> Which is basically the same drug but without glycemic control
No... The effects are the same because they are exactly the same drug (semaglutide), the difference is the dosing schedule and max dose (wegovy is 2.4mg and ozempic is 2mg).
> After all, the communication portal in MyChart is "Message My Provider", not "Message An MA To Message My Provider".
That is semantics, could be changed to "Message the office" but that isn't going to be the most clear title for the majority of people to understand what it is doing. It's the same as calling the office, 99.9% of offices (basically all outside of concierge/direct care) are going to be triaged by an MA/nurse first.
As far as the payment requirements I've heard of, I have never seen anyone bill just for the MA reply.
There are some codes that can be used for asynchronous portal messages, but to be honest the AMA is still pretty broken as far as how much time we need to spend for things... the codes are 99421 (5-10 minutes over 7 days), 99422 (11-20 minutes), 99423 (21+). It is not clear to me how well these codes are actually paid for by private insurance. In a wRVU system a PCP may get paid like $5-13 for the first code, $15-30 for the 2nd, $24-44 for the 3rd. This is a lot less than a visit... and you must spend the minimum 5 minutes on the portal message or you are billing it fraudulently. I can cover an in person level 4 visit (99214) in 5 minutes in some cases, which pays something like $100.
> The nurses have left and you can't legally 'bill' or code the appointment without the nurses.
What? I've never heard this requirement and I cannot think of why it would be the case (I'm a PCP). The rest of your comment is pretty much the issue as PCP though. I have at least 30 minutes a day of "out of visit" requests (reviewing documents from outside hospital/consults, labs, imaging, other results, extra nurse patient triages) in addition to anywhere from 30 minutes to 2 hours of completing my notes each night.
I think it's pretty stupid that basic appointments are billed on complexity and not time. Well, and lots of other things too. Getting a radiologist to do a definitive diagnosis using imaging doesn't actually make the ER doctors job harder (rather, it de-risks the interaction for them).
It's also ridiculous that I have to promise to pay any bills that my insurance won't cover. If some care can't be justified as medically necessary, there should be a specific contract for that when it comes up, not a blanket rider prior to accessing treatment.
Forcing the two sophisticated entities to have a workable agreement where they can't dump costs off on the individual patient would at least improve perceptions of care.
I'm a family physician working in an outpatient office... there's just so many viruses that can explain those types of symptoms that are STILL more common than sars-cov-2.
I saw a 31yo 2/18 with primarily sore throat, aches/feverish (not documented), and again on 2/20 because the sore throat got significantly worse. I started feeling iffy 2/21 (Friday) evening and worse Saturday with a bad sore throat and fever around 102F, lymphadenopathy, this persisted for at least 2 days. I went to work on Tuesday and did a rapid strep (I did not feel I had strep but the other doctor wanted to do it)... I'm not really thinking that was covid19.
I hate when this gets brought up, because it inherently implies that we can't improve them. Everyone talks about increases in handoffs causing increases in medical errors. I think handoffs have a long way to go, and we need to better utilize technology to help in this (ie make better EMRs).
The overworked doctor is just as bad IMO. I've been there on solo 28 hour calls going on my 11th admission. In the morning I'm next to useless and my handoff to that team was less than stellar.
I had a friend who was a QA process engineer at a regional hospital. He identified a significant source of errors - every morning there was a 'double-handoff' as the doctors handed off to nurses, who ended their shift and handed off to the next shift. The problem would be solved by moving hand-off time by a mere 15 minutes, but neither the doctors' group nor the nurses' group would budge on the matter.
I've heard a few other similar stories from him as well. Doctors have immense political power; if hospitals are grinding them to dust, it's because doctors as a group are letting them (the good old 'seniors don't care that juniors are getting crushed' problem). From my own limited experience working with them as a neuro tech, doctors will close ranks quickly against outside forces, but plenty will sell each other out within the profession. For every haggard ED doctor, there's a specialist somewhere making cushy deals with the administration.
House of God is indeed an interesting book and a good read. I read it during second year of my residency, and it is incredibly sad how the stuff that is talked about in the book has gotten worse in some ways, though better in others.
I'm actively against the "bowel run" mentality. I do my best to avoid even the CYA test ordering, though I'm not in the ED where this can be the most rife. I see first hand the "ponzi scheme" (though IMO it is not the correct term) of the system and I chose to go into primary care because I actively want to fix this in any way I can, and being a specialist was not the way I thought would be best to do this.
Whoa that's nuts! Sounds amazing for saving babies though after reading the article my next thought was using that plus a dialysis machine to create a Frankenstein body to cheat death.
My daughter owes her life to ECMO. Scary as hell, but I'm thankful for it every day. The team that saved her life just recently performed the first transport using a portable ECMO machine. The one they used on my daughter was the size of a vending machine. They now have the portable units down to the size of a small suitcase.
No... The effects are the same because they are exactly the same drug (semaglutide), the difference is the dosing schedule and max dose (wegovy is 2.4mg and ozempic is 2mg).