A Doctor – Economist’s Solution for Health Reform

Posted on July 1, 2022 by Dr. David Edward Marcinko MBA MEd CMP™

My Laundry Wish List for all US Healthcare Stakeholders

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]Fox News

As President Obama spoke, prodded and cajoled for Congress to pass HR 3200-3400 in 2008, I believe that for any healthcare reform effort to work successfully for the American people – for the long term – we need to consider the following in no particular prioritized order:

  • Insurance portability uncoupled from patient employment
  • Health insurance regional exchanges with inter-state purchase competition
  • Doctor, drug, DME and hospital pricing and payment transparency for HSAs, and all of us
  • Modifying or eliminating AMA owned CPT Codes®; a huge money maker for them
  • Abandoning ala’ carte medicine for values-based outcomes
  • Reduce JCAHO influence; encourage competition from Norwegian Det Norske Veritas [DNV]
  • Reduce big-pharma influence thru-out the entire medical education, career and care pipeline
  • End DTC advertising from big-pharma
  • Promote wholesale drug purchase competition, MC bidding and generic drugs
  • Encourage evidence-based medicine, not expert-based medicine
  • Less pay for medical specialists with a  re-evaluation of the hospitalist concept
  • Advance the dying art of physical diagnosis, teach and embrace Paretto’s 80/20 rule for clinic issues
  • Reduce lab test, diagnostic imaging and testing
  • Encourage private 24/7/365 medical offices and clinics; and on-site and retail clinics
  • Abandon P4P, medical homes and disease management ideas
  • Give more economic skin-in-game to patients relative to health benchmarks
  • Concretize the “never-event” prohibitions and include a list of patient health responsibilities
  • More pay for primary care docs and internists
  • Adopt digital records and cloud computing for patients
  • Phase in true eHRs incrementally; and abandon CCHIT for open source SaaS
  • Promote Health 2.0 social media.
  • Augmented scope of practice, numbers and pay for NPs and DNPs, etc
  • Reduce pay for CRNAs and increase it for staff RNs
  • Develop step down triage and treatment units to reduce the number of full service ERs
  • Increase medical, osteopathic, dental, optometric and podiatric medical school classes
  • Increased practice scope for dentists, podiatrists and optometrists
  • Make some sort of catastrophic HI mandatory, much like auto insurance for all
  • End pre-existing conditon health insurance contract clauses
  • More choice  and end of life control for the terminally ill patient
  • Increase marketplace competition with fewer political and financial “externalities”.
  • Teach basic healthcare topics in school and encourage physical exercise
  • Health and insurance education should be, but is not, the “answer” for Americans
  • Protect borders and discourage undocumented illegals
  • Adopt medical malpractice tort reform
  • Make all stakeholders fiduciaries
  • No public “option” unless you like food stamps, Section 8 housing, public transportation and schools
  • Budget deficit neutrality
  • Slow down!

Assessment

Recently, while in the Baltimore/Washing area, I was asked by several reporters to opine on the healthcare debate; which I did so freely having never been known as the shy type. And, regular readers will note that many of these items have been used as posts or comments on this ME-P. Unfortunately, my “laundry list” interview was pre-empted by two local but boisterous town-hall meetings with respective passionate politicians. It was redacted no doubt, but never broadcast. Thus, I missed the potential for my “five minutes” of fame. C’est la vive!

Conclusion

There you have it; direct and straight forward. And so, your thoughts and comments on this Medical Executive-Post are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe to the ME-P. It is fast, free and secure.

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On the Future of Nursing Practice

Posted on May 22, 2014 by Dr. David Edward Marcinko MBA MEd CMP™

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Focus on Scope of Practice

[By Staff Reporters]

Transforming the health care system to meet the demand for safe, quality, and affordable care will require a fundamental rethinking of the roles of many health care professionals, including nurses. The 2010 Affordable Care Act represents the broadest health care overhaul since the 1965 creation of the Medicare and Medicaid programs, but nurses are unable to fully participate in the resulting evolution of the U.S. health care system. This is true for nurses at all levels, whether they practice in schools or community and public health centers or acute care settings. A variety of historical, cultural, regulatory, and policy barriers limit nurses’ ability to contribute to widespread and meaningful change.

In 2008, the Robert Wood Johnson Foundation (RWJF) and the Institute of Medicine (IOM) launched a two-year initiative to respond to the need to assess and transform the nursing profession. The IOM appointed the Committee on the RWJF Initiative on the Future of Nursing, at the IOM, with the purpose of producing a report that would make recommendations for an action-oriented blueprint for the future of nursing.

As part of its report, the committee considered the obstacles all nurses encounter as they take on new roles in the transformation of health care in the United States. While challenges face nurses at all levels, the committee took particular note of the legal barriers in many states that prohibit advance practice registered nurses (APRNs) from practicing to their full education and training. The committee determined that such constraints will have to be lifted in order for nurses to assume the responsibilities they can and should be taking during this time of great need.

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RN

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The Changing Health Care System

In the 21st century, the health challenges facing the nation have shifted dramatically. The health care system is in the midst of great change as care providers discover new ways to provide patient-centered care; to deliver more primary care as opposed to specialty care; and to deliver more care in the community rather than the acute care setting. Nurses are well poised to meet these needs by virtue of their numbers, scientific knowledge, and adaptive capacity, and health care organizations would benefit from taking advantage of the contributions nurses can make.

Assessment

As the health care system has expanded over the past 40 years, the education and roles of APRNs, in particular, have evolved in such a way that nurses now enter the workplace qualified to provide more services than had been the case previously. Yet while APRNs are educated and trained to do more, some physicians challenge expanding scopes of practice for nurses. The committee stresses that physicians are highly trained and skilled providers and that some services clearly should be provided by physicians, who have received more extensive and specialized education and training than APRNs. However, given the great need for more affordable health care, nurses should be playing a larger role in the health care system, both in delivering care and in decision making about care.

The committee argues that APRNs are not acting as physician extenders or substitutes. They work throughout the entirety of health care, from health promotion and disease prevention to early diagnosis to prevent or limit disability. APRNs sometimes provide services that many people associate with physicians, such as assessing patient conditions or ordering and evaluating tests, but they also incorporate a range of services from other disciplines, including social work, nutrition, and physical therapy.

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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