A version of this op-ed was published on April 12, 2011 in USA Today.
“Would you like to discuss your end-of-life plans today?”
It’s a question that I ask my patients, although not as often as I would like. Talking about death may be uncomfortable, but it’s a conversation that needs to happen more often.
We can never know …
End of life care is being influenced by politics
In 1994 Jeff Bezos revolutionized how consumers shop. He founded Amazon.com.
Shortly after, Ebay followed suit—solidifying a paradigm shift that has redefined shopping from an in-person to online experience. In 2004, Facebook capitalized on another trend: individuals were becoming more comfortable sharing personal information online. Interestingly, people did not wake up one morning and decide it would be convenient to shop from home, or that sharing pictures with their friends online …
Medicine’s paradigm shift is a microcosm of a trend occurring in society
During the election season, the biggest loser appears to be civility. Anger, attack ads and name calling ruled the day. We are faced with enormous and complex challenges, issues not easily addressed in sound bites. Yet that is what we usually get from our representatives. I find myself asking are we not willing or able to do the hard work of examining the issues before us?
During the ongoing discussions over …
People feel anger and fear over our health care situation
by Jeffrey L. Cohen
The current fixation on Accountable Care Organizations (ACOs) is causing an enormous amount of two things: 1) talking, and 2) inactivity.
Yes, the concept of delivering care in a manner that reduces or at least controls costs is important and interesting. Yet, the marketplace is replete with people and businesses that have adopted …
Physician responsibility and leadership is critical for ACO implementation
by Justin Chang, MD
I think we can all agree — physician, payer, provider, patient, etc. — that the ultimate goal of regulations and reform should be to improve the delivery of healthcare, lowering costs and ultimately, making patients healthier and more satisfied.
Coupled with driving toward the results defined by CMS, this requires some fairly significant changes …
How the ACO model can be successful
As a young primary care doctor in Kiev, Ukraine (then part of the Soviet Union), Dr. Elena Rogova learned her craft well, working in a hospital that catered to scientists, celebrities, artists, musicians and senior government officials.
As a top medical student, this hospital had sought her services, and she enjoyed her work there. Dr. Rogova had no intention of leaving …
Interviewing a primary care doctor to better understand her professional day
Everyone knows that the excess growth in health care costs is driving the fiscal crisis in our country.
The problem is that while everybody wants to somehow cut the cost of Medicare/Medicaid, in theory, when it comes time to actually make cuts, the courage of our politicians fails in the face of unrelenting public opposition to cuts in Medicare.
How the IPAB takes policy and puts it in the hands of health care experts
Glory be. There’s good news tonight in American healthcare.
It did not come from laws, regulations, or government edict, although there has been much government activity in the field; it did not come from the behemoths of information technology like Google, Microsoft, Oracle or Cisco, although much hard work in IT did precede it; it did not come from the for-profit healthcare industry giants like GE, Big Pharma, United Healthcare, or …
Organizations that link their IT systems to share electronic health records
What medical condition is the most costly to employers? I’ll give you a hint. It is also a medical condition that is likely to go unrecognized and undiagnosed by primary care physicians.
If you guessed depression you are correct. If you mentioned obesity you get a gold star since that comes in right behind depression for both …
Why depression continues to go undiagnosed and untreated in primary care
On January 1, the White House announced a new policy that would have paid doctors for discussing end-of-life planning during their Medicare patients’ annual wellness visit.
Under this policy, physicians would be paid to encourage their patients to establish an advance directive, which would guide medical care if the patient became incapacitated from illness, and could …
The advance directive is only a part of end of life decision making
Accountable Care Organizations (ACOs) are supposed to be provider-led (physician groups +/- hospitals) and, they are supposed to inject a new accountability, at the provider level, for the value of services delivered.
You know the old equation. Value=Quality/Cost. Those of us inside the health policy “beltway” know this mantra well. We have been talking about it for years (decades, really).
I spent almost …
An ACO must make the patient experience meaningful
by Andrew M. Ibrahim and John A. Brockman
Despite the landmark progress of recent healthcare reform, it missed the mark on long term cost control by failing to address medical education.
Radical changes are needed in the way we finance tuition and how we teach our students.
While last month a new graduating class of medical students celebrated their Read more…
A moral imperative to address the costs of training our doctors
A recent blog post in Health Affairs proclaimed The End of Internal Medicine As We Know It. What the article is really asking is the future of primary care in the world of health care reform and the creation of Accountable Care Organizations (ACOs).
While doctors should be naturally concerned about change, I don’t completely agree with this …
The future of primary care in Accountable Care Organizations
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by Vanessa Hurley
Like many American patients, the American health care delivery system suffers not only from acute crises, but also from a chronic, poorly managed and debilitating disease.
Primary care is in trouble. Not only are primary care physicians (PCPs) fleeing the profession in droves, but fewer and …
Primary care providers are needed to support health reform
The new healthcare reform law appears to be using the idea of improved quality to justify the enormous expense of changing the way care is delivered in the United States.
As a justification for the need for change is the reporting currently being touted as a great measure of quality. This information is gathered in many different ways and …
When quality of care becomes customer satisfaction demands
Good primary care physicians are becoming harder and harder to find.
You may not have noticed it yet, but I predict that a year from now we’ll find it almost impossible to find primary care doctors who are willing to take on new patients – at least any primary care doctor worth seeing won’t be …
Smart patients need to establish a relationship with a primary care doctor
I’m often asked how healthcare reform will impact IT planning and implementation over the next few years.
First, some background. The Patient Protection and Affordable Care Act (HR 3590) and Health Care and Education Reconciliation Act (HR 4872) were passed to address several problems with healthcare in the US. We’re spending 17% of our …
Top IT implications of healthcare reform
Recently, 47 American medical specialty societies sent Rep. Jim McDermott (D-WA) a letter, with copies to all members of Congress, containing a detailed defense of the American Medical Association’s (AMA’s) Relative Value Scale Update Committee (RUC).
For 20 years, the RUC has exclusively advised the Centers for Medicare and Medicaid Services (CMS) on physician procedure valuation …
Can the Relative Value Scale Update Committee (RUC) be defended?
Paul Grundy is IBM’s Director of Healthcare, Technology and Strategic Initiatives for IBM’s Global Well Being Services and Health Benefits.
He has led the development of the Patient-Centered Primary Care Collaborative, which is leading the way to create a more efficient and responsive healthcare system. Before I go any further, let me be very clear by saying that his work is hugely important and I agree with 90% of what this …
Patient centered care and the family physician’s brain
I took my eye off the ball for just a little while, and guess what happened? When I looked again, I discovered that familiar solo practitioner or small group physician medical practices are on the verge of disappearing. Going the way of the dinosaur.
At least, that’s what the pundits are saying.
In a recently published nifty newsletter, STAT Monthly, I read:
Primary care physicians and other specialists will continue to be the …
To sell your practice or not: The decision facing most physicians today
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