Post Author: Kent Bottles, MD

Who’s truly responsible for the $2.7 trillion medical bill?

Kent Bottles, MD

Policy

June 16, 2013

As someone who professionally closely tracks the debate over the transformation of the American health care clinical delivery system, I did not learn much new from the New York Times article: The $2.7 Trillion Medical Bill. I did find the article’s approach useful in explaining how the wide variations in price for procedures contribute to the unnecessary high cost of American health care.

Although the article did document many procedures …

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Are physicians really that special?

Kent Bottles, MD

Policy

January 16, 2013

We physicians like to think that we are really different from other workers. We physicians, perhaps thinking back to that medical school application essay we all wrote, really believe that we went into this career to simply help others. We physicians truly believe that we always put our patients first.

Because we sincerely believe all of the above, we are shocked when someone like Uwe Reinhardt points out that collectively we …

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What is the ideal payment system for health care delivery?

Kent Bottles, MD

Policy

January 3, 2013

The 21st century challenge for the American health care delivery system is to deliver higher quality care for less money. Republican and Democratic experts agree that payment reform involving transitioning from fee-for-service to global, value-based systems is necessary for us to achieve that goal. Accountable care organizations (ACOs) are the new entities that will receive the new global payments and distribute them to the doctors, allied health professionals, hospitals, and …

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Want to be a physician executive? 8 things you need to know

Kent Bottles, MD

Physician

October 7, 2012

1. You will have to move a lot. I went to medical school in Cleveland and did my pathology residency in San Francisco at UCSF. I was on the medical school faculty at UCSF, Iowa, Allegheny University of the Health Sciences, and Michigan State.

Since leaving academic medicine, I have worked at a bio-tech start up in Cambridge, an educational and research institute in Grand Rapids, a $2 billion integrated delivery system …

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Is the quantified self movement the future of American health?

Kent Bottles, MD

Tech

April 6, 2012

If you cannot measure it, you cannot improve it.
-Lord Kelvin

Asking science to explain life and vital matters is equivalent to asking a grammarian to explain poetry.
-Nassim Nicholas Taleb

Of course the quantified self movement with its self-tracking, body hacking, and data-driven life started in San Francisco when Gary Wolf started the Quantified Self blog in 2007. By 2012, there were regular meetings in 50 cities and a European and American conference. …

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Break out of the prison of the American health care delivery system

Kent Bottles, MD

Tech

February 17, 2012

Speaker after speaker at the recent Care Innovations Summit in Washington, DC concluded that increasing the quality and decreasing the per-capita cost of health care is the dominant political, social, and economic issue of our time. More than one expert called for a “jailbreak.”

“Jailbreak” for me meant either an obscure English reality television show or an expression applied to overriding the software limitations deliberately placed on computer systems for security …

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The rise of citizen scientists and patient initiated research

Kent Bottles, MD

Patient

December 10, 2011

Whether you call it Health 2.0, Medicine 2.0, or e-Health 2.0, the Internet is changing medicine in ways that challenge the status quo. This article explores how a group of amateurs who call themselves “health hackers” and “citizen scientists” are trying to use the Internet to connect with other patients, run experiments, and conduct clinical trials on their own diseases.

Dr. Gunther Eysenbach states “Medicine 2.0 applications, services and tools are …

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Patients and physicians in the digital age

Kent Bottles, MD

Patient

November 1, 2011

The digital age has had a deep and likely permanent effect on the patient-physician relationship. I can’t tell you how many times I’ve had physicians beg me to provide them with a way to stop their patients from Googling their symptoms and diagnosing themselves before their first office visit and much to their chagrin, my answer is always the same, “You can’t stop them. Get over it.”

The Internet acts …

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Physicians should embrace patient engagement

Kent Bottles, MD

Patient

October 20, 2011

The doctor/patient relationship is certainly changing and evolving. A term I hear a lot today is: “patient engagement/activation.” Why is this concept so important and what does it mean? What can physician executives do to make it easier for our patients to become engaged and activated?

Judith Hibbard has pioneered the study of patient engagement, and she noted that one needs knowledge, skills, and emotional support to actively engage in one’s …

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A hospital board needs to understand generative thinking

Kent Bottles, MD

Physician

September 29, 2011

Hospital systems and physician groups are faced with unprecedented change demanding decreased per-capita cost and increased quality in American health care. Boards of directors are underutilized resources that must be tapped more effectively in order for such organizations to survive in a time of industry consolidation. Generative thinking is a tool that can help organizations innovate in order to improve patient care and the financial bottom line.

