Connecticut Medicine

Mar 2015

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volume 79, no. 3 187 Chaos Following Fragmentation RobeRt D. Russo, MD A s I watch all the mixed signals concerning healthcare, I can't help but feel that the lack of direction is leading us into chaos. e governmental agencies appear to be saying everything everyone wants to hear. e insurance companies are struggling to gain control of the patients, and the entrepreneurs are making billions by screwing up the quality of medicine. Most of my concerns are rooted in the fragmentation of medical care. both the state and Federal Governments are encouraging physicians to develop "Medical Homes" and "Health Neighborhoods." ere is a significant push to change primary care into the "team" concept. Yet at the same time, Governor Dannel Malloy made it a priority to give the APRNs independent practice rights. at action helped break up many teams, as some of the best APRNs left the team to go independent. Many practices cannot function efficiently without the skills of the APRNs. ey fill a need in the delivery of care within the team approach. Why give them incentive to leave the team? e insurance companies are encouraging their members to seek care outside of the community based doc- tors using telemedicine portals. ese web-based solutions are dangerous for patient care if not done correctly. telemedicine has great benefits, but not if it takes the patient out of the continuum of care. episodic care, where the treating doctor or nurse practitioner knows nothing about the patient's medical history and has no concept of follow up care, is poor quality medicine. It deceives the patients into thinking that they are getting good care. Physicians for years have been taking patients' calls for free, yet insurance companies believe that doctors who know nothing about the patient should be paid. Are we sure having patients call practitioners they don't know is better than calling their own doctor? ese companies are narrowing their physician networks in order to save money and gain control over where patients seek medical care. ey have even gone so far as to tell patients that they will schedule their doctor's appointments for them. I can't help but wonder how they would decide which doctor is best for you. Would it be too cynical to think it might be based on cost or control? In the past, it was taboo to use economic credentialing, but we seem to be headed that way. Remember the companies refused to tell the Connecticut state Medical society what criteria they used in determining who was in or out of a network. Minute clinics and urgent care centers could be a good thing, but only if they are tied into a bigger community- based system that can handle the continuum of care. Who said corporations are better than doctors for telling patients where to seek medical help? When companies limit the drug formularies that are available, does this help doctors treat patients? Adding to the chaos, how about the cry that medical access is limited and therefore these new ways of deliv- ering care are necessary. If there are too few physicians, whose fault is it? Isn't it the Federal Government that controls the number of residents in training through the Medicare system? ere would be plenty of room for more training positions if there was adequate funding. It's the government cutting of the funding to hospitals for residencies that is the problem. e government maintains there aren't enough doctors while it's the one causing the shortage. Confusing? President's Page — Personal insights

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