Medicine
It is about time that Small Health Care received some attention as the small hospitals and small practices, but will this continue. Off and on over past decades, primary care has received much attention, but the attention has not resulted in changes in payment policy. In fact the increased cost of delivering care has made matters worse.
Small Health Care is at least half made up of primary care and much of the remaining local care is basic services - services lowest paid by design. Small health does not have multiple lines of revenue with the top reimbursement in each line as seen in large health care.
It is an impressive run of articles with some content regarding small health care, often negative but a few positive
The AMA says changes are needed in health information technology - but our nation plunges on with far less efficient HIT. The software still takes far too much time and effort.
CMS moves on recklessly with Meaningful Use regulations in 2015 even though experts in HIT and those representing rural health care (National Rural Health Association) have encouraged more caution.
AAFP experts also agree that the Meaningful Use regulations are ridiculously complex.
9/11/14 Commonwealth - All Health Care Is Local
9/10/14 Headlines - Small Hospital Closures Accelerate, Finances Weaker for Stand Alones
Changes have not come
Can rural and small practice urban sites rally together to get more than just discussion?
Will federal facilities and funding supports contribute to care or undermine what remains of private small health care?
What will turn clinicians around to primary care and small health care when payment so obviously rewards specialized care and sites with concentrations of clinicians?
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...
- Stop The Hit Glitches And Delays For Better Care
Water is essential for life, but floods are destructive. Health information is essential for life, but floods of information, software, hardware, techs, consultants, and salespeople are too much - too much for cost, too much for patients to comprehend,...
- 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
Will Small Health Make the News Long Enough to Matter?
It is about time that Small Health Care received some attention as the small hospitals and small practices, but will this continue. Off and on over past decades, primary care has received much attention, but the attention has not resulted in changes in payment policy. In fact the increased cost of delivering care has made matters worse.
Small Health Care is at least half made up of primary care and much of the remaining local care is basic services - services lowest paid by design. Small health does not have multiple lines of revenue with the top reimbursement in each line as seen in large health care.
It is an impressive run of articles with some content regarding small health care, often negative but a few positive
The AMA says changes are needed in health information technology - but our nation plunges on with far less efficient HIT. The software still takes far too much time and effort.
CMS moves on recklessly with Meaningful Use regulations in 2015 even though experts in HIT and those representing rural health care (National Rural Health Association) have encouraged more caution.
AAFP experts also agree that the Meaningful Use regulations are ridiculously complex.
9/11/14 Commonwealth - All Health Care Is Local
9/10/14 Headlines - Small Hospital Closures Accelerate, Finances Weaker for Stand Alones
9/9/14 Commonwealth Do Health Care Costs Fuel Economic Inequality in the United States?
9/8/14 Regarding the flaws in Pay for Performance
Small practices do better in preventable hospitalization
Changes have not come
- Primary care pay remains low and especially low compared to non-primary care specialized services
- Disproportionate share funding is going away and across the board cuts have continued to reduce revenue.
- Graduate medical education has not been reformed despite legislation and nearly a decade to observe the legislation going for naught.
- Continued funding for Medicaid to remain at higher rates of pay has not passed.
- The government has not eased up on penalties that more commonly go to sites where small health is found.
- The state governments have not reformed Medicaid criteria, eligibility, payment barriers, or low pay.
Can rural and small practice urban sites rally together to get more than just discussion?
Will federal facilities and funding supports contribute to care or undermine what remains of private small health care?
What will turn clinicians around to primary care and small health care when payment so obviously rewards specialized care and sites with concentrations of clinicians?
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.
- GME Changes in Academic Medicine by Jolly
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...
- Stop The Hit Glitches And Delays For Better Care
Water is essential for life, but floods are destructive. Health information is essential for life, but floods of information, software, hardware, techs, consultants, and salespeople are too much - too much for cost, too much for patients to comprehend,...
- 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...