Health Insurance Plan Of Greater Ny Careers
The retention model or single-payer "What willsave primary care?
http://www.medscape.com/viewarticle/571133
Point / Counterpoint
The retention model or single-payer – this will save primary care?
Robert M. Centor, MD, Charles P. Vega, MD
Point: The retention model in May to stimulate the rebirth of care Ambulatory Internal Medicine
Robert Centor, MD
Ambulatory Internal Medicine has joined the list of threatened species extinction, or at least as many commentators have opined.
residents in internal medicine Less opt for jobs ambulance. Internists are likely to leave clinical practice or for scholarships or for hospital jobs.
As I consider the choice of the medical student's career in internal medicine, I noted that the attractiveness of general internal medicine, results the complexity of the field. Complex care internists champion. We like Puzzle diagnosis and management. In the 1970s and 1980s, many internists adopted a definition primary care as the Institute of Medicine (IOM) coded:
"A set of attributes, as in 1978, the definition IOM – the care that is accessible, comprehensive, coordinated, continuous and responsible – or as defined by Starfield (1992) – attention that is characterized by a first contact, accessibility, longitudinal and integrity. [1]
Training programs produce internists who could take care of diseases complex and also meet a wide range of variety of clinical issues, including episodic care and preventive medicine. During the next 30 years our company has apparently redefined primary health care at a definition that degrades the original concept. The American Heritage Dictionary gives this definition in 2006 for Primary Care: "The care you receive first contact with the patient with the system health, before referral elsewhere in the system. "
I think most insurers and other doctors no longer consider the scale when you think of primary care.
I would say that internists do not want and can not do this conceptualization limited primary health care as defined by the American Heritage Dictionary, but are trained Add primary care services in our comprehensive care. These distinctions are the basis of the anxiety of many practicing internists. We trained a generation of internists for comprehensive care, including episodic care and prevention, and yet insurers and in particular organizations of health maintenance complain that internists are not good at providing immediate care, primary effective. Family physicians are in a similar situation. We have a problem of semantics and thus our discussion on primary health care remain unclear.
Our reimbursement system does not pay enough internists to provide high quality comprehensive care, Despite our patients are very complex and require more time than you think insurance is a standard office visit.
In particular, patients need different levels of intensity. A mother of doctor of 30 years with a sore throat has different needs from a 55-year-old man with disease obstructive pulmonary disease, heart failure and diabetes mellitus type II.
It is clear that the last patient will need more time and more visits frequent. In addition, our current system is not the repayment of the continuity of the office. We have no reimbursement for phone calls or email, Although patients often have questions
their physicians. They would call your doctor for advice or to discuss a possible symptom. And, on the contrary, as we often see in our patients to know, for example, how to react to a new treatment.
Our scheme current business practices are slowly killing the ambulatory internal medicine. In this context, some enterprising doctors recreates the retention model. They thought and practice has created a model that the wishes of the patient and improve physician satisfaction.
The idea is simple. The patient pays a fee for access to the doctor, who makes an appointment the same day, access to telephone and e-mail. Doctors call these patients regularly and even make home visits when necessary. The physician panel size is limited to much less than most Internists have today. Although the retention model has variations, the above principles represent the basic concepts.
During the interview, physicians focus on keeping your job satisfaction with this arrangement. They can spend enough time with each patient because they have more pressure see 20 or 25 patients every day. Patients seem to love this model. They want easy access and are willing to pay for this access. While rates retention, which typically ranges from $ 1,000 per year for about $ 4000per 90% of patients each year to renew their contracts.
Many have criticized these practices for ethical reasons and under medical care should primary care for a wide range of patients. I believe that medicine can save Outpatient retention in internal medicine. I doubt that all patients entering a retention practice, but suspect that the number is growing join these practices and patients recognize the value of access to health care.
