The Time Has Come: Physician Productivity and Telemedicine

Richard Reece

Posted 1/10/12 on MedInnovation Blog

Time is totally irreplaceable. Moreover, time is totally perishable and cannot be stored. Yesterday’s time is gone forever and will never come back.

Peter F. Drucker (1909-2005)

This blog’s genesis is three-fold: one, an article I read by Phillip Betbeze, “Telemedicine as Talent Strategy,” in today’s HealthLeadersmedia.com; 2) an interview I conducted in May, 2010 with Ron Pion, MD, chairman of Telemedicine Associates in Los Angeles , titled “The Internet Lifts All Boats”; and 3) frequent Skype conversations I’ve been having with my son, who lives in Madrid, Spain.

From these encounters, I predict: new sophisticated Internet technologies may be key to enhancing physician productivity.

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The Great Finesse in Health Reform- Changing The Language

Richard Reece

Posted 10/13/11 on MedInnovations Blog

One man’s words are another man’s poison.

Anonymous

We were reasonably calculating in our approach. We consciously began using the language of the marketplace, rather than the language of medicine. We began talking in terms of “providers and consumers” instead of “doctors and patients,” for example. This, of course, was and still is highly offensive to many people in medicine, and we felt the old language was almost like the language of religion, and, thus, harder to use when trying to affect widespread change.

Paul Ellwood, MD, 1985, “Life on the Cutting Edge,“ Twin Cities Magazine, 1985

1n 1988 in Who Shall Care for The Sick: The Corporate Transformation of Medicine in Minnesota, I said that words matter in health reform, that use of “providers and consumers” signaled a transformation in American medicine, and that these words a “Grand Finesse” of American physicians, effectively distracting them from what was really happening.

I predicted physicians would become serfs of payers, physicians would be disillusioned , and ultimately, a doctor shortage would ensue.

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The Great Prostate Debate: “We” Versus “Me”

Richard Reece

Posted 10/12/11 on MedInnovation Blog

The public demands certainties but there are no certainties.

H.L. Mencken (1880-1956)

The government, representing “We, The People,” is responsible for spending the public’s money intelligently based fact. The individual citizen, “Me, The Person,” is responsible for preserving his/her health based on what he/she perceives to be in his best interest.

With PSA screening for prostate cancer, these responsibilities conflict because the screening may do more harm than good. Prostate cancer is a common, slow moving cancer. Five times more men with it than from it, and the side effects of biopsy and treatment can be devastating.

Hence, the great prostate debate – whether to screen routinely for prostate cancer with PSA testing, and whether to biopsy and treat patients with marginally elevated levels.

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Why Doctors Don’t Like Electronic Medical Records

Richard Reece, MD

Posted 10/07/11 on Medinnovation Blog. It originally ran in the 9/27/11 issue of Technology Review, an MIT Press publication.

Why are doctors so slow in implementing electronic health records (EHRs)?

The government has been trying to get doctors to use these systems for some time, but many physicians remain skeptical. In 2004, the Bush administration issued an executive order calling for a universal “interoperable health information” infrastructure and electronic health records for all Americans within 10 years.

And yet, in 2011, only a fraction of doctors use electronic patient records.

In an effort to change that, the Obama economic stimulus plan promised $27 billion in subsidies for health IT, including payments to doctors of $44,000 to $64,000 over five years if only they would use EHRs. The health IT industry has gathered at this multibillion-dollar trough, but it hasn’t had much more luck getting physicians to change their ways.

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A Primary Care Revolt

Richard Reece MD

First published 4/17/11 on MedInnovation Blog

An under-the-radar revolution is going on out there. It is a  revolt of primary care physicians against the AMA and CMS.  It is a request for parity with specialists.  It is a movement to replace how primary care practitioners are paid.

Why the revolt against the AMA and CMS? Because primary care doctors yearn to correct myths about primary care vis-à-vis specialists, and because they believe, by altering how the AMA and CMS pay doctors, health costs can be brought down, and primary care can be re-invigorated.  Health systems with a broad primary care base have lower costs. In the U.S., two-thirds of doctors are specialists, and one-third are in primary care, the reverse of most nations, which have 50% or lower costs.

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