As we behold the continued wonders of Obamacare, we receive another reminder of the president’s empty promise: “If you like your doctor, you can keep your doctor.” The New York Times observed, “No matter what kind of health plan consumers choose, they will find fewer doctors and hospitals in their network — or pay much more for the privilege of going to any provider …
Walter White and the narrow networks of Obamacare
Health care is but one element of what makes the biggest difference in health outcomes: Social factors play a far more significant role. Income and its distribution, education, employment, social supports, housing, nutrition, and the wider environment — what we have come to know as the social determinants of health — are the most powerful predictors of wellness and longevity. This has been understood for centuries, and empirically validated in …
Health has to go beyond health care
There’s a war being waged on one of America’s most revered institutions, the emergency room. The ER, or emergency department (ED for the sake of this post) has been the subject of at least a dozen prime-time TV shows.
What’s not to love about a place where both Doogie Houser and George Clooney worked?
Every new parent in the world knows three different ways to get to the closest ED. It’s the …
Stop the war being waged in the emergency department
The fate of the Affordable Care Act (ACA) will be the big issue in the upcoming mid-term congressional elections, with Republicans and their allies continuing to press for repeal, believing that it is a winning issue with voters (or at least the base voters who lean Republican). Opinion polls are not as clear-cut, though. Although more Americans continue to have a less favorable than more favorable view of the law, …
4 ways to improve the Affordable Care Act
Whether it’s a knee replacement avoided for years or an urgent life-saving tumor removal, when the decision for surgery occurs, too often the patient begins a journey into a complex system of fragmented medical care. Perioperative care, which generally refers to the three phases of surgery — preoperative, intraoperative and postoperative — can be variable and fragmented. …
Better outcomes and lower costs: The perioperative surgical home
I just realized what all these new insurance intermediaries, programs and organizations remind me of: derivatives. And we all remember how well that worked out for stocks a few years back.
Let me explain.
A few years back, a bunch of Wall Street financiers came up with a bunch of new ways to package various stocks and securities that were intended to be too convoluted for anyone to figure out that they were nothing …
The health insurance shell game reminds me of derivatives
An excerpt from Pharmacy on a Bicycle.
One of the more impressive success stories in health improvement in a low-income country is Rwanda. This small landlocked country of 11.37 million was devastated by genocide in 1994 that left 800,000 people dead, affecting everyone in the country. The tragedy occurred …
Rwanda: The little country that could
An excerpt from Beyond Heroes: A Lean Management System for Healthcare.
Lean was a serious initiative from the beginning. It was energetically championed by our CEO at that time, John Toussaint, MD, who began his own lean investigations in 2002. By this time, I was a vice president with operational responsibilities …
Implementing lean: A hospital case study
Health care reform is a reality. The ACA and its associated mandates have forever changed the landscape of medicine in the U.S. today. The Obama administration touts the goals of reform as providing affordable, cost effective, high quality care for all Americans. Certainly these are noble and lofty goals: But have we completely missed the mark?
Today, many remain uninsured and the majority that have signed up for the exchanges are simply …
The salaries of health executives: What can doctors do?
How do we motivate physicians and other health professionals to work at their best? How do we create systems of high performance? Is it by a series of top-down highly specific mandates or by setting up general guidelines and providing tools?
I believe it comes down to one’s vision of physicians. Are physicians knights to be empowered in their service of patients …
Improving health care: Are physicians knights or pawns?
The process of becoming an excellent physician is one of mastery. The passion of the child is replaced by the studiousness of the teenager, and the bottomless energy of the young adult. The leap from decision to clinician takes decades. Forged in the steel of experience, trampled by pain and tortuous repetition, ability accrues.
The apprentice guards his knowledge closely. He bows …
Demonizing doctors won’t solve our problems
Whether you are a veteran of not, the recent report of waiting lists, and possibly preventable deaths of veterans, has implications for all citizens. There is no large health system which functions perfectly. But I would say that the efficiency of any given system is inversely related to its size. If this is true, then the VA health system is, and has always been, a bureaucratic and wasteful mess. Like …
What happens in the VA health system matters to all of us
A Veterans Affairs hospital in Fort Collins Colorado, it was recently revealed, falsified its wait times for outpatient clinic appointments. In order to appear to meet the goal of clinic appointments within 14 days, the hospital taught its clerks how to falsify the appointment records to create the illusion that the appointment goals were being met. Many of the 6,300 veterans treated at this clinic actually …
The VA wait list scandal: A sign of our future?
ADVERTISEMENT
This post deserves a caveat — health care shouldn’t be a political issue. When someone comes into my office because they have chest pain, I don’t ask them, “What’s your political leaning?” before administering care. And now after reading about the recent delay of ICD-10 in Congress, I realized that my choice in practicing direct care was the most political and least political thing I could have done.
According to Read more…
Health care shouldn’t be a political issue
If my car insurance isn’t linked to my employer, should my health insurance? A recent projection by S&P Capital IQ, a research firm in the financial industry, estimated that 90% of Americans will receive health insurance from government exchanges by 2020. If this estimate were to come to fruition, it would represent a monumental shift in the structure of the American health care system. For over half a century, employer-sponsored …
Health insurance shouldn’t be tied to employment
“If you insure them, they will come.”
Those words might as well be the mantra of hospitals across the country, because they can expect an onslaught of customers thanks to the expansion of health insurance under Obamacare. A recent study published in Science showed increased emergency room use among people in Oregon who became eligible for Medicaid, compared to others who, literally by the luck of the draw, were not chosen to …
Protocol-driven observational units can reduce ER crowding
I had a silver-and-gold Passover. Hearkening back to the old Girl Scout song I learned from my mother:
Make new friends, but keep the old;
One is silver and the other’s gold.
With no space or equipment to have a seder myself, I was nevertheless the lucky recipient of not just one, but two invitations. The gold was thanks to a quarter-century-plus friendship; the silver was from a family we met the week before …
When are doctors truly accountable to their patients?
While grappling with the costs and imperfections of our health care system in recent years, a multitude of experts in the field found it useful and enlightening to compare health care to a variety of more familiar industries, and to suggest that health care should adopt operational models that have been shown to work well in those other industries.
From the financial industry, we learned that health care must be computerized. …
Applying the lessons learned in other industries to health care
Writing in the Wall Street Journal, Daniel F. Craviotto Jr. an orthopedist, made a plea to physicians to declare independence from third parties and emancipate themselves from servitude to payers, mandates and electronic health records (EHR).
As rants go, this was a first class rant. But its effect was that of a Charles de Gaulle’s whisper to Vichy France rather than a Churchillian oratory at the finest hour.
The article went viral (it has …
Rebutting a physician’s plea to declare independence
House Energy and Commerce Committee Republicans seemed surprised recently when representatives of the insurance industry reported that they didn’t have enough data yet to forecast prices for next year’s health insurance exchanges, the market was not about to blow up, and that so far at least 80% of consumers have paid for the health insurance policies they purchased on the exchanges. The executives also reported there are still …
Obamacare is up for grabs: Who wins in November?
Get free updates delivered free to your inbox.
