RE: Re: Is inappropriate primary care the problem with US health care?

[Guest guest]

We WERE part of the problem. However, we are out of the game at this time. Their heels are on our foreheads and they think it is funny.

Beck, M.D.

Subject: Re: Is inappropriate primary care the problem with US health care?To: Date: Friday, December 19, 2008, 7:22 AM

Completely agree. My posts the last couple of days were only intendedto spark a conversation about things we can do immediately to improveour own performance while we advocate for proper support from thesystem. I labeled the first post as "food for thought" - hope no onethought my intent was to blame primary care for the mess. However, Ido believe that we will be most effective as a solution if we can showthat we practice in ways supported by evidence rather than habit orpatient demand. I know it's a chicken and egg problem - we don't havea system that supports doing the right things so we often don't do theright things. However, to be effective, I need to avoid the easyroute of simply blaming insurance companies, specialists, thegovernment and the stars for all that is wrong - we are not completelypowerless as primary care docs. That was my only intent in spurringwhat I hope at least some found to

be a friendly debate worth having.Best and happy holidays.Chad>> No need to speculate on this topic, there are volumes of publications on> this issue. I present one of the most recent - not as the> be-all-and-end- all of publications, but merely as a reflection of awealth> of data.> > > > Parts of the US with greater concentrations of PCP per capita havebetter> satisfaction, better health outcomes, lower total cost.> > Parts of the US with greater concentrations of specialty care andhospital> beds have worse satisfaction, worse outcomes and higher total cost.> > > > The reasons are explained in the attached..>

> > > Does this mean primary care is pristine and we only need more of usaround?> Not for a second. There are certainly times when PCPs orderinappropriate> tests and treatments, there good studies documenting the inadequatelevels> of care delivered by PCPs in the US. This is an unfortunateconsequence of> being put in the professional equivalent of Lucille Ball on the assembly> line in the candy factory.> > > > The current system is perfectly designed to get us these woeful results:> inadequate resources, low fee-for-service pay for visits and noremuneration> for all the other work of primary care, the unfunded mandate of theinsane> administrative trivia game (billing, prior auth, and forms from hereto our> collective grave). In general we are on a diabolical treadmill andunable> to live up to our

professional obligations.> > > > We can work to put our houses in order, to use the best medicalinformation> to support our patients, to provide superb access, excellentcontinuity, a> broad array of service, and coordinate care across the continuumwhen we are> adequately resourced to do the work and we lose the crushing yoke of> administrative trivial pursuit.> > > > High performing health systems are founded on effective primarycare. Give> us the resources and relief we need to do our work.> > G>

[Guest guest]

We WERE part of the problem. However, we are out of the game at this time. Their heels are on our foreheads and they think it is funny.

Beck, M.D.

Subject: Re: Is inappropriate primary care the problem with US health care?To: Date: Friday, December 19, 2008, 7:22 AM

Completely agree. My posts the last couple of days were only intendedto spark a conversation about things we can do immediately to improveour own performance while we advocate for proper support from thesystem. I labeled the first post as "food for thought" - hope no onethought my intent was to blame primary care for the mess. However, Ido believe that we will be most effective as a solution if we can showthat we practice in ways supported by evidence rather than habit orpatient demand. I know it's a chicken and egg problem - we don't havea system that supports doing the right things so we often don't do theright things. However, to be effective, I need to avoid the easyroute of simply blaming insurance companies, specialists, thegovernment and the stars for all that is wrong - we are not completelypowerless as primary care docs. That was my only intent in spurringwhat I hope at least some found to

be a friendly debate worth having.Best and happy holidays.Chad>> No need to speculate on this topic, there are volumes of publications on> this issue. I present one of the most recent - not as the> be-all-and-end- all of publications, but merely as a reflection of awealth> of data.> > > > Parts of the US with greater concentrations of PCP per capita havebetter> satisfaction, better health outcomes, lower total cost.> > Parts of the US with greater concentrations of specialty care andhospital> beds have worse satisfaction, worse outcomes and higher total cost.> > > > The reasons are explained in the attached..>

