Fixing Frequent Flyers

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Did you know that about 90% of the cost of hospital and ED care is spent on 20% of the patients?  So, how do we fix the “frequent flyer” problem?  This article was sent to me by a long time reader.  It describes how “Dr. Jeffrey Brenner is spearheading an innovative approach to primary care, using health data to identify hospital frequent flyers and deploying teams of nurses and health coaches to get patients’ health – and health care costs – under control.”   Interesting, I had the same kind of idea myself so I was actually excited to see this.  Here were my thoughts in this blog entry called Super Utilizers.  In that piece I recommended:
  • Buying a small building or park a nice trailer next to the ER.  
  • Get a few family docs and pay them a ton and I mean a ton (these are the toughest patients in the world).
  • Give them adequate staff to call these patients, visit these patients, etc.  
  • Lastly, pay each of these patients $50 to show up to their regular visits.
  • Sorry, and one more thing, remove the EMTALA law for these patients and have a staff member (runner) literally walk them over from the ER to this new clinic when they show up.  
  • The hospital and government would save millions of dollars each year.
I thought that was a pretty good concept, didn’t you?  What does the great Dr. Brenner want to do?
  • Dr. Brenner said that in an ideal primary care practice, RNs would handle the well-child visits, the sore throats, and the simple medication adjustments.
  • We need to industrialize primary care so that it becomes highly reliable, it becomes protocolized, standardized, and delegated so that we can stand out on a limb and customize and individualize for the sickest and most challenging patients,” Dr. Brenner said
  • He wants to see nurses and project managers given the chance to run clinical care teams.
  • The coalition also relies heavily on Americorps volunteers.
  • “It’s time we got out of the way and let our nurse colleagues get into the game,” Dr. Brenner said. “I think their training is much better suited, frankly, for running teams, for working collaboratively, and for really improving quality and reducing costs.”

As you can see, Dr. Brenner and I do not have the same plan.  Trust me, I want to delegate the time wasting stuff too but I define that as clerical work and computer entry not CLINICAL CARE!  He wants to dilute healthcare by having lesser educated and lesser trained people deliver it.  He wholeheartedly supports INDUSTRIALIZED MEDICINE (mooooo go the cows) versus AUTHENTIC MEDICINE. I fight every day against the concept of industrialized medicine and will continue that battle forever.

Why does Dr. Brenner think this way?  I don’t know.   The article says he couldn’t make it when he had his own office:
Dr. Brenner said that he knows firsthand what’s like to try to do it all – that was his approach in his own practice. He had a completely paperless office and open-access scheduling, but he tried to make everything work by simply working harder. Ultimately, declining reimbursement from payers made it impossible to keep the doors open.
The guy couldn’t handle it in his own practice but he has a way to industrialize medicine for everyone else?  I give this guy some credit.  His heart is in the right place but that doesn’t make him right.   No where does he give any type of incentive for a family doctor to work with his coalition.  All he does is jump on the bandwagon to try and get lesser qualified people to give care in order NOT to pay his colleagues (primary care is the lowest on the totem pole for pay).  And somehow family docs are going to join and let Americorps volunteers treat these patients while the docs get paid little or nothing for supervising them and take on all the liability?  What does that get?  I will tell you what it gets.  It gets Dr. Brenner a MacArthur Foundation award, which is a “no strings attached” stipend of $625,000 to be paid out over 5 years.  Why?  Because these groups and the media support any idea or method to take the power out of the doctors hands.
As for me?  I get nothing.  Not even a free pen from a drug company anymore.
44100cookie-checkFixing Frequent Flyers