On March 31, 2011 CMS issued its proposed rules for Accountable Care Organizations (over 400 pages).
There is now a 60-day comment period. Shortly thereafter, the final rules will be issued. I am sure there will be changes in the proposed rules as there were changes in the “meaningful use” rules for electronic health records (EHR’s). Yet, much of the intent of …
Health care coordination under the rules of an ACO
“Psychiatry consult, returning a page,” she said, cradling the phone between her left ear and left shoulder. Digging around in her pockets, she eventually pulled out a half-sheet of paper that wasn’t already covered in barely legible writing and boxes marked with Xs. Her right hand clicked the pen and prepared to write.
“Hi, this is Cardiology,” the male voice on the phone said. Doctors tend to lose their names when they …
Why medical students should go through a psychiatry rotation
Our society thrives on tension and competition.
Ideas, like sports teams, compete to win. We are the referees of these contests. Many of these competitions in the public square are ongoing. Some of these duels are locked in a dead heat. Others are in overtime. Some are ‘challenge matches’ when a vanquished idea wants another shot to change the original outcome. …
Honored to care for many priests and nuns in my practice
I am really enjoying my geriatrics rotation.
Although my attending preceptor is primarily a geriatrician, and practices deep in the heart of retiree central in southeast Florida, he also sees some patients who are younger. I took a history on a patient who was younger than me today, in her early thirties.
She started off complaining about insomnia and headaches, and then said …
Bereavement related depression and consoling a new widow
Bullying is a problem within health care.
Stung by a physician’s rebuke, Theresa Brown, an oncology nurse, takes to the op-ed pages of the New York Times to address the issue.
In it, she cites several vignettes that paint doctors poorly:
But while most doctors clearly respect their colleagues on the nursing staff, every nurse knows at least one, if not …
Theresa Brown unfairly blames doctors for hospital bullying
Eric Cropp was a pharmacist who was sent to prison for a mistake that resulted in the death of a child.
This was a high profile case, but it was just one of many examples of a disturbing trend I’ve seen in the U.S. in recent years: a person commits a mistake–with no malicious intent and without being under the …
Where do we draw the line on criminalizing mistakes?
When I was a little girl, attending the circus was the highlight event of the year. I remember looking forward to it each year – perhaps because it was something fun, and each year something new. Never the same show twice. Very busy behind the scenes, yet at the same time, quite organized and appearing smooth on the surface.
In the same way, the clinic can be a truly hectic scene. …
Be like a circus ring master when seeing a patient in the clinic
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 67-year-old businessman is evaluated during a routine health examination. He has a 30 pack-year history of smoking, but quit 5 years ago. He consumes two or more alcoholic beverages on most days. He is asymptomatic, but performs no regular physical exercise. He takes no medications.
On …
MKSAP: 67-year-old man with an abdominal aortic aneurysm
As a specialist, one of the saddest truisms about practicing medicine in the private world has always been how little one’s clinical skills determines referrals. Unfortunately, as our present healthcare climate pushes “providers” to consolidate along the lines of major hospital networks this injustice will only worsen.
A decade-or-so ago when I started private practice it was obvious that referrals came to me because of my association with an established …
Fewer choices for patients with health care consolidation
One year after passage of the Affordable Care Act, the Department of Health and Human Services (HHS) has unveiled two programs that will most certainly be transformative for U.S. healthcare, affecting both quality and safety.
With the announcement of the first-ever National Quality Strategy in March, HHS signaled a strong commitment to improving the quality of healthcare.
In essence, …
National Quality Strategy and Partnership for Patients to improve care
I am deeply conflicted about how we as a society have come to use physicians, medical science and advanced technology in our lives.
Everything has its place in life, but we have given modern medicine with its focus on the chemistry and physics of illness too prominent of a place. We’ve forgotten that we are not treating diseases; we are helping people with diseases.
Many readers, especially those with lifestyle diseases, can …
3 ways to deal with serious illness and engage the health care system
I’ve read a number of recent articles on social media and medical professionalism. The post in the New York Times about physicians and Facebook prompted me to think about my own presence online.
Dr. Ryan Greysen, a Robert Wood Johnson Foundation clinical scholar at Yale School of Medicine, says he is concerned about the professionalism of “the new generation of physicians and …
How tagged Facebook pictures can affect a doctor’s online reputation
“She’s a really interesting patient!”
The doctor visiting the lady in question at home is correct. Nothing about her illness either has been routine. The progression of her disease has confounded her regular doctors for months. Nothing about her condition is normal. Medications have not worked as expected. The original diagnosis — Parkinson’s — is in question. All my training and expertise is inadequate, for I am an ENT surgeon, not …
Be a boring patient, not an interesting patient
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An excerpt from The Inner Pulse: Unlocking the Secret Code of Sickness and Health.
by Marc Siegel, MD
The Pulse of Recovery
People are like stained-glass windows. They sparkle and shine when the sun is out, but when the darkness sets in their true beauty is revealed only if there is light from within.
–Elisabeth Kübler-Ross
The inner pulse can keep beating—loudly—long after doctors, researchers, and their monitors …
Recovery may be predicted with a perception of the inner pulse
by Mellanie True Hills
I have heard from thousands of atrial fibrillation patients who have shared their afib experiences with me. For so many of us, the diagnosis and treatment of afib is confusing and scary.
To improve communication between patients and their health-care providers, and ultimately, provide better care, I recently shared with doctors at the Western Atrial Fibrillation …
Improving atrial fibrillation communication between doctors and patients
After all the ridiculous fear-mongering about “death panels,” Congress dropped a proposal to encourage end-of-life planning from the health reform legislation passed last March.
But the administration had in fact quietly included reimbursing doctors for end-of-life counseling along with a host of new Medicare regulations. The provision, which authorizes payment for “voluntary advance care planning,” went into …
The government reversal on end of life planning
Little more than a decade ago, most people had never heard of the word genomics; today it is used frequently. It is indeed a revolutionary science that is and will transform medical research and medical care. To better understand how this new science will markedly change medicine, it is convenient to consider it through a few categories:
How genomics can help doctors target drug therapy
We all like lists. US News & World Report has told us for years which colleges are considered the top in the nation. Castle Connolly tells us which are the “Top Doctors” in our community and Car & Driver gives us a ranking of cars by type.
In The Order of Things, Malcolm Gladwell pokes serious holes in some of our most revered rankings and lists.
If …
Best hospital lists influence consumer decision making
Content drives conversations. Conversation engages your customers.
Engaging with people is how your company will survive and thrive in this newly social world. In other words, online content is a powerful envoy for your business, with an ability to stir up interest, further engagement, and invite connections. Why hasn’t the healthcare industry focused more on better content that drives engagement and creates trust?
Creating and sharing relevant, valuable information that attracts people …
Creating and sharing great content builds authority for your brand
Primary care is a unique field of medicine.
Primary care physicians (PCPs) are the gatekeepers to specialized care, provide preventative care, and most importantly, they have the ability to manage patients with multiple chronic conditions. Thus, primary care physicians are in prime position to become the point men in the Read more…
The future of primary care in an ACO model
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