Enjoy our most current issue of the most popular medical e-newsletter on the internet.
Blogs and Thoughts for November 16th to November 22nd, 2017
Here is what we had this past week:
- Give It Up, Christine Sinsky MD!
- ZDogg, Doc Vader and Dr. Peter Gallogly MD
- What Does Aetna’s CEO Think About Healthcare?
- Doctor Wants to Kill Netflix by Pat Conrad MD
- Ridiculous Study of the Week: Medicaid Payment
- Friday Funny: Which AAFP Ad is Real (or Realistic)?
- Quote of the Week: Pauline Kael
1. Give It Up, Christine Sinsky MD!
November 22, 2017
The funny thing about this blog is that we have touched on so many issues that the same ones and the same people keep coming again and again. This is what Dr. Conrad wrote back last January:
Christine Sinsky, MD coauthored a 2015 Mayo study that found: physician burnout had risen 15% since 2011, to 54%. There was also a corresponding decline in reported satisfaction with work-life balance. Dr. Sinsky recognizes that this burnout rate is the result of increasing time spent documenting, EHR’s, and loss of control “to government regulators and third party payers.” And now for the fun part.
Sinsky says, “It’s a cumulative effect of well-intended efforts adding up to a burden of work that no one anticipated.” Well-intended by whom, exactly, the sellouts at the AMA? And why is any credit given for good intentions, when those of us on the receiving end of this garbage absolutely anticipated the results? In what sounds like a parody from the old Placebo Journal, “the AMA has created a series of online tutorials – which Sinsky calls “transformation toolkits”—designed to help practices operate more efficiently and enable physicians to gain more control over their workday. Many of the tutorials focus on ways doctors and practices can save time, such as renewing all of a patient’s medications once a year, or spreading documentation and data entry among members of a care team.” She suggests straight-faced that doctors “reengineer” their days to “create a lot more room in their day for enjoyment.”
Yeah, I laughed at this stuff too. That’s when I tried to find out who Christine Sinsky MD was. Here is what I said:
So, who is Christine Sinsky? It turns out that she is a member of the Board of Trustees of the ABIM Foundation and a director of the American Board of Internal Medicine. This is the same organizations found to be corrupt by Wes Fisher MD. Interesting. How is it that someone can be so high up in the the AMA, the ABIM and the ABIM Foundation? Is this one, big, good old “boys and girls” club? What am I missing here?
Yup. She has made a ton of money off our backs (with things like the MOC) but now she wants to help us? The newest joke of an attempt comes in Medical Economics’ article Fighting Burnout at Three Levels. In the piece, Sinsky states that physicians “highly resilient” as a group and emphasizes, “If this group is struggling, the environment must be particularly problematic.” Yeah, and YOU HELPED CREATE THIS ENVIRONMENT!!
Here are more of her delusional thoughts:
- She believes that most primary care practices can save three to five hours of patient care every day by reengineering the way work is done.
- For larger medical systems, she recommends their newest module, called the Organizational Foundation for Joy in Medicine, which makes plain that what’s good for physicians is good for the bottom line, as well: “A more engaged, satisfied workforce will provide better, safer, more compassionate care to patients, which will, in turn, reduce the total costs of care,” the module notes.
- “This is a solvable problem. I wouldn’t be devoting my work life to this topic if I felt it was futile.” She believes that by pairing solid data that asks the question “Is this a wise use of the societal investment in the training of physicians?” with resources, tools and innovations like those at the AMA and others cropping up because “the medical community is at the breaking point,” will help advance the conversation.
Dr. Sinsky, you go ahead and keep devoting your work life to this topic. You say that only 20% of your weekly hours are devoted to patient care so go ahead and sit at your desk or go to meetings for the other 80% trying to rack your brains for the solution. You won’t find one unless you take my advice and take the government and the insurers out of the equation. Boop. It’s solved. Until then you will continue to litter these throwaway magazines with your incredibly stupid ideas that continuously fail. But I bet you don’t care because it keeps you in the position of AMA’s Vice President of Professional Satisfaction and your paycheck will be just fine. How much? Well, it turns out it is impossible to figure out. See Dr. Wes’s newest blog.