> > > Does this mean primary care is pristine and we only need more of usaround?> Not for a second. There are certainly times when PCPs orderinappropriate> tests and treatments, there good studies documenting the inadequatelevels> of care delivered by PCPs in the US. This is an unfortunateconsequence of> being put in the professional equivalent of Lucille Ball on the assembly> line in the candy factory.> > > > The current system is perfectly designed to get us these woeful results:> inadequate resources, low fee-for-service pay for visits and noremuneration> for all the other work of primary care, the unfunded mandate of theinsane> administrative trivia game (billing, prior auth, and forms from hereto our> collective grave). In general we are on a diabolical treadmill andunable> to live up to our

professional obligations.> > > > We can work to put our houses in order, to use the best medicalinformation> to support our patients, to provide superb access, excellentcontinuity, a> broad array of service, and coordinate care across the continuumwhen we are> adequately resourced to do the work and we lose the crushing yoke of> administrative trivial pursuit.> > > > High performing health systems are founded on effective primarycare. Give> us the resources and relief we need to do our work.> > G>

[Guest guest]

Chad,

Your post are always well thought out and make for excellent conversation. Keep up the " food for thought " ideas.

What I particularly like about this list-serve is only very rarely do egos get involved in the postings. I have visited other listserves and quickly left due to the extreme emotions and ego wars that seem to dominate the conversations.

This list serve is an amazing group of forward-thinking primary care providers who are willing to challenge the status-quo and think outside the box. Instead of placing blame, we are working on real solutions and measuring the impact of our attempts.

What I do here in Durango with my IMP is still looked upon with distrust and anger mixed with some curiosity by my primary care peers. I had a peer tell me once " How dare you ask patients " Do you receive the health care you want and need! " You are making the rest of us look bad! Who's side are you on? "

I just tried to smile and I asked him whose side he thought I was on. I never got an answer.

I am often shocked into reality by going out into the community of physicians and seeing/feeling the utter despair and anger that permeates. Primary care is like a drowning person right now. (Bear with me, I was a life guard in my past life). When some one is drowning and you are trying to rescue them, they will thrash and grab on to anything or anyone that will float. They are not thinking of drowning their rescuer, just acting out of blind instinct. As a trained lifeguard, you know this and try to come from behind and get them into a position that is safe for both individuals. I try and remember this mantra when I am talking to other primary care providers who are caught, for whatever reason, in the abyss of what is left of primary care.

Some more " food for thought. "

Thanks for being there, " " . This group continues to be a steadying hand in a turbulent ocean.

, MD

Family Physician

Durango, CO

We WERE part of the problem. However, we are out of the game at this time. Their heels are on our foreheads and they think it is funny.

Beck, M.D.

Subject: Re: Is inappropriate primary care the problem with US health care?

To: Date: Friday, December 19, 2008, 7:22 AM

Completely agree. My posts the last couple of days were only intendedto spark a conversation about things we can do immediately to improveour own performance while we advocate for proper support from the

system. I labeled the first post as " food for thought " - hope no onethought my intent was to blame primary care for the mess. However, Ido believe that we will be most effective as a solution if we can show

that we practice in ways supported by evidence rather than habit orpatient demand. I know it's a chicken and egg problem - we don't havea system that supports doing the right things so we often don't do the

right things. However, to be effective, I need to avoid the easyroute of simply blaming insurance companies, specialists, thegovernment and the stars for all that is wrong - we are not completelypowerless as primary care docs. That was my only intent in spurring

what I hope at least some found to be a friendly debate worth having.Best and happy holidays.Chad>> No need to speculate on this topic, there are volumes of publications on> this issue. I present one of the most recent - not as the> be-all-and-end- all of publications, but merely as a reflection of a

wealth> of data.> > > > Parts of the US with greater concentrations of PCP per capita havebetter> satisfaction, better health outcomes, lower total cost.> > Parts of the US with greater concentrations of specialty care and

hospital> beds have worse satisfaction, worse outcomes and higher total cost.> > > > The reasons are explained in the attached..> > > > Does this mean primary care is pristine and we only need more of us

around?> Not for a second. There are certainly times when PCPs orderinappropriate> tests and treatments, there good studies documenting the inadequatelevels> of care delivered by PCPs in the US. This is an unfortunate

consequence of> being put in the professional equivalent of Lucille Ball on the assembly> line in the candy factory.> > > > The current system is perfectly designed to get us these woeful results:

