Comments on: Intelligent Healthcare Information Integration 5/27/09

By: Les Claypool

Les Claypool — Thu, 28 May 2009 13:04:30 +0000

Please don’t misinterpret my cynicism, Dr. Alexander. I really appreciate all the medicine that happens below the radar of CMS, the Feds, etc. I can’t imagine there is a much more rewarding career than being a small town pediatrician (I’m quite close to the concept, personally). Knowing a few hundred of them as I do, I can’t actually think of _any_ who are in it for the money.

C’mon, small town primary care is not about $$/hour!

That said, it isn’t a ticket to the poor house, either. You are very right – done well, it’s a very comfortable living with an amazing career return. Keep it up.

By: Gregg Alexander

Gregg Alexander — Thu, 28 May 2009 01:07:49 +0000

Les,
I’m glad my cynicism only goes so far. (Otherwise, I probably wouldn’t be happy as a small town pediatrician.) My take on the value of trickle down Obama HIT Bucks for us grunts, sarcastic thought it may be, is tempered by the fact that, despite how the big boys may continue to undervalue the small community primary care docs, we’re still a pretty happy bunch who aren’t all in it just for the profit margin. (Again, if not so, I definitely wouldn’t be happy as a kid doc.)

Still, I believe a smart cookie could wean huge advantage with a smart, small community focus. Health- and dollar-wise.

By: Les Claypool

Les Claypool — Wed, 27 May 2009 12:42:49 +0000

C’mon, Dr. Alexander, as a pediatrician you are already screwed. Let me see if I get this right as it relates to the EHR stimulus scam:
- First, you’re only earmarked for 2/3s of the ~$65K that every other speciality is getting, right? Too bad kids don’t vote.
- Second, you *must* take 20-30% Medicaid (depending on what you read) in order to qualify. I realize that you already do, but for some practices, that 20-30% influx of Medicaid removes a multiple of the potential benefit.
- Third, the money isn’t guaranteed to come to you anyway. It will be handed to your local Medicaid program where they will distribute it as they fit. If you’re in a state whose Medicaid relationship with kids is bad (like, say, OK or NJ), har har har. In fact, I don’t know what state will do it right. Is there a state with wise Medicaid spending? VT? RI?
- Finally, and this is true for every speciality and every practice: I don’t know what economic background everyone else has, but in MY microeconomics courses, I learned that when there is a known subsidy in place, what happens to the prices? They stay artificially inflated. If anyone thinks that the “big boys” above aren’t acutely aware of the additional budget possibilities for each and every doctor, they’re insane. You think they won’t figure out a way to extract every cent, or more, of the mythical $65K? Can anyone here name a time when subsidy money was pushed into an industry and it actually drove prices DOWN?

I would have voted for Obama three times if I’d had the chance, but if anyone thinks that this HIT stimulus bill is anything more than a way to move taxpayer $$ to the VPs of the top systems (’cause it sure ain’t going to improve healthcare), they’re dreaming.