Hamster health care

Morrison, Ian; Smith, Richard

doi:10.1136/bmj.321.7276.1541

Cited by 90 publications

(43 citation statements)

References 1 publication

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“…Robinson 1 run faster just to stand still…The result of the wheel going faster is not only a reduction in quality of care, but also a reduction in professional satisfaction and an increase in burnout among physicians." 12 The structure of FFS payments for office visits may be the engine driving this treadmill (see Table 1). …”

Section: Living Off Visits: the Traditional Economics Of Fee For Servmentioning

confidence: 99%

US Approaches to Physician Payment: The Deconstruction of Primary Care

2010

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The purpose of this paper is to address why the three dominant alternatives to compensating physicians (feefor-service, capitation, and salary) fall short of what is needed to support enhanced primary care in the patient-centered medical home, and the relevance of such payment reforms as pay-for-performance and episodes/bundling. The review illustrates why prevalent physician payment mechanisms in the US have failed to adequately support primary care and why innovative approaches to primary care payment play such a prominent role in the PCMH discussion. FFS payment for office visits has never effectively rewarded all the activities that comprise prototypical primary care and may contribute to the "hamster on a treadmill" problems in current medical practice. Capitation payments are associated with risk adjustment challenges and, perhaps, public perceptions of conflict with patients' best interests. Most payers don't employ and therefore cannot generally place physicians on salary; while in theory such salary payments might neutralize incentives, operationally, "time is money;" extra effort devoted to meeting the needs of a more complex patient will likely reduce the services available to others. Fee-for-service, the predominant physician payment scheme, has contributed to both the continuing decline in the primary care workforce and the capability to serve patients well. Yet, the conceptual alternative payment approaches, modified fee-for-service (including fee bundles), capitation, and salary, each have their own problems. Accordingly, new payment models will likely be required to support restoration of primary care to its proper role in the US health care system, and to promote and sustain the development of patient-centered medical homes.KEY WORDS: primary care; reimbursement; health care delivery.

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Section: Living Off Visits: the Traditional Economics Of Fee For Servmentioning

confidence: 99%

US Approaches to Physician Payment: The Deconstruction of Primary Care

2010

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“…Investing extra time in a patient's psychological problems can be a problem, because GPs already complain about their increasing workload [10][11][12]. One of the reasons for the GP's investing extra time is the entanglement of mental health problems with somatic problems [6,13] resulting in longer consultations covering more than one topic.…”

Section: Introductionmentioning

confidence: 99%

The workload of general practitioners does not affect their awareness of patients’ psychological problems

Zantinge

Verhaak

Bakker

et al. 2007

Patient Education and Counseling

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Objective: To investigate if general practitioners (GPs) with a higher workload are less inclined to encourage their patients to disclose psychological problems, and are less aware of their patients' psychological problems. Methods: Data from 2095 videotaped consultations from a representative selection of 142 Dutch GPs were used. Multilevel regression analyses were performed with the GPs' awareness of the patient's psychological problems and their communication as outcome measures, the GPs' workload as a predictor, and GP and patient characteristics as confounders. Results: GPs' workload is not related to their awareness of psychological problems and hardly related to their communication, except for the finding that a GP with a subjective experience of a lack of time is less patient-centred. Showing eye contact or empathy and asking questions about psychological or social topics are associated with more awareness of patients' psychological problems. Conclusion: Patients' feelings of distress are more important for GPs' communication and their awareness of patients' psychological problems than a long patient list or busy moment of the day. GPs who encourage the patient to disclose their psychological problems are more aware of psychological problems. Practice implications: We recommend that attention is given to all the communication skills required to discuss psychological problems, both in the consulting room and in GPs' training. Additionally, attention for gender differences and stress management is recommended in GPs' training. #

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“…A survey by the Commonwealth fund shows that physicians believe that spending more time with their patient is effective in improving patient care and they are not satisfied with the limited time available for patients during consultations [17]. One of the main goals of Healthcare Reform is to increase quality of care and patient access to care while making healthcare more affordable [18].…”

Section: Introductionmentioning

confidence: 99%

Determining Primary Care Physician Information Needs to Inform Ambulatory Visit Note Display

Clarke¹,

Steege²,

Moore³

et al. 2014

Appl Clin Inform

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SummaryBackground: With the increase in the adoption of electronic health records (EHR) across the US, primary care physicians are experiencing information overload. The purpose of this pilot study was to determine the information needs of primary care physicians (PCPs) as they review clinic visit notes to inform EHR display. Method: Data collection was conducted with 15 primary care physicians during semi-structured interviews, including a third party observer to control bias. Physicians reviewed major sections of an artificial but typical acute and chronic care visit note to identify the note sections that were relevant to their information needs. Statistical methods used were McNemar-Mosteller's and Cochran Q. Results: Physicians identified History of Present Illness (HPI), Assessment, and Plan (A&P) as the most important sections of a visit note. In contrast, they largely judged the Review of Systems (ROS) to be superfluous. There was also a statistical difference in physicians' highlighting among all seven major note sections in acute (p = 0.00) and chronic (p = 0.00) care visit notes. Conclusion: A&P and HPI sections were most frequently identified as important which suggests that physicians may have to identify a few key sections out of a long, unnecessarily verbose visit note. ROS is viewed by doctors as mostly "not needed," but can have relevant information. The ROS can contain information needed for patient care when other sections of the Visit note, such as the HPI, lack the relevant information. Future studies should include producing a display that provides only relevant information to increase physician efficiency at the point of care. Also, research on moving A&P to the top of visit notes instead of having A&P at the bottom of the page is needed, since those are usually the first sections physicians refer to and reviewing from top to bottom may cause cognitive load.

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Hamster health care

Cited by 90 publications

References 1 publication

US Approaches to Physician Payment: The Deconstruction of Primary Care

US Approaches to Physician Payment: The Deconstruction of Primary Care

The workload of general practitioners does not affect their awareness of patients’ psychological problems

Determining Primary Care Physician Information Needs to Inform Ambulatory Visit Note Display

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