<p>“a lukewarm supporter of the ACA.”</p>
<p>bclintonk, I went back and looked at many of your previous posts in this thread and I have yet to find one where you didn’t ardently defend Obamacare. If this is what it is like to be lukewarm supporter, I hate to see what you’re like when you’re enthusiastic about something.</p>
<p>LasMa, I predict the millennialist will not have to trouble themselves with data entry per se either…;)</p>
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</p>
<p>That said, I do appreciate the conundrum independent docs face. From anecdotal info shared with me by various associates, at least early versions of software have had less-than-intuitive interfaces. It is a major investment and its meaningful use is contingent on having a very smooth IT implementation that is not inexpensive to maintain. Its another way in which large hospital or commercial entities have more buying power and advantageous influence, and ergo another market pressure on the independent practice at a time when insurance companies are exerting a downward influence in approved fees. So in that sense, I feel that rather than being Luddites per say, many independent docs resent the continued commoditization of their profession toward corporate control that is not especially patient-centered so much as profit-centered.</p>
<p>There is another element to this resentment. What would be so bad about joining a large entity to maintain your EMR overhead? Well, in theory nothing, except then you have things like the statistical evaluation of how much time you spent with a patient, (the answer is always too much) …why didn’t you prescribe a cholesterol drug to that menopausal woman (a valid answer from a doc who’s actually comprehensively read the true research would be that he didn’t because it will actually INCREASE risk of cardiac event in her case instead of decrease it…but that files in the face of what governing med policy dictates for treatment parameters) ETC.</p>
<p>So I suspect many docs feel like the market pressures are creating a Walmart effect. I don’t know if you’ve ever been involved in a company selling a product to Walmart, but I can assure you there’s a reason many well-meaning inventors end up having their products produced in China instead of America.</p>
<p>That said, EMT makes sense and is an interim step toward a more comprehensive technology of health status and valuable data mining. I’m not at all against it, but I wish it were uniformly developed, implemented, and paid for by pooled groups to keep the playing field reasonable for those who pursue independent practice.</p>
<p>The idea digital records risk too much spying and control has been around for a long time. (Crap, when my anti-banner hiccups, some of what I google shows up on my CC page, regardless of whether it has anything to do with CC topics. My tv provider knows what shows I watch and annoyingly makes recommendations.) </p>
<p>Who says if research shows a cholesterol med in menopause poses (or may pose) more risks, that some system is going to question and override the doc’s decision? What the connected system can do is update the doc or make him/her aware. But not because some independent vendor thinks to include something. The links are to much larger profession-based data bases. Eg, PDR (Phys Desk Ref) eg, is/will be the data base for pharm. </p>
<p>In IT terms, these are still pretty much what we called “dumb systems.” Not artificial intelligence. They take what is input and format it- like word processing, like templates. Keywords are flagged for cross-reference. Eg, enter vitals and a dosage recommendation chart can pop up. If you’ve ever worked your way through a Merck Manual, you know how the professional documentation can only suggest possible syndromes and collateral issues to look for, as signs/signals- not provide actual diagnoses. That still requires the (human) craft of doctoring.</p>
<p>There are cases where any given med may resolve a more immediate risk (and should be used) and cases where it should be avoided. Until recently, statins were worshiped. Estrogen is another great example. It needs a holistic decision. Nearly every doc recommended it to women at a certain stage- long before ACA was even a glimmer in anyone’s eye. Long before health records (not accounting) were digitized. And long before they knew the risks.</p>
<p>If you read the ‘practice management’ web sites (this thread has been educational, in between the spats,) you see tracking things like number of patients/day or time spent with each, has been part of medical management for a long time. Systems are not “creating” new needs or threats, they are responding to long established interests.</p>
<p>Let’s look at this another way. Compared to the old way of charting, EHR is worse for the doctor who is doing the charting, maybe. But it’s better for everyone else. </p>
<p>It’s better for the patient: not only does every doctor I see have my medical information in front of her, but I don’t have to repeatedly fill out charts and forms with my medical information; the system has it already, and I don’t have to remember yet again whether that episode of <whatever> was in 2002 or 2003. I can look at my health records myself. I can be assured that the system will make it hard to prescribe for me a medicine I’m allergic to. When I go to a new provider, I don’t have to undergo the same lab tests and X-rays I’ve already had.</whatever></p>
