Longer looks: Penalties for doctors who keep patients waiting

Jul 15 2011

Every week, Kaiser Health News reporter Jessica Marcy selects interesting reading from around the Web.

MedPage Today: Time Is Money And Some Doctors Are Paying The Price
When she makes a doctor's appointment, Cherie Kerr makes it clear that she better not be kept waiting long. She said she usually tries to schedule the first appointment of the day, or the first one after lunch. But if the doctor is going to be late, she insists the staff give her a call -- lest the office be billed for her time in the waiting room. … Kerr's technique has received much media attention recently, as a CNN report expanded on a blog in which Pamela Wible MD, wrote about a friend who bills her doctor the equivalent of her hourly wage -- $47 -- for wasted time. It has stirred much debate over whether doctors should reimburse patients for their time. Wible said physicians should apologize for delays -- and pay up if patients invoice them for excessive waiting room time. Other physicians have been more preemptive in their approaches to easing the pain of having to rifle through old magazines or watch TVs that loop healthcare programming for longer than desired (Kristina Fiore, 7/7).

The Economist: If You Build It, They May Not Come
A new website from the US Department of Agriculture (USDA) shows that 10% of the country is now a "food desert." The Food Desert Locator is an online map highlighting thousands of areas where, the USDA says, low-income families have little or no access to healthy fresh food. First identified in Scotland in the 1990s, food deserts have come to epitomise urban decay. They suggest images of endless fast-food restaurants and convenience stores serving fatty, sugary junk food to overweight customers who have never tasted a Brussels sprout. … No surprise, then, that neither USDA nor the Institute of Medicine of the National Academies has been able to establish a causal link between food deserts and dietary health. In fact, both agree that merely improving access to healthy food does not change consumer behaviour. Open a full-service supermarket in a food desert and shoppers tend to buy the same artery-clogging junk food as before—they just pay less for it (7/7).

Governing: Underinvesting In Children
In case you missed it, there's new findings out that confirm what we've known for eons: investing early in children pays off in the long run. The analysis was of 1,000 low-income, mostly black kids from Chicago, who attended preschools where they and their families could receive early intervention services. These students were tracked for up to 25 years. What the study found was that those who attended pre-school wound up with higher high school graduation rates, more went to college, got better jobs, experienced less drug abuse and had fewer run-ins with the law, along with a long list of other individual and social benefits. Despite that, spending on programs for children -- whether in human services, health or education -- is on the federal chopping block right now (Jonathan Walters, 7/12).

The Nation: ALEC Exposed: Sabotaging Healthcare
Apparently fearful that a bill would reach Obama's desk that would allow states to establish single-payer systems, (the American Legislative Exchange Council) crafted the Freedom of Choice in Health Care Act, which, despite its Orwellian name, was written to deny the citizens of any state that passed it the freedom to set up such a system. By declaring that Congressional attempts to regulate health insurance at the federal level would be unconstitutional, it would effectively ban not only a federal single-payer proposal but also a federally created health insurance exchange and a federally operated public insurance option. ALEC has boasted that some forty-four states have introduced its Freedom of Choice in Health Care Act (which itself would not withstand a constitutional challenge). … In sum, ALEC's model legislation would not only undermine the consumer protections in the Affordable Care Act; it would shred the social safety net for the most vulnerable among us: older, disabled and poorer Americans, and those who become victims of a system that is supposed to heal, not harm (Wendell Potter, 7/12).

Slate: A Bad Case Of The Brain Fags
In 1951, Hong Kong psychiatrist Pow-Meng Yap authored an influential paper in the Journal of Mental Sciences on the subject of "peculiar psychiatric disorders"—those that did not fit neatly into the dominant disease-model classification scheme of the time and yet appeared to be prominent, even commonplace, in certain parts of the world. … The American Psychiatric Association has conceded that certain mysterious mental afflictions are so common, in some places, that they do in fact warrant inclusion as "culture-bound syndromes" in the official Diagnostic and Statistical Manual of Mental Disorders. … The DSM-IV defines culture-bound syndromes as "recurrent, locality-specific patterns of aberrant behavior and troubling experience that may or may not be linked to a particular diagnostic category." And therein lies the nosological pickle: The symptoms of culture-bound syndromes often overlap with more general, known psychiatric conditions that are universal in nature, such as schizophrenia, body dysmorphia, and social anxiety. What varies across cultures, and is presumably moulded by them, is the unique constellation of symptoms, or "idioms of distress." Some scholars believe that many additional distinct culture-bound syndromes exist (Jesse Bering, 7/11).

American Medical News: Why HHS Abandoned "Mystery Shopper" Study
A proposed initiative using so-called mystery shoppers to determine the level of access to primary care physicians across the country has been put on hold indefinitely following scrutiny of the proposal. The Dept. of Health and Human Services decided June 28 not to go forward with the proposed study after reviewing public comments on the plan, an HHS official said. Instead, the department said it will continue to focus on other initiatives aimed at increasing access to health care services. HHS had first published a notice about the study on April 28. The $347,000 study would have targeted more than 4,000 family medicine, pediatric, general medicine, internal medicine and obstetrics-gynecology practices in nine states: Florida, Hawaii, Massachusetts, Minnesota, New Mexico, North Carolina, Tennessee, Texas and West Virginia, according to supporting documents from HHS (Charles Fiegl, 7/11).

Modern Healthcare: Against The Clock
Reforming the nation's healthcare system may be, as the well-worn saying goes, a marathon and not a sprint. But when it comes to setting up the health insurance exchanges, as mandated by January 2014, states had better pick up the pace, experts say. The deadlines are so compressed that many fear states, health plans and providers will be caught flat-footed in just a few years' time when 30 million more people are expected to gain access to health insurance, largely through the exchanges. Politics are playing a leading role with governors, statehouses and sometimes state insurance commissioners at odds about how and whether to proceed with the federal mandate. And the success or failure of the exchanges will likely depend on work done in the next 18 months (Rebecca Vesely, 7/11).