.

Having said that, I've specifically told you that EMR is good and that there is a place for telemed.. just not where many think it is... I've also suggested the government allow pushing more primary care to less expensive practitioners as a solution to supply... I've repeatedly called for more residency slots and funding... and 'supported' all sorts of things that others (including you) have mentioned.

If you consider that 'shooting them down', then I don't know how to help you.

Perhaps you should see a doctor. Mental health is covered under the ACA right?

Oops.

(that's meant as an ACA joke... not really suggesting you have mental problems)

!. I never suggested it was the answer. I posted an article about it and asked for input about it. You continue to twist what I post and make lots of incorrect assumptions.
2. I would expect that there is no one silver bullet, but that there a lot of things that need to be done and collectively that would improve the problem.
3. The problem with pointing out the ACA doesn't provide more slots etc. isn't that you have pointed it out, you have done that repeatedly. That isn't in dispute. The problem is that you can't seem to get beyond that. The fact that it isn't addressed in the ACA in no way prevents it from being addressed going forward. Congress should take steps to do so and the president should encourage this type of legislation.
4. The UNC offices comment is an uninformed cheap shot. The idea that having cardiologists offices in rural areas doesn't improve the health of those of us located in rural areas, and in fact save lives is short sighted.
5. I certainly agree with many of your suggestions, and respect the fact that your role as a hospital administrator gives you added insight, but it seems at times you think that your expertise extends to all aspects of health care, even the ones outside your wheelhouse, and your perspective is the only one that can possibly be correct. I'm posting for the most part information I pick up about the topic and putting it out there for discussion, so I'm not pushing anything in particular here. But others that work in or have worked in the industry has addressed things specifically as being part of the solution and those are the ones that you seem to disregard.

(06-14-2015 07:26 AM)dfarr Wrote:  People crack me up when they think that electronic medical records somehow link together every doctor in the world. I can't tell you how many patients think that I can pull up labs and notes from other offices like there's a big giant Facebook for healthcare providers that we can all access.

It does help greatly if all your medical care is within one network. We have gone from a PCP appointment at 9am, to a cardiologist appointment at 11am and to a 3pm urology appointment and the med changes and prescription updates are there after the first appointment. And the prescriptions are waiting for us at our local drug store (not a part of the network) if we get back home before they close at 6.

(06-14-2015 08:24 AM)dawgitall Wrote:  !. I never suggested it was the answer. I posted an article about it and asked for input about it. You continue to twist what I post and make lots of incorrect assumptions.

I said i believe you suggested it was. Okay, you presented an article that suggested it was.

What difference does it make to the point? Once again, this is the most trivial point of what I said... Your persecution fantasy is a real problem for you.

Quote:2. I would expect that there is no one silver bullet, but that there a lot of things that need to be done and collectively that would improve the problem.

Yet when people suggest a comprehensive solution, you complain that they keep bringing in unrelated points

Quote:3. The problem with pointing out the ACA doesn't provide more slots etc. isn't that you have pointed it out, you have done that repeatedly. That isn't in dispute. The problem is that you can't seem to get beyond that. The fact that it isn't addressed in the ACA in no way prevents it from being addressed going forward. Congress should take steps to do so and the president should encourage this type of legislation.

The only one not moving past this is you. As I said, I've presented a relatively comprehensive solution... and your poor feelings get hurt because it includes things that the ACA not only didn't do, but made worse.

BTW, since I don't believe I've started one single thread complaining about the ACA, but you've started a number trying to praise it, I think 'the one who can't move past it' is you.

Quote:4. The UNC offices comment is an uninformed cheap shot. The idea that having cardiologists offices in rural areas doesn't improve the health of those of us located in rural areas, and in fact save lives is short sighted.

Just another example of how you don't understand the issues so you don't understand when educated people talk about it.

