A Smoking Interest Call From My Doctor
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Sorry, National Health Service - I suspect you don't have one, and the way we are going ours won't be worth the name soon!!
If we have one it's called something else here, I havnt heard of a NHS. I don't know much about how UK's healthcare works admittedly. I still would like to hear what. Your GP has to say though would be interesting to get "his side".
WELL.... since I was so aptly quoted from a previous post I'll jump in and talk about what else is going on in the industry now - as I have talked about before with Meaningful Use stage I and stage II - the doctors are being incentiveized to collect the information about smoking. As the next stages roll on - the other pieces are rolling your PHI into data warehouses where they can analyze the data.
BUT the scariest part is ACO's Accountable Care Organizations - essentially are the way the medical industry is going to move - especially the more we move closer to single payer systems in the US. The way ACO's are different is that doctors will no longer be paid "fee for service" ie you go and have a cold and get a prescription - doctor spends 15 minutes with you and bills you.. $120 bucks or whatever. They will be paid "PAY FOR PERFORMANCE" so if you can improve the health of your population the reimbursement to the providers is better - so the doctor is incentiveized to go after smokers - regardless of cigarette, pipe, cigar - they are all the same in the governments book when it comes to health.
Oh - NHS is very similar to our own HHS (Department of Health and Human Services) they've been given a LOT more power because of obamacare and prior to that the 2009 stimulus outlined the Meaningful Use Requirements. (The stimulus was rammed through by Republicans and Obama Care the democrats so let's not go blaming either side, they are both equally crappy in my book.)
BUT the scariest part is ACO's Accountable Care Organizations - essentially are the way the medical industry is going to move - especially the more we move closer to single payer systems in the US. The way ACO's are different is that doctors will no longer be paid "fee for service" ie you go and have a cold and get a prescription - doctor spends 15 minutes with you and bills you.. $120 bucks or whatever. They will be paid "PAY FOR PERFORMANCE" so if you can improve the health of your population the reimbursement to the providers is better - so the doctor is incentiveized to go after smokers - regardless of cigarette, pipe, cigar - they are all the same in the governments book when it comes to health.
Oh - NHS is very similar to our own HHS (Department of Health and Human Services) they've been given a LOT more power because of obamacare and prior to that the 2009 stimulus outlined the Meaningful Use Requirements. (The stimulus was rammed through by Republicans and Obama Care the democrats so let's not go blaming either side, they are both equally crappy in my book.)
Pylorns you seem very knowledgable about the changes being made do you work in the medical field or do you just care about your politics? Also do you have any reference material online I could read? Not that I don't trust you it's just that I find a different answer no matter how many times I ask the same question, I would like to be more informed.
As I've said in other threads like this, these aren't political issues. They are social issues. I can't speak for citizens of other countries, but in the United States we used to value and appreciate individualism. All the things a guy did that set him apart from the pack were generally praise worthy.
Now, in age approaching collectivism, the individual is a liability. I believe the reasons for this are mostly because we all rely more and more on social support systems that require uniformity. There can be no smokers, no gun owners, no gas guzzlers, no incandescent light bulb burners or back yard BBQers. The laws apply to all and there can be no exceptions. If you do any of those things or about a thousand others you are a burden to society and are costing everybody for your individualistic lifestyle.
Just my take. I could be wrong.
Now, in age approaching collectivism, the individual is a liability. I believe the reasons for this are mostly because we all rely more and more on social support systems that require uniformity. There can be no smokers, no gun owners, no gas guzzlers, no incandescent light bulb burners or back yard BBQers. The laws apply to all and there can be no exceptions. If you do any of those things or about a thousand others you are a burden to society and are costing everybody for your individualistic lifestyle.
Just my take. I could be wrong.
I think you are - to put it gently, I think you are exaggerating an irrelevant fear.
The image of the USA is Land of the Brave, where independent men and women (have to include them - equality regulations natch) forged new lives and a new way of living. But that was two hundred years ago and things have changed since then.
