I’m sure Ezekiel Emanuel hates being referred to as Rahm Emanuel’s brother, so I won’t describe him as such. After working as one of Obama’s main health care advisors, he’s now at U-Penn in a job spanning medicine, economics, and ethics. He’s also been writing engaging essays in JAMA about health care reform and economic change that give us an augur into where health care reform might lead us.
Here, …
Why physicians may not buy into ACOs
A guest column by the American College of Physicians, exclusive to KevinMD.com.
Is medical ethics an important aspect of real world medical practice today? Or a quaint notion for the history books based on mom and apple pie generalisms?
For the patient and for the physician in practice, medical ethics is — or should be — a daily aspect of care. …
ACP: Medical ethics should be a daily aspect of care
There’s a great deal of planning and testing of new models of care and delivery to respond to healthcare’s ever increasing costs. We’ve all heard about Accountable Care Organizations (ACO) and medical homes. The common concern is that they become a repeat of HMOs with the accompanying misaligned incentives undermining their effectiveness. An exciting new medical home model is rapidly expanding that avoids the dreaded “gatekeeper” that was the undoing of …
How to avoid HMO gatekeeper problems in medical homes
Everyone in our industry — policymakers, clinicians, healthcare facility administrators, public and private payers, technicians, pharmacists — shares concerns about the state of healthcare in the U.S., each of us from a slightly different viewpoint.
The thread that joins us all is that one day each of us will be a patient.
As its title suggests, patients are central to almost every provision of the Patient Protection and Affordable Care Act (Act), …
Patient preferences may not be rational, but they are not irrelevant
I found a recent Associated Press article on an aspect of the new health care law that many of us may have overlooked. It requires consumer-friendly summaries of what insurance plans cover, a provision that now seems to be at risk. The insurance industry is up in arms about implementation costs and added regulatory burdens. (There’s a good story at NPR, which includes a link to an example of what …
Why we need to go from e-patient to i-patient
Jack and John are identical twins but have varying interests in life. One day Jack, 43 years old, decides he has had enough of these headaches and calls his family doctor and asks what he should do. He is told that his doctor can see him in 4 days and to take some over-the-counter ibuprofen. And to go to the ER if the headaches worsen.
John, who has also been having …
Identical twins with different ideas about health care
Don’t get me wrong, EMRs (electronic medical records) are inevitable. Over the long-run they are almost certainly good for physicians, patients and the healthcare industry.
However, their origin and the ulterior motives currently driving their adoption is sowing the seeds of their failure. First, what is actually happening out there? The most recent CDC data would seem to be encouraging for EMR adoption, with EMR use (finally) passing 50%.
Too bad …
Why EMR is a dirty word to many doctors
President Barrack Obama delivered a 6,944 word State of the Union address to the American people. Of the speech, less than .01% was devoted to healthcare, which is remarkable considering the major changes in healthcare that are on the horizon if Obamacare survives a challenge in an upcoming U.S. Supreme Court case. During the speech, there were only three sentences that mentioned healthcare.
The first was this: “I will not go …
Analyzing what the President said about health care
It has taken 13 years for us to revisit the issues in To Err Is Human, the 1999 landmark government report that shocked our nation with its revelation that 98,000 people died yearly in hospitals due to doctors’ errors. For decades, and through one administration after another, the lack of safety in our healthcare system has gone un-addressed, placing us at greater and greater risk. Hospitals have disappeared, …
Improve patient safety to improve healthcare quality
A social media movement is happening before our eyes with action starting to take shape. The #occupyhealthcare movement has begun within to the blogosphere and through various areas of social media by storm.
What does the #occupyhealthcare movement mean to me? My main focus in advocacy for family medicine is the production of an adequate primary care workforce distributed adequately to best serve our country. Those close to me also …
A lack of incentive for medical schools to train primary care doctors
The triple aim of health care, as defined by the Center for Medicare and Medicaid Services (CMS) is: improving the experience of care, bettering the health of populations, and reducing the per capita costs of health care.
This struck me as odd when I first read it. Why should the stated aim of any system become to decrease the costs associated with that system?
Which led to the next logical questions: What should be the stated aim of …
What should be the stated aim of health care in America?
The storyline is familiar. An organization is challenged to achieve better results without spending more money. An executive is committed to obtaining these better outcomes and recognizes that more financial resources aren’t forthcoming . Faced with the option of near-certain failure if he continues to work within the historic operating framework, he decides that a different approach is necessary. With the help of a young and visionary analyst, they decide …
How Moneyball applies to healthcare
Why are cancer organizations waiting until it starts to rain before they suggest buying an umbrella?
“Join my Medicare Advantage plan and get free membership to a local health club, free glasses and dental care.” This time of year, during Medicare Advantage Annual Enrollment period, the only TV commercials that annoy us more often are for lawyers who want to help us if we were injured at work or in a …
The problem of insurance gaps in cancer patients
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While payers and providers are usually in the spotlight when it comes to accountable care, the most successful models will be the ones that place a strong focus on patient accountability. More and more frequently patients are selecting doctors with the best outcomes, asking proactive questions, and taking an active role in their lifestyle and behaviors. Empowering patients with the support and tools to be responsible for and more involved …
Implementing strategies to encourage patient accountability
A guest column by the American Medical Association, exclusive to KevinMD.com.
Let me start by wishing you and your families a very happy and healthy new year. This is my first column of 2012 for this blog, and I am excited to talk about a new initiative that is beginning this year. Medicare accountable care organizations (ACOs) have been discussed at length …
AMA: A new model of patient care
Most hospital managers have never had the power to exert leverage over their most valuable resource, the physician, who, after all, admits the patients who make the hospital’s economic existence possible in the first place.
So I wrote in introducing a chapter in my first book in 1988. I hastened to add, however, at the close of that chapter, these admonishments:
1. The economic powers of the hospital is shifting from those …
How hospitals are gaining leverage over physicians
I am a little fish in a big sea. And so are most of us. Or we are used to be. For better or worse, the era of private practice, outpatient medicine as we know it, is ending.
And faster than we thought. The choice now: downsize or supersize. No longer can a doctor operate a private practice as a solo practitioner or in a small group practice. We are getting …
Doctors are forced to choose between really small or super big
As the new year starts, I’m eager for a fresh start and working on improving myself both physically and emotionally. I’m also eager for the NFL playoffs and seeing how my favorite team, the New England Patriots, fares under the leadership of Coach Bill Belichick and quarterback Tom Brady. Doctors and health care can learn much from their examples.
Over the past decade, the New England Patriots have been dominant …
What health care can learn from the New England Patriots
Health care is in crisis. Reimbursements from insurance companies continue to dwindle, while the expenses of running an office continue to rise. Looming cuts in Medicare are only weeks away, and many physicians may stop taking Medicare. If these cuts go into affect, it is possible that primary care physicians could lose up to 50% of their salary. Just recently CNN reported that some doctors are going bankrupt.
How …
A concierge or boutique label is discredits retainer medicine
“The moral test of government is how it treats those who are in the dawn of life, the children; those who are at the twilight of life, the aged; and those in the shadows of life, the sick, the needy, and the handicapped.”
We all know that health care in America is too expensive and yet ineffective, falling consistently at the bottom of the rankings of industrialized nations when it comes …
Addressing the needs of the disadvantaged in our health system
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