Marcus Welby M.D. had it right all along

marcus_welby_intro_screenFor those too young to remember, this was an ABC series that ran from 1969-1976. Though the program had house calls as part of its outreach, this was not the main point of the series. Having said that, wise people understand what is old tends to come back as new again to a different audience. With Sen. Bernie Sanders (I-VT) announcement (PDF) of Medicare-for-all sponsored legislation being first an impetus to cover everyone with healthcare and second to do so cheaper than the current system, all opportunities to flip the current fee-for-service payment model are welcome; that is if your ox is not gored by doing so. Right now, the throwback concept of House Calls is limited to the most intensive patient care clients, as is the case with most test programs. Hey, it’s 2017, it is known what works and what doesn’t by now; let’s just get on with it.

Personally, I have a chronic leg situation that has alternating bouts of treatment. If home visits from Nurse Practitioners at a minimum and Doctor’s based on need were truly funded, the system and my condition would be greatly improved.

This is not an isolated cause, despite it being new to me. Another organization in Virginia is employing a provision of the Affordable Care Act named Independence at Home. It is a project that involves 14 practices and consortia with the closest branch being a group in Durham (NC). A team-based approach to care that involves physician assistants, pharmacists, social workers, and other staff (Daniel Farmer, 2016), I would be interested to know what the other staff is; one way it can be enhanced is the utilization of Electronic Health Records that are clean and functional.

via Bringing Back House Calls to Cut Spending on High-Risk Patients

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Medicaid expansion cuts uncompensated care costs

One would think that this is a no-brainer for healthcare providers in states such as the bloggist’s residence, but the only conclusion I can make is that the politicians in power have some other non-rational explanation for why Medicare expansion was not implemented. This article eliminates the financial part.

In states that expanded their Medicaid programs under the Affordable Care Act, uncompensated care costs are down and revenues are up compared to those that didn’t.

http://www.fiercehealthcare.com/finance/medicaid-expansion-cuts-charity-care

Fitness patches, maybe

Once upon a time, last year, I had a chance to receive a Microsoft Band v.1. As much as I use and like Microsoft products, the rule of thumb is to never buy on version 1. So I received a credit for the retail cost of the item ($200), and used it for better purposes. The current wearable that I dreamed about is the Fitbit Charge ($99), If researchers @ UT/longhorns can get it right, a patch could be used, not unlike the Cigarette patches available today (I’ve never smoked, so no personal knowledge of such). My guess it would also be cheaper and potentially paid for with Insurance (Hello Blue Cross and Blue Shield of NC) or Medicaid/Medicare. If one can spend some money to monitor health, report to primary doctors and healthcare providers to catch solvable little problems before they become intractable and expensive fixes, the better for all concerned.

It would be nice if the nice people in Durham understood this concept, but still working on that.

http://www.zdnet.com/article/your-next-fitness-wearable-could-be-a-patch/.