Perhaps these practices, if they continue to prosper, it will stimulate a resurgence of internal medicine outpatients. We will be able to continue to train internists to understand the diversity and complexity of the disease, because the retention model provides an option for those who prefer the outpatient setting, but they also want the complexity and magnitude. Whereas many critics refer to the financial condition of this model and care about inequality, supporters emphasize on the holding capacity to provide medical care and the level of attention that patients deserve.
The retention model was Origin and succeeds because of the classical market forces. Doctors and patients find our current regime does not, if this new alternative model provides an attractive option. Maybe store in ambulatory internal medicine.
Counterpoint: But the retention model for improve health care?
Carlos Vega, MD
Dr. Centor should be commended for the most important points regarding the state of primary health care. He is absolutely right that the current model of primary health care is not satisfactory for both provider and patient. In fact, as suggested by Dr. Centor, this model can not be sustainable in the long term. Doctors can continue to choose careers in medical and surgical specialties, which are more lucrative in the financing of our current health care system.
The concept conservation practices is a logical answer to this dilemma. conservation practices can solve some of the toughest challenges for primary care including follows:
Better access to doctors? Check.
Improving doctor-patient relationships, on the occasion to focus on the biopsychosocial model of health? Check.
More time for preventive care and advice to patients? Check.
The opportunity to nirvana medical practice financially viable, if not very profitable? Check.
Improve care health in our country? Well … Is an inspiration that health care is back on the national agenda. Each presidential candidate is in a position on health reform, regardless of party affiliation, the appeal has been to increase access to care. Such care will emphasis on preventive medicine, quality and results-oriented Evidence of a chronic disease.
practice restraint which can improve health care for the patient, but is it justifiable that a greater proportion of our offer of reduced quality of physicians primary care involved in these practices?
As noted in an essay Needell and Kenyon, doctors' responsibility to support health the whole community. [Retention rate of medical practice] does little to advance this cause, except that by optimizing the conditions in which patients receive private medical treatment, they call attention to the shortcomings of current public health policies, which compared the fall of this standard. [2]
Primary care physicians are using the creation of this standard. We physicians focus the well-being, not just treat the disease, the patient as a whole. We are the best tools for ensuring quality and cost-effective health. [3]
Primary care is now facing its moment in history. At this critical juncture, we allow insurance companies to dictate how care patients? conservation practices represents a reversal of the expansion of health access and quality to our American community in general. With the end of each practice primary care in favor of a general practice of withholding the medicine loses some of its soul, and it would be naive to believe that there will be a reckoning when we as a profession away from our responsibility towards society.
How can we take this responsibility? Advocating for change. Have a voice in health care are provided in this
countries, questions as a basis for reimbursement of preventive services for the repair of health boards and the increased use of technology in medical practice routine. Our country needs us and it is urgent to act.
Answers
Point A: Robert Centor, MD
I understand the concerns of Mr. Vega on "health care in our country." He believes that retention practices reduce access to primary care physicians. On the other hand, it raises an interesting point that doctors have "a responsibility to support health the whole community. "End of the essay with a passionate request that the case for change.
He wants to change and improve the reimbursement of compensation to get health advice.
I think I can convince Mr. Vega that withholding medical model can meet all these needs.
As I said earlier, the current model of primary care receives little respect and pay the poor (a term more precise than the refund). Therefore, attract fewer students and residents. We in the South often say: "If it is not broke, do not fix it." Well, our main current healthcare model is broken, and we must therefore develop a better model.
Mr. Vega is the idea of integrating primary care: if only small adjustments to the payment system, all work well. My position is that the current system has problems so severe that we feel better.
Taking into account any monetary tightening, all patients would have a doctor check. We all want access to our doctor. We wish he or she has sufficient time to provide care. We do not want any motivation for our doctor to speed with our appointments, or provide e-mail communication, or it is almost impossible to talk on the phone.
