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Why popularity based payment for doctors is not the answer

Jan Gurley, MD

Physician

June 5, 2011

Part three of the three-part series, Let’s Pay Popular People More!

Perhaps you remember Sam, the chronic inebriate whose story I shared to discuss the pitfalls of basing doctor pay on patient satisfaction surveys.

Looking at his discharge papers, I wondered who helped Sam fill his survey out, and how much their “help” affected the results.

After all, millions upon millions of dollars are already now at stake for …

Helping acute care patients find the right care in the correct setting

Donald Tex Bryant

Health Policy

June 5, 2011

The number of patients with acute care problems visiting the emergency rooms is steadily climbing.

According to the article Hospitals Work to Reduce ER Wait Times posted on the ASQ website the rate is increasing at a 3% annual rate. This leads to several problems, including longer waiting time. An analysis of the growth reveals several trends in the demographics …

How to minimize the costs of surgery

Christopher Chang, MD

Health Policy

June 5, 2011

Surgery is expensive, there are no doubts about that. However, there are a few things a patient without insurance who desires surgery can do to minimize the costs as much as possible. Before going into cost-cutting measures, you first need to understand where the costs come from.

In rank order, the costs of surgery come from (highest to lowest):

Hospital Charges …
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How to minimize the costs of surgery

What the physician hiring process can learn from the NFL draft

Mark W. Browne, MD

Physician

June 4, 2011

As I was getting my daily fix of ESPN recently, something a bit different than the routine scores and highlights came across my TV.

Two very talented men, both potentially bound for NFL stardom, were showcasing their talents for scouts, coaches, recruiters, and reporters – a panel of judges if you will. Although these players have certainly proved their talents in the past, these workouts will likely determine which player an …

Vermont’s version of the Independent Payment Advisory Board (IPAB)

Kevin

Health Policy

June 4, 2011

by J. Walden Retan MD

Begin with what everyone knows. Healthcare costs and health insurance costs are climbing more than twice as fast as the cost of living, and have been for years. There is no need for numbers to prove the point. Just ask anyone who buys health insurance on their own, any employer trying to take care of his employees, any employee whose wages …

Will paying for outcomes improve healthcare quality and efficiency?

David B. Nash, MD, MBA

Health Policy

June 4, 2011

With the expected cutbacks in healthcare funding and the increasingly dismal outlook for “new” money in the healthcare pot, “value” has quickly become a key watchword.

In the past decade, we’ve seen many public and private payers implement value-based, pay-for-performance (P4P) programs as a means of spurring healthcare providers to improve the quality of services they provide and, tangentially, reduce the …

Themes explaining why people are obese

Arya M. Sharma, MD

Conditions and Diseases

June 4, 2011

In my interactions with patients, I always ask them to tell me when their weight problems began and what they believe contributed to their weight gain.

Broadly speaking, there are two categories: people, who were big (or were considered big by others) as long as they can remember and those, who can often clearly pinpoint when their weight …

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Themes explaining why people are obese

Examining the evidence behind a community health screening

Kenneth Lin, MD

Physician

June 3, 2011

The following deceptive advertisement appeared in my church’s bulletin yesterday:

Life Line Screening, the nation’s leading provider of preventive health screenings, will offer their affordable, non-invasive, painless health screenings [in the church cafeteria] on April 9th. Five screenings will be offered that scan for potential health problems related to: blocked arteries, which is a leading cause of stroke; abdominal aortic aneurysms, which can lead to a ruptured aorta; hardening of the …

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Examining the evidence behind a community health screening

Niaspan and how comparative effectiveness research was done well

Harlan M. Krumholz, MD

Medications

June 3, 2011

Comparative effectiveness research — investigations that determine which treatments are best — has attracted attention in the health care debate. Critics charge that these studies are designed to restrict choice. The Center for Medicine in the Public Interest released a report that suggested that they would stifle innovation. Often they are framed as studies to support efforts to keep useful but expensive …

The science and treatment of jet lag

Kevin

Conditions and Diseases

June 3, 2011

by Mike Cadogan, MB ChB

Crossing multiple time zones can produce a constellation of symptoms known as jet lag.