It's nice that you don't have to travel as far to see your cardiologist... but if it means that your local hospital closes and consolidates with one 20 minutes down the road... Someone will die because their trip to the ER is now 30 minutes instead of 10. I deal with these sorts of situations every day... managing staffing at 3 rural hospitals. We have relocated services in order to deal with the ACA, which is GREAT for those who live near where those services are now located, but risky for those who live near the one that doesn't have those services anymore. As of yet, we haven't closed the ER, but the hospital I kow a lot about that I've mentioned numerous times (DMC San Pablo) which isn't even in a rural area, SPECIFICALLY noted that the poaching of their previously uninsured ER patients by Kaiser, who don't offer full ER services contributed to the closure of the facility... which was a stroke center... which means that people in that area with strokes now have to travel 20+ minutes further. 20 minutes for a stroke victim is quite often the difference between life and death.

Period.

Once again, it is YOU who is uninformed, and when better informed people try and inform you, you argue because of your politics.

Sickening

Quote:5. I certainly agree with many of your suggestions, and respect the fact that your role as a hospital administrator gives you added insight, but it seems at times you think that your expertise extends to all aspects of health care, even the ones outside your wheelhouse, and your perspective is the only one that can possibly be correct.

You don't know my wheelhouse, nor do you understand what I do. I am not a clinician... my job is to work on care integration... from cradle to grave... which means I work with administrators at clinics and urgent care centers and SNFs and Hospice and home care and labs etc etc etc. My wheelhouse when it comes to the business side of healthcare is pretty wide... and I work closely with caregivers... Oh, and in my PREVIOUS life, for 20+ years I consulted the c-suite of insurance companies. I also managed a plaintiff's firm specializing in insurance work. I have 2 kids in college, one of whom is pre-med and one of my multiple degrees is in political science. There are lots of things I'm not an expert in, but finance and healthcare (non-clinical) aren't two of them... and I'm still pretty learned in those area where I'm not an expert. I tend not to post (often) in threads where I don't feel qualified to add value at least.

Tell me, what is YOUR healthcare experience or expertise?

Quote:I'm posting for the most part information I pick up about the topic and putting it out there for discussion, so I'm not pushing anything in particular here. But others that work in or have worked in the industry has addressed things specifically as being part of the solution and those are the ones that you seem to disregard.

Point them out. I tend to agree greatly, only disagreeing on minutiae with people who work in or have worked in the industry... including in this thread.

(06-14-2015 08:34 AM)dawgitall Wrote:  

(06-14-2015 07:26 AM)dfarr Wrote:  People crack me up when they think that electronic medical records somehow link together every doctor in the world. I can't tell you how many patients think that I can pull up labs and notes from other offices like there's a big giant Facebook for healthcare providers that we can all access.

It does help greatly if all your medical care is within one network. We have gone from a PCP appointment at 9am, to a cardiologist appointment at 11am and to a 3pm urology appointment and the med changes and prescription updates are there after the first appointment. And the prescriptions are waiting for us at our local drug store (not a part of the network) if we get back home before they close at 6.

Yes, and that's a great model for those integrated networks. Unfortunately, those integrated networks aren't required to offer emergency services. Hospitals are. So if your integrated services are a full fledged hospital (lots of 'clinics' say they are an ER but only offer services to members... no non-directed ambulance service... and urgent care centers also aren't required to have facilities to treat ALL patients) then this isn't a bad thing... but in areas like DMC and numerous suburban areas IT CAN COST LIVES

Here. Read this... one of HUNDREDS of similar articles
http://www.mercurynews.com/my-town/ci_27...s-patients

And when you read it, consider where this paper is and where these people live. This isn't a Republican area, and in fact is the district of one of the main architects of the ACA

Now you can choose to ignore them, or claim that it is anecdotal... and it is... but it is offered merely to offer a very clear and unambiguous retort to your personal experience.

Absolutely, healthcare needs to be integrated... but unless you understand that the major difference between a hospital ER and any other business not REQUIRED to offer life saving services (which is FAR more than just having a doctor on site)... and the economics of such an operation (and you clearly don't) then you can't possibly offer an informed opinion on what is better for the system.

Period.

Yet not only do you offer opinions (which is absolutely fine) but you start numerous threads with an obvious political and often uninformed or misleading slants.

You show me how many threads I've started complaining about the ACA.

(06-14-2015 07:26 AM)dfarr Wrote:  People crack me up when they think that electronic medical records somehow link together every doctor in the world. I can't tell you how many patients think that I can pull up labs and notes from other offices like there's a big giant Facebook for healthcare providers that we can all access.