<p>It’s better for the doctor who is seeing the patient for the first time, who can look at the patient’s health trends and medication history without having to wade through prose. Has medication X been tried already? Has test X been done? Has this patient always been so underweight, have they suddenly lost weight, or have they been gradually losing weight? For the diagnostician, more information in an easily accessible form is going to result in better diagnoses.</p>
<p>It’s better for the insurance company, who can make sure that they are reimbursing correctly.</p>
<p>In other words, using EHR is practicing better medicine. Older doctors who are set in their ways don’t want to switch-- nobody wants to switch their way of doing things, that’s always a pain in the neck-- but younger doctors just being trained are not going to even comprehend why anyone would think that the old way of charting was better than having patient data at one’s fingertips.</p>
<p>GP, to you, anyone who points out anything positive about ACA – and despite what you think, there are positives – is an "ardent supporter. "</p>
<p>I’m saying typing it in isn’t even necessarily “worse for the doctor who is doing the charting.” They have to get the details down. They had to before. They didn’t just write narrative before- or try to remember, from one appt to the next, what LasMa or CF or Emily told them. “Remind me, Mrs Bee, what we discussed last time. Didn’t you have some sort of issue?” They had procedures for what they inquired, how they assessed, what they thought the diagnoses could be, what they suggested to the patient and relevant details. And they still do. During or just after the appt, they noted info down, in a format.<br>
Now, during or just after the appt, they note info. </p>
<p>Is some of this a possible hassle? Sure. Many times, I prefer a pencil. Oops, pencil isn’t good for maintaining notes.</p>
<p>Is there anyone here who has never, on visiting a doctor for themself, a child or an aging parent, had to repeat health details that should have already been known to the provider? We shouldn’t have to do this, but in my experience and the experience of people on Parents Supporting Parents thread, we have to do it all the time. Why am I telling the doctor details about a symptom I reported the last time I was here, or a treatment that was delivered by this very facility? The “good old days” of the wonder doctors remembering everything weren’t so good for patients.</p>
<p>Well, I don’t really think the doctor is going to thoroughly read through the records of every patient before he enters the exam room, either. That’s not reality. Neither doctors nor patients are robots. </p>
<p>Yes, but they shouldn’t be asking me questions when they should already know the answer.</p>
<p>“Well, I don’t really think the doctor is going to thoroughly read through the records of every patient before he enters the exam room, either. That’s not reality. Neither doctors nor patients are robots.”</p>
<p>When I saw my new Uro after the two months of seeing other doctors, having multiple tests, lab work, different medications, invasive diagnostic procedure, etc., etc., etc., it was apparent to me immediately that my doctor read my complete record before my appointment, and I expect no less. In addition, I was required to complete and send to her office before the day of my appointment a 4 page new patient questionnaire (basic health history, parent’s health history, and lots of very specific questions about my symptoms.) If not done my appointment would not have been honored. It’s clear that the doctors in this office, do indeed want to have as much information as possible before a patient’s appointment. </p>
<p>About a week after that appointment, I had an appointment with my PCP for a follow up from the months before when I first started having symptoms. Since he had received a complete record from my Uro, I didn’t have to explain to him any of the details (and yes, I asked him immediately if he had gotten the info.) </p>
<p>Your doctor should read your file. I suppose it’s ok to say, maybe he/she couldn’t, uh, read the handwriting.</p>
<p>
Neither is confusing participation rates in a coerced activity for a measure of it’s merit. Nor, ignoring that it’s not what they reported in the past that they seem to be unhappy with but the additional they’re being required to do today. Whatever.</p>
<p>From the LVRJ:<a href=“Las Vegas News | Breaking News & Headlines | Las Vegas Review-Journal”>‘AGT’ alum Daniel Emmet shines in Las Vegas Strip residency | Kats | Entertainment | Entertainment Columns;
Even without a dispensation for accidental drinkers and those born behind the wheel with a drink in their hands, the analogy has some merit.</p>
<p>
I believe that translates to:* lets put off the inevitable skyrocketing in premiums as long as we possibly can, no matter that it’ll be the mother of all rate hikes when we finally admit to the economics.*</p>
<p>For the states that chose not to go along with the additional delays granted by Obama, I agree that small business employees are in for a shock come Nov. Not only will see they see huge premium increases, but they will probably be offered plans similar to what we are seeing in the individual market, which means limited networks for millions of more people.</p>
<p>and surely death panels. 
