Coding hampers physician-patient communications that enhance care

Med students need better communication skills, and this training program in Massachusetts shows why: 1. “Studies have shown that patients who have [substantive] conversations with clinicians are...more likely to receive care and experience better quality of life.” 2. “With a national shortage of [physicians] to care for an aging population, it is mandatory to find innovative solutions to train all physicians in effective high-quality communication for seriously ill patients.” So why don't physicians devote time to these types of conversations? And why do we have such a shortage of physicians for aged patients? The simple answer is that the billing and coding system does not incentivize these conversations. It is basic economics. My book, The Journey’s End, provides a detailed analysis of these issues, along with pragmatic solutions to remedy them.

How to ease access to palliative care

Palliative care is increasingly recognized as a vital patient care treatment model. Unfortunately, we created a new specialty but forgot to create an insurance mechanism to pay for it. Access to palliative care as a result, is limited and nonexistent for outpatient care.

This article highlights the need for providing insurance compensation for this critical patient care service. While this observation is an important one, the proposed solution is overly complex.

We should make access to palliative care easy and encourage its use. All palliative care should be deemed medically necessary and not subject to the absurd coding requirements.

In my book, The Journey’s End, I provide a detailed reform recommendation to make palliative care easily accessible without coding.

Primary care is key to reforming healthcare but we have to fix it first

Primary care is critical to successfully reforming healthcare and yet this specialty has been seriously neglected for decades. This article once again documents the nature of this neglect which it defines as follows:

1. Financial neglect

2. Excessive panel size

3. Poor access for patients

4. Burnout

Unfortunately, these problems are long standing and getting worse. The dilemma is that we can not seem to offer a practical road forward to address these issues.

My book The Journey’s End (thejourneys-end.org/) covers the history of all these challenges in great depth and most importantly offers a road map to correct them. Ironically, addressing these concerns will dramatically improve End of Life care as well.