There’s no question the Accountable Care Act needs work – everyone agrees on that.
So let’s talk about the specifics – what needs fixing, why, and how can we get those fixes passed.
First, let’s understand how bad our current system is. Some who want to repeal and/or replace the ACA continue to publicly state we have “the best health care in the world.”
While that may – or may not – have …
Having insurance does not mean you get health care
The intersection of social media and privacy has made an older generation, and even some of my own generation, incredibly uncomfortable. There is talk of present and future consequences. Lost jobs, lost income, civil judgments, loss of respect/embarrassment, even criminal penalties for all that you put online. There is an idea that the blurring of intimate boundaries will come back and bite a whole generation.
Being online has responsibilities and consequences, …
Social media should be embraced by health care
Here’s a simple key to parsing the future economics of healthcare. We have been trying for over 30 years to control healthcare costs. And there is little evidence that any of these efforts have had much effect. For decades the rise in healthcare costs has been consistently several times higher than the general inflation level.
There have been dozens of schemes used in various parts of the industry — inpatient, ambulatory, …
Healthcare costs can be reduced with emerging business models
When you think about giving a premature baby the best possible start in life, it is important to consider the hospital where they are born. The care an extremely premature baby receives immediately after birth makes a big difference in outcomes.
A premature baby who is less than 32 weeks gestation or weighs less than 1500 g at birth should be cared for in a level III NICU. These babies also …
Where an extremely premature baby immediately receives care matters
About seven months ago, I began training kung fu with my family. Our classes are intense and require the students to really pull out our personal best. Periodically our instructor will remind us by shouting out, “Train like a black belt!” when she catches us being sloppy or less than enthusiastic. Her exclamation inspires me to squat a little lower in my horse stance, amps up my intensity, and focuses …
Integrity, discipline, respect: Using kung fu to control your eating
“How to Haggle With Your Doctor” was the title of a recent Business section column in the New York Times. This is one of many similar directives to the public in magazines, TV and Websites urging us to lower the high price of our health care by going mano a mano with our physicians about the price of tests they recommend and the drugs they prescribe. Such articles provide simple, …
Haggling with your doctor about the costs of care
I recently pointed to a BMJ study concluding that pay for performance doesn’t seem to motivate doctors. It has been picking up steam in major media with TIME, for instance, saying, “Money isn’t everything, even to doctors.”
So much is riding on the concept of pay for performance, that it’s hard to fathom what other options there are should it fail. And there’s mounting evidence that it will.
Aaron Carroll, a …
What’s next for doctors if pay for performance fails?
In a hospital setting, administrators love to work with physicians; they make sure whenever a new system is being formulated and implemented, this is discussed with a team of physicians, as they are also an integral part of success. All physicians work with each other in harmony and synchronicity.
Cardiologists never step on each other’s toes, radiologists call admitting doctors for any bizarre findings and hospitalists notify the primary about their …
The void between physicians and administrators in hospitals
I recently headed off to a reception for students from the new Pacific Northwest University of Health Sciences in Yakima, WA who are spending their third year of osteopathic medical school in Puyallup, WA doing rotations with the physicians in our community. I’ve had a student with me recently, and it brings back memories of my third year in med school, and how things have changed. It also leads me …
Seeing a family physician at work is valuable for medical students
Electronic medical records and pay for performance are among the ways health reformers are going to improve patient care.
It’s a fundamental shift in how doctors practice, with more practices adopting expensive EMRs. And with the advent of Accountable Care Organizations, doctors will soon be compensated in part by quality measures.
But will they work? Well, the jury’s still out.
Two articles caught my eye recently.
The first, from the WSJ’s Health Blog, reports …
Electronic medical records and pay for performance don’t improve care
by Dennis Grace
I recently received a message from the Center for Connected Health. I must admit the opening of the letter really put me off. It asked:
How do you solve the puzzle of patient compliance?
I responded to the gentleman who sent the invitation with:
Well, you might start by calling it something less offensive. Patient compliance? The phrase assumes “patient” as direct object rather than subject of participatory medicine. We …
Solving the puzzle of patient compliance
The approval of dabigatran (Pradaxa) has been long awaited in the cardiology community. Although just about everyone agrees that a good alternative to warfarin is highly desirable, there are many remaining questions about the drug as it prepares to enter the marketplace.
Here are a few questions raised by electrophysiologist John Mandrola on his blog:
Dabigatran (Pradaxa) questions in atrial fibrillation
by Danielle Leach, MPA
“A true friend walks in when everyone else walks out.”
I read that on a magnet on my friend’s refrigerator recently and the simple power of that saying brought me to tears. I have learned that lesson of true friends since my son’s diagnosis of cancer in 2007.
Anyone who has faced a serious illness as a patient or a caregiver knows that you quickly learn who your …
A lesson about true friends for those facing serious illnesses
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Adoption of electronic health records (EHR) systems remains a challenge, both for hospitals as well as for physicians in ambulatory practice. The process of adoption, implementation, and meaningful use of EHRs (let us keep in mind) is actually quite different between those two setting.
Much has been written concerning EHR adoption within hospitals. Much of the experience in computerized physician order entry (CPOE) comes from hospital EHR adoption, and many of …
EHR implementation in the ambulatory or hospital setting
As I walked into the ED for my shift, the nursing supervisor was fumbling with a syringe attempting to get medication out of a small vial.
“Ummmm. Looks like you need to adjust your bifocals,” I quipped. We have a running joke about who is older and bust on each other about our ages every chance we get.
When she turned around, the look she gave me signaled that it was no …
Your worth as a physician can be judged by how people invoke God
The other day, I happened to be talking to Mark, a sales representative from one of the pharmaceutical companies. He’s the type of rep that many doctors don’t mind seeing – someone who is careful of your time, is happy to hunt down the answers to questions that come up on the medications his company makes, and brings by useful information about new drugs that seem to be practice-appropriate. He …
FDA regulation and non-approved use of drugs
The following is a brief list of some of the things I think have been useful and worth their money in my first two years of med school:
1. Large, widescreen computer monitor. The volume of information required to internalize during the preclinical years of medical school can’t be compiled and organized on paper. You would end up with bookshelves filled with those gigantic 4″ binders. Therefore, almost everything happens on …
Useful things to buy during medical school
The Institute of Medicine has been an advocate for clinical guidelines for many years.
Although the value of guidelines has never really been established, both clinicians and medical malpractice attorneys often want to ascribe greater credibility to them than they deserve. The issue was raised again in the past few months and I review it briefly here.
A few years ago Dr. Robert Ewart discussed the ethics of using guidelines to screen patients …
Malpractice attorneys shouldn’t rely on clinical guidelines
US District Judge George Steeh of Michigan ruled last year that the constitution permits the federal government to require individuals to obtain health insurance coverage.
This lawsuit was filed by a Christian legal organization called the Thomas More Law Center, as well as others. Other lawsuits are in the works in numerous other states. These suits are filed primarily by Libertarian-types who don’t want to be forced to buy health insurance …
Government is already involved with the majority of health care
Every once in awhile amidst the weekly deluge of medical articles comes a show-stopper that has the potential to change the way we practice.
Rarer yet is the article that not only changes how we practice, but calls into question why we do what we do.
This recent article from the New England Journal of Medicine is just such an article. Before you bolt, let me simplify it for you.
Palliative care can lead to higher quality of live and longer survival
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