</p>
<p>As a new Medicare recipient after many years of no insurance/underinsurance, I am extremely grateful to be able to go to a doctor–any doctor–and not have to worry about paying the rent and feeding myself and my kid. Insurance is a wonderful thing, as many previously uninsured Americans are finding out. </p>
<p>May 2: In every state this summer, insurance customers, advocates, and politicians will stop speculating and find out exactly what health insurance plans hope to charge in 2015. Until these rate filings are submitted, anticipating what health insurers will do falls somewhere between educated opinions and anyone’s guess. The reason is simple: many key variables are unknown. Health insurance companies have to balance pushing for big increases against Obamacare restrictions, and certain federal benefits health insurers will receive. As one expert put it, trying to predict 2015 health insurance rates is like “like nailing Jell-O to a wall.”" Consumers Union.</p>
<p><a href=“Search Rate Review Filings”>DMHC - Error; So, off the top, I don’t see anything in CA near the “inevitable skyrocketing,” certainly not at this point. If you play with the table, scroll down, etc, you can also see (some) prior increases. I’m not seeing filings for NV 2015 rates so that’s premature. </p>
<p>Maybe catahoula can actually link us to the filings.</p>
<p>Just to remind people in case they forgot or didn’t know, most small group plans were renewed before Dec 31, allowing their employees to keep their plans for another year. In states like Ca., non-grandfathered individual plans were not accorded this type of favorable treatment. Obama, recognizing the political ramifications of people losing their plans and doctors, gave these non-grandfathered plans and small group plans another couple of years before complying with Obamacare. However, many states didn’t go along with these Obama waivers and chose to adhere to the original rules for cancelling plans. California is one of those states. Come Nov, may employees in the small business market will lose their plans unless the state has a change of heart.</p>
<p>
Because ‘many key variables are unknown’, in whole or part.</p>
<p>And for a primer on that, it’s worth looking at that Politico piece again…
<a href=“Parts of Obamacare site still missing - POLITICO”>Parts of Obamacare site still missing - POLITICO;
… because incompetence can sometimes be a reward unto itself:
</p>
<p>That incomplete back end is expedient. A slush fund with no measure of accuracy.</p>
<p>Although I knew the networks for Obamacare plans were bad in my region, I didn’t have any idea how bad it is in Monterey County.</p>
<p>"Local leaders in the medical field tell us candidly that the sad fact is: in Monterey County only about 5 percent of doctors are accepting the coverage, and even less than that in specialty fields, due to the very low reimbursement rates the program provides.</p>
<p>This so-called “network inadequacy” might only get worse with the coming deadline of June 30th. That’s when the few physicians still accepting the Anthem Pathway coverage have to give a final word on whether or not they will opt-out."</p>
<p><a href=“Editorial: Covered California 'Uncovered'?”>http://www.ksbw.com/tv/editorials/covered-california-uncovered/25666608</a></p>