> inadequate resources, low fee-for-service pay for visits and noremuneration> for all the other work of primary care, the unfunded mandate of theinsane> administrative trivia game (billing, prior auth, and forms from here

to our> collective grave). In general we are on a diabolical treadmill andunable> to live up to our professional obligations.> > > > We can work to put our houses in order, to use the best medical

information> to support our patients, to provide superb access, excellentcontinuity, a> broad array of service, and coordinate care across the continuumwhen we are> adequately resourced to do the work and we lose the crushing yoke of

> administrative trivial pursuit.> > > > High performing health systems are founded on effective primarycare. Give> us the resources and relief we need to do our work.>

> G>

[Guest guest]

Chad,

Your post are always well thought out and make for excellent conversation. Keep up the " food for thought " ideas.

What I particularly like about this list-serve is only very rarely do egos get involved in the postings. I have visited other listserves and quickly left due to the extreme emotions and ego wars that seem to dominate the conversations.

This list serve is an amazing group of forward-thinking primary care providers who are willing to challenge the status-quo and think outside the box. Instead of placing blame, we are working on real solutions and measuring the impact of our attempts.

What I do here in Durango with my IMP is still looked upon with distrust and anger mixed with some curiosity by my primary care peers. I had a peer tell me once " How dare you ask patients " Do you receive the health care you want and need! " You are making the rest of us look bad! Who's side are you on? "

I just tried to smile and I asked him whose side he thought I was on. I never got an answer.

I am often shocked into reality by going out into the community of physicians and seeing/feeling the utter despair and anger that permeates. Primary care is like a drowning person right now. (Bear with me, I was a life guard in my past life). When some one is drowning and you are trying to rescue them, they will thrash and grab on to anything or anyone that will float. They are not thinking of drowning their rescuer, just acting out of blind instinct. As a trained lifeguard, you know this and try to come from behind and get them into a position that is safe for both individuals. I try and remember this mantra when I am talking to other primary care providers who are caught, for whatever reason, in the abyss of what is left of primary care.

Some more " food for thought. "

Thanks for being there, " " . This group continues to be a steadying hand in a turbulent ocean.

, MD

Family Physician

Durango, CO

We WERE part of the problem. However, we are out of the game at this time. Their heels are on our foreheads and they think it is funny.

Beck, M.D.

Subject: Re: Is inappropriate primary care the problem with US health care?

To: Date: Friday, December 19, 2008, 7:22 AM

Completely agree. My posts the last couple of days were only intendedto spark a conversation about things we can do immediately to improveour own performance while we advocate for proper support from the

system. I labeled the first post as " food for thought " - hope no onethought my intent was to blame primary care for the mess. However, Ido believe that we will be most effective as a solution if we can show

that we practice in ways supported by evidence rather than habit orpatient demand. I know it's a chicken and egg problem - we don't havea system that supports doing the right things so we often don't do the

right things. However, to be effective, I need to avoid the easyroute of simply blaming insurance companies, specialists, thegovernment and the stars for all that is wrong - we are not completelypowerless as primary care docs. That was my only intent in spurring

what I hope at least some found to be a friendly debate worth having.Best and happy holidays.Chad>> No need to speculate on this topic, there are volumes of publications on> this issue. I present one of the most recent - not as the> be-all-and-end- all of publications, but merely as a reflection of a

wealth> of data.> > > > Parts of the US with greater concentrations of PCP per capita havebetter> satisfaction, better health outcomes, lower total cost.> > Parts of the US with greater concentrations of specialty care and

hospital> beds have worse satisfaction, worse outcomes and higher total cost.> > > > The reasons are explained in the attached..> > > > Does this mean primary care is pristine and we only need more of us

around?> Not for a second. There are certainly times when PCPs orderinappropriate> tests and treatments, there good studies documenting the inadequatelevels> of care delivered by PCPs in the US. This is an unfortunate

consequence of> being put in the professional equivalent of Lucille Ball on the assembly> line in the candy factory.> > > > The current system is perfectly designed to get us these woeful results:

> inadequate resources, low fee-for-service pay for visits and noremuneration> for all the other work of primary care, the unfunded mandate of theinsane> administrative trivia game (billing, prior auth, and forms from here

to our> collective grave). In general we are on a diabolical treadmill andunable> to live up to our professional obligations.> > > > We can work to put our houses in order, to use the best medical

information> to support our patients, to provide superb access, excellentcontinuity, a> broad array of service, and coordinate care across the continuumwhen we are> adequately resourced to do the work and we lose the crushing yoke of

> administrative trivial pursuit.> > > > High performing health systems are founded on effective primarycare. Give> us the resources and relief we need to do our work.>

> G>

[Guest guest]

Chad,

Your post are always well thought out and make for excellent conversation. Keep up the " food for thought " ideas.

