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Posts Tagged ‘ family medicine ’

How the American Medical Association Represses Family Medicine

1
December 10, 2017

In a very unique study, researchers have tabulated how often family physicians provide patient care that is not covered with a CPT code. This is a little complex, for the non-physicians and even for many physicians to grasp, so I will provide a little more background first. CPT stands for Current...
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The Myth of Student Debt and Family Medicine

3
November 14, 2017

OK, “myth” is a bit of an exaggeration. A study from 2014 by the Robert Graham Center found a U-shaped relationship between medical student debt and the likelihood of students going into family medicine. Actually, it was more of a saucer-shaped curve. Students who had debt > $150,000, but also those with...
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The High Costs of Hospitalists

3
October 9, 2017

Hospitalists, doctors who only see patients in the hospital, almost always in a shift work model, are the fastest growing “specialty” in medicine, from nothing about 15 years ago to about 50,000 today. There were some studies that I won’t review much here that showed some benefits from hospitalists compared to...
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More Disappointing News on the PCMH

2
September 6, 2017

First, I recognize that the whole PCMH experiment was not a total failure. There were some successes. The Patient Centered Primary Care Collaborative (PCPCC) puts out an annual review on PCMH demonstration sites that is always positive. On the other hand, the AAFP PCMH National Demonstration Project was mostly a failure....
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Ways to Improve Family Medicine Quality – Target Ranges without Absolute Goals

1
June 18, 2017

In our recent paper criticizing how industrial Quality Improvement has been misapplied to primary care, we didn’t just complain, we made suggestions for a better way forward. This was under the assumption that regulators and payers will continue to insist on some kind of numeric reporting of outcomes by physicians or...
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Ways to Improve Family Medicine Quality – Shared Decision Making

1
June 7, 2017

In our recent paper criticizing how industrial Quality Improvement has been misapplied to primary care, we didn’t just complain, we made suggestions for a better way forward. This was under the assumption that regulators and payers will continue to insist on some kind of numeric reporting of outcomes by physicians or...
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Industrial QI Does Not Work in Primary Care

1
March 15, 2017

Traditional industrial QI does not work in primary care. A recent publication brilliantly makes this case on both theoretical and practical levels ;-). On a theoretical level, primary care is best thought of as a complex adaptive system, not a simple linear mechanical system. Think of complex adaptive systems as kind...
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Family Physician Payment – A Lesson from Switzerland

0
June 27, 2016

There was a nice opinion piece in JAMA Internal Medicine recently where the primary author talked about moving from the U.S. to Switzerland and his experience in both systems. Primary care physicians are allowed to bill based on time there. This includes travel time, phone work, and documentation time. What a concept!...
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MedPAC Calls for More Primary Care Support — Again

0
April 25, 2016

The Medicare Payment Advisory Committee (MedPAC) just released its annual report on Medicare expenditures. Congress technically votes on the fees that Medicare pays, but it created MedPAC to serve as its primary advisor. If MedPAC sounds familiar to some, it may be because of reports in the past of the American...
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Retail Clinics Increase Costs

1
March 13, 2016

A study in the latest Health Affairs took a snapshot of utilization and costs associated with retail clinics. These are the small clinics located in Wal-Mart, CVS, Walgreen’s and the like. They were touted by proponents as low-cost options for primary care. They are usually staffed by nurse practitioners or physician assistants....
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