Louisville Medicine Volume 62, Issue 9 | Page 31

DOCTORS’ LOUNGE care spending. Hard data is still lacking. Regarding Qliance, whose goal is to prove a 15- 30 percent cost reduction overall, Mr. Jay Fathi, an executive of the Centene Corporation which was hired by the state of Washington to manage its Medicaid plans, noted, “We already have evidence to show us that they are doing a good job.” Knowing the patient, for internists, means keeping very detailed documentation on past and family history, because these inform all future complaints. Will this model support the costs of dictation, or are we all back to typing into the EMR so that some- one besides us can read the chart eventually? Still, there is a bit of light at the end of the tunnel. If big employers in Louisville jumped on this bandwagon and partnered with doctors in a direct primary care model, many of us would be very tempted. But it’s a pipedream that we would not have to deal with health insurance companies ever again, unless we chose the luxury of the concierge practice, where fees are so high that plenty of help abounds. If we treat enough Medicare patients (imagine firing your long term patient just because they got old enough for Medicare) then we have to conform to god-awful federal mandates for the Patient Centered Medical Home. Doing that in the context of the direct primary care model seems difficult. If the Qliance group can prove cost savings with Medicaid, there’s some hope they could figure out Medicare. So keep looking down the tunnel: one day, that light might reach us. Note: Dr. Barry practices Internal Medicine with Norton Community Medical Associates-Barret. She is a clinical associate professor at the University of Louisville School of Medicine, Department of Medicine. MINIMUM EFFECTIVE DOSE Martin Huecker, MD P eople wants specifics. We tell our patients to get out there and exercise but do not tell them how or when. One method is the 30 minutes of walking, either once a day or four days a week. We hope our patients who sit at desks, or in the driver seat of a truck all day, will get out and move their legs at least once a day. We might not, however, counsel our marathon runner patients on the inflammatory effect of hours of daily exercise with minimal time for recovery. Most of us pride ourselves on evidence-based medicine, including prescribing of medications. And many of us understand that lifestyle changes usually have more of an impact on health than medications. So should we spend more time researching and advising our patients on how exactly to exercise? Dr. Doug McGuff, an emergency physician in South Carolina, does. Though he is a shift-working Emergency Physician, he finds the time to run an exercise center with a very specific, albeit a one size fits all, regimen. Dr. McGuff has combed the exercise literature in Pubmed and elsewhere (a vast supply when you go looking) to synthesize a method of resistance exercise meeting important criteria: time-efficient, s