Generative thinking is …

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United States health care may need reverse innovation

Kent Bottles, MD

Policy

September 15, 2011

The realization that the American health care system must simultaneously decrease per-capita cost and increase quality has created the opportunity for the United States to learn from low and middle-income countries. “Reverse innovation” describes the process whereby an inexpensive innovation is used first in countries with limited infrastructure and resources and then spreads to industrialized nations like the United States.

The traditional model of innovation has involved the creation of …

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Will patients trust sociable humanoid robots?

Kent Bottles, MD

Tech

August 25, 2011

Within in five years primary care providers will begin being replaced by sociable humanoid robots, avatars, and computer programs. Within ten years you will no longer hear any complaints about medical students choosing specialty residencies over family practice because the role of the physician will be completely redefined to complement a rules based approach to the diagnosis and treatment of many diseases. This transformation is inevitable because of demographics, economics, and …

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What would an ACO would look like if it was truly patient centered?

Kent Bottles, MD

Policy

July 26, 2011

Health care leaders are busy talking to attorneys and consultants about how to set up Accountable Care Organizations (ACOs). A recent Advisory Board survey found that 73 per cent of hospital finance executives said that creating such an organization was a top priority for their health system.

Last year my most popular keynote topic was patient-centered medical home creation; this year everyone wants a presentation on ACOs.

However not …

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Google Health failed because consumers did not see the value of a PHR

Kent Bottles, MD

Tech

June 29, 2011

To measure is to know.

-Lord Kelvin

If you can not measure it, you can not improve it.
-Lord Kelvin

Versus:

Asking science to explain life and vital matters is equivalent to asking a grammarian to explain poetry.
-Nassim Nicholas Taleb

Technology is at its best when it is invisible.
-Nassim Nicholas Taleb

How can technology help us live healthier lives? Why did Google Health fail? Why are Klout and Twitter Grader publicly issuing a number to me …

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How robots will teach us who we are as humans

Kent Bottles, MD

Tech

June 10, 2011

Recently, I took a Megabus from Philadelphia to Hunter College in New York City to attend Man-Made Minds: Living With Thinking Machines, a World Science Festival program.

Rodney Brooks, who until recently was Panasonic Professor of Robotics at MIT and who now is Chief Technology Officer at Heartland Robotics, was the first expert to speak, and he emphasized a very practical approach that was not too concerned with any negative consequences …

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Change of culture in a rapidly evolving health care environment

Kent Bottles, MD

Policy

February 19, 2011

When a health system asked me to facilitate a Board discussion on physician alignment and integration on November 12, 2010, I was already committed to giving a keynote on the future of health care for the American Institute of CPAs in Las Vegas on November 11. Although I usually fly Delta or USAir where I have priority frequent flyer status, the only way I could get to the Board meeting …

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Comparative effectiveness research (CER) needs honest discussion

Kent Bottles, MD

Policy

December 17, 2010

Comparative effectiveness research (CER) is suddenly a hot topic at all the health care conferences.

How come? Everybody agrees that we have to decrease per-capita cost and increase quality. Why? Government programs like Medicare and Medicaid foot more than 50% of our nation’s health bill, and if everything stays the same these programs will go belly up (bankrupt) in 8 years. Big problem.

Health and Human Services (HHS) has defined comparative effectiveness …

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Doctors should embrace feedback and learn from it

Kent Bottles, MD

Physician

October 31, 2010

In Quality Measures and the Individual Physician, Danielle Ofri, MD, PhD questions the usefulness of feedback report cards for individual providers. She states, “Only 33% of my patients with diabetes have glycated hemoglobin levels that are at goal. Only 44% have cholesterol levels at goal. A measly 26% have blood pressure at goal. All my grades are well below my institution’s targets.”

It would be better for Dr. Ofri’s patients if …

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Physicians must be aware of what they know they don’t know

Kent Bottles, MD

Physician

September 15, 2010

St. Augustine: “Fallor ergo sum”

When I was in charge of the medical residency programs in Grand Rapids, Michigan, David Leach introduced me to the expanded Dreyfus Model of how physicians can progress from beginners to masters.

I was always struck by how master physicians freely admitted their mistakes and used them as a teaching tool. As a young surgical and cytopathologist, my sanity was saved more than once by University of …

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