Jet lag is most noticeable in the first 24-48 hours following travel and can last for up to 5 days before individuals return to normal functioning. Symptoms are closely affected by both the length and direction of travel. Symptoms include: reduced alertness, night-time insomnia, loss of appetite, depressed mood, poor …

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The science and treatment of jet lag

Unrealistic optimism in early phase new drug studies

Richard Leff, MD

Medications

June 3, 2011

In a thoughtful posting in the New York Times, Dr. Pauline Chen, a well respected observer of the doctor-patient relationship, points out an ethical dilemma that faces cancer researchers working in drug development conducting early phase (I) new drug studies. Ethicists have identified that patients in these studies often have unrealistic optimism about their personal outcomes despite …

Health reform’s prejudice against specialist physicians

Gary Levin, MD

Health Policy

June 3, 2011

Have you noticed the recent trend against specialty physicians? Policy experts have determined that primary care needs incentives to attract medical students away from those “highly lucrative” specialties such as plastic surgery, orthopedic surgery, interventional cardiology, and neurosurgery.

Our federal government believes in equal opportunity — if you wish to become a family doctor. There are incentives sponsored …

Stem cells will bring us closer to personalized medicine

Stephen C. Schimpff, MD

Conditions and Diseases

June 3, 2011

Stem cell therapies promise to be one of those scientific breakthroughs that will have an enormous impact on health care in the future.

Stem cells will bring us closer to the goal of personalized medicine, just as genomics is doing. The course of a disease will change once we have the technology to develop and then insert stem …

Nurses who work in the cardiac catheterization lab

Gina, RN

Patient

June 3, 2011

Ready to learn more about nurses who work beyond the bedside? Nurses who work in the Cardiac Catheterization Lab (CCL) play an important role in cardiac care. Amy Sellers, RN blogs at Nursing Influence and graciously agreed to give us a peek at what a nurse is responsible for doing in the CCL.

Amy has worked in the Cath Lab for about 6 months now. She previously worked in cardiovascular intensive …

Talking patients out of doing tests takes effort and time

Eric Van De Graaff, MD

Physician

June 2, 2011

I find that it takes more effort for me to talk patients out of doing tests than it takes to get them to submit. It doesn’t seem like it should be that way:

I need you to undergo a test where you fast for 12 hours, show up to the hospital 3 hours before the sun comes up, strip down and slide into a breezy hospital …

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Talking patients out of doing tests takes effort and time

Why cognitive doctors need to be paid more

Richard Reece, MD

Physician

June 2, 2011

Everybody has a theory of what’s wrong with American health care and why costs are high.

I have my own theory – talk is cheap. By this, I mean Americans and third party payers are unwilling to pay more for what mere talk is worth.

They do not want to pay more for a visit to the family doctor, …

How a dispute with an insurance company can affect patients

Donald H. Taylor, PhD

Health Policy

June 2, 2011

8,000 patients will no longer be able to receive care from UNC Hospitals and their affiliated physician practices because of a dispute between UNC and the insurance company Aetna.

The bottom line is that Aetna does not want to pay as much for care provided by UNC as UNC wants to be paid for providing this care. No surprise there, as the interests of the two parties (health care provider and …

Cancer in the gross anatomy lab

Jessica Gold

Medical Education

June 2, 2011

“I just want to learn the abdomen and the pelvis”, I thought to myself, while staring at our donor’s metastasized body. Nothing looked normal, tumor was everywhere, and for the 4th lab my group looked at each other, looked at the lab steps, and concluded it was going to be “just another day where we just … found what we could find and did … …

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Cancer in the gross anatomy lab

How primary care physicians can improve health and lower costs

Ricky Choi, MD

Physician

June 2, 2011

Ok, I confess. I have contributed to the $2.3 trillion that our country spends on health care every year. As a patient I want the best possible care for my family and me. As a physician I am the gatekeeper to expensive procedures, medications, and diagnostic tests. However, by several indices including life expectancy, infant mortality rate, and satisfaction with the health care system, we are not getting our money’s …