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Institutionalizing HIV Healthcare -
VALUE BASED CARE (VBC) is & will be a disaster
 
 
  From Jules Levin
 
The quality & quantity of healthcare in HIV in the USA has become a disaster due to restrictions on care & visitation time imposed by public & private insurance & by the hospitals to improve their bottom line. As a result time with all HIV+ patients & evaluations are not as comprehensive & thorough as they should be. All too often its 10-15 minutes in and out at visits as clinicians are told by their hospital administrators to do this, its required. The MBAs are running care at large hospitals. This is not different than in the general population. If Value Based Healthcare is fully implemented as it appears we are headed this way, this will make healthcare worse with less time & worse outcomes for patients, For older aging patients who are "high risk" they need more time attention & longer visits. Reimbursement by insurers has dwindled so low many private HIV practices have closed. Many HIV doctors have retired or gone to work for industry because of this, many have closed their private practices and sold them to their hospital where they go to work in the hospital for the hospital & when that happens the hospital takes over all billing & income, and the patient becomes subject to these restrictions imposed by hospital administrators. In NYS many are trying to sell Vale Based Care as the solution including unexpected stakeholders in this fight, who have vested interests in running clinics and the profits from them. DO NOT LISTEN to the sales pitches from federal and state governments & these stakeholders - they will say patients will have better outcomes, NO WAY. As part of this process of VBC patients will be required to fill out surveys to evaluate the care they receive and these will be used to evaluate the care provided, but this will never really reflect reality. In addition HIV care has become part of HIV clinics that have increasingly become in hospital clinics which have become almost "medicaid mills", in this setting the commitment from the doctor to each specific patient has become more tenuous, its not like it was in private practice where the doctor really cared. This is the result of imposed economic restrictions by insurers & hospitals which has resulted in private practices closing & hospital clinics taking them over, where MBAs not doctors dictate care. We need special dispensation for care in HIV but more particularly for high risk older aging HIV+ who need more visit time, more attention & more intense care and more support services, for clinic, doctors & patients. This means HRSA & RWCA & CDC must step up to the plate and address these issues.

 
 
 
 
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