A few weeks ago I wrote a piece about performance metrics in medicine. People asked me: “Well, if you don’t like the metrics, what would you use?” So I thought about this, and the best way I can think of to explain what I mean is to use an example from a different field: education.
Standardized testing has become ubiquitous in schools. …
Doctoring to the test. Look to education for a cautionary tale.
I just finished reading the Journal of Hospital Medicine article called “The highest utilizers of care: individualized care plans to coordinate care, improve health care service utilization, and reduce costs at an academic tertiary care center.”
Using a multidisciplinary team of volunteers including members from hospital medicine, ER, psychiatry, ambulatory care, social work, nursing and risk management, individualized care plans were developed for high utilizer patients. These patients had multiple co-morbidities, …
The low-hanging fruit of health care costs
When I was a resident at the University of Virginia, my wisest mentors gave me one piece of advice that far exceeded all the scientific and statistical jargon that others expected me to swallow. Consider this: When patients walk into your room and sit down, shut up and look into their eyes. When they are done talking, have a conversation. The key word is conversation. The visit should not include a lecture or statistics …
What value do primary care doctors offer to our health care crisis?
This is important to you. Trust me.
If you’re young at heart, it matters because it’s your tax dollars this April. If you’re wiser in years, it directly affects your health and the system you’ve been pumping money into for decades. This is the same medical system that you thought would take care of you later in life. Again, this is about your money and your health, so read on.
Government-funded health insurance in the United States is administered …
Why CMS should get out of measuring health quality
According to OECD data, Americans see doctors less frequently than people in any developed nation. We are hospitalized less frequently, and we stay in the hospital less time than citizens of other nations. The vast majority of Americans, more than any other nation, describe themselves as healthy, and America has the largest percentage of young people in its population. So why is health care in America so much more expensive …
Tomatoes, ketchup, and direct primary care
I am not an economist.
This is how I start my high-value care session during the internal medicine clerkship orientation day at the Medical College of Wisconsin (MCW), and it is absolutely true. It doesn’t take an economist, though, to realize that health care is too expensive. Health care spending as a percentage of GDP has increased from around 7 percent in 1970 to almost 18 percent in 2010. An …
There are limitless opportunities to practice high-value, cost-conscious care
Life is tough for physicians in solo and small group practice. The federally mandated introduction this fall of ICD-10 requires physicians and their staffs to learn a new system of coding diseases. “Meaningful use,” another federal program, requires physicians to install and use electronic health records systems, which are complex and expensive. And PQRS, the Physician Quality Reporting System, is beginning to penalize physicians for failing to report individual data …
How can independent physicians survive the new health care climate?
Health care in America is a perfect example of the Pareto principle, because 80 percent of our gargantuan expenditures on health care are due to only 20 percent of us who are very sick, elderly, disabled and vulnerable in many other ways.
If we genuinely wished to reduce health care expenditures, common sense dictates that we would leave the 80 percent alone and zero in on those 20 percent, trying to …
Why not turn our health care disaster into an opportunity?
You’re 56 years old. You’re one of the 30 million people (give or take a bunch) that you hear have received health insurance in this country as a result of the Affordable Care Act. You are a positive number in the New York Times headlines the Department of Health and Human Services (HHS) have been wanting you to read. And, this is how it’s working …
People deserve real health care, not pseudo-insurance
I am of the belief that every ACO must be physician-led. We must depend on them not only for clinical improvement, but also for developing a culture of improvement. Culture is vitally important. Culture trumps dollars, technology, data, and about anything else you would use in clinical medicine.
If I was getting into the ACO business, I would start recruiting clinicians that embrace these characteristics:
1. Team leadership. Every doc is a leader to some degree, …
These are the clinicians you want for your ACO
Yeah, it happened. The SGR is finally dead. Hooray! Sort of.
I mean, it’s great and all that — we’ll no longer have the annual threat of a massive payment cut from a poorly crafted piece of legislation from the 1990s; we’ll no longer have to endure the annual ritual of last-minute legislative theatrics to avert the yearly cuts, we’ll no longer have to waste our lobbying time and effort …
The 92-8 vote in the United States Senate to join the House in passing the Medicare Access and CHIP Reauthorization Act (MACRA), H.R. 2, represents a remarkable milestone for the Medicare program, and for ACP advocacy on behalf of internists and patients.
It is remarkable not only because it eliminates the failed Medicare SGR — how often does Congress admit it made a mistake, and then correct it? — but because it …
SGR repeal and MACRA: Here’s why it’s remarkable
New York officials are doing an “experiment” that should strike fear, anger, and outrage in the hearts of doctors who take care of Medicare patients. (New York has the highest Medicaid budget of any state.)
As any doctor who has a high volume of Medicaid patients knows, Medicaid pays practically nothing. Doctors who take Medicaid usually have to carry a bigger patient load to survive. Medicaid patients are often sicker than …
Accountable care for Medicaid. No, we need real solutions.
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As the Obamacare machine continues to grind forward, many patients have re-enrolled in a second year of coverage. While most have not had to use their insurance (the young and healthy crowd), others have found their newly minted coverage to be far less than promised. High deductibles, and up front out of pocket expenses, forced many covered by the exchanges to avoid seeking regular preventative care. Prevention was one of …
Obamacare re-enrollment: What can patients do?
As the CMS Innovation Center rolls out the Next Generation ACO Model, I wonder what doctors are thinking. The Next Generation ACO model ups the ante on risk and reward and is the next delivery model iteration as CMS marches on to 30 percent at risk Medicare in 2016. Some of the docs will generally acknowledge that medicine is changing, but there is often no corresponding change in behavior. Other …
Can doctors afford to ignore the changes in medical practice?
It has become perhaps the silliest four letters in health care: PQRS. It stands for Physician Quality Reporting System. It’s another this and another that created by the Centers for Medicare & Medicaid Services (CMS). After you read this, you’ll be like me, scratching your head trying to understand why anyone thinks our health care system is better under CMS’s leadership.
CMS has setup a thing called PQRS, so physicians across the country …
The silliest four letters in health care: PQRS
It is amazing to me how far emergency medicine has come as a specialty. Until the 1970s, emergency rooms were staffed by low-level resident interns who moonlighted for extra money or physicians who couldn’t find work elsewhere. After finally getting recognized as a specialty, the specialty still spent a few decades finding its way: developing training programs, improving quality, and generally trying to raise the bar on emergency care in …
ER physicians can help meet the triple aim
Like most of my age cohort, I was brought up to believe that the great Satan threatening to undermine the bloated American health care system was our broken-down, antiquated, self-interested model of reimbursement for care provided called “fee-for-service.” Being a professional who, to the best of my ability, tries to maximize the value of the care I provide to my patients, I subscribed wholly to the notion that the cause …
Is there a role for doctors in the brave new health care world?
Recently, I had the opportunity to sit at the table with some of the nation’s top thought leaders. We convened at the Newseum in Washington, DC, for the Healthcare Leadership Council’s National Dialogue for Healthcare Innovation; it was like a health policy nerd red carpet. Center for Medicare Director Sean Cavanaugh was there. Leapfrog Group CEO Leah Binder was there. America’s favorite bioethicist–oncologist–
What exactly is value in health care?
One of the most revolting pleasures in life is to read learned opinions and in-depth analyses of consumers’ behavior written by beautiful people clad in designer clothing, dining at eclectic chic trattorias or enjoying the occasional canapé under crystal candelabra at their favorite charity gala. These wondrous creatures, having pored over a few disjointed numbers selectively allowed to escape from our struggle with health care, are informing us that there …
Health care consumer products need not contain real doctors
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