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America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

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Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

The urgent care facilities I was talking about are in actual, normal, family clinics. They're setup much like an ER, but are determined to handle the less serious cases than, say, impaled body parts, gun shot wounds, or diabetic shocks, etc. They're for the bad bouts of whatever that just hit little junior, or a severely sprained/possibly broken leg or arm. The copay for me to attend one of those instead of an ER visit is incentive enough if I know I'm not in mortal danger.

I wasn't talking about the Minute Clinics offered by CVS/Target or their direct competition. I've used those for other things, like suspected strep throat, and each time they've fixed me up. Only once did it require a follow up with my PCP, and she came to the same conclusion as the Minute Clinic nurse - I simply wasn't progressing very fast in my recovery.
 
Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

Les (and others)

Does this work????

Level 1: Colds, fevers, aches and pains -- the CVS/Target/storefront. Staffed by an LPN (?)

Level 2: Stiches, simple fractures, stuff that can't be treated @ Level 1, but are not up to ER. The Urgent Medical Care place. Staffed by a GP and LPN/RN.

Level 3: The ER. Generally severe injuries or life threatening emergencies. Specialized trauma doctors and nurses.

Ideally there would be more Level 1's than Level 2's and more Level 2's than ER's. Think of it as a pyramid.

If I don't have a personal physician, this works, but I'm not sure where I would go to get the annual checkup (Level 2????). If I have a primary care doc, then he/she is the one to go to for annual stuff and non emergency care.
 
Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

joecct said:
Les (and others)

Does this work????

Level 1: Colds, fevers, aches and pains -- the CVS/Target/storefront. Staffed by an LPN (?)

Level 2: Stiches, simple fractures, stuff that can't be treated @ Level 1, but are not up to ER. The Urgent Medical Care place. Staffed by a GP and LPN/RN.

Level 3: The ER. Generally severe injuries or life threatening emergencies. Specialized trauma doctors and nurses.

Ideally there would be more Level 1's than Level 2's and more Level 2's than ER's. Think of it as a pyramid.

If I don't have a personal physician, this works, but I'm not sure where I would go to get the annual checkup (Level 2????). If I have a primary care doc, then he/she is the one to go to for annual stuff and non emergency care.
Click to expand...

joecct - I like the concept; it's just the execution that I worry about. We'd have to rely on patients to self-triage to one of the levels, and my prediction is that people's tendency will be to over-diagnose. Badly. We have to accept that as a fundamental part of being human (or at least, American) and make sure our system works in spite of it.

When you get sick, it's a shame. When I get sick, it's a CRISIS! :(
 
Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

joecct said:
Level 1: Colds, fevers, aches and pains -- the CVS/Target/storefront. Staffed by an LPN (?)

Level 2: Stiches, simple fractures, stuff that can't be treated @ Level 1, but are not up to ER. The Urgent Medical Care place. Staffed by a GP and LPN/RN.

Level 3: The ER. Generally severe injuries or life threatening emergencies. Specialized trauma doctors and nurses.

Ideally there would be more Level 1's than Level 2's and more Level 2's than ER's. Think of it as a pyramid..
Click to expand...

Level 1 should be handled by "self" or advocate - no need for experts.

Level 2 happens in most communities now where there are no ER's or large hospitals....and some with larger hospitals. Plenty of urgent care facilities in NH.

IMO, niether of the above will change current "Level 3" care, other than you won't have to wait as long. ER's will still require the same number of emergency staff on hand and still require experts/specialists being called in only when needed. ER's won't turn away people and tell them to travel miles to the nearest "Urgent Care" facility unless they triage the person first - which takes the most time for an ER visit, including registering said patient just to look at them....and the ones that are bad enough to by-pass registration are the ones that need the ER anyway.


------------------

States like NH and MA need to get rid of their geographic regs so insurance carriers can go state to state and make insurance portable - which is nearly impossible now.

*States* and their insurance regulatory bodies can also mandate that no single carrier (including subsidiaries, etc.) can hold more than 35% of the total insured people in any one state. That will increase competition and pretty much guarantee a minimum of 3 carriers in each state. Those carriers will need to group policies regionally and make insurance portable so it's more attractive to consumers.
 
Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

ETB:

States can modify insurance governing bodies to mimic public utility commissions for rate modifications, etc. - IOW, insurance carriers are guaranteed to make $, but can't gouge consumers or bid-rig / collude with competitors.

...and most states already have anti-collusion/bid rigging/price gouging laws.
 
Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

joecct said:
Les (and others)

Does this work????

