If you live in NYC, keep your eye on property in or around Union Square, Soho, the West Village, or the Flatiron District. Something revolutionary will begin to take shape. Think the Apple Store, FedEx, Toyota Lean, Eugene Debs, 1984, The Fountainhead, Experience Design, continuous quality improvement, iPhones, video chats on your mobile phone or computer, IMs, emails, text messages from your doctor designed to respect your time that say “Your appointment is in 20 minutes, please make your way to the office and enter room 3,” evidence-based medicine, cost-consciousness, free generic medications, and a powerhouse of some of the most talented thinkers, businessmen, marketers, programmers, software architects, graphic designers, graphic user interface specialists, interior designers, architects, and some of the best physicians the world can offer all smiling in triumphant admiration.

"If we train village health workers, and make sure they're compensated," he said, "then the resources intended for the world's poorest--from vaccines, to bed nets, to prenatal care, and to care for chronic diseases like AIDS and tuberculosis--would reach the intended beneficiaries."

A recent HANYS analysis of hospital financial data found that more than half of the state's hospitals lost money or recorded margins of less than 1% in 2006.

6. Physician Empowerment - Doctors are re-awakening to the reality they hold the key to effective, efficient, and safe healthcare. They’re asserting themselves through legislative efforts to reduce malpractice costs, state medical societies curtailing health plan abuses, social online networking in sites like Sermo, and health care practices offering prompt same-day access and more efficient and friendly care.

CHA leadership has apparently convinced itself that the same bureaucrats who crippled California hospitals by underfunding Medi-Cal are going to change their stripes under Arnoldcare. They actually seem to believe that all of the revenue generated by the tax (and federal matching funds as well) will be set aside by the bureaucrats for payments to providers.

Judge White ruled that the employer assessment violates the federal ERISA law (Employee Retirement Income Security Act of 1974) which, among other things, prohibits state and local governments from mandating that employers must provide health insurance to their workers. ERISA was the federal law cited by Maryland and New York federal courts in overturning so-called Wal-Mart laws passed last year to require very large employers to cover their workers or pay a tax.

Some might argue that these “highly ethical physicians” aren’t so highly ethical by practicing retainer medicine. One ethical framework would suggest if all physicians just practiced retainer medicine, there would not be nearly enough physicians to go around. In that framework, retainer medicine would be viewed as unethical.

So fantastic is insurance at heart attack prevention that the researchers of this important trial never even had to consult a single health record to verify their claims. Not one. From the studies "limitations" section:

"Our study relied on self-reported health measures rather than data from medical records. Although our measure of adverse cardiovascular outcomes summarized related items selected for their face validity, this scale has not been formally evaluated as a measure of cardiovascular disease severity."

Would physicians practice medicine differently if they were paid differently? There is ample evidence that the answer is yes. Unlike other forms of surgery, the typical cosmetic surgery patient can find a package price in advance covering all services and facilities, compare prices prior to the surgery, and pay a price that is lower in real terms than the price charged a decade ago for comparable procedures—despite considerable technological innovations in the interim.

...why can't doctors revive someone who has been dead for an hour? Because once the cells have been without oxygen for more than five minutes, they die when their oxygen supply is resumed. It was that "astounding" discovery, Becker says, that led him to his post as the director of Penn's Center for Resuscitation Science, a newly created research institute operating on one of medicine's newest frontiers: treating the dead.

Dickens has long been recognized as a skillful and accurate chronicler of human behavior. His characters are rendered with a realist’s dedicated, unstinting eye. Physician readers of Dickens’s stories have commented on the precision with which he portrays his characters’ quirks and oddities — many of which are now recognized as disease states. Some of his most memorable characters are virtual case studies of diseases that were not described or understood until long after Dickens’s time.

Singh is not your typical patient of a boutique medical practice; he earns about $50 or $60 a day—far less than the CEOs and other wealthy types who tend to pay the monthly, out-of-pocket fees that boutique (or concierge) practices charge for on-demand access to their doctors. That's because Qliance is not your typical boutique service. Indeed, it doesn't even like that term, which it says smacks of elitism.

Rather, Qliance's target demographic is the working poor and uninsured. It does not accept insurance, instead charging between $39 and $74 a month for an individual, depending on age. (The older you are, the more you pay.) That fee covers most of what encompasses primary care, including office visits, phone consultations, common X-rays, and some procedures and lab tests. Other tests, including those for cholesterol, diabetes, and blood count, will be offered at close to cost, for $7 to $17.50 each.

...before he left his former practice, he was delivering a standard of care which troubled him. He was losing his love for medicine and patients.

As I asked SP about his typical day, he told me that he physically saw 6-8 patients each day. He spent at least as much time on the phone or answering email as physically seeing patients. At least once each week he makes home visits. He often calls his patients preemptively.

Because of his intense outpatient work, his admission rate is very low. He needs less consultants and orders fewer high ticker imaging studies.

This movement continues to grow. It grows because patients are willing to pay for service. Unfortunately, the Medicare reimbursement system drives what other insurers pay. This illogical, bureaucratic system is destroying outpatient internal medicine. Retainer medicine and cash based practice may save these practices.

1) Do you want to have the luxury of time, allowing you to provide superb care to your patients?
2) Do you want to be financially rewarded for your skill, while still saving the patients thousands of dollars?
3) Would you to escape the current beast of billing, ICD-9 codes, high volume, low efficiency practices?
4) Would you like to enjoy medicine again?

1. An individual mandate, with exemptions if premiums are more than 5% of family income
2. Tax subsidies to families <400%>
3. Expansion of Medicaid (including to young adults <250%>
4. Employer pay or play mandate (tax of up to 6.5% on wages if employer doesn’t provide insurance as a benefit)
5. Hospital tax of up to 4% of revenues
6. New cigarette tax of at least $1.50/pack
7. State fund (employer pay + hospital taxes + cig taxes) to fund indigent who cannot afford care
8. Insurance requirement that 85% of premiums go to patient care
9. Kills experience rating and doesn’t allow insurers to refuse coverage because of a pre-existing condition
10. Increase in Medicaid reimbursement, potentially up to Medicare fee schedule

Altruism is a beautiful [emphasis mine] virtue, but it has fallen painfully short of its goal. We must be bold and experiment with offering prospective donors other incentives for giving, not necessarily payment but material reward of some kind — perhaps something as simple as offering donors lifelong Medicare coverage. Or maybe Congress should grant waivers so that states can implement their own creative ways of giving something to donors: tax credits, tuition vouchers or a contribution to a giver’s retirement account.

Why not add to your algorithm extra points for those hospitals that voluntarily publish clinical indicators of the degree to which they harm patients? I am not talking about the usual hodgepodge of outdated CMS data, which are available anyway. I am talking about substantive clinical metrics, like central line infections, ventilator associated pneumonia, and the like. Or the ultimate, the hospital standardized mortality rate calculated by the Institute for Healthcare Improvement.