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Nurses want to be act like doctors – and so it begins!

Nurse practitioners are pressing lawmakers in 34 states to relax laws requiring doctors to oversee their work. That’s the latest news. Meaning as Obama care takes hold, we the patients will be putting our health in the hands not of our doctors but of untrained nurses. Untrained in the sense that they will be “acting” like full doctors overstepping their nursing training limitations.

We knew this was coming. To lower the costs of health care, we all will pay more for it and we all will be getting less and less service in the hands of non-physicians.

The writing is on the wall and we all will suffer. There really is not more to say  – just watch.

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A virtual office visit for your cold is not a good idea

[preamble]Cutting costs that’s what this is all about – whilst i am a big advocate of technology and its applications, i am not a supporter of it being used and endorsed by companies to only generate more profits at the expense of health.
Insurance companies are making decisions and lobbying for practices that ar enot medical or for the better good but to simply cut costs and increase their profits.
Tele-health has a place in rural areas and for specific purposes but i do not believe it should take the place of the physician/patient relationship.
What we all forget is that the doctor/patient relationship is what medicine is all about and what helps with the cure. Virtualizing, impeding and putting more layers in front of this basic core of the medical world is not good for anyone, does not reduce costs and does not promote better medicine.

“Doctor i am sick” “Let me examine you – take this and call me if you still don’t feel well”- in its simplest form, this is what promotes better health, higher compliance because patients want to get better and listen to their doctors. This cannot be regulated – we all hear of compliance and meaningful; use – meaningfully useless! A patient WANTS to trust and work with their doctors – always have and always will  – its so simple the pundits don’t get it and increase the complexity and government involvement until its destroyed and meaningless.

Nothing the government has done or mandated has shown any benefits in medicine.

technology and tele-health have a place in medicine and will grow more and more useful – but it will not and should not take the place of the doctor/patient interaction that is crucial for the essence of medicine.[backtopost]
| Kevin’s Take | February 10, 2013
Like many other primary care doctors across the country, I’m seeing my fair share of patients with runny noses during this winter season.

I recently saw a patient for a sinus infection whom asked, “Why did I have to come in to see you? Couldn’t you have given me an antibiotic over the Internet?”

If health insurers had their way, more doctors would be seeing patients and possibly prescribing medications online. However, I would be wary of this scenario.

Despite video chats being commonplace, so-called virtual office visits have yet to be the standard in healthcare. It seems that companies and health insurers are currently driven by cutting costs and are open to changing the physician/patient interaction process. More are starting to offer services where patients can consult doctors through a webcam-enabled laptop, or through a smartphone or tablet. According to a survey by Mercer, a human resource consulting firm, 15% of very large employers use some form of telemedicine, and another 39% are considering it.

This type of process typically costs around $40, and patients with minor illnesses can instantly access a physician or nurse practitioner and be prescribed medication online. Patients rave about the convenience, while they sidestep the frustration of scheduling an appointment with a doctor, or worse, going to the emergency room, which can cost hundreds of dollars.

But something is lost through these virtual connections.  There is value to face-to-face interaction, where a provider talks to and examines a patient in person. For example, I’ve seen a patient convinced that he had a sinus infection only to find that he had a tumor inside his nose. Another complained of minor ear pain, but after examining her, I saw that it had spread to the point where she needed to be hospitalized for intravenous antibiotics. Both of these diagnoses would have been missed had I only treated them over the Internet.

Without the ability to talk to and examine patients in the exam room, many doctors play it safe and reflexively prescribe drugs, whether patients need them or not. A recent study from the Journal of the American Medical Association found that patients who were treated through Internet-based virtual visits had higher antibiotic prescription rates for their sinus infections, compared to patients whom were seen in the office.

That’s a problem when you consider that most sinus infections clear up themselves, and don’t require antibiotics. A study last year found that patients who had sinus infections felt the same after a few days, whether they received antibiotics or not. Worse, unnecessary drugs contribute to the growing problem of antibiotics resistance. Guidelines from the Infectious Diseases Society of America and Choosing Wisely, a consortium of national medical societies that provide evidence-based guidelines, also recommend against knee-jerk antibiotic prescriptions for sinus infections.

It is important to consider what would happen if something went wrong after the online only consultation. For example, what if the patient had an allergic reaction to an antibiotic, or symptoms that got worse? Good luck getting a follow-up from that same online doctor.

I do believe that there is some room for virtual visits, with stricter conditions. For patients that I have already met and know well, managing their hypertension and diabetes through a video chat on my tablet is tremendously helpful. But I would not feel comfortable treating patients on the web that I’ve only met minutes earlier.

