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Policy and Design

Seeds of Health Improvement Fail on Barren US Soil – Any number of interventions can work in a nation that invests in children, and improved environments, situations, and social determinants. In nations failing in support, health interventions can be expensive and can fail to work.


Medicaid as Savior or Betrayer of Access – Higher payments from Medicaid can increase access for patients with or without insurance. Medicaid expansion with current payments too low cannot support Medicaid patients, local providers where care is needed, or patients with insurance either.

Selling and Swelling a Bigger HITECH Bubble – Cherry picking has become essential for those who provide or insure health care. Choose the easiest route will capture more dollars with less cost of delivery – and this will earn more bonuses and assure no penalties. Changes since 2010 will reward those already doing well and will penalize those already behind. Cherry picking has apparently moved to top importance for those who promote digital solutions. The digital leaders continue to present A Beautiful Day in the Neighborhood or Community as you will see. But which community, theirs or ours? 

BioMedical Focus is Ruining US – The problem with technology is that it becomes the only approach despite limitations such as cost and harm done. People factors impact health more than technology can do. Investing in people has can do more and in ways that can improve other societal areas. 

More Quality Measures for Homebound Seniors – Not Hardly – Mobility and transportation issues, basic nutrition, security, fixed income, and government cuts are huge problems. About half of homebound seniors reside where access is lowest due to health care payment design. Quality measures are far down the list.

Cancer Gets a Moonshot and STDs Get No Shot at All – Surging levels of STDs will impact more and more.

Changes in Patients Are Required to Improve Outcomes, But Innovations Are Impacting Physicians, and Are Changing Physician Behaviors the Wrong Ways – Turnover, retirement, closures of small practices, avoidance of complex patients, turning down ridiculously low payments by insurance companies, disengagement, lower productivity. Making health care less efficient and less effective is not the way to add value, improve quality, or increase access to care. Managed care must go back to the drawing board after micromanaging patients the wrong way and micromanaging physicians the wrong way – perhaps the payers should actually try to support patients and physicians.

Value Failure By Those Who Promote Value – Higher cost without improved quality is apparently The American Way. Rapid change is not valuable and neither is confusing change. Costly changes were predicted to save money but increased the cost and marginalized team members and productivity. The failure of payment to support necessary increases in generalists and general surgical specialties is exactly the wrong policy at exactly the wrong time in US history. Why do we tolerate those who promote value who implement changes that devalue patients in need of care, most needed specialties, and the team members that provide the care.

The Experts Assumed That They Could Decrease Costs By Forcing Physicians to Change, But They Apparently Forgot that High Cost High Need Patients Drive Consumption (and also Managed Cost or Managed High Need Programs Add to Costs for No Gain)

Primary Care, Workforce, and Training

What Is Stunning in Primary Care Is No Change By Design – Numerous failed attempts to recover primary care all point to insufficient payment made worse by accelerating cost of care. 

Oregon Primary Care Medical Home Supposedly Saved 240 Million But Spent Over 250 Million – A minimum additional cost of 250 million dollars was required to save 240 million and the actual cost of delivery increases should be much higher.

Blood Clots or How Dr. House Breaks Down the United States – Physicians are pushed to be complete and are pushed to cut down costs. What is needed is much better studies and less media exaggerations

Six Degrees of Discrimination By Health Care Payment Design – Medicare payment transparency exposes Medicare as paying less for primary care, less in the states in most need of workforce, less in counties in most need of workforce, and even less with Pay for Performance designs. Also places with concentrations of patients with plans least supportive of local care receive the fewest lines of revenue and have deficits of workforce by design. 

Primary Care Must Rise from the Ashes of the Last 20 Years of Policy

Recovering General Surgery Is Impossible Without Payment Design Changes As General Surgery, General Ob-Gyn, General Orthopedics… Shrink By Design


Most Visited Early Blogs


Three Dimensions of Non-Primary Care vs Zero Growth in Primary Care  

Finance-me-cratic Constants in the Bureaucratic Universe  

Meeting Primary Care Needs in the Last Half of the 21st Century 

Exploring the Health Consequences of Disease Focus  


Of all the forms of inequality, injustice in health care 
is the most shocking and inhumane.

Martin Luther King, Jr. 


Robert C. Bowman, M.D.        Robert.Bowman@DignityHealth.org

The blogs represent the opinion of the blogger alone.

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

Copyright 2016

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