What I particularly like about this list-serve is only very rarely do egos get involved in the postings. I have visited other listserves and quickly left due to the extreme emotions and ego wars that seem to dominate the conversations.

This list serve is an amazing group of forward-thinking primary care providers who are willing to challenge the status-quo and think outside the box. Instead of placing blame, we are working on real solutions and measuring the impact of our attempts.

What I do here in Durango with my IMP is still looked upon with distrust and anger mixed with some curiosity by my primary care peers. I had a peer tell me once " How dare you ask patients " Do you receive the health care you want and need! " You are making the rest of us look bad! Who's side are you on? "

I just tried to smile and I asked him whose side he thought I was on. I never got an answer.

I am often shocked into reality by going out into the community of physicians and seeing/feeling the utter despair and anger that permeates. Primary care is like a drowning person right now. (Bear with me, I was a life guard in my past life). When some one is drowning and you are trying to rescue them, they will thrash and grab on to anything or anyone that will float. They are not thinking of drowning their rescuer, just acting out of blind instinct. As a trained lifeguard, you know this and try to come from behind and get them into a position that is safe for both individuals. I try and remember this mantra when I am talking to other primary care providers who are caught, for whatever reason, in the abyss of what is left of primary care.

Some more " food for thought. "

Thanks for being there, " " . This group continues to be a steadying hand in a turbulent ocean.

, MD

Family Physician

Durango, CO

We WERE part of the problem. However, we are out of the game at this time. Their heels are on our foreheads and they think it is funny.

Beck, M.D.

Subject: Re: Is inappropriate primary care the problem with US health care?

To: Date: Friday, December 19, 2008, 7:22 AM

Completely agree. My posts the last couple of days were only intendedto spark a conversation about things we can do immediately to improveour own performance while we advocate for proper support from the

system. I labeled the first post as " food for thought " - hope no onethought my intent was to blame primary care for the mess. However, Ido believe that we will be most effective as a solution if we can show

that we practice in ways supported by evidence rather than habit orpatient demand. I know it's a chicken and egg problem - we don't havea system that supports doing the right things so we often don't do the

right things. However, to be effective, I need to avoid the easyroute of simply blaming insurance companies, specialists, thegovernment and the stars for all that is wrong - we are not completelypowerless as primary care docs. That was my only intent in spurring

what I hope at least some found to be a friendly debate worth having.Best and happy holidays.Chad>> No need to speculate on this topic, there are volumes of publications on> this issue. I present one of the most recent - not as the> be-all-and-end- all of publications, but merely as a reflection of a

wealth> of data.> > > > Parts of the US with greater concentrations of PCP per capita havebetter> satisfaction, better health outcomes, lower total cost.> > Parts of the US with greater concentrations of specialty care and

hospital> beds have worse satisfaction, worse outcomes and higher total cost.> > > > The reasons are explained in the attached..> > > > Does this mean primary care is pristine and we only need more of us

around?> Not for a second. There are certainly times when PCPs orderinappropriate> tests and treatments, there good studies documenting the inadequatelevels> of care delivered by PCPs in the US. This is an unfortunate

consequence of> being put in the professional equivalent of Lucille Ball on the assembly> line in the candy factory.> > > > The current system is perfectly designed to get us these woeful results:

> inadequate resources, low fee-for-service pay for visits and noremuneration> for all the other work of primary care, the unfunded mandate of theinsane> administrative trivia game (billing, prior auth, and forms from here

to our> collective grave). In general we are on a diabolical treadmill andunable> to live up to our professional obligations.> > > > We can work to put our houses in order, to use the best medical

information> to support our patients, to provide superb access, excellentcontinuity, a> broad array of service, and coordinate care across the continuumwhen we are> adequately resourced to do the work and we lose the crushing yoke of

> administrative trivial pursuit.> > > > High performing health systems are founded on effective primarycare. Give> us the resources and relief we need to do our work.>

> G>

[Guest guest]

What I particularly like about this list-serve is only very rarely do egos get involved in the postings. I have visited other listserves and quickly left due to the extreme emotions and ego wars that seem to dominate the conversations.

