Anyone who has ever tried to buy health insurance in the open marketplace knows how difficult and expensive it can be. I spent years working at jobs that did not provide health insurance, and I remember the annual feeling of dread when I received notice of the new premium increase. The only way I could keep the cost affordable was by continually raising the deductible until eventually, I was paying …
Why are there vending machines in hospitals? This seems like an odd question to ponder, and it certainly would seem to have nothing to do with the current state of medicine and health care in our country. But it is a question that I am having a hard time wrapping my brain around. Certainly, most hospitals do have vending machines that sell snacks and soda, and they are by no …
There are many apt comparisons to be made between aviation and health care. As a (lapsed) instrument-rated pilot, I may have some insight about the system in which planes function on a daily basis in the United States. It is truly an impressive system which is (to paraphrase Don Berwick) well-designed to achieve the safety results that it does. However, the kind of statement that some health care safety leaders …
The United States is facing a looming physician shortage, and some groups see this as an opportunity to promote an agenda of replacing physicians with nurses.
The nurse-as-doctor concept appeared in the Institute of Medicine Future of Nursing 2011 report, which called for a radical change to the nursing structure in the United States, including a goal of …
“Nurse practitioner (NP) education is seriously underfunded. The profession is attempting to saddle private physicians with this cost.”
That is how “Dr. X” replied to my email asking whether he would be willing to precept a nurse practitioner student for her clinical rotation. I read through his clearly disgruntled letter and wanted to explain to him why NPs have to train “on the backs” of physicians and why funding for nursing …
The announcement that CVS plans to acquire Aetna for US$69 billion raises hope and concerns.
The transaction would create a new health care giant. Aetna is the third-largest health insurer in the United States, insuring about 46.7 million people.
CVS operates 9,700 pharmacies and 1,000 MinuteClinics. A decade ago, it also purchased Caremark and now operates …
When interviewing for my book, I asked about insurance, but the topic came up even when I didn’t specifically ask about it. It was never positive in relation to practice.
A doctor said, “I expected to be around tough and hard cases. I expected it to be hard. I did not expect to have to think if the insurance company will not pay for it.”Another one said, “This completely changes the …
As a trainee at a large private health system (residency) followed by a NCI-designed comprehensive cancer (fellowship) in two large metropolitan areas in the United States, I was not prepared to face the challenges of working at a university setting affiliated with a county (public) hospital in more rural west-Texas. After one and a half years of experience as a practicing urologic oncologist, these are the five challenges I have …
Eat what you kill.
Sounds like a mantra from a survival reality show, right? Akin to “eat or be eaten,” “kill or be killed.” It’s also a common reference to the prevailing business model in our American scarcity-minded, competition-driven, fee-for-service health care culture. How ironic, the application of these words to this profession. It was explained to me essentially as: “Every man for himself, and you’re a minion. You are expected …
The truth about change in health care was never more perfectly captured than in an episode of Sex and the City, when Carrie Bradshaw lamented that we keep “should-ing all over ourselves.”
In the past decade, those of us on the front lines of health care have seen the passage of nine major pieces of federal legislation that, combined, have profoundly affected how they work. We’ve seen the number of people …
In 1729, a prescient Jonathan Swift wrote an essay that has a place in the health care debates of 2017. “A modest proposal for preventing the children of poor people from being a burthen to their parents or country, and for making them beneficial to the publick” reads almost like the title of a modern academic manuscript. Then, as now, it was important to look past the title before re-tweeting, …
Prescription opioid abuse is one of the United States’ greatest public health challenges. Approximately 97.5 million Americans consume opioids annually, and around 90 people die every day from opioid overuse. The last time in recent history a health care crisis garnered this much public attention was following the release of the 1964 “Surgeon General’s Report on Smoking and Health” correlating smoking to heart disease and …
The Office of the Surgeon General existed since 1871 when Dr. John Woodworth was appointed the first supervising surgeon of the national hospital system. In the previous year, the Marine Hospital was reorganized into the national hospital system. On January 4, 1889, Congress formally recognized the new personnel system as the Commissioned Corps. The Corps was established along military lines and initially consisted of only physicians. They …
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The Sunshine Act is part of the Patient Protection and Affordable Care Act passed in 2010. This act went into effect in August of 2013 and requires the full disclosure of any payments (or transfers of value, i.e., lunches and dinners) made to physicians from pharmaceutical and medical device manufacturers.
The spirit of the act is to have more transparency with regards to potential conflicts of interest created when physicians receive …
It’s a tale of two health systems: the VA and Kaiser Permanente.
The U.S. Department of Veterans Affairs, Veterans Health Administration (VA) is a mission-driven health organization, serving our nation’s veterans. A patient population of 8.9 million, led by David Shulkin, MD. An early leader in health technology adoption. The VA has faced serious issues; however: long patient wait times (deadly long in some cases) and high physician turnover rates.
Kaiser Permanente …
According to Wikipedia, “Productivity describes various measures of the efficiency of production. A productivity measure is expressed as the ratio of output to inputs used in a production process, i.e., output per unit of input. Productivity is a crucial factor in production performance of firms and nations.”
Please tell me how this relates to being a physician or a patient. We do not produce anything. Rather we work with individuals to …
There is a 4,300-strong grassroots movement known as “Save Our Hospital” gaining notoriety in Albert Lea, Minnesota. This story is symptomatic of the fact that hospital consolidation has slowly become a national pastime. With declining revenue under the Affordable Care Act, mergers increased by 70 percent, leaving small communities scrambling for health care access. The latest casualty in the “hospital-consolidation-for-sport” trend is Albert Lea, a small …
A curious post popped up on my Facebook feed recently: “Another doctor running for office!” A picture of an attractive family was nestled below that exclamation, asking to show your support (in the form of dollars) for this doctor running as a Democrat for the House of Representatives. It had that sense of enthusiasm that implied I was obligated to be excited, but instead came off more like Jeb Bush’s …
Repealing and replacing the Affordable Care Act is on indefinite life support. The political consensus was that President Trump needed to pass health care reform to be able to move forward with his legislative agenda. While this may be true, the passing of any repeal and replacement bill without fundamental reforms has little chance of long-term success, likely defining Trump’s presidency as a failure no matter how successful he is …
It’s a health care buzzword for sure, but when we talk about quality, what do we mean? We can compare the quality of similar things and focus on its absence, but otherwise, putting the idea into words becomes complicated. Context is important. And so is perspective: One’s position within the health care system influences how he defines quality to a larger degree than it does at a restaurant, or in …
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