errors of perspective

Senator Who Do You Think You Are Fooling

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The minute the Senate calls your name, in this case about the alleged lack of family physician response to the opioid crisis. This is the response of a family physician

We family physicians invite you Senator, to visit us in our practices.

We ask you to explain to us how we will be able to address growing opioid and other addictions, mental health deficits, expanding geriatric demands for care plus screening for hepatitis, depression, suicide, nutrition, health literacy, resources, medication access, and other complex areas that we must integrate and coordinate.

We would like you, Senator, to reflect upon the impact of deteriorations in situations, income, jobs, education, housing, and other determinants of health and health outcomes. 

We ask how we can do more with less since we are already paid least and CMS will pay us even less because we care for these more complex patients. Also we will be having to pay more for HIT, EHR, MU, MIPS, MACRA, PCMH – efforts that will worsen matters due to declining productivity.

These are the complications that front line family physicians must address despite least pay, most complexity, highest penalties, and shrinking cash to pay for team members.

We need an understanding national leader to partner with us to restore necessary care – one who will invest in front line basic health access to restore the team members in primary care and in mental health specific to access to care.

We need a leader who will participate constructively in rebuilding health care – one who will avoid participating in blame and shame campaigns popular in the media at this time that often distract us from our common health care goals.

To lead our nation well you must understand key areas such as human infrastructure and physical infrastructure – areas that can help our nation to be more efficient and effective. Investing in teachers, nurses, public health, public servants, primary care, and basic services is important. Distractions from these key areas are important to avoid – for a better nation.

I can assure you that you do not know what is going on on the front lines just as I know that those on the front lines know very well what you are not doing. The evidence is all around them and makes their jobs more difficult, day after day, year after year.

Recent Posts and References  

Poor Payment Dictates Poor Training Outcomes in Primary Care

No Positive Spin for the Innovator Tailspin

Population Health from Above or Below

Stop the Promotion To Restore Mental Health Access

The Consequences of Innovation Procrastination – Delays in indicated care result in harm to patients. Distractions due to innovation result in harm to millions who need care delivery, not rearrangements, confusion, reorganization, and rapid change.

The Massive Failure that is Primary Care Payment
Like past policies, ACA did not address cognitive vs procedural to balance workforce but it did take on quality payment with costs and questionable benefit.

Lack of Accountability for Accountable Care
Health Care Who Is it Good For? Count the billions in corporate earnings and the millions in CEO salaries to see who wins and who loses 2010 to 2016 and beyond

Innovation Incapacitation

Safety Net Must Sunset and Front Line Health Access Should Rise
Experimental Innovation or Basic Infrastructure? Wouldn’t it be nice if we actually funded infrastructure and basics instead of trying to substitute innovation or other distractions?
For Better or For Worse in Quality – More for fewer and less for more – thus continues the new innovative designs – same as the old designs
The Federal Cause of Shortage Areas and Access Barriers – It is the Federal Design for payment that shapes the breadth, depth, and locations of shortage areas. It is about concentrations of Medicaid and Medicare patients with lowest payment for health access by federal design.
The Shaky and Shady Primary Care Medical Home

PCMH costs of $105,000 per physician per year  – too much to achieve success in access

Overcoming Barriers to Health Access Including Portions of ACA

Best of Basic Health Access

Primary care can be recovered and should be recovered, 
but cannot be recovered when moving the wrong directions
Robert C. Bowman, M.D.

Basic Health Access Web   Basic Health Access Blog   World of Rural Medical Education

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