How do we change the way we think about taking care of patients, particularly when it comes to not the individual patient sitting in front of us, but a whole population of patients just like them (or somewhat like them)?
In our practice, we have been struggling with how to best do population health, trying to find the best ways to …
To do population health right, think about individuals
The term “physician compensation” could be among the top phrases in health care this year.
Though it’s always been a hot topic, it got hotter when the Trump administration announced a proposal that would affect nearly 40 percent of Medicare payments. That plan would replace a fee scale that compensated doctors more for seeing sicker patients with …
5 anomalies about compensation physicians should know about
This article is sponsored by Careers by KevinMD.com.
To err is human, and in the health care arena, avoiding errors is crucial. Efforts to address communication-related or “soft skill” failures have been ongoing since about 20 years ago when the Institute of Medicine (IOM) published reports titled To Err Is Human and Crossing the Quality Chasm. When we rely on …
3 surprising links to medical errors
In the United States, 25 million adult women are insured by their state Medicaid program. Medicaid covers 60 percent of all births in the United States as per federal law, and states must cover all pregnancy-related services for pregnant women with incomes up to 133 percent of the federal poverty line. There are two Medicaid insurance payment models: a fee-for-service model, where the state pays for individual services, and a …
How religious exemptions will affect Medicaid managed care
Of late, doctor/friends on social media have taken to reposting news articles detailing the horrors taking place in other nations because of the evil scourge known as socialized medicine. In fact, the two words, alone or together, just don’t carry anything near the weight of the pain and suffering they imply, so I have taken to adding this exclamation point, in parentheses, to make it absolutely clear how terrible a …
The demonization of socialized medicine
How can we forget John Bender from The Breakfast Club? How can we forget his tousled wave of chestnut hair, cutoff lumberjack shirt, emanating cool with a cigarette perpetually in hand? In light of the 78 percent rise in e-cigarette use by high school students this past year, what we cannot forget is how deftly he convinced his peers to smoke with him. While the …
What the FDA forgets in the battle against e-cigarettes
Many of us working in the “Gun Sense” field – that is, finding a middle ground position to advance firearm safety and reduce preventable injury in our patients – had an “a-ha” moment that led us to toil in these fields.
Mine was on Nov. 2, 1981, when my friend and co-resident Dr. John C. Wood II was shot right in front of our hospital emergency room …
Physicians have an obligation and an opportunity to reach out and speak out about guns
In 2006 Dr. Tom Bodenheimer wrote an article that was published in the New England Journal of Medicine entitled, “Primary Care – Will It Survive?” Dr. Bodenheimer spoke with great concern about patients’ growing unhappiness with their primary care physicians and physicians’ increasing frustration with their practice environments. The patient-centered medical home (PCMH) model entered the scene in 2007 -2008 with the lofty goal of fixing the ills of primary …
Primary care today: There are several concerning trends
Ask any physician what quality is, and you’ll get many different answers.
You will hear answers such as “finding a cause for their pain,” “ruling out a life-threatening condition,” “partnering with patients to improve their health” or “offering the most evidence-based and up-to-date medical treatments.”
Here’s what quality isn’t: Running a bunch of useless tests, prescribing non-evidence-based medicines, or spending hours on documentation in an EHR.
Therein lies my frustration with the government’s …
Redefining quality through a patient-centered approach
I spent my early and mid-career years working in a pediatric intensive care unit (PICU) at a large academic center. We did almost everything except for a few things esoteric at the time — small bowel transplants, a few kinds of experimental surgery. I’m now in my late career (but have no plans to quit anytime soon!) and work in a smaller PICU. I am frequently confronted with the issue …
The Wild West approach to PICU practice
Recently, social media and news organizations have been awash in the physician-led backlash to the NRA’s now infamous “stay in your lane” tweet, and consequently, awash in images of the literal blood of seriously wounded or now deceased patients. Gun control is undeniably a cause near and dear to many physicians, who are duty-bound to try desperately, many times in vain, to save the lives of too many innocent Americans …
The blood of patients is not a rhetorical device
I have had the fortune — both good and bad — of being at the forefront of reforming physician reimbursement as an advocate for physicians. I’ve worked on models spanning private practice, group employment, faculty practice plans, and independent physician associations.
It’s been a bruising journey.
There were the old ways — relative value units (RVUs) and other tortured renditions of …
6 ways to smooth the journey to value-based care
On Wednesday, I did a gunshot-wound autopsy. On Friday, I was going into the morgue to perform another when I checked Twitter and saw this.
Doctors across the U.S. and across medical specialties were already responding and sharing photos: their face shields spattered and scrubs drenched in their patients’ blood; more blood on the emergency room …
This isn’t just my lane, it’s my highway
ADVERTISEMENT
Does anyone in medicine, particularly emergency medicine, understand why we lose money? Why we have to push those metrics so hard to capture every dime?
I mean, we’re constantly reminded that satisfaction scores, and time-stamps and time to door, time to needle, time to discharge, reduced “left without being seen” scores are connected to the money we make.
Medicine now is far less about the wonder of the body, the ravages of …
Money will be lost in health care. This is true no matter how we describe it.
Have you ever been to a doctor’s office and felt that your evaluation was rushed? Have you been seen in the emergency room and felt that you were just a number in a long series of patients? Have you ever seen the same doctor for years and felt like the doctor just met you for the first time each visit?
Chances are we’ve all experienced this as patients. If we’re honest, …
Here’s what the corporatization of medicine is doing
Health care is on a different trajectory from most other businesses today. It’s a little hard to understand why.
In business, mass market products and services have always competed on price or perceived quality. Think Walmart or Mercedes-Benz, even the Model T Ford. But the real money and the real excitement in business is moving away from price and measurable cookie-cutter quality to the intangibles of authority, influence, and trust. This, …
Health care is on a different trajectory from most other businesses. Why is that?
Moving to the Bay Area from the Midwest was a culture shock in many ways. I was amazed by the diversity, the food, the openness of opinions. And I was struck by the traffic, the stark differences driving from one community to another and the homelessness — you could see signs of it everywhere. As time went on, I acclimated to these changes. Working in the hospital, I got used …
The problem with mental health funding and prisons
In a previous post on LGBTQ care, Dr. Carlene MacMillan called attention to the importance of respecting patients’ pronouns. As she points out, discrepancies between patients’ chosen names/pronouns and gender markers on official documents can pose real challenges to providing patient-centered care. Even if health care providers know their patients’ self-determined identities, electronic health records and insurance claims can still betray them.
The issue of compassionate and …
A need for structural change to improve the safety and well-being of LGBTQ people
Corporate health care mentality set up nurses up to be inhuman while holding us to superhuman expectations. We’re told to be caring — but not allowed to do it. It’s time to demand that we stop being abandoned and dismissed by dysfunctional leadership.
Early in my nursing career, I was assigned to the pediatric area for one shift in a busy emergency department (ED). Our team received notification of an incoming …
This seems to be the big take-home message from voters the mid-term elections, which bodes well for preserving gains from the Affordable Care Act and expanding coverage. Health care was the number 1 issue for voters according to several exit polls, beating out immigration, the economy, and gun violence, among others, with voters strongly favoring Democrats as the party more likely to protect patients with …
5 health care lessons from the mid-term elections
Get free updates delivered free to your inbox.
