tag:blogger.com,1999:blog-7255776707298393367.post219867270039484496..comments2023-10-09T06:23:42.682-07:00Comments on Saving Money and Surviving the Healthcare Crisis: Why the Solution to the Primary Care Crisis, the Patient Centered Medical Home, Will FailDavis Liu, MDhttp://www.blogger.com/profile/15320315964654209559noreply@blogger.comBlogger5125tag:blogger.com,1999:blog-7255776707298393367.post-27914169722470358012010-09-01T08:14:58.315-07:002010-09-01T08:14:58.315-07:00Dr. Liu. I wish to offer some refuting information...Dr. Liu. I wish to offer some refuting information in regards to your statement "Though the British may have high satisfaction with non-physician providers, given a choice and a level playing field of the same amount of time and access, I believe Americans will choose a doctor over a nurse practitioner (NP) or physician assistant (PA)."<br /><br />My wife has worked for the last 15 years as a Gerontological Nurse Practitioner exclusively in the long term care setting. According to the nursing home staff and administration at more than one facility, many of her patients prefer being seen by her to being seen by the physician.<br /><br />Some Americans can and do accept alternatives to the traditional care model.MChttps://www.blogger.com/profile/05290564898544011511noreply@blogger.comtag:blogger.com,1999:blog-7255776707298393367.post-977048490830654952010-08-25T21:27:48.088-07:002010-08-25T21:27:48.088-07:00Americans were stupid in not converting to metric....Americans were stupid in not converting to metric.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-7255776707298393367.post-8215584514098686502010-08-25T17:23:54.005-07:002010-08-25T17:23:54.005-07:00Lisa, appreciate your comments and all of the hard...Lisa, appreciate your comments and all of the hard work you are doing. Always good to hear from an alumna!<br /><br />Dr. Mavromatis - I think third party doesn't mean insurers. It can be employer groups who contract services with other organizations to deliver chronic care as noted in recent NY Times - http://www.nytimes.com/2010/07/24/business/24patient.html?pagewanted=2<br /><br />I'm not against small practices. The challenge is that there is no standard where a practice can virtually integrate with larger referral centers / specialists. Right now there are different vendors jockeying for position. This is not unlike the dot.com boom. Until this settles, I fear that small practices will be left behind.Davis Liu, MDhttps://www.blogger.com/profile/15320315964654209559noreply@blogger.comtag:blogger.com,1999:blog-7255776707298393367.post-2489085847668576472010-08-25T08:33:32.153-07:002010-08-25T08:33:32.153-07:00David, I enjoyed reading your blog. I am curious a...David, I enjoyed reading your blog. I am curious about your vision: "instead, third party organizations should be accountable for managing chronic conditions and reporting to a patient's primary care doctor if the patient is not compliant with care or not following practice protocols." My view is that third party management (insurance company generated feedback reports) is not very effective in terms of inspiring quality improvement. Most doctors tend to ignore these types of reports unless they themselves generate the reports, or their own health care organization generates them. <br /><br />I guess that I am less pessimistic than you about the future ability of small practices to use electronic records and interconnect in a meaningful way to larger referral centers and specialists. I think that this will come eventually with meaningful use. I think the current challenge for small practices is how to afford the transition. Some of the less favorable data on the medical home pilot projects has to do with the lack of support during this time of transition. Clearly a medical team in a small practice will look very different than a medical team in a integrated health system. Some patients may continue to prefer the intimacy of this type of practice setting.Juliet Mavromatis, MDhttps://www.blogger.com/profile/15621812541697154967noreply@blogger.comtag:blogger.com,1999:blog-7255776707298393367.post-81801489370659189972010-08-24T21:11:23.044-07:002010-08-24T21:11:23.044-07:00Sigh. I hope you are wrong too. But there are som...Sigh. I hope you are wrong too. But there are some disturbing trends here. I have been in practice 10 years, general Internal Medicine (hi Davis, long time, no see!). I am not certain I will be doing this in another 10 years... student loans are paid off... no life balance ... we can all do the math here ...<br />I am dedicated, but endless self-sacrifice, aggravation and harassment, with only intermittent satisfaction is not enough.....<br />-- Lisa, UCONN 1997Anonymousnoreply@blogger.com