Commentary on medical news by a practicing physician.

  • Epocrates MedSearch Drug Lookup


    "When many cures are offered for a disease, it means the disease is not curable" -Anton Chekhov

    ''Once you tell people there's a cure for something, the more likely they are to pressure doctors to prescribe it.''
    -Robert Ehrlich, drug advertising executive.

    "Opinions are like sphincters, everyone has one." - Chris Rangel

    email: medpundit-at-ameritech.net

    or if that doesn't work try:


    Medpundit RSS

    Quirky Museums and Fun Stuff

    Who is medpundit?

    Tech Central Station Columns

    Book Reviews:
    Read the Review

    Read the Review

    Read the Review

    More Reviews

    Second Hand Book Reviews


    Medical Blogs


    DB's Medical Rants

    Family Medicine Notes

    Grunt Doc




    Code Blog: Tales of a Nurse

    Feet First

    Tales of Hoffman

    The Eyes Have It


    SOAP Notes


    Cut-to -Cure

    Black Triangle



    Kevin, M.D

    The Lingual Nerve

    Galen's Log



    Doctor Mental



    Finestkind Clinic and Fish Market

    The Examining Room of Dr. Charles

    Chronicles of a Medical Mad House



    Health Facts and Fears

    Health Policy Blogs

    The Health Care Blog

    HealthLawProf Blog

    Facts & Fears

    Personal Favorites

    The Glittering Eye

    Day by Day


    The Business Word Inc.

    Point of Law

    In the Pipeline


    Tim Blair

    Jane Galt

    The Truth Laid Bear

    Jim Miller

    No Watermelons Allowed

    Winds of Change

    Science Blog

    A Chequer-Board of Night and Days

    Arts & Letters Daily

    Tech Central Station





    The Skeptic's Dictionary

    Recommended Reading

    The Doctor Stories by William Carlos Williams

    Pox Americana: The Great Smallpox Epidemic of 1775-82 by Elizabeth Fenn

    Intoxicated by My Illness by Anatole Broyard

    Raising the Dead by Richard Selzer

    Autobiography of a Face by Lucy Grealy

    The Man Who Mistook His Wife for a Hat by Oliver Sacks

    The Sea and Poison by Shusaku Endo

    A Midwife's Tale by Laurel Thatcher Ulrich



    American Academy of Pediatrics

    General Health Info

    Travel Advice from the CDC

    NIH Medical Library Info



    Thursday, December 15, 2005

    Time for Change: Here's an interesting proposal - separate Medicare payments into two separately funded groups - primary care physicians and specialists. The argument is that primary care takes budget cut hits in response to increased specialty care spending:

    The services of primary care doctors have long been undervalued by the Medicare programme, which often cuts its annual payments to cope with overspending on procedures in secondary and tertiary care.

    ....Separating funding for primary care from secondary and tertiary care could protect primary care from costs in more expensive settings and preserve access to primary care for patients. The UK has tried various means of separation, and the US could learn from these. One mechanism for this in the US would be to split the Medicare sustainable growth rate formula into evaluation and management codes (which mainly apply to primary care) and other codes (mostly procedural and used in secondary and tertiary care). This would protect the most important primary care functions from the cost cutting required when Medicare spending targets are exceeded (largely due to procedural costs).

    Separation of funding for primary and secondary care could also facilitate different ways of paying for care and the transformation of primary care. Other healthcare purchasers and payers could make similar separations in their funding pools since they tend to follow Medicare's lead in payment policies. Such a separation could also promote quality and safety by assuring access to essential and robust primary care services while reducing overuse of other treatments.

    He also suggests that all primary care physicians - internists, pediatricians and family physicians - should join together to improve our political clout.

    These aren't bad ideas. It's true that primary care takes the hardest hits when Congress decides its time to cut back on the budget, even though we aren't responsible for the burgeoning cost of Medicare. It's also true that as the population ages, it's the specialty and hospital care that they're going to be needing more and more. Will Congress listen? I doubt it. Most politicians are like every one else - they have trouble understanding the concept of primary care - or of believing that a primary care physician is capable of providing most of a person's medical care. But, maybe, if we join forces, we can get them to listen.

    posted by Sydney on 12/15/2005 08:25:00 AM 3 comments


    There needs to be a disincentive to use specialty care. Many Medicare beneficiaries that are well off (enough to afford medigap insurance) have no out of pocket fees to see specialists. They can self-refer and they don't hesitate to go to several different docs for each organ system - and then be followed chronically for what may have been an acute problem. I was a PCP at the VA and had many such patients coming in for meds. It was amazing how many docs they saw and how little one seemed to communicate with the other.
    I am now in cardiology at the VA. We routinely get consults from PCPs for patients who have outside private cardiologists, but the pts want to see a VA cardiologist too.
    "Just because", or for a "second opinion" - not that they will heed that second opinion mind you.
    They have no insight into the fact that they are using up scare healthcare dollars by "double dipping". If the vet does not have a service connnected cardiac condition and is seeing a private cardiologist, many times our attending will deny the consult as we have finite staff and cannot accommodate every patient who wants to be followed in cardiology.


    By Anonymous Anonymous, at 10:50 PM  

    Just what we need, more reasons to pit doctor against doctor.
    The problem is, the "system" if you want to consider it that, does not reward the conscientious or the frugal. Money which is saved goes elsewhere, and for private insurance this means to shareholders and for ever-increasing bonuses for executives, "for doing such a good job."

    For the public sector, money saved merely leads to the next round of budgetary cuts.

    And the VA -- its own world. My patients go to the VA so they can get medications, and the VA says you have to see a VA doctor to get those medications, whether you want (or need) the VA doctor or not.

    By Blogger Greg P, at 9:29 AM  

    i agree with you. here are my reasons:

    By Blogger Dr. Charles, at 6:15 PM  

    Post a Comment

    This page is powered by Blogger, the easy way to update your web site.

    Main Page


    Home   |   Archives

    Copyright 2006