Thursday, July 30, 2009

What changes do we need in healthcare

PPP and pay your deduct able of 20-30% and use out of area network specialists or labs or radiologist and pay extra thousands of dollars and be happy but that is not what most of people want.8-10 yearProbleFact is that health care cannot sustain with17% of total GDP at present and the way premium keeps doubling every s. People who have insurance pay for people who do not have it.Do not be in fools Paradise that the people who do not have insurance and we do not care.Ask the hospital administrators how they have to pay for uninsured people admission in hospital and they raise cost of daily bed for Health plans and then health plans in turn raise premium every years. Quality of care and cost do not run parallel and it has been shown by several private clinic managements like Mayo or Cleveland or better managed clinic like Scrips clinic etc, all over the country. People need to ave basic coverage and then if they want to buy Ala ca rte on top of it they that is their choice. You can buy basic coverage to take care of most of your health care needs.HMO is about population medicine and what is good for population is good for you and if you are not happy then stay m is that health care companies and all ancillary service providers are stuck to Medicare like leach and sucking the blood out of it because their lobbyist would not, because of their money influence, would not allow medicare to have a bargaining power for medicines or hospital services. We as a customers go to Costco or Walmart or buy in bulk to save money so should medicare and medicaid but it is not doable?There is more than enough money in medicare to pay for 70% of cost and take a look at this number and then tell me how cheap it is with current proposal to pay for every body's health care cost.Much cheaper that what it cost right now.....
The way I figure it is if health care will cost 1.5 trillion over the next 10 years that comes to $4285.71 per person for 10 years. That's $428.71 per year, and $35.71 per month for 350,000,000 people counted in the census. For an average family of 3.2 persons per family that's $114.27 per month. At present it cost $7000.00 per person per year?These are the facts and many of comments posted here are just nonsense.Get you facts and stop bullshitting.

Tuesday, July 28, 2009

rationing of medical care

The inherent meaning of HMO medicine is rationed medicine for whole polulation. As an Internist we hget denial for necessay medicines and services on daily basis. Rationing is there for different level of consumers. Fo rmedicaid pts, rationing is rampant but not so mcuh for Medicare pts. For Medicare advantage rationing is done to make sure there is enough profit for HMOs and IPAs.Le's not be disallusioned that we have the unrationed and uncontrolled healthcare delivery system.When a healthcare deliver is based on profitabilty, then profitabilty depends on rationing.Pankaj Karan,MD

Monday, July 27, 2009

Prescription medicines for sale for food

One of my patient made a shocking confession today early this morning. This elderly lady told me that she bought Proventil inhaler for 15 dollars. She mentioned to me that her copay if she would have bought directly pharmacy would have been$25 and so this way she saved $10.00.This is the first time she has done it and she plans to do it more often.I asked her how do you know that it has not been used and many have in smaller number of inhalers left over and for that she responded that package was not even open. She further mentioned that people ( patients) sale all of their medicines for some cash so that they can buy their food for survival. I have asked to help me meet with some of these folks so that I can look into this plight and anonymously report to the media. I am keeping my fingers crossed.

Friday, July 24, 2009

Unnecessary tests for patients

The attitude and training of doctors and expectations of patients( how educated and rich they are) and extent of coverage by HMO/PPO determine which tests are needed or not. In HMO setting ,we are taking about popultaion medicine and the appropriate test is decided by n factor or number needed to treat .It is simple to say that what is good for a popultaion in general is good for you and that is what covered by ins company. On the other hand pts with PPO coverage and high deductable want to pay for tests for which may not be necessary, we just cannot say no because pts expectation is high and is willing to pay. There are several executives panel offered by Labs which can cost 3-4K which included several type of scancer screening, is sometimes ordered for such pts.I have never done that. Severeal time sI have had pts who would bring Carotid US screening test for STROKE???? done outsode for which they paid 100-150 dollars, without even asking their doctors?More evidence based medicine needs to be practiced with focus on strong prevention methods. Good practive of medicine needs to be emphasized.

Sunday, June 28, 2009

Doctors as entrepreneur: Continuity Of care for patients

Doctors as entrepreneur: Continuity Of care for patients

Continuity Of care for patients

HMO and IPA ( Independent Physician Association) in California and Other states do not believe in pt's continuity of care and that results in poor quality of care being delivered to pt, high dissatisfaction rare and high readmission rate to hospital. I belong to two IPA,mainly,Greater Covina Medical group and Health care partners and both have hospitalists who take care of my patients in hospital.These hospitalist has no clues about my patients and they never communicate either during admission or discharge.Only goal of theirs is to maintain Length of stay and good average bed day .They do not spend enough time with my pts and pt come back from hospital and tell me how these so called hospitalist spend not more than 30 seconds per day and do not even spend time during discharge process. Most of my patients are so unhappy and I have informed IPA about it and told them that let me take care of my patients in hospital,nursninghome and home to make sure there is continuity of care and best of all, these are my patients and I know their problems well and there is trust and they will follow my advise. My request did not have any positive effect instead , they have now SNIFist and Nocturnist and Specialty Clinic Docs( same Hospitalist act as Specialty clinic Docs)...
HMO and IPA do not believe in taking care of patients best interest rather their bottomline.
They have been part of breaking the healthcare sytem in piecemeal and then trying to do patchworks and when it os not working out they come and blame PCPs.
IPA people like medical director will sit down with PCPs and show them number and say "well, these numbers do not look good,you need to take care of pts and keep them away from ER"
In a recent meeting I told them " If I donot have control in hospital care or discharge or any communicaiton with hospitalsit or SNIF care or home care,why should I be responsible" They were stunned with my response. I am still negotiating with them to let me take care of my patients from A-Z. I am hoping good sense will prevail in their heads .

Tuesday, February 10, 2009

PrimaryCare Driven Healthcare in America

Healthcare is in shambles and no one has control over quality and cost. Doctors and Patients and hospitals are all looser as a result.Only winner is Payor because they control the purse string.

Monday, February 9, 2009

Community Physicians as Hospitalist

There is debate going on with Medical staff at Citrus valley Hospitals if community physicians should be involved in taking care of ED panel patients who do not has any assigned MD or patients who do not have any insurance. Hospital Administration is forcing Internist to work as a hospitalist group and lower the LOS or loose privilege to be on ED panel.Being on ED panel has been a source of revenue for many established Internist in San Gabriel Valley area and has been a great way to help establish a new doctor in community in long term.
I believe that it is is the responsibility of every physicians who work in hospital to utilize the resources responsibly and make their best efforts to keep Length Of Stay ( LOS) under control so that hospital is not loosing money. As a community Internist we can practice and also take care of those pts. if we work part time as hospitalist.

Pankaj Karan,MD

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