Ask yourself what the United States of America is for. For whom does it exist? I would say, as a European socialist, that the country exists as a homeland for the American people and whose fantastic wealth, towards which everyone contributes one way or another, should be used not only to promote "freedom and democracy" throughout the world but also to ensure that those lucky people with an American birthright have a secure and realistic standard of living and quality of life (not the same thing). The USA can afford to ensure that none of its citizens are homeless or unemployed and without any income to allow them the dignity of choice, rather than charity. That is does not is a growing concern not only for newly impoverished Americans but also to the rest of the world who look on with trepidation.
The image of the USA is Land of the Brave, where independent men and women (have to include them - equality regulations natch) forged new lives and a new way of living. But that was two hundred years ago and things have changed since then.
Ask yourself what the United States of America is for. For whom does it exist? I would say, as a European socialist, that the country exists as a homeland for the American people and whose fantastic wealth, towards which everyone contributes one way or another, should be used not only to promote "freedom and democracy" throughout the world but also to ensure that those lucky people with an American birthright have a secure and realistic standard of living and quality of life (not the same thing). The USA can afford to ensure that none of its citizens are homeless or unemployed and without any income to allow them the dignity of choice, rather than charity. That is does not is a growing concern not only for newly impoverished Americans but also to the rest of the world who look on with trepidation.
Well stiivn, I'll I can tell you is I'm not as free as I used to be. You could say it's for my own good or for the good of the many, but that's the way it is. I live in a world where a kid is suspended from school for pointing a finger at another kid or where a teenage girl wearing a sweat shirt with her team's BB gun shooting club logo gets sent home from school. I can't even say what would happen to me if I showed up at a school meeting with a pipe in my mouth, lit or unlit. It's just not the way I grew up. That's all I'm saying.Things have changed.
Other than that, the US can't afford to to lift anyone out poverty. We are already in debt by trillions of dollars. My feeling is, we as a country have done plenty since WWII (a lot of good things and some not so good things) for the rest of the world. I'd be happy to see my country return to a pre-war isolationist nature and let someone else have a go at! However, I realize you can't go back. It's all in the hands of the coming generations.
Other than that, the US can't afford to to lift anyone out poverty. We are already in debt by trillions of dollars. My feeling is, we as a country have done plenty since WWII (a lot of good things and some not so good things) for the rest of the world. I'd be happy to see my country return to a pre-war isolationist nature and let someone else have a go at! However, I realize you can't go back. It's all in the hands of the coming generations.
Flakyjakey......I live in Wales and would certainly like to know what your GP friend says on the subject. It really would not be a surprise to find out they are getting cash incentives to get people to give up smoking. Of course smoking is a medical concern but it is also a political thing these days. The idea that my GP is being used to enforce a political agenda distresses me.
I am also curious of what you mention in regards inducements to reaching other targets. I am reserving judgement here as I do not possess all the facts but the notion that my GP has to be offered incentives to make me well again is a little disturbing. I find myself wondering what the targets they are being induced to meet are?
I am used to being asked questions about my smoking when I visit the surgery whether it dental or doctors but I have to admit that to receive a call from the practice nurse about it irritated me slightly.
Some research on these things is in order I think.
As for you chaps and Chapettes across the pond being asked about your guns when you visit the doctor. I found myself laughing aloud when I read that. Really, things do seem to be getting strange in the world.
James
I am also curious of what you mention in regards inducements to reaching other targets. I am reserving judgement here as I do not possess all the facts but the notion that my GP has to be offered incentives to make me well again is a little disturbing. I find myself wondering what the targets they are being induced to meet are?
I am used to being asked questions about my smoking when I visit the surgery whether it dental or doctors but I have to admit that to receive a call from the practice nurse about it irritated me slightly.
Some research on these things is in order I think.
As for you chaps and Chapettes across the pond being asked about your guns when you visit the doctor. I found myself laughing aloud when I read that. Really, things do seem to be getting strange in the world.
James
I know this is not necessarily going to be a popular statement but: I am a physician and I can assure you that I DO NOT get a penny to discuss guns or anything else from anyone. I don't frankly give a crap about your guns as long as you are adequately trained in their use (that's called responsibility) and use them wisely. We do, after all, still have a second amendment...
