Physician Patient

Archive for the ‘Message from the President’ Category

Motivational Interviewing

Tuesday, July 10th, 2018

This well written article by Rebekah Bernard MD highlights a perplexing dilemma for physicians and patients today. Doctors and other professionals who are denoted as “providers” within a clinic, insurance plan, or government program are graded and paid based on lab tests or questionnaires aggregated as scores for their performance derived from a population of patients who’ve been (arbitrarily) paired with that physician or “provider.”

Yet, we know that in most outpatient settings physicians have little control over what their patients will actually do. The terms “patient adherence” or “patient compliance” attempt to quantify discrepancies between the recommendations of the physician and the actual result of the patient in following his or her advice. Ironically, given the narrow (and narrowing) time crunch for allowable doctor-patient interactions, current P4P methodologies are likely to discourage patients from taking responsibility for their health care.

That’s where motivational interviewing comes in. Motivational interviewing enhances (realistic) patient and doctor decision-making. It helps put “skin in the game” for patients and doctors, especially when both patient and doctor can readily compare real, consequential prices of health care services, medications, and insurance benefits.

Minnesotans to lose Medicare Choices in 2019

Sunday, June 24th, 2018


The advice to “Stay calm, and check your mail” from Minnesota Council of Health plans CEO Jim Showalter is not at all reassuring. Be skeptical when government or Big Business says not to worry about Minnesota Medicare costs or choices.

For about 400,000 Minnesota patients (consumers), the Medicare Cost Plan option is going away next year. 
Compared to other states, Minnesota has a lot of patients now enrolled in Medicare Cost plans. But it’s also true that Minnesota has a growing majority of seniors who are enrolled in Medicare Advantage plans (at least 53% ) compared to thoise on traditional fee-for-service Medicare.

The difference between a Medicare Cost Plus and Medicare Advantage plan is that a Cost Plus patient is able to go to a “health care provider” of her choice outside of a restricted provider network.
Minnesota seniors will receive a huge increase in solicitations for Medicare Advantage plans. But will this result in true competition for access to quality care? I’m very skeptical. The business frenzy is due to the now dominating managed care business model in Minnesota. Whether sponsored by government, businesses or insurance companies, the managed care companies make money (profit) by ensuring the difference between the aggregate payments they take in for a population of patents and what they pay out to the care “providers” who actually treat the patients. To succeed financially, organizations (whether profit or nonprofit) must tightly control their payouts to their “provider” network (hospitals, physicians, and other health care professionals). Today, payers pass on the financial “risk” of the 10% or so most expensive patients to their “providers” through Accountable Care Organizations (ACO). Then the contracted “providers” internally restrict access to expensive and “unnecessary” health care.
The Minnesota Medicare crunch is here.