I must say I agree The AAFP list servs werelike that forme I could never see that they accompliush anything

..

What I do here in Durango with my IMP is still looked upon with distrust and anger mixed with some curiosity by my primary care peers. I had a peer tell me once " How dare you ask patients " Do you receive the health care you want and need! " You are making the rest of us look bad! Who's side are you on? "

REALLY?

..

I like the life gurd analogy alot the patietn thrashing around looking for anything to help-eg get me that free cbc even if I do not need it. I have to t ell you I failed the lifeguard test.

I was about 98 lbs and I could not get to the bottom of the pool to get the whatever it was 90 lb brick I had to rescue. I kept floating up. The brick drowned. If you are a patient please allow up to 24 hours for a reply by email/

please note the new email address.Remember that e-mail may not be entirely secure/ MD ph fax

[Guest guest]

What I particularly like about this list-serve is only very rarely do egos get involved in the postings. I have visited other listserves and quickly left due to the extreme emotions and ego wars that seem to dominate the conversations.

I must say I agree The AAFP list servs werelike that forme I could never see that they accompliush anything

..

What I do here in Durango with my IMP is still looked upon with distrust and anger mixed with some curiosity by my primary care peers. I had a peer tell me once " How dare you ask patients " Do you receive the health care you want and need! " You are making the rest of us look bad! Who's side are you on? "

REALLY?

..

I like the life gurd analogy alot the patietn thrashing around looking for anything to help-eg get me that free cbc even if I do not need it. I have to t ell you I failed the lifeguard test.

I was about 98 lbs and I could not get to the bottom of the pool to get the whatever it was 90 lb brick I had to rescue. I kept floating up. The brick drowned. If you are a patient please allow up to 24 hours for a reply by email/

please note the new email address.Remember that e-mail may not be entirely secure/ MD ph fax

[Guest guest]

What I particularly like about this list-serve is only very rarely do egos get involved in the postings. I have visited other listserves and quickly left due to the extreme emotions and ego wars that seem to dominate the conversations.

I must say I agree The AAFP list servs werelike that forme I could never see that they accompliush anything

..

What I do here in Durango with my IMP is still looked upon with distrust and anger mixed with some curiosity by my primary care peers. I had a peer tell me once " How dare you ask patients " Do you receive the health care you want and need! " You are making the rest of us look bad! Who's side are you on? "

REALLY?

..

I like the life gurd analogy alot the patietn thrashing around looking for anything to help-eg get me that free cbc even if I do not need it. I have to t ell you I failed the lifeguard test.

I was about 98 lbs and I could not get to the bottom of the pool to get the whatever it was 90 lb brick I had to rescue. I kept floating up. The brick drowned. If you are a patient please allow up to 24 hours for a reply by email/

please note the new email address.Remember that e-mail may not be entirely secure/ MD ph fax

[Guest guest]

I thought your post was great and very

helpful in stimulating discussion, even when folks respond with passion, don’t

feel beleaguered & keep on posting.

Thank you for your contributions. I agree

that we need to avoid the easy solutions, avoid simple blaming & bashing

and continue to be inventive and thoughtful.

Gordon

From: [mailto: ] On Behalf Of chadcostley

Sent: Friday, December 19, 2008

4:22 AM

To:

Subject:

Re: Is inappropriate primary care the problem with US health care?

Completely agree. My posts the last couple of days

were only intended

to spark a conversation about things we can do immediately to improve

our own performance while we advocate for proper support from the

system. I labeled the first post as " food for thought " - hope no one

thought my intent was to blame primary care for the mess. However, I

do believe that we will be most effective as a solution if we can show

that we practice in ways supported by evidence rather than habit or

patient demand. I know it's a chicken and egg problem - we don't have

a system that supports doing the right things so we often don't do the

right things. However, to be effective, I need to avoid the easy

route of simply blaming insurance companies, specialists, the

government and the stars for all that is wrong - we are not completely

powerless as primary care docs. That was my only intent in spurring

what I hope at least some found to be a friendly debate worth having.

Best and happy holidays.

Chad

>

> No need to speculate on this topic, there are volumes of publications on

> this issue. I present one of the most recent - not as the

> be-all-and-end-all of publications, but merely as a reflection of a

wealth

> of data.

