For decades the designers have ignored the consequences of their designs as hundreds of small hospitals, small practices, and practices where needed have fallen prey to revenue too low, costs of delivery accelerating as complexity overwhelms health access. More counties are added and millions more a year are added to those with low or no access - by design. Triple Threat translates to little or no treatment for most Americans. Vampires suck the life blood of health access while zombies design costly and cumbersome innovations.
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Fight Zombie Thinking - Stop the Insanity
- The evidence basis is quite clear. Clinical interventions and especially digital clinical interventions are costly and can only address process - not outcomes (Annals of IM Comprehensive Review, more)
- Less Datapalooza and more Team Member Support - Team Members cannot celebrate their contributions because digitizers are celebrating.
- Health Access Care Still Fails Despite 153 Tricky Studies
- Triple Threat Tricks Destroy the Essence of Who We Are in Primary Care
- Health Access Mission Foundations Need to Focus Upon Those Who Deliver Health Access and Address the Tricks that Prevent Treatment
- No Training Intervention (Expansions of Graduates, Special Pipeline, Rural Training, Underserved Training, Family Medicine training) can address health access woes because of the trickeration of Triple Threat financial design.
- The Zombie Assumptions of Overutilization Trick Away Health Access Where Most Americans Face Underutilization by Design
- True Reform is more Revenue for Cognitive Services and Equity in Payment. True Reformers fight Triple Threat, Avoid Zombie Innovation, and Fight Vampires Sucking more more billions a year from primary care, small practices, small hospitals, and care where needed.
The Trick of Triple Threat Continues while No Treat
Consumes More Millions of Americans Each Year.
Consumes More Millions of Americans Each Year.
The 132 million (40%) Americans left behind are growing by millions a year to become 50% left behind as small practices, small hospitals, and basic services providers are closed and compromised by design.
Most Americans left behind need new leaders that examine health care delivery from their perspective - where 90% of local services are basic, generalist, and general specialty services. They need leaders willing to consider what is happening to the team members that deliver the care, to the small hospitals, and to the small practices critical for health access where most Americans most need care. They must understand the evidence basis demonstrating the lack of evidence regarding innovations. They should see that any and all training interventions cannot work - except for those receiving the training dollars and the finances padded by those receiving interest on the loans. Awareness is a curse - on Halloween or any day.
Vampire Digitalization, Certification, Innovation, and Regulation
Vampire innovation has sucked 8 billion dollars out of the heart (team members) of primary care delivery in 2621 lowest workforce concentration counties where primary care is half enough due to only 40 billion a year. This is the wrong direction rather than movement toward 70 billion - long the minimum for sufficient primary care for 132 million Americans (40% and increasing) with or without insurance in these counties. Note to those addicted to insurance expansions - it only works in places where workforce already exists where plans pay at least the cost of delivery. These metrics dictate shortages and access barriers as small practices and small hospitals most dependent upon the basics are eliminated with even higher costs and less revenue.
Turns out that changing designs for speculative and assumed benefits is very good for shipping more dollars to consultants, associations, corporations, institutions, and largest practices leaving fewer dollars remaining where 40% of Americans most lack care (and will be 50% by 2040 via Triple Threat and housing collapse in higher concentration counties). Selling training to prepare for innovation to members with lowest margins should appear to be counterproductive, but the promotions continue.
Even primary care leaders have been caught up in innovation and its promotion rather than efforts to fight for their members - as fewer and fewer members have remained in primary care. The hypnotic reign continues.
Zombie Brain Control Lacking in Evidence Basis and Common Sense
Innovation thinking appears to take over the brain so that logical thinking is suppressed. Comprehensive evidence based reviews demonstrating no outcome improvement from the use of financial incentives has had no penetration into the minds of those who are supposed to remain evidence based. They have also ignored CBO reports indicating that micromanagement costs as much as it saves. Even worse, those that spout population based or social determinant language fail to understand that outcomes are almost entirely about factors outside of clinical intervention - making clinical or digital clinical interventions worthless at high cost - the opposite of value based claims.
Predatory Policies Hurt Practices Most Valuable for Health Access
Even worse, the primary care practices long paid the least who have managed to keep the same or similar outcomes have long been higher value. But CMS is paying consultants to help them to innovative value based designs - even though they represent greater value in cost vs outcomes as well as in where they practice and who they serve.
Digitalizations, certifications, and regulations have reduced revenue, have reduced productivity, have reduced morale, have reduced remaining revenue to support team members and care delivery, and have increased meaningless complexity. It is harder to deliver care and caring. The life of the practice is sucked away along with the time and talent and treasure of the physician, clinician, and team member. The practice takes over to an even greater and abnormal degree and relationships are compromised within the practices as well as with home and family.
The effects are all magnified where practices doing the basics are paid least (primary care, mental health, rural, small practices, small hospitals, women's health) and where they are paid 15% less by payment design and where they have the greatest increase in costs of delivery - by design. Revenue, costs of delivery, and complexities are the Triple Threat Terror taking out basic health access in the United States for all sources - MD DO NP and PA. Primary care has seen the collapse of internal medicine from 120,000 to less than 30,000 as 4000 a class year is less than 1000 since 1980. Physicians in primary care, women's health, mental health, general surgery, and general orthopedics have been shrinking at rates of 2 to 3 percentage points a year as seen in the AMA Masterfile 2005 compared to 2013.
The changes have relegated the last best primary care source of family medicine to less than 50% primary care result as seen in the 2010s graduates. This is half the level compared to the graduates of the 1970s and 1980s as designs for revenue, cost of delivery, and complexity drive all sources to ever lower result. All other sources dipped below 50% active and in primary care long ago and are now less than 10% for IM and less than 30% for peds, PA, and NP. More specialties are added with more added to each specialty and subspecialty, alternative health careers bloat non-delivery costs and drive health care spending to even higher levels, and careers outside of health care have been made better choices across lowest paid and least supported primary care, mental health, and other basic workforce.
Why not go where the payment results in more team members, better team members, better team member support, better salaries, better benefits, and less complexity?
Sucking the Experience Out of Primary Care Workforce
Innovation has helped the US to the least experienced primary care workforce in the history of the US as the design has moved IM and FM and PD away from 30 year careers. The flexible NP and PA designs have been even more likely to follow the financial design away from health access careers. NP and PA were paid less and turned over twice as fast - also by design. More and more graduates translate to less health access result across MD DO NP and PA sources.
Why would anyone who understands the challenges of primary care support zombie innovation and predatory policies that such the life blood from health access practices and hospitals? Why fail to fight against policies that prevent primary care choice and that send primary care clinicians and physicians away from primary care after shorter and shorter primary care contributions?
Why defeat primary care as fewer patients can be seen a week, as patients have less time with physicians, and as team members are clawed away from their care and caring?
It is hard to stop a Bandwagon, but a Bandwagon rolling the wrong way needs to come to a halt. Pay for Performance has had its 15 years, and has been found lacking. “In summary, we found low-strength, contradictory evidence that P4P programs could improve processes of care, but we found no clearevidence to suggest that they improve patient outcomes.” from The Effects of Pay-for-Performance Programs on Health,Health Care Use, and Processes of Care: A Systematic Review, Annals of InternalMedicine 1/10/17.
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