Mac Bowen

Dad, wife, family doc, residency program director, humanist interested in giving back, spreading joy, and adding to the vibrancy of the world.

[New Mexico Primary Care Training Consortium @NMPCTC]

We're at the NMAFP Family Medicine Seminar in Santa Fe! We'll be here until 3:30 pm today and tomorrow so drop by the exhibit hall for a chat with Lezley and to pick up some cool swag!

#FamilyMedicine #FMRevolution #FamilyMedDoc #BestSpecialtyEver #NMAFP

[Mac Bowen @macbomed]

We were promised interoperability a long time ago. Epics complacency is ridiculous.

[Gabriel Perna @GabrielSPerna]

My interview w/ Seema Verma of @OracleHealth. The former administrator of CMS left no doubt that she agreed with her colleague Ken Glueck that "Epic CEO Judy Faulkner was the single biggest obstacle to EHR interoperability."

https://t.co/PQhWyJhjK4

[Mac Bowen @macbomed]

@Culture_Crit Beautiful posts mate! I get a boost of wonder/marvel/positivity reviewing your content. Thank you!

[Mac Bowen @macbomed]

Optimism is good, but we can't let up

[Assaad Razzouk @AssaadRazzouk]

Good climate news this week
1 Installed capacity of China’s clean energy generation exceeded 1.57bn kilowatts in 2023, surpassing coal for the first time in history
2 Italy's renewable power output overtakes fossil fuels for 1st time
3 China's June thermal power down 7.4% while wind and solar up by 12.7% and 18.1%
4 93% of new steelmaking capacity announced in 2024 to use lower emission electric arc furnaces
5 Amazon deforestation cut by 83% in places protected by Indigenous communities
6 UK close to 1 million electric car chargers
7 UK Science Museum ends sponsorship deal with oil company Equinor

[Mac Bowen @macbomed]

Oy this is too accurate. When the corporate overlords use AI to unlock our productivity finally we might actually have that "access" they always chirp about

[Anthony DiGiorgio, DO, MHA @DrDiGiorgio]

Modern EHR means paying highly trained (and expensive) workers to perform data entry and coding.

It would be like making the athletes on a pro sports team keep and submit their own stats to the league office.

[Mac Bowen @macbomed]

Driving a car is sometimes necessary, sometimes lazy and selfish. Biking is none of those things, and thus beautiful. Help people make better choices and be less harmful.

[big_pedestrian @big_pedestrian]

When motorists kill people on bicycles or foot it’s not “an accident.” It is the predictable, preventable result of US policy which prioritizes the convenience *and property* of motorists over the mobility, health, safety and lives of people outside of cars. It’s a policy choice.

[John Frey @jjfrey3MD]

We know about the decline. All that is needed (!) is to change med school admission criteria, triple NHSC scholarships and loan forgiveness, pay clinicians prospectively, not production, and let clinicians and staff do their work. Not hard. @aafp

[Mac Bowen @macbomed]

Don't blame docs, other than we got content and complicit and got out advocated by MBAs, lobbyists and politicians

[Anthony DiGiorgio, DO, MHA @DrDiGiorgio]

What a great question!

*clears throat... arranges notes on podium*

There's a food-based analogy coming at the end of this, don't worry...

In traditional Medicare, physicians are reimbursed through a system that converts procedures to dollars, known as "professional fees."

To calculate a professional fee, doctors assign a code for each service they provide, from a standard office visit to a complex brain tumor resection. These codes (called CPT codes) have a value in units called RVUs (Relative Value Units).

For example, a 15-minute office visit generates about 1 RVU, while a complex brain tumor resection can be 30-40 RVUs (depending on the specific codes used). These RVUs are then converted to dollars using the conversion factor. This amount is set by the government.

Multiply the conversion factor by the RVU, and you get the professional fee. The RVU conversion factor was $31 in 1992 and is around $32 now (it should be over $65 to keep up with inflation).

If the doctor runs an independent practice, the entire practice must be sustained using these RVUs and the conversion factor (which includes a practice expense component).

Confused yet?

Hope not, because here's where it massively favors hospitals.

Hospitals are paid either using the OPPS (for outpatient services) or DRG (for inpatient services).

For example, if an independent practice gets bought by a large hospital system, the physician typically agrees to let the hospital bill on their behalf, so the hospital keeps the professional fees. These might be passed directly to the doctor, or the doctor may have a production-based contract or a straight salary.

However, the hospital now bills under OPPS instead of the physician-based CPT/RVU system. That procedure code is converted using another scale called Ambulatory Payment Classification (APC, for those keeping track of the alphabet soup).