>

>

>

> Parts of the US

with greater concentrations of PCP per capita have

better

> satisfaction, better health outcomes, lower total cost.

>

> Parts of the US

with greater concentrations of specialty care and

hospital

> beds have worse satisfaction, worse outcomes and higher total cost.

>

>

>

> The reasons are explained in the attached..

>

>

>

> Does this mean primary care is pristine and we only need more of us

around?

> Not for a second. There are certainly times when PCPs order

inappropriate

> tests and treatments, there good studies documenting the inadequate

levels

> of care delivered by PCPs in the US. This is an unfortunate

consequence of

> being put in the professional equivalent of Lucille Ball on the assembly

> line in the candy factory.

>

>

>

> The current system is perfectly designed to get us these woeful results:

> inadequate resources, low fee-for-service pay for visits and no

remuneration

> for all the other work of primary care, the unfunded mandate of the

insane

> administrative trivia game (billing, prior auth, and forms from here

to our

> collective grave). In general we are on a diabolical treadmill and

unable

> to live up to our professional obligations.

>

>

>

> We can work to put our houses in order, to use the best medical

information

> to support our patients, to provide superb access, excellent

continuity, a

> broad array of service, and coordinate care across the continuum

when we are

> adequately resourced to do the work and we lose the crushing yoke of

> administrative trivial pursuit.

>

>

>

> High performing health systems are founded on effective primary

care. Give

> us the resources and relief we need to do our work.

>

> G

>

[Guest guest]

I thought your post was great and very

helpful in stimulating discussion, even when folks respond with passion, don’t

feel beleaguered & keep on posting.

Thank you for your contributions. I agree

that we need to avoid the easy solutions, avoid simple blaming & bashing

and continue to be inventive and thoughtful.

Gordon

From: [mailto: ] On Behalf Of chadcostley

Sent: Friday, December 19, 2008

4:22 AM

To:

Subject:

Re: Is inappropriate primary care the problem with US health care?

Completely agree. My posts the last couple of days

were only intended

to spark a conversation about things we can do immediately to improve

our own performance while we advocate for proper support from the

system. I labeled the first post as " food for thought " - hope no one

thought my intent was to blame primary care for the mess. However, I

do believe that we will be most effective as a solution if we can show

that we practice in ways supported by evidence rather than habit or

patient demand. I know it's a chicken and egg problem - we don't have

a system that supports doing the right things so we often don't do the

right things. However, to be effective, I need to avoid the easy

route of simply blaming insurance companies, specialists, the

government and the stars for all that is wrong - we are not completely

powerless as primary care docs. That was my only intent in spurring

what I hope at least some found to be a friendly debate worth having.

Best and happy holidays.

Chad

>

> No need to speculate on this topic, there are volumes of publications on

> this issue. I present one of the most recent - not as the

> be-all-and-end-all of publications, but merely as a reflection of a

wealth

> of data.

>

>

>

> Parts of the US

with greater concentrations of PCP per capita have

better

> satisfaction, better health outcomes, lower total cost.

>

> Parts of the US

with greater concentrations of specialty care and

hospital

> beds have worse satisfaction, worse outcomes and higher total cost.

>

>

>

> The reasons are explained in the attached..

>

>

>

> Does this mean primary care is pristine and we only need more of us

around?

> Not for a second. There are certainly times when PCPs order

inappropriate

> tests and treatments, there good studies documenting the inadequate

levels

> of care delivered by PCPs in the US. This is an unfortunate

consequence of

> being put in the professional equivalent of Lucille Ball on the assembly

> line in the candy factory.

>

>

>

> The current system is perfectly designed to get us these woeful results:

> inadequate resources, low fee-for-service pay for visits and no

remuneration

> for all the other work of primary care, the unfunded mandate of the

insane

> administrative trivia game (billing, prior auth, and forms from here

to our

> collective grave). In general we are on a diabolical treadmill and

unable

> to live up to our professional obligations.

>

>

>

> We can work to put our houses in order, to use the best medical

information

> to support our patients, to provide superb access, excellent

continuity, a

> broad array of service, and coordinate care across the continuum

when we are

> adequately resourced to do the work and we lose the crushing yoke of

> administrative trivial pursuit.

