Healthcare Reform Proposal
Dr. Louis Frayser Posted May 8, 2009
The issue of Healthcare Reform is now front and center in the national discourse. The idea of Universal Healthcare for all Americans is at the heart of the debate; I am in total support of this concept. I am submitting the following suggestions for your review and possible inclusion in the design of the Universal Healthcare Plan:
1. That non-profit community clinics be designated primary venues for the delivery of comprehensive healthcare. Non-profit community clinics have a long history of providing care to communities with limited access to primary care resources. Further, non-profit community clinics have been and continue be very effective in marshaling community resources that enhance and expand healthcare delivery and improve patient outcomes.
2. That the Universal Healthcare Plan mandates a healthcare delivery model inclusive of the following:
a) A Private Practice Model that provides each patient with a personal physician, thus providing for the critical components of the doctor-patient relationship and continuity of care.
b) A Triage System designed to provide support to the Private Practice Model, assuring immediate care for the unscheduled patient seeking episodic care. Patients seen in this setting would be dispositioned according to clinical findings and assigned to the Private Practice Model for continuing care.
c) An in-house subspecialty consultation service is essential to the delivery of high quality comprehensive primary care: Presently, community clinics rely on such services provided by already overwhelmed county/municipal hospitals. This often results in long, even dangerous delays in getting these services. These services are of vital importance to patients with complex health issues e.g. diabetes, chronic lung diseases.
3. An intensive Chronic Disease Management Program is and must be a core component of high quality comprehensive primary healthcare delivery. An effective chronic disease management program is key to the prevention of the premature loss of patient productivity and diminution of quality of life, as well as reduction in healthcare costs caused by emergency room visits and acute care hospitalizations resulting from preventable aspects of chronic diseases, e.g. diabetes, chronic obstructive pulmonary disease. Every Chronic Disease Management Program should be required to have formal patient education classes that include exercise, smoking cessation objectives, obesity prevention/reduction, and behavior modifications.
4. Patient data recording, including in-depth patient evaluation, description of patient management plans, and identification of expected care outcomes, should be done according to the design of the Problem Oriented Record authored by Lawrence Reed, M.D. It has long since been recognized for its excellence in the systematic recording of patient data and management plans.
5. Program evaluation must insure effectiveness of the healthcare delivery model as described with an intense focus on measurable patient outcomes, e.g. reduction in the number of patient emergency room visits/hospitalizations and measurement of diabetes control.
Methods
a) The Federal Government should contract with the Joint Commission
for the Accreditation of Health Organizations to perform program
evaluation. JCAHO, as it is often referred to, is recognized as being
the gold standard in evaluating health organizations. By contracting
with JCAHO the need to create a new program evaluation government
bureau is eliminated.
b) The Universal Healthcare plan must compel every participating clinic to maintain an aggressive Peer Review System including documentation of the methods and findings of the internal Peer Review System.
6. The Billings and Reimbursements System presently employed must be discarded. I suggest:
a) That fees for services rendered be fixed with reimbursements by a date certain. This would allow clinics to engage in sound fiscal policy development and sound finance management. In turn, this would allow the planned enhancement and expansion of patient services. This would also permit the elimination of "the 10 minute one complaint patient visit" policy now present in many healthcare venues.
7. A patient co-pay system must be mandatory and should allow for both individual circumstances and the national economic environment to be taken into account.
Summary
These proposals, taken as a whole, constitute a firm foundation and framework for the delivery of high quality Comprehensive Primary Healthcare and for the practice of effective Preventive Medicine. I trust you find them useful. Thank you for your time.
Louis C. Frayser, M.D.
Abbreviated Medical Biography
1. M.D. degree, Case Western Reserve University, Cleveland OH
2. 27 years, private practice, Internal Medicine, Los Angeles, CA
3. Medical Director, Saint Johns Well Child and Family Centers, a Community Clinic, LA, CA
4. Director, Chronic Disease Management, Saint John’s Well Child and Family Centers, Community Clinic, LA, CA
Detailed personal resume available upon request.
My contact information:
Email address: lcfraysermd@comcast.net
Telephone# - 770-731-0004
Fax# - 770-731-0005
Cell# - 770-820-8000
© Louis C. Frayser 2009
Abbreviated Medical Biography
1. M.D. degree, Case Western Reserve University, Cleveland OH
2. 27 years, private practice, Internal Medicine, Los Angeles, CA
3. Medical Director, Saint Johns Well Child and Family Centers, a Community Clinic, LA, CA
4. Director, Chronic Disease Management, Saint John's Well Child and Family Centers, Community Clinic, LA, CA
Detailed personal resume available upon request.
My contact information:
Email address: lcfraysermd@comcast.net
Telephone# - 770-731-0004
Fax# - 770-731-0005
Cell# - 770-820-8000
© Louis C. Frayser 2009