Medicine
America is aging. With increases in age, Americans become more dependent and have more care needs in areas such as health, activities of daily living, finances, and more. Aging in America is not equitably distributed. States like Alaska and many of the locations associated with small health care have more rapid rates of aging growth and oldest American growth. Once again increasing demand for health and other services is occurring in locations that have lowest resources and fewest clinicians.
Unprecedented changes are being seen across America - particularly where small health care is dominant. Only a few years after penalties have been proposed and implemented for Pay for Performance or for Readmissions penalties, the landscape has changed. Economic declines, cuts in state and federal spending, failure to produce the specific clinicians needed, higher cost of delivery, and increasing patient complexities have proceeded and have even accelerated in some locations.
Why Do Payment Designs Persist in Penalizing Small Health Care Providers?
The situations are quite different from a few years ago and even worse is on the way. Just when you think you have Summarized Small Health Complexities, new studies come out to contribute even more to our understanding of complexities - and the folly of attempting to link quality issues to lower payment. A new study highlights the rapid rise of care needs in seniors as reported in Healthjournalism.org from Millbank Quarterly.
Overall, researchers found:
And our nation's politicians want to continue to cut needed areas of support?
There is nothing about this report that would indicate anything other than declines in local health outcomes where these scenarios are most likely to be found. We know from national payment distributions of nutrition funding, disability funding, Social Security, Medicare, and Medicaid that small health is where these populations are concentrated.
From what we understand about small health or the 2621 counties with lesser concentrations of clinicians, there are more elderly and they are more likely to be older and less healthy in a number of dimensions. Health literacy correlates with education level and age.
Slow steady worsening of rural hospital outcomes regarding Medicare patients (JAMA study) may actually reflect the slow steady worsening of patients and their situations as guided by aging and deterioration of local resources.
What happens in rural America has is often a prelude to what will happen in the rest of America. Adverse consequences and challenges often proceed from the smallest health care sites and smallest concentrations of workforce to somewhat larger and eventually even the largest:
Current and even accelerated declines seen in rural and smaller hospitals may already represent what happens to health care redesigned by health designers who fail to understand the people, their situations, their health care, or their health outcomes.
Will Teaching CHC Sites Deliver on the Promise of Health Access?
How Bad Medicine is Sweeping The Country.
Basic Health Access Web Basic Health Access Blog World of Rural Medical Education
- Medicare And Medicaid At 50 And Beyond
When did M and M design change from support for health access to against health access and why? Government and Foundations are currently celebrating the accomplishments of Medicare at Age 50 - but which Medicare? Claims of improving the cost of care are...
- Distribution Failures Behind By Many Designs
The 3138 US Counties can be coded by physicians, by types of physicians such as active family physicians seen here, by population and by other demographics, including those age 65 that are increasing rapidly and even more in health care demand. As previously...
- Summary Of Small Health Complexities
No small part of America is impacted by designs and information sources that disadvantage small health hospitals and practices and the people that depend upon small health care.Small Practices Are perceived as impacting relatively few, but small...
- Too Many And The Wrong Clinicians
Expansions of clinicians are out of control. There appear to be no obstacles to accelerating numbers of clinicians. This is the result of more sources of clinicians plus expansions in US MD, US DO, Caribbean, non-citizen international, nurse practitioner,...
- Damn The Reality Of Small Practices - Full Speed Ahead
The Graham Center has released a study indicating that 45% of primary care physicians are found in small practices with 5 or fewer physicians. Studies by county and by zip code indicate substantial portions of the American population dependent upon small...
Medicine
More Reasons for Lesser Performance for Small Health
America is aging. With increases in age, Americans become more dependent and have more care needs in areas such as health, activities of daily living, finances, and more. Aging in America is not equitably distributed. States like Alaska and many of the locations associated with small health care have more rapid rates of aging growth and oldest American growth. Once again increasing demand for health and other services is occurring in locations that have lowest resources and fewest clinicians.
Unprecedented changes are being seen across America - particularly where small health care is dominant. Only a few years after penalties have been proposed and implemented for Pay for Performance or for Readmissions penalties, the landscape has changed. Economic declines, cuts in state and federal spending, failure to produce the specific clinicians needed, higher cost of delivery, and increasing patient complexities have proceeded and have even accelerated in some locations.
Why Do Payment Designs Persist in Penalizing Small Health Care Providers?
The situations are quite different from a few years ago and even worse is on the way. Just when you think you have Summarized Small Health Complexities, new studies come out to contribute even more to our understanding of complexities - and the folly of attempting to link quality issues to lower payment. A new study highlights the rapid rise of care needs in seniors as reported in Healthjournalism.org from Millbank Quarterly.
Overall, researchers found:
- Out of the 18 million older adults with some late-life disability, 19.6 percent had difficulty and 28.7 percent received help from another person with self-care, mobility or household activities.
- Another 11.5 million adjusted for their limitations through assistive devices or reducing activity frequency.
- About 20 percent of those under age 85 and more than 75 percent of those age 90 or older received some type of additional help
- Women and widows made up a disproportionate share of those needing assistance, which is not unusual since women tend to outlive men. African-Americans and Hispanics were overrepresented in self-care and mobility assistance categories.
- Those in the lowest-income quartile had significantly higher needs across all levels of assistance, especially those requiring help with three or more ADLs or IADLs.
- Family caregivers continue to provide most of the assistance to older adults, particularly for those in lower income brackets.
- Fifteen percent of older adults reported adverse consequences related to unmet needs in the month before the analysis. Minorities, widows, or never-married, and those with the lowest income reported the greatest number of adverse consequences.
- For those living at home or supportive care environments, 32 percent reported at least one adverse consequence in the previous month.
And our nation's politicians want to continue to cut needed areas of support?
