Lee A. Resnick, MD, FAAFP In my last column I examined the recent study by the Center for Studying Health System Change which reviewed data from the 2008 National Hospital Ambulatory Medical Care Survey (NHAMCS). I identified critical flaws in the definitions used to distinguish “appropriate” emergency department (ED) visits from “non-urgent” or so-called “routine” visits. I concluded that the study missed a tremendous opportunity to identify alternatives for the vast majority of patients with …
Read MoreIt Depends on What the Meaning of the Word ‘Is’ Is
Lee A. Resnick, MD, FAAFP Much has been written of late about use of emergency services by patients covered by Medicaid. For some time, consensus has been that Medicaid patients overuse emergency services for non-emergencies. The emergency department (ED), it was thought, served as the de facto primary care physician for this because of problems with access and lack of pricing pressures to deter use. Until recently, supportive data were lacking and the notion of …
Read MoreWhat a pain!
Pain management in urgent care is a minefield of monstrous proportions. The controlled substance prescribing landscape is body trapped indeed, and the well-meaning, unsuspecting physician stands right in the middle. The regulatory, criminal and litigious nature of this highly charged issue is not to be trifled with. Like it or not, physicians are essentially the licensees of some of the most dangerous and destructive weapons of modern medicine, and we have a clinical, legal and …
Read MoreM.O.C.: What a Mess!
“Marauding Our Cash,” Mockery of Certification, “Malady of Commonsense.” I’ve had a lot of fun coming up with new definitions for the wildly unpopular Maintenance of Certification, or M.O.C. Back in 2003, the American Board of Medical Specialties (ABMS) and their member boards, decided unilaterally that 8 years of education, 3 to 7 years of residency training, MCATs, USMLE Parts I, II and III, specialty board certification exams, annual continuing medical education (CME) requirements, “specialty …
Read MoreNotes From the Convention
Lee A. Resnick, MD, FAAFP As I write this, the annual convention of the Urgent Care Association (UCA) is in full swing in Las Vegas. This year’s assembly is the largest gathering of urgent care professionals in the world … ever. With well over 700 attendees, the energy is palpable. The excitement surrounding the discipline and the industry has never been greater as more and more physicians, entrepreneurs, health systems and others clamor for a …
Read MoreReinventing RUC
Lee A. Resnick, MD, FAAFP In my last column, I explained how physician reimbursement is determined by a relatively obscure and highly politicized committee shockingly biased by a specialist representation. The so called “RUC” (Relative Value Scale Update Committee) has created a pay formula that heavily favors proceduralists at the undeniable expense of the primary care physician. This biased system of reimbursement has not only created an unbalanced pay scale amongst physicians, but has equally …
Read MoreThe Ruckus About ‘RUC’
Lee A. Resnick, MD, FAAFP Perhaps you are unaware about the secretive, biased way that physician reimbursement is determined in this country. Perhaps you would be surprised to learn that the committee tasked with these determinations is composed of only 2 primary care physicians … out of 29 members! Perhaps you didn’t know that their recommendations are unregulated and largely given a rubber stamp by the Centers for Medicare & Medicaid Services (CMS). Perhaps you …
Read More‘First, Do No Harm’ But Don’t Be a Harmful Do-Nothing!
As scientists, we are trained to question through research – to pose hypotheses and test for proof. Science, however, is notoriously flawed and imperfect, and has left a trail of discarded practice standards refuted through additional study or missed statistical error. Many a medical proverb has fallen out of favor this way – but none has withstood the test of time longer than “First, do no harm.” With an almost religious favor, physicians have embraced …
Read MoreReforming Patient Expectations
In my last column, I addressed the contribution of unrealistic patient expectations to unsustainable healthcare costs. I postulated that the competing societal goals of preserving freedom of choice while providing healthcare for all will produce a futile tug-of-war. I further warned that leaving the solutions to politicians and government administrators will inevitably lead to myopic reforms that threaten the doctor-patient relationship and fail to consistently incentivize good care. In this month’s column, I’d like to …
Read MoreReforming Healthcare Starts With Reforming Patient Expectations
Back in 2008, while the Obama administration was first evaluating healthcare reform, Peter Orszag, then the director of the Congressional Budget Office, estimated that 5% of the nation’s gross domestic product, or $700 billion per year, goes to medical tests and procedures that have no proven positive impact on outcomes. Unaccounted for in this estimate are the billions more spent managing the often lifelong complications inherited from inappropriate tests and unproven procedures. MRIs that identify …
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