Level 1: Colds, fevers, aches and pains -- the CVS/Target/storefront. Staffed by an Nurse Practitioner

Level 2: Stiches, simple fractures, stuff that can't be treated @ Level 1, but are not up to ER. The Urgent Medical Care place. Staffed by a GP and/or Nurse Practitioner and LPN/RN.

Level 3: The ER. Generally severe injuries or life threatening emergencies. Specialized trauma doctors and nurses.

Ideally there would be more Level 1's than Level 2's and more Level 2's than ER's. Think of it as a pyramid.

If I don't have a personal physician, this works, but I'm not sure where I would go to get the annual checkup (Level 2????). If I have a primary care doc, then he/she is the one to go to for annual stuff and non emergency care.
Click to expand...
This system is in place in many areas already. NPs and PAs staff a lot of these places. You can go to walk-ins for preventitive stuff.

There are a few issues with it. The ones that come to mind quick are these:

-Lynah is right. Pts always think they are more acute than they are and many times they think they should be treated with all this high tech malarkey when they need to problem solve for themselves.

-many patients will shop until they get what they think they need- ie- go to the Minute clinic, primary, fast track, EDin whatever order. They keep going because they know they need an antibiotic (most common) or whatever and the person they see is just too stupid to give it to them.

-The idea of the primary is they can't shop around and it gives continuity. Example "I always get a sinus infection". Primary looks back and sees that for the last 3 yrs the person had allergies at that time of yr, not sinus infection. Treat the allergies preemtively and viola no sinus sx the next yr. Go to a bunch of different places and the person treating doesn't know you= more testing, more aggressive RX because the person can sue your azz if they fail treatment and didn't f/u with you and most important if the patient is a revisionist historian then you miss patterns. If they ever had a national record that was accessible like in France this would not be a problem so much.

-One of the things I have seen change drastically is the patient's ability or willingness to do the most basic things before getting checked. I cannot tell you how many people insist they have to be seen right now. They haven't tried even the simplist things to help themselves and they want me to prescribe something for an instant fix.

We have an entire generation of folks that have no common sense to try anything before a visit. This is huge waste of medical dollars. I see people who have sore throats, colds, vomiting (X1). diarrhea (X1) who have been sick less than a few hours. They wake up, feel sick and immediately need to be seen. When we were cash, 80/20 people tried OTC stuff, hydrated, rested and ate popsicles. Now they want an antibiotic to 'nip it in the bud', they want a narcotic to stop coughing because they absolutely know the OTC never works, they can't vomit or have diarrhea- they need something....

Still, the system does have merit is the places it is in place. Some folks use it correctly and that is good. Some of the places charge way more (for profit is how all this is run) than the primary but it does unclog the system.
 
Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

LynahFan said:
joecct - I like the concept; it's just the execution that I worry about. We'd have to rely on patients to self-triage to one of the levels, and my prediction is that people's tendency will be to over-diagnose. Badly. We have to accept that as a fundamental part of being human (or at least, American) and make sure our system works in spite of it.

When you get sick, it's a shame. When I get sick, it's a CRISIS! :(
Click to expand...
In my city, Urgent Care is located in the hospital with the ER and takes over the day surgery space on nights and weekends. Urgent Care isn't open during the day so you would need to go to your primary care physician or the Minute clinic type places. If something comes up after hours or on a weekend you go to the ER area of the hospital and then see a triage nurse(?) who either admits you to the ER or directs you down the hall with your paperwork to Urgent Care depending upon your issue. It seems to work pretty well in terms of handling the issues that arise when your primary physician is closed.
 
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Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

Another little anecdote: my wife was just on a trip recently from our home here in the UK to France. She got ill there, so went to see a doctor. There was no receptionist and the doctors just called "next" on a first-come, first-served basis. They took her temperature, looked at her throat with a tongue depressor, diagnosed her with strep throat, and sent her away with antibiotics. When she got back home, she went in to see her regular doctor here, just to be sure the antibiotics were the right ones for her, since they know her medical history, etc. Again, a quick look in the throat, a quick Googling (I kid you not) as to the type of antibiotic she'd been given in France (since the doctor couldn't read the French label), and she's on her way. So in her experience with the socialized medicine in two different countries, at no point were any diagnostic tests or lab work done. No samples were taken. No cultures were grown. And you know what? She's totally fine.

Do you think that level of care would be considered acceptable by most patients in the US? I don't.

