Wedding Kurat

The designs for training and for payment that worked so well to improve health access during the 1960s and 1970s gave the illusion that training alone could make up the workforce gaps. Such is not the case. The financial design fueled the 1960s and 1970s improvements. The failure of this design since the 1980s prevents further gains - continuing to leave most Americans behind. The family medicine leadership still clings to the 1960s design, but must embrace a 2040s design to continue to lead in family medicine, in primary care, and in health access. It is quite revealing that family medicine associations and leaders have embraced the innovation/regulation/certification bandwagon. There is a willingness to embrace the academic, association, institution, and association designs. But do these designs match up to family medicine now - or in the future? Past family medicine graduates that were active were 90% committed to office family medicine for decades. More recent tracking ind...

Triple Aim, innovation, regulation, certification, cost cutting, and other changes have widened the gap between small primary care practices and large practices for the past 37 years. The treatment of small practices and those that they serve will some day be recognized as discrimination by design. Revenue and Collections The financial design for primary care has been an issue since the 1980s. Stagnant payments, increasing costs of delivery, and increasing complexity represent the Triple Threat to primary care. This threat is most prevalent in the smaller practices. 15% higher payment are common in large vs small practices for the same office codes (Medicare Data 2011). This translates to about $65,000 less payment per primary care doctor.  This is shaped by a number of different factors such as being small or rural, not being associated with a hospital, being in the wrong state, and being less organized. Large systems and practices often have 5% annual escalation clauses. Sm...

Once again the designers are promising a solution for shortages of physicians that cannot work. The expansion of graduate medical education will not send more physicians to counties short of physicians. Expansions of MD DO NP and PA have all resulted in steadily higher concentrations in fewer counties that already have higher concentrations. The evidence is already in the databases. Until the financial design is fixed with more dollars for basic services, there will be no solution for care where needed. MD DO NP and PA are finding more ways not to go into primary care and this pathway is all about dollar distributions, or lack thereof. Under the current financial design there is no way that any GME, MD, DO, NP, or PA expansion can actually address shortages. GME is 94% in the wrong counties with only 6% found in counties lowest in physicians, health spending, economics, and health outcomes. Residents are 154 per 100,000 in 79 top physician concentration counties. The 2621 lowest p...

A significant number of standards and objective elements of NABH are applicable to Pharmacy of a hospital. Most of these requirements are given under the chapter of ‘Management of Medication’, but there are objective elements under other chapters also, which are applicable to pharmacy. The checklist below has been prepared after taking in consideration all such requirements. Objective of this checklist is that the hospital should be able to prepare and quickly evaluate everything that is applicable to pharmacy under NABH accreditation preparation. A. Legal requirements 1. The person dispensing the medicine in pharmacy is a qualified pharmacist (B. Pharm or D. Pharm). The qualification certificate should preferably be displayed in pharmacy. 2. List of prescription drugs is available (Schedule H drugs) and is dispensed only against doctor’s prescription 3. Schedule ‘X’ drugs are dispensed against valid medical prescription and a copy of prescription is retained for a...

NABH puts high importance to safety in hospitals and ask the preparing hospitals to ensure that the facility is safe for patients, staff and visitors. As per one of the objective elements (FMS.1 e. of NABH 4 th edition), the preparing hospital is required to conduct facility inspection rounds to ensure safety. Further, it also states that the round should be conducted at-least twice in patient care areas and once in non-patient care areas. In-order for these rounds to be effective, it is important that a comprehensive checklist be used so that common safety hazards and potential risks could be checked and necessary remedial measures be taken. Below, I have prepared a checklist of points that could be used for such rounds. The checklist also addresses various other safety parameters that has been asked in different standards and objective elements of NABH standards book. This checklist would be of much more value if used along-with the Infrastructure checklist for NABH accreditation pre...