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Dr Richard Young on what's wrong in family medicine and the paradigm shift that's needed to fix our healthcare system

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İçerik Descant tarafından sağlanmıştır. Bölümler, grafikler ve podcast açıklamaları dahil tüm podcast içeriği doğrudan Descant veya podcast platform ortağı tarafından yüklenir ve sağlanır. Birinin telif hakkıyla korunan çalışmanızı izniniz olmadan kullandığını düşünüyorsanız burada https://tr.player.fm/legal özetlenen süreci takip edebilirsiniz.

Richard Young MD, family medicine physician, faculty, researcher and innovator, has spent most of his career at a safety net hospital. He details how quality metrics and payment based on CPT codes devalue the practice of family medicine. Primary care is disadvantaged compared to other specialties, with family physicians earning perhaps one half to one third what other specialists earn. Yet primary care physicians are responsible for the care of the whole patient, which often involves effects of mental health, socioeconomic and other challenges. By contrast, specialists and emergency department physicians are usually able to restrict their care of the patient to the specialty or emergency at hand. The complexity of dealing with the whole patient means quality metrics based on individual disease measures are very inadequate to reflect the totality of care primary care physicians provide.

Dr. Young describes the Sentire system he developed for primary care delivery, in which patients pay directly for services and insurance is not involved; he compares his system to Direct Primary Care, characterizing them as close cousins.

Dr. Young explains how primary care is a complex adaptive system. While some healthcare services (e.g. surgeries) can be viewed as a linear or mechanical system, attempts to view primary care or the health care system in simple mechanical terms leads to failure. In a mechanical system, one-size-fits-all rules can be implemented in a top-down fashion and the results are predictable. In most of healthcare, such approaches lead to failure and unintended consequences. Dr. Young points out that HMOs, PPOs, HEDIS, PCMHs, MIPS, MACRA, etc, have all failed to control costs and have damaged patient care and family medicine practice.

What can be done to improve our healthcare system? Dr. Young shares what he has learned by observing general physicians in Britain and studying how healthcare is delivered in other countries. He points out that America is the only country where we don’t put limits on healthcare. In Britain and Canada, patients know they can discuss one concern in a visit to their GP. Brits accept that they cannot have all the healthcare they want. In the US, patients expect to discuss all of their concerns and they expect to receive all of the services they want. Dr. Young says we need a paradigm shift, a new mindset if we are ever going to get a handle on our healthcare spending. Gayle suggests that the NHS in Britain and the systems in other countries use top-down one-size-fits-all approaches such as global budgets to have some control over spending. Perhaps instead we should consider that in the US, we think about and deliver healthcare completely differently than other goods and services. Perhaps the paradigm shift that we need is to stop thinking about all healthcare under the same umbrella and realize that primary care is a routine expense, akin to oil changes and furnace filters; we don’t use car and home insurance to pay for routine expenses so perhaps we should pay for primary care directly. Dr. Young agrees that his Sentire system and DPC get rid of lots of the overhead that results from EMRs, quality reporting, and many other top-down mandates.

One thing is for sure. To improve healthcare delivery, restore the doctor-patient relationship and liberate the practice of family medicine, we must engage with physicians such as Dr. Young, who know what is going on in the trenches.

  continue reading

21 bölüm

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iconPaylaş
 
Manage episode 289014411 series 2844736
İçerik Descant tarafından sağlanmıştır. Bölümler, grafikler ve podcast açıklamaları dahil tüm podcast içeriği doğrudan Descant veya podcast platform ortağı tarafından yüklenir ve sağlanır. Birinin telif hakkıyla korunan çalışmanızı izniniz olmadan kullandığını düşünüyorsanız burada https://tr.player.fm/legal özetlenen süreci takip edebilirsiniz.

Richard Young MD, family medicine physician, faculty, researcher and innovator, has spent most of his career at a safety net hospital. He details how quality metrics and payment based on CPT codes devalue the practice of family medicine. Primary care is disadvantaged compared to other specialties, with family physicians earning perhaps one half to one third what other specialists earn. Yet primary care physicians are responsible for the care of the whole patient, which often involves effects of mental health, socioeconomic and other challenges. By contrast, specialists and emergency department physicians are usually able to restrict their care of the patient to the specialty or emergency at hand. The complexity of dealing with the whole patient means quality metrics based on individual disease measures are very inadequate to reflect the totality of care primary care physicians provide.

Dr. Young describes the Sentire system he developed for primary care delivery, in which patients pay directly for services and insurance is not involved; he compares his system to Direct Primary Care, characterizing them as close cousins.

Dr. Young explains how primary care is a complex adaptive system. While some healthcare services (e.g. surgeries) can be viewed as a linear or mechanical system, attempts to view primary care or the health care system in simple mechanical terms leads to failure. In a mechanical system, one-size-fits-all rules can be implemented in a top-down fashion and the results are predictable. In most of healthcare, such approaches lead to failure and unintended consequences. Dr. Young points out that HMOs, PPOs, HEDIS, PCMHs, MIPS, MACRA, etc, have all failed to control costs and have damaged patient care and family medicine practice.

What can be done to improve our healthcare system? Dr. Young shares what he has learned by observing general physicians in Britain and studying how healthcare is delivered in other countries. He points out that America is the only country where we don’t put limits on healthcare. In Britain and Canada, patients know they can discuss one concern in a visit to their GP. Brits accept that they cannot have all the healthcare they want. In the US, patients expect to discuss all of their concerns and they expect to receive all of the services they want. Dr. Young says we need a paradigm shift, a new mindset if we are ever going to get a handle on our healthcare spending. Gayle suggests that the NHS in Britain and the systems in other countries use top-down one-size-fits-all approaches such as global budgets to have some control over spending. Perhaps instead we should consider that in the US, we think about and deliver healthcare completely differently than other goods and services. Perhaps the paradigm shift that we need is to stop thinking about all healthcare under the same umbrella and realize that primary care is a routine expense, akin to oil changes and furnace filters; we don’t use car and home insurance to pay for routine expenses so perhaps we should pay for primary care directly. Dr. Young agrees that his Sentire system and DPC get rid of lots of the overhead that results from EMRs, quality reporting, and many other top-down mandates.

One thing is for sure. To improve healthcare delivery, restore the doctor-patient relationship and liberate the practice of family medicine, we must engage with physicians such as Dr. Young, who know what is going on in the trenches.

  continue reading

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