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I agree with this bill. I am an Internist in a solo practice. my geriatric patients are complex people with heart disease lung disease, mental health issues, etc. When they come in I realistically have to deal with all their issues. Some issues are more salient. It’s what they’re there for, but one cannot ignore the 800 pound gorillas in the room. Example patient comes in with back pain, but his blood pressure is high and he’s still smoking. His pain pills are ineffective and they are making him at risk for stomach ulcers, and the pills might be contraindicate if his kidnays get any worse. Oh but he just came in for the back pain, and oh by the way what did my last blood test show and can I get a Viagra?

Complex seniors need referrals, In this case for an xray and physical therapy, forms to be filled out, in this case for the physical therapy, the ok on a certain med. a follow up phone call, lab letters, and the like.

Unfortunatley the bulk of this patients care is not reimbursed. The most I can get is a level 4 visit, but will probably be reimbursed as a mere level three.

Why does this matter? Becaue doctors make so much money right? Well not me personally. I make less than a good plumber makes nowadays, My overhead is killing the practice. The cost in coordinating this complex care cannot be swept away. It goes to my staff and their benefits.

How can we ecpect more primarcy care doctors to emerge from our health care traning system if we don’t reimburs our primary care doctors fairly and honestly?

My care and coordination of care in the above mentioned patient will be more individualized, more appropriate, more correct than the fragmented and probably overly procedure oriented care he would recieve from an uncoordinate care plan.

In an uncoordinated health care system pain management might result in increased use of expensive services and with poorer out comes. Certainly the peripheral issues would not be addressed until a later date, perhaps to the patients detriment.

I think we need to embrace the concept of the “Medical Home” and start reimbursing for it and fostering it. I can only hope that this concept will be shown to save money in the long run and improve outcomes.

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• healthcare reform
• Coordinated Healthcare
• Medical Home

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