>

>

>

> High performing health systems are founded on effective primary

care. Give

> us the resources and relief we need to do our work.

>

> G

>

[Guest guest]

OK, sorry for this, but for the third time this morning, I'll say,

" ditto. " Chad, your post and the questions raised by it

were excellent, even helpful in the on-going conversation that we are all part

of. No one post will be the answer to all of health care's problems (though

those of Gordon, Brady, and many others often seem close to doing that!!

;-). But each post helps us keep moving in the right direction I believe.I think I was one of the folks who answered " passionately " and

disagreed with the feelings of your friend. But, as someone who joined the

list when there were only a couple dozen of us, I'll say that the passions we feel

for issues on this list do not, or at least rarely, reflect on the person we are

responding too. (I'd still love to know what he thinks to some of the

questions we raised. His thoughts could be valuable to us all. Please share them if

you ever have the chance)Let's remember, life has no destination. The

journey is the destination. I very much believe that we are all better doctors

simply because of the conversation we are all part of here, as well as our wish to

be better than we have been in the past or think we would be in a different

situation. For me, that is the essence and the beauty of this list serve!All the best --TimOn Fri, December 19, 2008 9:22 am EST, L. Gordon wrote:

I thought your post was great and veryhelpful in stimulating discussion, even when folks respond with passion,

don’tfeel beleaguered & keep on posting.

Thank you for your contributions. I

agreethat we need to avoid the easy solutions, avoid simple blaming &

bashingand continue to be inventive and thoughtful.

Gordon

From:

[mailto: ]

On Behalf Of chadcostleySent: Friday, December

19, 20084:22 AMTo: Subject: Re:

Is inappropriate primary care the problem with US health care?

Completely agree. My posts the last couple of dayswere only intendedto spark a conversation about things we can do immediately

to improveour own performance while we advocate for proper support from thesystem. I labeled the first post as " food for thought " - hope no onethought my intent was to blame primary care for the mess. However, Ido

believe that we will be most effective as a solution if we can showthat we

practice in ways supported by evidence rather than habit orpatient demand. I

know it's a chicken and egg problem - we don't havea system that supports

doing the right things so we often don't do theright things. However, to be

effective, I need to avoid the easyroute of simply blaming insurance

companies, specialists, thegovernment and the stars for all that is wrong - we

are not completelypowerless as primary care docs. That was my only intent in

spurringwhat I hope at least some found to be a friendly debate worth

having.Best and happy holidays.Chad>> No need to speculate

on this topic, there are volumes of publications on> this issue. I present

one of the most recent - not as the> be-all-and-end-all of

publications, but merely as a reflection of awealth> of data.> > > > Parts of the USwith greater

concentrations of PCP per capita havebetter> satisfaction, better

health outcomes, lower total cost.> > Parts of the USwith

greater concentrations of specialty care andhospital> beds have worse

satisfaction, worse outcomes and higher total cost.> > >

> The reasons are explained in the attached..> > > > Does this mean primary care is pristine and we only need more of

usaround?> Not for a second. There are certainly times when PCPs

orderinappropriate> tests and treatments, there good studies

documenting the inadequatelevels> of care delivered by PCPs in the

US. This is an unfortunateconsequence of> being put in the

professional equivalent of Lucille Ball on the assembly> line in the candy

factory.> > > > The current system is perfectly

designed to get us these woeful results:> inadequate resources, low

fee-for-service pay for visits and noremuneration> for all the other

work of primary care, the unfunded mandate of theinsane>

administrative trivia game (billing, prior auth, and forms from hereto our> collective grave). In general we are on a diabolical treadmill andunable> to live up to our professional obligations.> >

> > We can work to put our houses in order, to use the best

medicalinformation> to support our patients, to provide superb

access, excellentcontinuity, a> broad array of service, and

coordinate care across the continuumwhen we are> adequately resourced

to do the work and we lose the crushing yoke of> administrative trivial

pursuit.> > > > High performing health systems

are founded on effective primarycare. Give> us the resources and

relief we need to do our work.> > G>

---------------------------------------- Malia, MDMalia

Family Medicine & Skin Sense Laser6720 Pittsford-Palmyra Rd.Perinton

Square MallFairport, NY 14450 (phone / fax)www.relayhealth.com/doc/DrMaliawww.SkinSenseLaser.com--

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