This whole thing (and Dr. Sinsky) stinks.
2. ZDogg, Doc Vader and Dr. Peter Gallogly MD
Nov 21, 2017
“Doc Vader on Losing Your Temper in the ER.”
Another great one from Zubin. Here he is protective of an ER doc who got a ton of crap from this video. When the whole story came out is wasn’t what it seems.
3. What Does Aetna’s CEO Think About Healthcare?
Nov 20, 2017
Here is basically the whole article in Becker’s Hospital Review:
During a keynote discussion at a Financial Executives International conference in New York City Monday, Aetna CEO Mark Bertolini described healthcare as a “rat’s maze,” according to CFO.
Mr. Bertolini joined Johnson & Johnson CEO Alex Gorsky in a conversation about healthcare’s shifting reimbursement landscape. Aetna’s executive spoke about his frustrations with the complexity of healthcare.
“They [physicians] refer you here; then you get a test, and you don’t know how much it costs; and then you get a bill 30 days later and it’s got all this gobbledygook,” Mr. Bertolini told attendees.
He added, “Every time I sign up for my healthcare, I have someone else do it for me, because I just can’t take it. It’s too hard. It’s too confusing. It’s got to be easier,” CFO reports.
Now, why is he saying this? Foor one, he is a smug idiot but obviously, he has another motive. Digging into that CFO link above I found this:
In separate keynote discussions at a Financial Executives International conference in New York City on Monday, Mark Bertolini, the CEO of Aetna, and Alex Gorsky, his counterpart at Johnson & Johnson, argued that a key to fixing the U.S. health-care system would be to move away from health-care providers being paid for each procedure, office visit, or test they perform. Instead, the providers would receive a single fee for an entire “episode” of medical care, with the fee varied according to the quality of service provided.
It gets better:
Gorsky said that to make the Affordable Care Act more sustainable, it might help to “move from a health-care system right now that’s predicated on reimbursement for a particular procedure to one that’s focused more on an outcome or an episode of care.”
I wonder if we should pay for J&J products depending on their outcome? Or how paying Aetna’s premium depending on the quality of service you get from them? Service and outcomes are important for doctors, too, but only when it’s a true free market. Not the crap we have now. And all the quality metric attempts have FAILED!!
Once again we let the idiots in the government or insurance industry, who created this mess, try to fix it. They created the gobblygook! They created the rat’s maze! Bertolini whines about lack of transparency but his company negotiates different deals with hospitals and drug companies causing that lack of transparency. He is an unbelievable hypocrite and a quick scan shows this is not the first time for him.
There is a better way and that is the free market plus DPC. We just need to keep the insurers away and let them be used only for catastrophic issues.
4. Doctor Wants to Kill Netflix by Pat Conrad MD
Nov 19, 2017
Hey, does this sound familiar? Just up the road from King Doug in Lynchburg, another Direct Primary Care spark has flamed up in the region. Dr. Maura McLaughlin has a DPC practice in Charlottesville, Virginia, “one of nearly 700 nationwide.”
Here is some info from her website:
“Ages 0-30 years: $30/month, discounted to $15/month if enrolled with a parent. Ages 31 years and up: $60/month”
What does that get you?
Clinic visits for chronic and acute problems; reduced labs pricing; preventive care for adults and children, and GYN care; certain procedures “for cost of supplies ($20)”; nights and weekend physician access, and “Treatment over the phone when medically appropriate”; home visits for an additional fee (and free for newborns and hospital follow-ups).
And I just love this quote: “The model itself works sort of like Netflix,” Dr. McLaughlin says. “They can use the services here as often as they need to.”
“Chuck Gulat isn’t rushed when he sees his primary care doctor. He comes as often as he wants, and doesn’t need insurance to pay for it … Patients like Gulat are still encouraged to carry a lower cost insurance plan to cover medical emergencies … Gulat comes every three months for his high blood pressure and diabetes. ‘Hands down, it’s made me physically healthier, and financially healthier.’ He’s now saving about $1,300 a year.”
