by Chris Chen
Recently, I stood in the back of a boisterous, packed auditorium as each of our school’s fourth-years received their match letters and proudly announced in front of friends, family, and classmates where they would be headed for residency.
As peers enthusiastically cheered each other, significant …
Why medical students should be passionate about health reform
There is a lot of buzz over the creation of Accountable Care Organizations (ACOs) under the Patient Protection and Affordable Care Act (PPACA).
An ACO is a network of health care providers and hospitals that collaboratively manage patient care and prospective budgets. Perhaps the biggest draw of ACOs is the potential to create innovative ways to improve quality and decrease costs. To …
Accountable Care Organizations and the need to innovate
A reader recently wrote to me: “Brandon, in our area, we’ve seen a few retail clinics pop up. What can we do as a practice to let patients know that visiting retail clinics is not in their best interest?”
We had along discussion. So I put together a summary of our conversation. Below is a rundown, more of less, of what I …
How physician practices can compete with retail clinics
I was talking to a young man who is starting medical school this fall. His tuition at one of South Carolina’s newer schools will be $40,000 per year. That’s admittedly on the high end. On the low end, it runs a paltry $33,000 per year.
And this is all after college, of course. He and others like him are taking out loans to the tune of $240,000 to pay for their …
Why medical education needs to be more affordable
Here are a few facts to enliven the next public discussion about death panels.
An analysis of Medicare claims by researchers at Dartmouth University found that nationwide nearly one in three cancer patients died in hospitals or in intensive care, the most expensive form of end-of-life care and contrary to most patients’ wishes. Nearly half are not offered hospice …
Reduce variations in cancer care that do not improve outcomes
You try to do the right things to sustain your business. You set high standards for delivery of quality care, follow the basic tenets of marketing, align your organization so that everyone in your firm “gets it,” avoid unnecessary expenses but identify important growth opportunities and prudently invest so that you remain competitive and serve your patients well. But can you afford investing in the assets you require to become or …
Expand health care systems in a way that is professionally satisfying
Dr. William Follansbee is the chairman of the American College of Cardiology/American Society of Nuclear Cardiology (ACC/ASNC) task force on non-invasive cardiac imaging and the director of nuclear cardiology at the University of Pittsburgh Medical Center Cardiovascular Institute.
He recently published an editorial in the Pittsburgh Post Gazette in which he criticized the local Blue Cross/Blue Shield carrier, Highmark, for restricting the use of nuclear cardiac stress testing in …
Restricting nuclear cardiac stress testing in favor of stress echocardiography
by Sharolyn Rhees Medina, MD
It’s no secret that healthcare’s inevitable move toward accountable care organizations (ACOs) has many physicians feeling a bit …nervous. Admittedly, most physicians are creatures of habit who fiercely defend their individual approach to patient care, focus on cures not cost, and dread the concept of “cookbook medicine.”
And under the ACO model, physicians …
Accountable care organizations: The lost art of medicine?
As a consultant, I spend a lot of time on airplanes and subsequently get to meet a new “person in the next seat” almost every week. Once the small talk is over, the conversation is nearly the same every time. “Oh, you work in healthcare! What do you think about all of this reform stuff anyway? Is there an answer?” I’m always very cautious how I frame my answer. As those …
Concierge and primary care medical home hybrid model of care
Huge holes exist in the health reform law you can drive an 18-Wheeler through. These holes are not “devils in the details.” They are so obvious nobody talks about them. They are the proverbial elephants in the room. I suppose this makes sense. It takes an 18-wheeler to transport …
Huge holes exist in the health reform law
If we ever slow health care cost inflation to a sustainable pace, it will be because we learn how to ask 3 simple questions when thinking about a medical treatment.
Asking the questions are of course much simpler than figuring out the …
Slowing health costs requires answering 3 simple questions
We badly need effectiveness research — which medical treatments work and which ones don’t. After all, some reasonable estimates are that a third or so what we spend on medical treatments is for things that aren’t known to work, or worse, don’t work. Effectiveness research means comparing two competing therapies to see which works better; if both work the same, our preference …
A global view on effectiveness research
I received my Masters in Public Health from Johns Hopkins in 2006. I took a course on transportation safety where we focused on designing roads for safety, making airlines safer, and decreasing the risk of medical helicopter crashes.
In 2007, I worked for Public Citizen, Ralph Nader’s consumer advocacy group. Ralph’s book, Unsafe at Any Speed, forced the automobile industry to focus on converting their cars from …
The next generation of public health won’t involve the medical world
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Match Day marks one of the most important days in a medical student’s career.
A computer algorithm “matches” prospective doctors with the residency program they’re destined go to.
It’s also a look at the future trends for various specialties. With a major part of health reform about to be implemented, one naturally gravitates towards primary care, where there currently is a …
Match Day 2011: Family medicine grows, but enough to save primary care?
Before I had even begun medical school, I already knew that I would enter primary care when I finished. I had successfully applied for and received a scholarship from the National Health Service Corps Scholars program. By the time I graduated, I knew that after my three years of residency training, I would practice in an underserved area for at least four years, one year of service to America for …
The National Health Service Corps impact on primary care doctors
It’s no secret that our health system encourages doctors to order too many tests. Compounded with the widespread belief that more tests equates to better medicine, the reasons why health costs are spiraling out of control aren’t a secret.
In a perspective piece from the New England Journal of Medicine, physician Sean Palfrey notes our dire situation:
Recent advances …
Health costs need to be addressed by doctors, patients, and lawyers
If you are one of the more than 100 million Americans who visit emergency rooms (ER) at least once a year, you’re not alone.
Americans, insured and not, make ample use of hospital emergency rooms. One out of every five visited an ER at least once in 2007, the latest year for which the National Center for Health Statistics …
Danger of multiple emergency room visits to different hospitals
by Peter J. Pitts
“Newspeak,” the language of Big Brother, was designed “not to extend but to diminish the range of thought.”
Some well-known examples of Newspeak are Bellyfeel (a blind, enthusiastic acceptance of an idea), Duckspeak (meaning literally to quack like a duck or to speak without thinking), Crimethink (the Newspeak word for thought crime) and Goodthink (or “political orthodoxy”).
Which brings us from the nightmare fantasy of “1984” to the health …
The differences between comparative and clinical effectiveness
Governor Brewer’s decision to withhold liver transplants for Medicaid recipients in Arizona should serve as a loud warning to the electorate regarding governmental intrusions into health care financing and health care operations.
The decision was ill advised on the basis of multiple factors. The survival rates differ from one facility to another.
What is the liver transplant survival rate and what information needs to be considered when looking at such numbers?
For example, …
Withholding liver transplants for Medicaid recipients in Arizona
Despite the advances in evidence-based medicine, not every patient benefits.
In a recent column from the New York Times, Pauline Chen looks at a study showing exploring the issue:
For many patients, evidence-based medicine isn’t working. Two-thirds of patients with diabetes, a disease with some of the strongest evidence-based guidelines available, continue to have trouble controlling their blood sugar levels; and only half of all …
Why team based primary care won’t help evidence based medicine soon
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