They aren't now but the Feds are mandating HIE

In the future there won't be totally integrated EHRs per se but there will be massive amounts of data exchanged between EHRs.

I'm on my systems HIE committee and have about 3 meetings a week on the subject.

(06-14-2015 03:45 PM)Hambone10 Wrote:  

(06-14-2015 08:24 AM)dawgitall Wrote:  !. I never suggested it was the answer. I posted an article about it and asked for input about it. You continue to twist what I post and make lots of incorrect assumptions.

I said i believe you suggested it was. Okay, you presented an article that suggested it was.

What difference does it make to the point? Once again, this is the most trivial point of what I said... Your persecution fantasy is a real problem for you.

Quote:2. I would expect that there is no one silver bullet, but that there a lot of things that need to be done and collectively that would improve the problem.

Yet when people suggest a comprehensive solution, you complain that they keep bringing in unrelated points

Quote:3. The problem with pointing out the ACA doesn't provide more slots etc. isn't that you have pointed it out, you have done that repeatedly. That isn't in dispute. The problem is that you can't seem to get beyond that. The fact that it isn't addressed in the ACA in no way prevents it from being addressed going forward. Congress should take steps to do so and the president should encourage this type of legislation.

The only one not moving past this is you. As I said, I've presented a relatively comprehensive solution... and your poor feelings get hurt because it includes things that the ACA not only didn't do, but made worse.

BTW, since I don't believe I've started one single thread complaining about the ACA, but you've started a number trying to praise it, I think 'the one who can't move past it' is you.

Quote:4. The UNC offices comment is an uninformed cheap shot. The idea that having cardiologists offices in rural areas doesn't improve the health of those of us located in rural areas, and in fact save lives is short sighted.

Just another example of how you don't understand the issues so you don't understand when educated people talk about it.

It's nice that you don't have to travel as far to see your cardiologist... but if it means that your local hospital closes and consolidates with one 20 minutes down the road... Someone will die because their trip to the ER is now 30 minutes instead of 10. I deal with these sorts of situations every day... managing staffing at 3 rural hospitals. We have relocated services in order to deal with the ACA, which is GREAT for those who live near where those services are now located, but risky for those who live near the one that doesn't have those services anymore. As of yet, we haven't closed the ER, but the hospital I kow a lot about that I've mentioned numerous times (DMC San Pablo) which isn't even in a rural area, SPECIFICALLY noted that the poaching of their previously uninsured ER patients by Kaiser, who don't offer full ER services contributed to the closure of the facility... which was a stroke center... which means that people in that area with strokes now have to travel 20+ minutes further. 20 minutes for a stroke victim is quite often the difference between life and death.

Period.

Once again, it is YOU who is uninformed, and when better informed people try and inform you, you argue because of your politics.

Sickening

Quote:5. I certainly agree with many of your suggestions, and respect the fact that your role as a hospital administrator gives you added insight, but it seems at times you think that your expertise extends to all aspects of health care, even the ones outside your wheelhouse, and your perspective is the only one that can possibly be correct.

You don't know my wheelhouse, nor do you understand what I do. I am not a clinician... my job is to work on care integration... from cradle to grave... which means I work with administrators at clinics and urgent care centers and SNFs and Hospice and home care and labs etc etc etc. My wheelhouse when it comes to the business side of healthcare is pretty wide... and I work closely with caregivers... Oh, and in my PREVIOUS life, for 20+ years I consulted the c-suite of insurance companies. I also managed a plaintiff's firm specializing in insurance work. I have 2 kids in college, one of whom is pre-med and one of my multiple degrees is in political science. There are lots of things I'm not an expert in, but finance and healthcare (non-clinical) aren't two of them... and I'm still pretty learned in those area where I'm not an expert. I tend not to post (often) in threads where I don't feel qualified to add value at least.

Tell me, what is YOUR healthcare experience or expertise?

Quote:I'm posting for the most part information I pick up about the topic and putting it out there for discussion, so I'm not pushing anything in particular here. But others that work in or have worked in the industry has addressed things specifically as being part of the solution and those are the ones that you seem to disregard.

