Comments on: Connected Health, Connected Reform

By: Sandy Fackler

Sandy Fackler — Wed, 22 Jul 2009 22:34:44 +0000

Sorry, correction. The last sentence of the first paragraph should read “…overwhelming influences.”

By: Sandy Fackler

Sandy Fackler — Wed, 22 Jul 2009 22:32:38 +0000

Ugh, I don’t like those words “how a patient is performing.”
Does that mean that all outside influences on health such as food additives for color,and better shipping, spraying with pesticides, water, air and soil pollution will be disregarded in favor of the notion that a patient has control of his/her health in the face of these overpowering.

Well people like to take all the credit for their good health but it’s not all lifestyle, you know. Unless you mean the lifestyle of first shipping our food around the world before consuming it.

By: Mike

Mike — Fri, 17 Jul 2009 23:36:39 +0000

In addition to the adoption of health information technology, universal access, and payment reform, we must also address the supply side of the equation. We need to fund increased training of nurses, nurse practitioners, and primary care physicians.

One component of our health costs are the compensation provided to physicians. Physicinas have higher earnings in our country than in any other. I am not advocating levying an ecise tax on physicians. Rathe, I’m advocating substantial government underwriting of the costs of a medical education. Physician earnings must come down, but it’s unreasonable to suggest that to a new physician carrying $500,000 in student loans.

By: Gregg Masters

Gregg Masters — Fri, 17 Jul 2009 16:54:26 +0000

It’s about time the underbelly of health reform be exposed; i.e., the need to foster integration, both clinically AND economically, amidst a culture of physicians who value independence and a ‘cowboy mindset’ than of embracing a (coordinated) group practice culture per se.

Slapping solo docs into IPAs and layering a withhold on an already discounted fee schedule (one element of the ‘grand plan’ of managed care to go mainstream by extending HMO market share out from group or staff models into private (i.e., solo) medicine, was destined to fail at the outset absent a re-engineering of the underlying culture of medicine.

Fast forward from the mid 90s when the capitated and aggressively discounted models admitted failure (witness United abandoning UM), and we are revisiting the payment issue from the point of view of it’s paradigm of incentives, i.e., pay more, do more, etc.

Certainly bundling payments begins to drive the conversation towards integration potential. Why not start with hospital based physicians? The ‘RAPERs’ (or REAPERs) are a natural to drive into actual or virtual merged practice vehicles to accept and administer global payments to the participating specialties of radiology, anesthesia, pathology, aand emergency room docs.

Thanks for the piece!