When I think of the advantages of holding the medicine, I think that revolution in primary care. Physicians can provide affordable medical retention should not lead to an enormous rate. For example, if a primary care physician may limit his practice to 1000 patients and cost $ 50 per month and the numbers can work. In this practice, the overhead is minimal, because the doctor does not need an expert group billing and insurance.
I believe such practices to attract patients and physicians. Given this profession more desirable, more doctors are choosing to enter these practices and more physicians to continue providing care. retainer medicine may increase the attractiveness of generalist careers ambulatory.
While I understand the objections of Mr. Vega said that the dynamics of a new model for improving access to GPs. Each physician is responsible first to provide the best possible care to their patients. When we see more patients, all of our patients suffer. When looking for subspecialists because we have no time to be with our patients, health suffers. When imaging studies rather than spend more time interviewing and examining the patient, health suffers.
We can not be satisfied with a system of primary health care unless they provide primary care in circulation. Our current payment system that discourages primary care physicians spend our most precious resources for our patients. Of course, our most precious resource is time. Our patients deserve our time, and we deserve a fair wage for all of our time.
We examine the movement of medical care deduction. This movement focuses on care of the highest quality. I think we have reinvent our system of payment for care that expectation, not the exception.
Answer Counterpoint: Charles Vega, MD
Dr. Centor is still an excellent job of describing the real challenges for primary care and general medicine United States. Está Nadie está claro that satisfecho con el sistema e ineficiente injusto our run property, y las prácticas sin duda retainer puede ser atractivo para los médicos. But adoption this practice on a large scale would be a disaster for health care in the United States. These practices are exclusionary by their very nature: Doctors open these practices to reduce the number of patients they serve. The annual "membership" costs of these practices cost thousands of dollars and many
these practices, but to exclude all the most lucrative Health Insurance Plans. In addition, many practices support for retention visits to the doctor, adding to the burden of the cost. And for all these costs, there is little evidence that these practices provide results senior health.
The real cost of our inability to establish a better system of health goes far beyond disgruntled patients and doctors, or even loss of property primary health care. In relative terms, it is selfish concerns. problems of inequality and health costs in the health of individuals and the U.S. too often their lives.
I would also call a revolution in the way whose doctors to practice in this country. While we advocate a more holistic approach to preventive maintenance and well-being, compared to treatment of the disease, the patient as a whole. Patients want an overall health who understands your needs. These are areas where primary care physicians to excel.
But the concepts themselves are not very revolutionary. Dr. Centor is quite right that we need a new course that holds greater doctor-patient interaction. Imagine a system where primary care physicians are paid fairly for the good work we do. In this scenario, strong relationships and improve health outcomes for patients are encouraged for all interested in improving health. More Again, this system is fully inclusive, providing access to basic health care for all.
An impossible dream? Not all countries worldwide. This plan is called single-payer system. You may have heard about it, perhaps by being despised by insurance and pharmaceutical companies. There are many controversial issues related to a single-payer health care, but it is time for everyone involved in care Health realize that the consequences of our current quagmire of anti-health system are too important to follow remains intransigent to change. The work is hard, and some sacrifices must be accepted by all sides. However, in the end, we have a system that is fair and effective, but care and personal.
References
Starfield B. Primary Care: Concept, Evaluation and Policy. New York, New York: Oxford University Press, 1992. 1.
Needell MH, JS Kenyon. Ethical evaluation of "retainer" medical practice. J Clin Ethics. 2005, 16:72-84.
Summary
2.
Starfield B, Shi L, Macinko J. Contribution of health care systems and health. Milbank Q.
2005, 83:457-502. Summary
3.
Robert M. Centor, MD, professor and director of General Medicine within the University of Alabama at Birmingham
Charles P. Vega, MD Associate Professor, Director of Residence, Department of Family Medicine University of California,
Irvine
Disclosure: Robert M. Centor, MD, has not revealed relevant financial relationships.
Disclosure: Charles P. Vega, MD, has disclosed that he acted as an advisor or consultant to Novartis.
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