Unlimited Access to Primary Care May Not Reduce ED Costs


In a recent article in The Direct Primary Care Journal, a primary care medical group in Washington State called QLIANCE published a review of two year’s worth of healthcare claims data on thousands of patients that purports to show that unlimited access to primary care visits “drives down overall costs while improving patient outcomes and experience”. This report of the impact of a direct primary care managed care model that provides ‘unrestricted’ access to primary … Continue reading

Posted in Bending the Cost Curve | Tagged , , , , , , , , , | Leave a comment

How I Got My Mojo Back

Emergency Medicine in Yosemite

I am sure you have had the experience of having something happen to you that just seems a bit more fortuitous than a simple lucky break or accidental windfall. My wife says this is just your angels looking out for you; I call it a tip of the hat from the Fickle Finger of Fate. For me these incidents are more likely to happen in places that I happen to feel particularly blessed to be … Continue reading

Posted in The Lighter Side | Tagged , , , , , | Leave a comment

Is the Business of Medicine and Physician Income Disparity Undermining the Profession?

Physician Income Disparity

It was about in the middle of my career as an emergency physician that the business of medicine began to intrude on my practice in a serious way. As the Director of the ED, I found that I was responsible for negotiating with one of the local IPAs for contract rates for our ED site. Prior to that time, I was of course aware of the financial issues that permeated medicine and hospital-based care in … Continue reading

Posted in Bending the Cost Curve, Managed Care Contracting, Payment Reform, Rants, The ER Experience | Tagged , , , , , , , , , , , | 2 Comments

2014 Fickle Finger of the Year Award

The Fickle Finger of the Year Award for 2014

Once again it is time to post the winner of the Fickle Finger of the Year award for dubious achievements (in health care). When Roan and Martin dispensed their award on some unlucky recipient for fumbling the ball (often, a political football) on the ‘Laugh In’ TV show many moons ago, I remember wondering how many times really serious errors and bloopers are committed every year that never get any attention at all, let alone … Continue reading

Posted in Rants, The Lighter Side | Tagged , , , , , , , , , , | Leave a comment

Is Medicaid Managed Care a Fraud?

What you can't see won't embarrass you.

The recently released report from the DHHS Office of the Inspector General entitled “ACCESS TO CARE: PROVIDER AVAILABILITY IN MEDICAID MANAGED CARE” raises some serious issues about the fraudulent tactics many of these plans use to support state funding of their activities. The OIG’s summary of their study to assess availability of Medicaid managed care providers indicated that: “slightly more than half of providers could not offer appointments to enrollees. Notably, 35 percent could not … Continue reading

Posted in Health Care Reform, Medicaid | Tagged , , , , , , , , , , , | 1 Comment