The massive confusion about Obamacare (the Affordable Care Act) is much worse than I thought. The Kaiser Family Foundation came out with a poll that shows 42% of Americans don’t even know that Obamacare is the law. Seven percent of people think the Supreme Court struck it down and 12% think Congress repealed it.
I understand that there is confusion about the way it will work and who will be affected. …
Why Obamacare is a marketing fail
The seemingly irreconcilable conflict between the medical and nursing professions usually boils down to one question: who is in charge? Physicians often use a football analogy: they are the quarterbacks of the team, calling the plays that others on the gridiron must follow, because of their greater training and skills. Advanced practice nurses (APNs) respond: not so, we are also highly trained and qualified to call the plays and lead …
There should be no quarterbacks in health care
Unplanned readmissions to the hospital have been the focus of much attention in recent years for obvious reasons. First, they are relatively easy to measure using administrative claims data. Second, like all inpatient hospitalizations, they cost a lot of money–and are therefore a target for reducing spending. Third, they are a proxy for quality of care, as at least some portion of them are likely avoidable if the hospital does …
Is the hospital readmission rate a measure of quality?
If a mosquito lands on someone’s head and you hit the mosquito with a shovel, is the death of the guy under the mosquito considered an unintended consequence?
So now we know that the government of the United States of America is spying on its own citizens, not specifically on any one in particular, but massively and indiscriminately collecting troves of data on all American people. All perfectly legal, …
Protecting us from the terrors of unhealthy lifestyles
On a recent trip to Lincoln, NE, I visited Lincoln Industries, a company that makes chrome trims for Harley-Davidson motorcycles. I was curious about the firm’s award-winning wellness program, especially since more employers are penalizing workers by making them pay more for their health insurance if they fail to meet certain health goals.
At the heart of Lincoln Industries’ wellness program is its Platinum Scorecard, which awards points to workers who …
Do corporate wellness programs work?
Most Republicans hate Obamacare for what they consider to be government over-reach, most Democrats support it because they believe only a strong policy of government intervention can extend coverage to the millions of uninsured—and there are no signs that their ideological battle will abate anytime soon. But there may be one sweet spot that both parties could agree on: providing consumers (or patients, if you prefer) information on the prices …
Health care price transparency should receive bipartisan support
Nearly every hospital leader in America will tell you their hospital is all about patient-centered care. Of course, we know this isn’t true in many cases, especially when it comes to hospital capacity management. Though many institutions will deny to its last dying breath that they have any priorities that supercede patient care, nearly all do.
They usually go like this: first priority is high margin surgical cases; second priority is …
Is your hospital leader committed to patient-centered care?
It is clear that healthcare in the US is more costly than in any other place in the world. We spend 18% of the gross domestic product on healthcare and our outcomes are no different than those of other industrialized nations who spend less than half that amount. How did we get here and what are we to do about it?
Recently, an article appeared in the Read more…
American’s health cost problem has no easy fixes
Many ask of our profession, “Are you knight or knave?”
The supposition, that there exists a dichotomy of options for the current physician, is a false one. Likely we are a little bit of both, and many shades in between. The maddening belief that the future of our healthcare system depends on this delineation is preposterous. I would more aptly characterize us as pawns.
The time for change has come.
After patiently listening to my …
Physicians need to speak with a unified voice
As my head reels at the implications of the IRS scandal mushrooming in Washington, the IRS’s recently disclosed ability to access emails without warrant, the intricacy of the NSA PRISM wiretap techniques that includes their ability to acquire tech firms’ digital data, and even the Justice Department’s ability to secretly acquire telephone toll records from the Associated Press, I wonder (as a doctor) what all this means for the privacy protections afforded …
Does HIPAA really protect our privacy?
In 2009 I wrote a post titled “Quality or Conformity,” where I pointed out that many of the quality measures in primary care have more to do with whether doctors follow guidelines than if they deliver care that helps patients live long and well. There is a tendency to focus quality efforts on measuring what is easy to measure, rather than what matters the most.
That phenomenon is called …
Quality is a word that lacks universal meaning
Do you want to know if your doctor has been eating pizza for lunch that was purchased by Pfizer as she listened to a drug rep describe a new medication? Do you want to know if your endocrinologist has been paid $1,500 to give a brief talk about a new injectable diabetes medication to his colleagues as they gobble down filet mignon? If the answer is “yes,” then you are …
Should the Sunshine Act be celebrated?
Ralph Cramden was the quintessential sucker. I suppose only people of a certain age — my age, for instance — will remember Ralph. If you have fewer gray hairs than that, perhaps you will remember the next incarnation of Ralph, Fred Flintstone. The Honeymooners character, brought indelibly to life by Jackie Gleason, was the inspiration for Fred, just …
Either we are suckers, or we think health sucks
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If you are a healthcare provider—physician, administrator, or some other leader at a healthcare site—then you know that you face many challenges. Some seem overwhelming and you may be thinking that you may not be able to handle some of them well. Perhaps the transition to ICD-10 coding is your main concern right now.
The solution to difficult challenges begins with the first step. I am taking the liberty of adapting …
The transition to ICD-10: Where to begin?
As we walk the halls and sit in the lectures at the annual meeting of the American Society of Clinical Oncology, there’s an elephant in the room. It is right there in front of us, but not many of us seem willing to talk about it. Fewer still are making any commitments to do something about it.
So what is …
Directing cancer resources in a limited resource world
If you listen to the pundits, the future of medicine is big: big medicine, big data. And indeed the healthcare policy of our nation is couched in the promise of what is to come. Many dictates of the accountable care act focus on the ability to aggregate and consume a variety of inputs. ICD-10, EMRs, and meaningful use all tie nicely into a beautiful computational orgy.
Big data, however, has it drawbacks. One wonders if in …
Do we want big medicine or good medicine?
As Americans we spend more money on healthcare per capita than any other nation in the world. We have the latest medical innovations and for decades have been able to provide cutting edge therapy without regard to cost. However, as a profession, doctors are not doing nearly enough when it comes to prevention of disease. Certainly, costs will be reduced if we are able to prevent chronic illness and associated …
The powerful effects of culture and lifestyle on health
Racial disparities in health and healthcare are a persistent and troubling problem for the U.S. Despite substantial policy efforts to the contrary, racial and ethnic minorities, especially African-Americans, often receive a lower quality of care and have worse outcomes. The key questions, of course, are why do these disparities exist, and what might we do about them?
Over the past decade, two primary theories have emerged to explain disparities and propose …
Addressing racial disparities in health care
Twelve years ago, in its landmark study Crossing the Quality Chasm, the Institute of Medicine (IOM) found that “the health care industry is plagued with overutilization of services, underutilization of services, and errors in health care practice.” In simple English, the IOM reported that health care was riddled with overuse, underuse and misuse of medical services.
The IOM also defined quality health care as “the degree to which health services for …
Some patients are receiving too little care
When an employee leaves a position, management might conduct an exit interview. The idea is obvious: one can learn a lot from those who are free to speak candidly.
This is why I think it’s worth listening to doctors who no longer practice medicine.
Enter Dr. Ed Marsh, a former pediatrician, who writes this poignant and relevant essay. His tone and candor is one of a man who still cares about …
Obamacare fails by not listening to the voices of the caregivers
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