This scale yields higher reimbursement!

These are the so-called "facility fees" that make the exact same service cost more at a hospital than in an independent physician's office.

The government keeps INCREASING the OPPS (to keep pace with inflation) while DECREASING the RVU conversion.

For the exact same services, hospital reimbursement keeps going up while independent physician reimbursement keeps going down.

OK, now the food-based analogy you've all been waiting for:

It's like if you had government insurance that pays for your food. If you get a burrito at an independent food truck, it uses the "deliciousness scale" and has a dollar-to-deliciousness conversion. Meanwhile, if you get that same burrito at a chain restaurant, it uses the "scrumptious scale," with a completely different conversion, including extra fees to support the large multi-state organization.

Over time, the dollars per deliciousness unit decrease, not even keeping pace with inflation. Meanwhile, the dollars per scrumptious unit keep increasing.

Would the independent food truck have any chance of competing with the chain restaurant? The chefs have few options. Get bought out by the chain or stop taking government insurance.

How would this affect access to burritos for those with government insurance?

Not needing to compete, since they are guaranteed to get paid more than the independent establishment, the large chain restaurants have no incentive to improve quality.

The chefs making the burritos at the large chain restaurant have no control over their workplace anymore. Gone is the art of their craft, replaced with orders from a corporate overlord. They bring in a ton of money for their corporations, but the accountants still use the devalued deliciousness-units to determine their reimbursement. They demand they make more and more burritos. The chefs are burned out. They are undervalued. They look for a way out of their beloved careers. There are fewer options for those with government-sponsored food insurance. The cycle continues...

That's how the government devalues physicians while increasing healthcare consolidation. It's been a long, targeted destruction of independent practice. There are many other factors (340B, quality metrics, EHR), with this lack of site neutrality being just one nail in the coffin.

But it's a big nail.

@anish_koka @cscla @JPGK_MD @VPrasadMDMPH @RealJoeGrogan @realdocspeaks @DutchRojas

[Mac Bowen @macbomed]

Grifting MBAs infected our healthcare system...anybody know a remedy?

[Real Doc Speaks @realdocspeaks]

Physician payments are the only part of the Federal budget with a hard cap. The plan is to replace independent physicians with easily controlled, indoctrinated, employed physicians.

[Mac Bowen @macbomed]

Tell me we invest in "our future" again?

[Matthew Yglesias @mattyglesias]

The federal government mostly spends money on old people.

[Assaad Razzouk @AssaadRazzouk]

In more hopeful news
1 China's solar power output surged an incredible 78% year-on-year in May
2 China coal and gas fell to new record lows
3 US wind overtakes coal for 1st time, with 28% more MWh in April
4 100,000 Irish households connected their rooftop solar to the grid

[Bob From Accounts 🚲 @BobFromAccounts]

Whilst we're discussing auto-obesity, never overestimate the sheer stupidity and selfishness of vehicles like this within a city.

2.6 tonnes transporting 1 x 80kg person most of the time, then statistically remaining parked for the other 95% of its life.

Tax them to oblivion

[Rep. Seth Moulton Press Office @RepMoulton]

👀

I have a bill to make it happen. Let's build #HighSpeedRail! 🚅

[Brent Toderian @BrentToderian]

Never forget, car dependency is the opposite of freedom.

[U.S. Surgeon General @Surgeon_General]

The toll of firearm violence on young people has been particularly devastating. As shared in my new Surgeon General's Advisory, firearm violence is now the leading cause of death among children and teens. https://t.co/bNS7xD9Bhp

[Mac Bowen @macbomed]

Dang, this guy is HARD! Answer questions or you're DONE! We deserve answers not spin!!!

[Brent Toderian @BrentToderian]

Watch this. What if every political debate was moderated THIS way? #Fantastic https://t.co/rxKNN08gQn

[Urban Cycling Institute 🚲  @fietsprofessor]

If you don't know how to say it, say it with a sticker!

(via @TheWarOnCars)

[Urban Cycling Institute 🚲  @fietsprofessor]

This machine fights climate change...and makes you happy in the process.

[Mac Bowen @macbomed]

We've never needed trees more. Best time to plant? 20 years ago!

[Jonathan Berk @berkie1]

Urban tree canopies like this one on Commonwealth Avenue in Boston are literally a lifesaver during heatwaves.

It’s more important than ever for cities to look to reclaim areas of excessive pavement to incorporate more green space in all neighborhoods.