Currently, only 13 states allow doctors to prescribe drugs and treat patients online, without actually meeting the person in person first. With the zeal to cut costs and maximize convenience to patients, there will be tremendous pressure to expand that number. Please remember what is cheapest for insurers, and easiest for patients, isn’t necessarily what is best.

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[preamble]What can we say – as Ross Perot said “you can her the sucking sound of jobs being moved to Mexico” Well, now with the Obama scare forcing us to pay for something we don’t want or need, we now will outsource more of our workforce. Whats wrong with you people? Don’t you see the how this damages America?
I am just going to lay off more people and put the rest to part time.

The Huffington Post  |  By Posted: 01/30/2013 12:27 pm EST  |  Updated: 01/31/2013 8:14 pm EST

A San Diego-based entrepreneur has proposed a solution for small business owners who face rising payroll costs under Obamacare: Cut staff and outsource.

Paul Christiansen, founder of the tech company Quorim, wrote a column published in The Wall Street Journal this week suggesting that small employers could “outsmart Obamacare” by shrinking payrolls and operating with only a tiny number of core employees who outsource tasks to contracted workers.

“Thousands of small businesses across the U.S. are desperately looking for a way to escape their own fiscal cliff,” Christiansen writes. “That’s because Obamacare is forcing them to cover their employees’ health care or pay a fine.”

Some business owners have responded to the new law, which requires companies with more than 50 full-time workers to offer them health care coverage, by laying off staff, cutting hours or raising prices.

But for many firms, Christiansen says, a better move is to push workforces under the 50-employee limit by offering current employees contracts for doing their work as a “corporate entity” instead of as an “employee.”

“It’s not about replacing employees with contractors, but about replacing employees with corporations,” Christiansen writes. “There is almost nothing that cannot be outsourced,” including marketing, IT and manufacturing.

Christiansen calls the strategy “going protean,” referring to the concept of “Protean Corporations,” first described in Silicon Valley journalist Michael Malone’s 2009 book “The Future Arrived Yesterday.” Protean corporations are defined by their ability to “shape-shift” and rapidly adapt to market forces, often tapping contracted talent to do so.

While it may be easy to imagine a technology company going protean by paring down its workforce and outsourcing tasks to contracted entities, it’s harder to imagine in the restaurant industry, which has been among the fastest to react to Obamacare. One fast-food franchise owner recently announced that he would have to cut employees’ hours because of the new law.

But Christiansen says it is possible, theoretically, for restaurants to adopt the protean model. “Suppose there was a company, not unlike a professional employer organization (PEO), that set up a corporate structure for individual restaurant waiters, who are owners in the PEO-like organization,” Christiansen tells The Huffington Post. “It could be eight waiters or 10 or anything up to the magic number of 49 who bill the restaurant for their services.”

“We’re dealing with things that don’t exist but have the theoretical possibility of existing,” Christiansen adds. “Right now, we have as the default employer-employee relationships, but that whole paradigm is potentially problematic as we have more and more restrictions imposed by government.”

But according to Malone, small companies are going protean regardless of changes to America’s health care law, which take effect in January 2014.

“Even without the pressure of Obamacare, taxes and other government regulations, the protean model for organizations seems to me inevitable because of larger forces like competition, the need for organizations to adapt and change quickly, and the atomization of society created by Moore’s Law and emerging technology,” Malone says in an email to The Huffington Post. “Obamacare has just accelerated this evolution.”

Multiple studies support the claim that, long before Obamacare, technology allowed businesses to operate with fewer employees and outsource work more easily.

The Kauffman Foundation, an entrepreneurship advocacy group, identified this trend in a 2011 report called, “Starting Smaller; Staying Smaller.”

Its author, Robert Litan, wrote that “since at least the middle of the last decade and perhaps earlier” new companies were “opening their doors with fewer workers than the historic norm and were relatively reluctant to expand their workforces even during good economic times.”

Silicon Valley entrepreneur Naval Ravikant predicted last year that technology would inevitably shrink the size of companies and create a world without big corporations.

“The contract-work trend is going to increase,” he told PandoDaily. “The size of your average company is going to decrease. And we’re going to see more and more billion-dollar businesses built by four or five people, and it’s going to stay at that.”

Christiansen refers to the change as a corporate innovation, rather than belt-tightening.

“Bill Gates’ vision of a PC on every desk became a reality quicker than anyone could have imagined, but the vision of a corporation for every citizen could be a reality too. Particularly if realities like Obamacare continue to upset the status quo.”