FDA Needs Reform Or The Market Might Not Innovate Life-Saving Drugs.

Okay, maybe those doctoral economists will come in handy. Jokes aside, bringing life-saving drugs to market will never be cheap – and it will require government participation.

However, there’s a difference between red tape syphoning better-spent dollars to line the pockets of insurance companies who DON’T actually care for our population, and making sure a drug company developing an Alzheimer’s treatment can recoup their billion dollar investment.

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Research Suggests That Preventing Illness Won’t Curb Rising Healthcare Costs. So How About We Just Cut The Red Tape?

Spending on health care has consistently grown faster than the rest of the U.S. economy. What’s behind this trend is less certain, though. Economists point to two causes: the prevalence of diseases and conditions afflicting the U.S. population, or the rising costs of treating diseases.

New research from American University Associate Professor Martha Starr and Virginia Tech Research Professor Ana Aizcorbe shows it is the latter, with higher prices for treatment accounting for 70 percent of growth in health care spending.

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For Years The RAND Corporation Claimed EMRs Would Save Us $100 Billion Per Year — Until Their Own Research Proved Otherwise

Seriously, we’ve heard enough idealistic hoopla about EMRs improving patient care. It is not the reality of the situation. What appears to be the reality is that the companies who provide the EMRs, and get government kick backs for doing such, are definitely raking in a lot of dough. What’s not happening, though, is anything beneficial in the doctor’s office. The machines aren’t widely adopted and when they are, they’re costing doctors time with unnecessary clicks. And the nail in the coffin comes from the New York Times, who write, “The conversion to electronic health records has failed so far to produce the hoped-for savings in health care costs and has had mixed results, at best, in improving efficiency and patient care, according to a new analysis by the influential RAND Corporation.”

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Student Discusses Atlas MD, Capitalism And The Free Market In Research Paper

We’re blessed to have been the thesis of Sam Jordan’s academic paper, “Medicine Shrugged.” Originally from Salina, Kansas, she’s now a freshman at George Mason University in Fairfax, Virginia and is majoring in Economics. She included email correspondences with Dr. Josh as part of her sources to build a case for free market medicine. Texts from Ayn Rand, Alan Greenspan and other intellectuals were cited alongside our personal experience.

Thanks to Sam, for letting us share her work with our supporters. We have to admit, we blushed when she compared us to Aluminum Company of America. ALCOA is known for its shining example of profit-maximization and price-minimization in Greenspan’s paper, “Trust.” It serves as a concise way of understanding our mission to cut the red tape. And yes, it’s true: we’re motivated to offer the best healthcare while making the most money possible. Sam had no hesitation in addressing that.

We’ve included the complete work below. Take a look. And if you’re interested in a digital copy of Sam’s paper, send us a line at hello[at]atlas.md …

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Research Shows Top 10 States And Top 25 Cities To Practice Insurance-Free Medicine

Are you curious if your state or city made one of the lists? Keep in mind, we’re having a great time practicing direct care here in Wichita, KS, and get this–we didn’t make either one! On top of that, not all of these states are eligible to dispense prescriptions (New York, Montana, Texas, and Utah prohibit it). In our experience, the real value in running a direct practice comes from offering wholesale prescription discounts. Over time the savings add up, especially for patients with chronic conditions (diabetes, thyroid disease, asthma, migraines, etc.) where it becomes cheaper to subscribe to your clinic and stop using insurance to pay for prescriptions.

Given these facts, we’re not treating this as the ultimatum for who or where one should or shouldn’t open a direct care clinic. However, the research brings up some good reminders. According to Dr. Chris Ewin, Founder and physician at 121MD in Fort Worth, TX:

“Direct practices should be successful in most cities and states where there is an inadequate supply of primary care physicians.” He adds, “… Most important, a physician needs to have social skills to sell him/herself and their new practice model to their patients and their community.”

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A Third Of Med Students Aren’t Using EMR… Wait, Is That A Bad Thing?

A study published last year by the Alliance for Clinical Education found that just 64 percent of med school programs allowed future docs any use of electronic records. Oh, and of those that do, only two-thirds allowed students to actually write notes within the EHR.

Okay, so med schools are failing to fully prepare students for a future of potential bureaucratized headaches. But this is an interesting predicament, given the EMRs themselves are failing, too (just ask the doctors, the studies, etc.; no one is touting the current state of EMR as exemplary). However, there’s a relevant bit of knowledge here. Call it common, call it what you will, but we believe the best a person can be is well-informed, second to that is uninformed, because the worst spot to be in is misinformed. In this latter case, you not only are contaminated with bad information or insights, but you then have to unlearn what you know in order to move forward.

So, who thinks this finding is bad news? Not us. We’re more concerned with the two-thirds of students who were exposed to today’s kickback-savoring EMR. The same shoddy EMR we’re rejecting by launching our own practice management and EMR software specifically for direct care.

READ MORE ABOUT EMR USAGE IN MED SCHOOL CURRICULUM

AAFP Releases Detailed Projection Of Primary Care Physician Shortage

The AAFP reported on a recent study outlining the projected family doctor shortage that is facing our nation. According to the organization, “The projections rely on a combination of factors to gauge current and future workforce needs on a state-by-state basis, focusing heavily on increased patient demand that is likely to result from an aging population, overall population growth and coverage expansions due to the Patient Protection and Affordable Care Act.”

