Rural Public Health in Plumas County, California
Here is an interesting video on social media:
The Mayo Clinic in Minnesota recently opened a Center for Social Media focusing on social media and healthcare. Healthcare has been lagging behind other industries in social media use. Glad to see the Mayo clinic throwing their feet in the ring.
Since access and provider networks are constant challenges in rural healthcare, can we use social media to decrease the rural/ urban divide?
The Medical Board of California provides consumers with a service to investigate any disciplinary records leveled against doctors practicing in the state of California. On the Physician License Lookup page, users can access public information attributed to physicians who have been:
For a complete list of what information is public and would appear on a record under Public Disclosure, click here. This service is a no-cost service and reported by the Sacramento Bee as one of the best in the country. There are other consumer services, like Angie’s List, that aggregate consumer reviews of local services for public consumption. These services act as a way to capture word of mouth knowledge on a large scale, but require a monthly or annual membership fee.
According to the consumer advocacy group Public Citizen, California has one of the best consumer websites on physician discipline. However, the group also notes that the state has one of the worst rates in the country for taking serious disciplinary action against physicians accused of wrongdoing.
On Tuesday, Governor Schwarzenegger signed the legislation to establish the high-risk insurance program for people with pre-existing conditions that have been without insurance for at least six-months. In theory, this high-risk insurance pool would cover Californians until the prohibition for insurers to deny coverage to people with pre-existing conditions comes to fruition in 2014.
The Managed Risk Medical Insurance Board of California has initiated the process to establish the high-risk pool by beginning to accept names of people that qualify. Apparently, the plan is to maintain a list of people who would like to be notified when the application forms become available (Dahlberg, Sacramento Bee, 6/30). There are not yet any insurance policies designed for this pool or applications for entrance.
According to the San Francisco Chronicle, the program itself would draw down about $761 million in federal funding and has the potential to extend coverage to 25,000 – 30,000 Californians, a positive step towards coverage and access (AP/San Francisco Chronicle, 6/29). It remains to be seen how this increase in insurance coverage will affect primary care providers and their abilities to serve this newly covered population.
A recently released Commonwealth Fund report comparing the health systems of seven nations shows the United States consistently underperforms relative to other countries on most dimensions of performance, although the U.S. health system is the most expensive in the world. Obviously, we need significant changes and fast.
Among the seven nations studied—Australia, Canada, Germany, the Netherlands, New Zealand, the United Kingdom, and the United States—the U.S. ranks last overall, as it did in the 2007, 2006, and 2004 editions of Mirror, Mirror. Not only does the U.S. fail to achieve better health outcomes than the other countries, but the U.S. also ranks last on indicators of access, patient safety, coordination, efficiency, and equity.
The most glaring difference between the U.S. and the other countries studied is the lack of universal health insurance coverage. Universal access in the U.S. has the potential to significantly improve various access related indicators. When health reform is fully implemented in 2014, affordability of insurance and access to care should improve, but access and affordability are only the first step in improving our nations health. Primary care provider shortages and the obesity epidemic will test the bounds of current health system. It is not surprising that the U.S. currently under performs compared to other countries on measures of access to care and equity in health care between populations with above-average and below-average incomes.
But even when access and equity measures are not considered, the U.S. ranks behind most of the other countries on most measures. It is apparent that the U.S. is lagging in adoption of national policies that promote primary care, quality improvement, and information technology.
The report indicates areas for improvement for all countries. But, the other six countries spend considerably less on health care per person and as a percent of gross domestic product than does the United States. These findings indicate that, according to both physicians and patients, the U.S. health care system could and should do much better in achieving value for the nation’s substantial investment in health.
A new study published in the New England Journal of Medicine by Dr. Richard Baron outlines the invisible burden of disease for family doctors.
What does this mean?
Insurers only reimburse primary care providers for patient visits. In his study, Dr. Baron quantifies the variety of unreimbursed tasks, including making phone calls, reading and writing emails, writing prescriptions, reviewing x-rays, and examining lab reports, that burden primary care providers. Essentially, the study documents the large amount of invisible work required in primary care.
What can be done?
Dr. Baron explains that the study shows the need for new types of payment that reimburse primary care providers for the amount of care they provide. “Baron acknowledged that reimbursing for each phone call or e-mail a physician handles would be impractical, but he suggested that adopting capitation — in which physicians would receive an annual lump sum per patient — would better cover the amount of time primary care physicians actually spend on patients” (Rubin, USA Today, 4/29).
Other experts suggest that electronic health records can improve care coordination and efficiency reducing burdens on providers. Dr. David Blumenthal, the Obama administration’s National Coordinator for Health IT, said the study shows “the enormous strain” on primary care doctors but also show “a pathway toward escaping at least some of those burdens; the electronic health record combined with changes in work flow and payment” (Lohr, New York Times, 4/28).
The United States spends more on healthcare than any other country in the world, but was ranked as the 37th best health system by the World Health Organization in 2000. This combined with the current climate of economic uncertainty has led to much public discussion about healthcare issues in the United States and how to reform the current system. The amount the US spends each year sadly does not correlate with improved health outcomes. The Sierra Institute for Community and Environment has been tracking these conversations because we have been working to improve local healthcare through projects designed to evaluate, understand, and improve the Plumas County healthcare system for over five years now. And, as we all know, healthcare reform at the national level affects every one of us at the local level.
About this Blog:
Navigating the healthcare system can be a scary prospect, but it can be even worse when financial constraints, lack of insurance, geographic or language barriers are involved. I hope to create a dialogue with community members, partners, and other interested parties about rural community-based health work in Plumas County. Additionally, I would like to foster a discussion of public health and health care policy from a rural community perspective. In future posts, I look to discuss further our community-based work in Plumas County, such as what is telemedicine and telehealth? How can health reform in Congress affect us in Plumas County? I look forward to an open exchange of ideas and information and hope to involve many voices in this discussion.
About Sierra Institute’s Health and Wellbeing Work:
Changing demographics, rising poverty rates, learning difficulties among school-age children, and truancy among high school students all create a significant burden for overstretched schools and represent a major community health challenge in Plumas County. The Sierra Institute’s current work includes a Networked School-Based Telehealth Project that is a program implementing pilot projects in Plumas County schools to explore how networked and coordinated health services can most effectively meet identified health care needs, improve student performance, and improve quality of life. A major goal of the project is to reduce health disparities in Plumas County by improving access to the health system for residents. With partners, we are working on local health access issues in our communities. In addition, we work to improve language access capabilities for the Limited English Proficient (LEP) population.
Working with our partners, we have identified core activities for the project involving:
About Telehealth and Telemedicine according to the Center for Medicare and Medicaid Services:
Telehealth: The use of telecommunications and information technology to provide access to health assessment, diagnosis, intervention, consultation, supervision and information across distance.
Telemedicine: The use of medical information exchanged from one site to another via electronic communications to improve a patient’s health. Telemedicine is viewed as a cost-effective alternative to the more traditional face-to-face way of providing medical care.
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