Point them out. I tend to agree greatly, only disagreeing on minutiae with people who work in or have worked in the industry... including in this thread.

(06-14-2015 08:34 AM)dawgitall Wrote:  

(06-14-2015 07:26 AM)dfarr Wrote:  People crack me up when they think that electronic medical records somehow link together every doctor in the world. I can't tell you how many patients think that I can pull up labs and notes from other offices like there's a big giant Facebook for healthcare providers that we can all access.

It does help greatly if all your medical care is within one network. We have gone from a PCP appointment at 9am, to a cardiologist appointment at 11am and to a 3pm urology appointment and the med changes and prescription updates are there after the first appointment. And the prescriptions are waiting for us at our local drug store (not a part of the network) if we get back home before they close at 6.

Yes, and that's a great model for those integrated networks. Unfortunately, those integrated networks aren't required to offer emergency services. Hospitals are. So if your integrated services are a full fledged hospital (lots of 'clinics' say they are an ER but only offer services to members... no non-directed ambulance service... and urgent care centers also aren't required to have facilities to treat ALL patients) then this isn't a bad thing... but in areas like DMC and numerous suburban areas IT CAN COST LIVES

Here. Read this... one of HUNDREDS of similar articles
http://www.mercurynews.com/my-town/ci_27...s-patients

And when you read it, consider where this paper is and where these people live. This isn't a Republican area, and in fact is the district of one of the main architects of the ACA

Now you can choose to ignore them, or claim that it is anecdotal... and it is... but it is offered merely to offer a very clear and unambiguous retort to your personal experience.

Absolutely, healthcare needs to be integrated... but unless you understand that the major difference between a hospital ER and any other business not REQUIRED to offer life saving services (which is FAR more than just having a doctor on site)... and the economics of such an operation (and you clearly don't) then you can't possibly offer an informed opinion on what is better for the system.

Period.

Yet not only do you offer opinions (which is absolutely fine) but you start numerous threads with an obvious political and often uninformed or misleading slants.

You show me how many threads I've started complaining about the ACA.

At this point we are just treading water. You assume everything I post is politically motivated and thus read more into everything I post than is intended. You press your same points over and over and go on the attack whenever I offer anything to the discussion. My post about electronic communication within a network is a prime example. There was nothing there but an observation of how it does have some redeeming value. It wasn't critical or political in any way yet you turned it into that.

I post about health care issues because my life outside of work pretty much revolves around it. I have started a few threads for that reason and also because I've read tons of partisan, incorrect, and misleading posts by those that oppose it and I figure there needs to be a counter balance. Do I get everything right myself? No not always. It is a complicated topic, but when I have been incorrect about something I've acknowledged it and corrected myself.

There isn't much else to say.

(06-14-2015 04:54 PM)dawgitall Wrote:  You assume everything I post is politically motivated and thus read more into everything I post than is intended.

Thats because you:

1) Only post inflated, bloated, and manipulated numbers when they are good, but avoid like the plaque numbers that show they arent good.

2) Pull a "this is proof the ACA is a success" quote out of your ass because yo ubelieve people being kicked out of the prior coverage and onto the exchanges qualifies as a success.

3) Talk about how republican states should have expanded medicaid, but dont talk about the democratic states that expanded it having issues now paying for it.

4) Talk about how great OBlundershit is, when you yourself dont have an Oblundershit policy.

5) Get Butthurt when you are proven wrong, time and time again.

(06-14-2015 08:34 AM)dawgitall Wrote:  

(06-14-2015 07:26 AM)dfarr Wrote:  People crack me up when they think that electronic medical records somehow link together every doctor in the world. I can't tell you how many patients think that I can pull up labs and notes from other offices like there's a big giant Facebook for healthcare providers that we can all access.

It does help greatly if all your medical care is within one network. We have gone from a PCP appointment at 9am, to a cardiologist appointment at 11am and to a 3pm urology appointment and the med changes and prescription updates are there after the first appointment. And the prescriptions are waiting for us at our local drug store (not a part of the network) if we get back home before they close at 6.

I prefer not being part of a group or network that large. I enjoy my nice, small office.