The projections are very specific. For example, according to the projection for Arizona, the state demands an additional 1,941 primary care physicians by 2030. This is 150 percent of the current number of doctors. According to the research, 1,466 primary care physicians are needed because of population growth, 360 because of increased utilization, and 115 because of insurance expansions that occur as part of the Affordable Care Act.

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EMRs Now Omnipresent, Along With Affiliated Stress…

Electronic medical records are being adopted at an all-time high. Now 409,839 eligible professionals and providers are getting “federal incentive payments” (i.e. kickbacks from Uncle Sam) for adopting or using an EMR system.

A recent study was published in the Journal of the American Medical Informatics Association that examines the effect of EMR omnipresence. Specifically they were curious what the machines do to working conditions and how they affect stress, satisfaction and burnout among primary care physicians.

How was the study conducted?

The survey results came from 379 physicians dealing with various EMRs in 92 clinics spanning New York, Chicago, Milwaukee, Madison, Wis., and even some rural areas in Wisconsin. The docs took a survey and reported on four aspects:

  1. Time pressure felt during patient encounters
  2. Perceived control over workplace issues
  3. Job satisfaction
  4. Job burnout

Afterwards, the clinic managers also marked which of 15 common features or functionalities were present in their EMR. From there, the clinics were grouped into three categories:

  1. Those having the majority of the 15 most common features (50% of the sample clinics)
  2. Those with a moderate amount (24%)
  3. Those with a low number of common features (26%)

What were the results?

Researchers compared the physicians’ responses to the clinic’s functionality classification (high, medium or low). Physicians at clinics with moderate-function EMRs experienced significantly more stress than physicians at clinics with low-function EMRs. The medium functioning EMR group had a higher rate of burnout. And here was a weird result: the physicians who operated the high- and medium-functioning EMRs felt less satisfied with their current position overall.

Okay, but what does this mean?

According to lead researcher Stewart Babbott, MD, of the University of Kansas Medical Center in Kansas City, the mid-functioning group having high stress might suggest that these clinics were transitioning. He went on to say, “Our finding that physician-reported stress was highest in the moderate-use group ‘made sense’ for those practices in which some of the functions were on paper and some in the electronic record or for those without a fully functioning EMR.” Fair enough, we’ve said it, too:

“A shoddy EMR is no doctor’s friend; it’s like having a friend you have to explain everything twice to.” – @AtlasMD (Click to Tweet)

And here’s our favorite part. Remember how we’ve been talking about all those boxes that need clicking? The ones that generally don’t do anything? The results showed a significant relationship between time pressure and physician stress in the group with high-functioning EMRs. It was only in this group, too. This suggests that physicians may be particularly pressured for time during patient encounters in the face of a large number of EMR functions. “This ‘made sense’ to us in thinking about the possibility that those in the high-use group had more to do in the EMR,” says Dr. Babbott.

Please, keep in mind that this study suggests CORRELATION and NOT CAUSATION. Dr. Babbott stressed this after the study, saying that further studies are needed to determine the precise relationships.

“Further study is needed to focus on those efforts which can be most specifically related to EMR use,” he says. “If the moderate-use group’s higher stress is due to that practice being in transition between a paper-based system and an EMR, then this work supports stress being an issue to address during that transition. Similarly, if the high-use group’s stress is related to more functions and requirements for each patient’s care, then addressing processes of care and care team support could be of benefit.” (We included this last quote if only to showcase how political this researcher is. We’d recommend better EMRs, too, but that’s just us.)

Unfortunately, there was no mention of Meaningful Use in the study. Strange, right? This is the same legislation demanding more features in the EMR, and incentivizing doctors to implement them. Of course, our perspective outside of the red tape is different than docs still operating within it. But if you ask us, a machine that stresses us out at work, is a machine we’d be happy to get rid of.

Hands Up — Who’s Bringing Their iPad into the Examination Room?

The Direct Primary Care Journal shared findings recently about the prevalence of iPad usage by physicians. According to the report, the most common activity of physicians who use an electronic health record (EHR) and use a smartphone or tablet is “sending and receiving emails.” The second most frequent activity among tablet users is “accessing EHRs (51% daily).” Compare that with just 7% of physicians using their smartphone to access EHRs.

VIEW THE COMPLETE BREAKDOWN OF RESEARCH FINDINGS ON THE DPCJ’S WEBSITE

We’ve highlighted some of the results here:

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No Copays, Easier Pills May Reduce Blood Pressure

No Copays, Easier Pills May Reduce Blood Pressure

According to AP, “New research suggests giving patients easier-to-take medicine and no-copay medical visits can help drive down high blood pressure, a major contributor to poor health and untimely deaths nationwide.” They released a new article highlighting the optimistic results. This is a major win for common sense, something direct care has been sticking up for years now. If people don’t have to pay to come in to the doctor, they will see the doctor. Of course, we want to toast these findings with everything in the cabinet. But, to be fair, let’s go over what actually happened in the study.

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