There is nothing about this report that would indicate anything other than declines in local health outcomes where these scenarios are most likely to be found. We know from national payment distributions of nutrition funding, disability funding, Social Security, Medicare, and Medicaid that small health is where these populations are concentrated.
From what we understand about small health or the 2621 counties with lesser concentrations of clinicians, there are more elderly and they are more likely to be older and less healthy in a number of dimensions. Health literacy correlates with education level and age.
Slow steady worsening of rural hospital outcomes regarding Medicare patients (JAMA study) may actually reflect the slow steady worsening of patients and their situations as guided by aging and deterioration of local resources.
- It is difficult to see how penalties and even lower revenue from Medicare or Medicaid or insurance would do anything other than worsen care and care outcomes.
- It is difficult to see how forced closure of remaining small hospitals or small practices would do anything other than worsen local workforce, local revenue, and local social determinants of health
What happens in rural America has is often a prelude to what will happen in the rest of America. Adverse consequences and challenges often proceed from the smallest health care sites and smallest concentrations of workforce to somewhat larger and eventually even the largest:
- Rapid aging
- Increases in populations in need of care and resources
- Poorly targeted programs
- Programs that are targets for cost cutting
Current and even accelerated declines seen in rural and smaller hospitals may already represent what happens to health care redesigned by health designers who fail to understand the people, their situations, their health care, or their health outcomes.
Open Season Upon Small Health Care
Continue on to Open Season on Small Health By Big Media
Summary of Small Health Complexities
Reference Links
- Small health care (< 5 physicians in a practice) is 45% of primary care in America as noted in the recent Robert Graham Center one pager.
- The common assumption that bigger is better should not be accepted without question
- Before readmission penalties, the adverse impacts upon Small Health and others with more complex patients were known
- Small practices do better in preventable hospitalization
- Commonwealth comments on inequality from health design
- Center for Rural Health Works
- Populations already behind pay more of their income for health insurance coverage and get less value for their investment.
- New Millbank Report Highlights Seniors Unmet Care Needs
Recent Works
Starting to Solve Societal Inequities - Support for a SMART Start from the Very Beginning of Life
Best Beginnings for Health Access Clinicians - Shared Origins and Optimal Health Access Focus During Trainings
Family Medicine Needs a New Beginning - Current Preparation, Admission, and Medical School Plus Health Policy Interact To Prevent Family Medicine Choice - and Health Access Result
Too Many and the Wrong Clinicians for graphic - Additional consequences result from designs not specific to primary care or care where needed.
Perverse Health Payment Dividing US - More for Fewer and Less for More, and Penalties for Those Caring for Those Most in Need
How To Resolve Health Access for 40 States Behind By Design
Preventing Rural Workforce By Design
And the Next Victims of Cost Cutting: Dual Eligibles - Those Most Vulnerable and Least Able to Defend Themselves Are Next
ALS Disease Focus Is Not a Top Priority - Have fun, but Minor Incidence Diseases Are Below the Major Diseases, and Far Below Health Care Caused Disease, and Causes of Early Death, and the top 10 priorities for most Americans - and America as a Nation
Information Technology Cannot Heal - Time to Get Out of the Way of Healing and Those Who Can Help Remove Barriers to Healing
Hotspotting Has Many Spots To Consider - Simple Interpretations Are Inaccurate, Many Different Characteristics Shape the Outcomes, Not Just Geographic Location
Retail Clinic Recoil - Many Side Effects Can Be Anticipated, And More to Come
Global Fails Local But Local Focus Succeeds Globally
What Veterans Need Is Family Practice - No Other Type of Clinician Comes Close to the Location or the Scope
Domino Decline By Design - as ERs Close, Those Nearby Face Challenges, as Small or Rural Hospitals Close or Practices Where Needed...
Declines in Health Care Delivery Despite Increases in Health Spending - If We Keep Accelerating Non-Delivery Costs, We Can Continue to Remain Behind Health Care Demand
Health Care Delivery Is No Laughing Matter - Political Cartoons are Nice, but...
Overcoming Barriers to Health Access Including Portions of ACA
Will Teaching CHC Sites Deliver on the Promise of Health Access?
How Bad Medicine is Sweeping The Country.
Best of Basic Health Access
Blogs indicate that primary care can be recovered and should be recovered.
Robert C. Bowman, M.D. [email protected]
Basic Health Access Web Basic Health Access Blog World of Rural Medical Education
Dr. Bowman is the North American Co-Editor of Rural and Remote Health. He was the founding chair of the Rural Medical Educators Group of the National Rural Health Association and the long term chair of the STFM Group on Rural Health.
- Medicare And Medicaid At 50 And Beyond
When did M and M design change from support for health access to against health access and why? Government and Foundations are currently celebrating the accomplishments of Medicare at Age 50 - but which Medicare? Claims of improving the cost of care are...
- Distribution Failures Behind By Many Designs
The 3138 US Counties can be coded by physicians, by types of physicians such as active family physicians seen here, by population and by other demographics, including those age 65 that are increasing rapidly and even more in health care demand. As previously...
- Summary Of Small Health Complexities
No small part of America is impacted by designs and information sources that disadvantage small health hospitals and practices and the people that depend upon small health care.Small Practices Are perceived as impacting relatively few, but small...
- Too Many And The Wrong Clinicians
Expansions of clinicians are out of control. There appear to be no obstacles to accelerating numbers of clinicians. This is the result of more sources of clinicians plus expansions in US MD, US DO, Caribbean, non-citizen international, nurse practitioner,...
- Damn The Reality Of Small Practices - Full Speed Ahead
The Graham Center has released a study indicating that 45% of primary care physicians are found in small practices with 5 or fewer physicians. Studies by county and by zip code indicate substantial portions of the American population dependent upon small...