@wnghanglow YES, I am in the medical industry. YES I have links about the programs - I've already provided links in my previous post that was being referred to - Here is Meaningful Use Stage 2:
http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Stage_2.html
Accountable Care Organizations:
http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ACO/
Medicare Shared Savings:
http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/index.html?redirect=/sharedsavingsprogram/
Advanced Payment:
http://innovation.cms.gov/initiatives/Advance-Payment-ACO-Model/
Pay for Performance:
http://en.wikipedia.org/wiki/Pay_for_performance_(healthcare)
Pay for performance is an emerging movement in health insurance (initially in Britain and United States). Providers under this arrangement are rewarded for meeting pre-established targets for delivery of healthcare services. This is a fundamental change from fee for service payment.
http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Stage_2.html
Accountable Care Organizations:
http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ACO/
Medicare Shared Savings:
http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/index.html?redirect=/sharedsavingsprogram/
Advanced Payment:
http://innovation.cms.gov/initiatives/Advance-Payment-ACO-Model/
Pay for Performance:
http://en.wikipedia.org/wiki/Pay_for_performance_(healthcare)
Pay for performance is an emerging movement in health insurance (initially in Britain and United States). Providers under this arrangement are rewarded for meeting pre-established targets for delivery of healthcare services. This is a fundamental change from fee for service payment.
Pay for performance is directed SPECIFICALLY at 1) Decreasing length of stay for hospitalized patient, 2) Reducing morbidity (adverse outcomes that may be preventable) and, 3) Decreasing usage of prescription drug utilization. Indirectly there should be decreased utilization on the part of the consumer (the patient) of emergency departments for routine care, as is being done entirely too much in the states. Questions about gun safety, cigarette usage (the wording specifically says cigarettes) and prescription drug and alcohol abuse should be discussed between physician and patient as a routine since these can be significant public health issues. If you do not like the question, please feel free to say you are not interested in discussing it. It is early in the process and appreciable fine tuning of the verbiage needs to be done. Safe gun storage in the household in which there is a mentally compromised person would seem to be a reasonable discussion point. We, as health care providers, just need to learn to do it better.
Hope this helps...
Hope this helps...
You are exactly right. I'm just turing the looking glass further into the future about what potentially will happen. I also suspect many primary care providers will just stop what they are doing - stop practicing, or will turn to concierge service, and surgeons will turn to the Caribbean and points south to do surgery's.
As ACO and pay for performance gets rolled out more and more - we're going to see some serious changes. We're also going to continue to see hospitals close - especially ones that gobbled up doctor groups to bring them into the fold -they won't be able to sustain.
Also point - you mentioned fine-tuning: The problem is you're not the one that gets to do the fine tuning - that's being done by the CMS and the so-called "open" period for comment.... Do what they say, else don't get paid by medicare/medicaid.
As ACO and pay for performance gets rolled out more and more - we're going to see some serious changes. We're also going to continue to see hospitals close - especially ones that gobbled up doctor groups to bring them into the fold -they won't be able to sustain.
Also point - you mentioned fine-tuning: The problem is you're not the one that gets to do the fine tuning - that's being done by the CMS and the so-called "open" period for comment.... Do what they say, else don't get paid by medicare/medicaid.
Be that as it may Jazz's experience sounds a little odd unless, as nsfisher suggests, she was hitting on you. And boy did you not see that coming!!!
(just trying to keep this thread on track)
(just trying to keep this thread on track)
.......Indeed I am.
........Although that notion is a flattering and certainly raises a :D and only a :D I am fairly certain she would not remember me if I walked in there tomorrow. I only see her once a year for blood tests and/or immunisations when I travel. That said I do have a memorable voice I keep being told. Very deep.
Anyhow, I do actually have to go there next Friday so we will find out if she is only after my blood or not.
In reality though I was just talking to a friend of mine and mentioned this phone call and he said he had the exact same experience during the week. He is also with a different surgery.
So if that is the case there is an agenda of sorts at work here. Unless there is some kind of virus affecting the nurses in general practices that makes them call up the men on their client list. In which case there is certainly hope for us all. (there are worse conditions to suffer from)
James
Pylorns thanks for reposting those links I didn't know you already did, I look foward to reading them. To everyone else I enjoyed reading your opinions, Thanks for putting so much time into explaining your views. Jazz sorry we side tracked your thread but you gotta tell us if anything happens between you and that nurse :p
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