Deans' stroke musings

Changing stroke rehab and research worldwide now.Time is Brain!Just think of all the trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 493 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It's quite disgusting that this information is not available from every stroke association and doctors group.
My back ground story is here:

Monday, September 19, 2016

Time To Change The 15-Minute Limit For Doctor Visits

Totally fucking useless for stroke rehab visits. Since all your doctor is going to do is write ET (Evaluate and Treat) on a prescription pad for Occupational, physical and speech therapy. There are no protocol efficacies to discuss or anything your doctor knows at all about rehab. The rest of the time is probably spent trying to tell you you need to work harder, your doctor knows nothing and does nothing to facilitate your recovery. I bet you get no explanation on how to implement neuroplasticity and neurogenesis to help your recovery, which could easily be a handout. Hopefully I get some doctor reaming me out about where exactly these statements are wrong. This is not about prevention, this is about rehab!

Who said that 15 minutes is enough time for a doctor to examine and take care of a patient? According to a Western Colorado radio station, KOOL 107.9 FM, this is roughly the same amount of time men spend on the toilet each day, which could increase depending on what you eat and how much toilet texting you do. Patient care is probably more complex than taking a dump (i.e., you don’t need as much training to poop). So how exactly did 15 minutes become the typical doctor’s visit length, and why isn’t this number being questioned more?
The reason is insurance reimbursement, which dictates a lot of what is done in medicine. Currently, insurance seems to pays hospitals, clinics and doctors only enough to justify 15-minute appointments. How, then, did insurance companies decide that 15 minutes is enough? As this piece by PBS explains, the answer is not completely clear but probably comes from a decision made by Medicare in the year 1992. Yes, 1992 was apparently when it all started. (Are you listening, Marty McFly and Doc Brown, in case you want to use your time machine?) Yes, the fateful decision that led to today’s visit length occurred several years before N*Sync and Google even got started. That year Medicare adopted the following “relative value unit”, or RVU, formula as a standard way to calculate doctors’ fees:
(Work RVU x Geographic Index + Practice Expenses RVU x Geographic Index + Liability Insurance RVU x Geographic Index) x Medicare Conversion Factor
The purpose of this now archaic formula was to reduce the variability in physician fees. Based on this formula, a typical primary care office visit should be 1.3 RVUs, which using the American Medical Association coding guidelines at the time translated to 15 minutes. Medicare then set its reimbursement rules based on this length of time, private insurance companies followed suit, managed care took over in the mid to late 1990′s, N*Sync emerged and then later broke up, Justin Timberlake became a star and medicine was no longer the same. Because of this series of events, nowadays, 15-minute doctor visits have become the norm with no apparent change on the horizon. Great Scott!
  Why in Justin Timberlake’s name are we still sticking to a rule from 1992? It seems absurd to have to say this, but times have changed over the past 25 years since that Medicare decision. People actually use the Internet now. Miley Cyrus and Justin Bieber were born. Medicine is also very different. Many new and different treatments, tests, rules and regulations have emerged. Electronic health records began and grew. And the amount of paperwork involved has skyrocketed.

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