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