The patient is happier and has more money in his pocket. The doctor is happier, and doubtless giving better care (arguably a chicken-egg question, so feel free to debate).
I like Netflix. I like convenience, and knowing exactly what I’m paying and exactly what I’m getting. And I like competition, and knowing that I can discontinue something I don’t like. I like choices. Who could possibly argue against this?
“Critics, like Dr. Ed Weisbart with Physicians for a National Health Program”, that’s who. Weisbart is quoted in the lead article wringing his hands over what he believes will be a growing shortage of primary care doctors, “since these [DPC] doctors see fewer patients. Also, high deductible plans leave specialists uncovered.”
“That opens the door to this huge range of medical problems, that fall in-between the catastrophe and primary care.” So is Weisbart just another Stockholm-Syndrome, hapless family doc beaten into submission and lack of imagination by a crushing system? Not exactly.
Weisbart is a nationally recognized advocate for single-payer health, who “now volunteers in a variety of safety-net clinics in the St. Louis area and is also assistant professor of clinical medicine at Washington University in St. Louis.” Now a humble volunteer and academic, he once was once a practicing family doc for 20 years, just a simple, altruistic, if misguided remnant of a noble profession, right? Not exactly.
In 2003 he left his practice “to become chief medical officer at Express Scripts, a Fortune 100 Company. After retiring from that position in 2010, he began organizing the St. Louis chapter of Physicians for a National Health Program, which he currently chairs.”
Whoa, whoa, let’s back up. This expert on how other doctors should make a living himself RETIRED from a Fortune 100 company?? So the guy that advocates a system that will trap physicians into a greater web of government mandates, himself escaped from primary care to turn what I imagine was some pretty good coin, before returning to academia and the volunteer life. But didn’t his time at Express Scripts reduce his availability as a primary care doc during a time of worsening shortage?
Yes Weisbart, if there is any good left in medicine, thinking physicians like Maura McLaughlin will add to the growing rolls of DPC practices, and definitely worsen the shortage of your preferred kind of primary care docs. The McLaughlin’s and Farago’s of the world are increasing patient satisfaction, providing better care, and leading happier lives. You Prof. Weisbart want doctors dragged back into a despair pit of increased workloads, flat wages, more meaningless administrative data gathering, anger, depression, and health commissars telling everyone what to do.
While Direct Primary Care is offering the next Netflix, you want to force us all to go back to watching PBS.
5. Ridiculous Study of the Week: Medicaid Payment
Nov 18, 2017
You are not going to believe this but lower Medicaid fees are linked to scarcer primary care appointments. Crazy, right? It amazes me that they had to do a study to prove this. The recent study alluded to, in JAMA Internal Medicine, found that “when the fees paid to healthcare providers by Medicaid go up, appointments with primary care doctors suddenly become more available to Medicaid beneficiaries – and the opposite happens when fees go down”. You don’t say? So is this saying that doctors are greedy? I don’t think so. I just think doctors feel they should be paid for their time and when the payment get’s so ridiculously then you are forcing them to give care for free. And they start pushing back. It is all just basic human nature. Before you judge us let me ask you this: If you are not a doctor, would you enjoy being forced by the government to do something that loses you money? I didn’t think so.
6. Friday Funny: Which AAFP Ad is Real (or Realistic)?
Nov 17, 2017
So, which of these ads do you think is real? Which one is more realistic? Feel free to send to the AAFP on my behalf.
7. Quote of the Week: Pauline Kael
Nov 16, 2017
“Where there is a will, there is a way. If there is a chance in a million that you can do something, anything, to keep what you want from ending, do it. Pry the door open or, if need be, wedge your foot in that door and keep it open.”
UNTIL NEXT TIME, KEEP SMILING, KEEP LAUGHING AND KEEP OUT OF THE SAMPLE CLOSET!
Douglas Farrago MDTweet