We can have cheaper health care in the US, but we really have to get over the notion that we need to run every test that's possible just because we can. I'm sure that unnecessary tests are run for many reasons: the patient demands it, the insurance company requires it, the doctor is treating defensively, the insurance company will pay for it anyway, etc. No matter the reason, at the end of the day, it still costs the same, and doesn't really improve the care for the patient.
 
Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

LynahFan said:
Another little anecdote: my wife was just on a trip recently from our home here in the UK to France. She got ill there, so went to see a doctor. There was no receptionist and the doctors just called "next" on a first-come, first-served basis. They took her temperature, looked at her throat with a tongue depressor, diagnosed her with strep throat, and sent her away with antibiotics. When she got back home, she went in to see her regular doctor here, just to be sure the antibiotics were the right ones for her, since they know her medical history, etc. Again, a quick look in the throat, a quick Googling (I kid you not) as to the type of antibiotic she'd been given in France (since the doctor couldn't read the French label), and she's on her way. So in her experience with the socialized medicine in two different countries, at no point were any diagnostic tests or lab work done. No samples were taken. No cultures were grown. And you know what? She's totally fine.

Do you think that level of care would be considered acceptable by most patients in the US? I don't.

We can have cheaper health care in the US, but we really have to get over the notion that we need to run every test that's possible just because we can. I'm sure that unnecessary tests are run for many reasons: the patient demands it, the insurance company requires it, the doctor is treating defensively, the insurance company will pay for it anyway, etc. No matter the reason, at the end of the day, it still costs the same, and doesn't really improve the care for the patient.
Click to expand...

Right on the money- you also have to consider the pressure coming from the people who are producing the tests and machines that do them. They direct market to patients- Why would my patient come in and tell me they want a particular kind of pap test (yes they do this:eek:) unless they saw the ad in some stupid lay magazine. Then there are of course the really dumb emails circulating about the tests the doctor won't do because they cost a lot but you need to insist on.:mad: There are all sorts of tests that are marketed and are costly that we used to do without and practice perfectly safe medicine.

Do I agree with antibx without confirmation of infection-NO! Way too much antibiotic resistance out there. But the American culture has turned medicine into a consumer business and a litiginous (is that a word??) rather than evidence based. Of course once the pt is on an antibx why try and test as the test will be negative anyway.

Denstists will not see folks with heart murmurs unless they have antibx. The cardiologists will tell you in most cases that it is not necessary and the evidence based research says so. The dentist requires a note from the Doc. Many times they won't accept the note. Too afraid of suit because this is 'standard of care'.
 
Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

500 amendments.

(Search for "9-19-09 Amendments submitted to the Chairman's Mark: America's Healthy Future Act of 2009")

I'm sure none of them are frivolous.

OTOH, it's a configuration management dream.
 
Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

I've gone to my doc a few and been sent home with nothing. I feel lousy and after a couple days call him. Either he or the nurse look at me and he'll say, "I can't give you anything. You'll feel better in a couple days, take Tylenol."

I am reassured it isn't serious and go home.
 
Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

Kepler said:
500 amendments.

(Search for "9-19-09 Amendments submitted to the Chairman's Mark: America's Healthy Future Act of 2009")

I'm sure none of them are frivolous.

OTOH, it's a configuration management dream.
Click to expand...
I can hardly wait for the John Murtha Medical Payment Processing Center...
 
Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

joecct said:
I can hardly wait for the John Murtha Medical Payment Processing Center...
Click to expand...

The insertion of pork projects into a cost reduction proposal is yet one of the many wonders to come in the next 4-6 months. :cool:
 
Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

ScoobyDoo said:
If that report is true it's not great news for the "TORT reform" fixes all crowd.
Click to expand...
I don't recall anyone saying tort reform would fix everything, but it would cut down on costs and does need to be "part of" the solution
 
Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

Bill said:
I don't recall anyone saying tort reform would fix everything, but it would cut down on costs and does need to be "part of" the solution
Click to expand...

Whats the percentage of non lawyers in house and senate? What does that tell you about any real tort reform that may happen?
 
Re: America's Affordable Health Choices Act of 2009 - Part 2 - Deathers vs. Commies

Bill said:
I don't recall anyone saying tort reform would fix everything, but it would cut down on costs and does need to be "part of" the solution
Click to expand...

There are as many definitions of "tort reform" as people. Capping awards in and of itself is not "reform," it's just weakening punitive actions when there's real negligence -- something nobody going under the knife wants to see. Has anybody actually written a tort reform proposal in good faith, or is it another "we must fix our crumbling infrastructure" canard?
 
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