Demystifying Medicine One Week at a Time

Category: health care reform (page 5 of 13)

Internet House Calls

It’s not the first, but it’s generated a fairly big announcement:

A company called American Well has introduced virtual visits directly to consumers in Massachusetts. [They’ve already been doing it in 43 states and the District of Columbia.]

A hand with a stethoscope to give an examThe company has been partnering with insurance companies to provide internet-enabled visits to select populations. But now going direct to the public in the state with the highest number of doctors per capita has increased their visibility.

For the introductory price of twenty bucks (visits usually are forty-nine per), you can sign up and have a vetted medical professional (one that you select from a roster based on background, specialty, and availability) diagnose and even treat you for your problem.

Treatments include e-prescribing of antibiotics or other medications, in addition to advice. Potentially addictive controlled substance pain medications (Vicodin, Lortab, et al.) are not permitted.

Depending on your viewpoint, this is another step forward in technology enabling consumer-driven and consumer-friendly health care. Or it’s another insult to the primacy of the doctor (aka “provider”)-patient relationship and the “Medical Home” model.

Would you confer with a doc online, if you could see her and talk to her “live?”

Broken Dishes

Here’s an idea that seems unfair:


Grady Memorial Hospital, Atlanta.

Hospitals, long searching for ways to minimize their streams of uninsured patients (written off as “charity” or “uncompensated” care), signed on to the Affordable Care Act (“Obamacare”) through their trade associations.

They stood to solve one of their longstanding problems by cooperating with Congress and the Administration to help Americans.

Now, in states not accepting Medicaid expansion (e.g. Georgia, Oklahoma, Texas, etc.), those hospitals are feeling the pinch twice.

Obamacare is in part financed by funds earmarked for hospitals providing a “Disproportionate Share” (i.e. “DSH“) of unfunded care.

Now hospitals in states that aren’t expanding Medicaid not only won’t get payments from newly enrolled Medicaid-eligibles, they’ll be losing their “DSH” payments.

Double whammy.

Here’s the thing, though: Stubborn governors and legislators who will not accept the 100% federal financing of Medicaid expansion will feel the bite. Eventually.

Hospitals will close. Citizens will be angered. Employees will lose jobs.

Those last two in any order.

#9 Dream*

It’s been an interesting week.doc-office-aca_wide-403577f90f9f2aa9fdfb92060c1f512825900d1f-s6-c30

I wrote an essay with some predictions (nine, to be precise) about where health care is headed in the Obamacare era, and it got some attention.

Please check it out: it’s on the NPR “Shots” blog, and it’s called “A Doctor’s 9 Predictions About the ‘Obamacare Era’.” Here’s a link: ARTICLE  [Or just click on the picture accompanying this post.]

I’m really happy with the response the article has been generating. If you scroll down below the article and read some of the comments, you’ll see that some folks think I’m anti-Obamacare, while others think I’m slandering Republicans. That’s how you can know when you’ve gotten it near-right. Critics from both sides!

I’ll say this: people often criticize journalists for bias. I think the comments demonstrate (if you read the article carefully) that respondents inject their own biases into how they see the article.

My thanks to the editors at “Shots” for shaping a solid piece and making it all the more logical, powerful, interesting and attractive.


*#9 Dream: a song by John Lennon. Click here to see John and Yoko canoodling all over town.

MD vs NP

Some friends and I have a piece posted on the Health Affairs Blog.

One co-author is a doctor, the other is a nurse practitioner (NP). He runs the student health center at a university.

Our piece reflects on the vitriol between physicians and nurse practitioners in online forums, and ideas for restoring civility to the conversation.

Nurse practitioners are nurses who get extra training in clinical medicine, such that they are able to diagnose and treat most illnesses and provide outstanding patient care. By now, if you haven’t been cared for at least once in some capacity by a nurse practitioner, then you haven’t really “used” the health care system.1tlcfl231

Licensure in health care fields is state specific. Historically, when NP certification came into being, NPs were uniformly expected to have “supervisory” relationships with physicians. The docs were supposed to oversee their practice, from case review to monitoring prescriptions. Hence, the origin of the term “physician extender.”

It was only a matter of time until NPs existed in sufficient numbers and had enough experience to amass data proving they can in fact practice medicine well without supervision. Many states, facing shortages of able-bodied health care professionals, have changed their licensure requirements to allow NPs to practice fully and independently.

Other states are considering the move. People feel very strongly on both sides of the issue. Medical societies have weighed in. Strong feelings are fine, but name calling and vilification of the other parties do nothing to advance progress, solve problems, or of course take care of patients.

I’ve worked with many nurse practitioners over my career. There are many standouts I’d choose to be my own caregiver.

What about you?

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