Public Health & Policy

Doctor owned hospitals: Are the rich getting richer?

Policy
May 14, 2013

It was bound to happen.

By “it,” I mean that the small group of specialty hospitals (usually orthopedic or cardiology-focused) across that country that are owned by doctors were going to have their “See! We Told ‘ya so!” moment.

Doctor-owned hospitals. How many are there? Two hundred and thirty-eight of them in the whole country (out of more than five thousand)–somewhere between four and five percent of the total in the U.S. (numbers courtesy …

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Increasing the role of nurse practitioners in the inpatient setting

Physician
April 12, 2013

We are fortunate in our country to have the best medical technology in the world. Unfortunately, delivery of this technology, reflected in a worldwide healthcare ranking of 37th, is a disservice to the American people and must be rectified especially when Cuba is ranked 39th.

As provisions of the Affordable Care Act are put in place, a daunting factor is the shortage of doctors who will be needed to provide this …

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Measuring quality: What doctors and teachers have in common

Policy
March 21, 2013

newsweek-cover-michelle-rhee-education-reform

I was watching Jon Stewart recently, and he had Michelle Rhee on.  For anyone who doesn’t know her, she’s the superintendent of schools in Washington D.C. who made a bunch of reforms that caused some controversy and resulted in her being one of the main spokespersons for education reform in this country.  Her conversation with Jon made me realize the similarities between …

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Doctors are the canaries in the coal mine of medicine

Physician
February 12, 2013

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Back in the day, coal miners always carried a canary with them in a small cage whenever they would go down in the mine. The canary is a very talkative bird, always singing and tweeting in a constant background noise. Canaries have one more characteristic important to a miner.

When there is bad air in the mine, the canary’s sensitive lungs will cause …

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What is observation care? Clearing up common misperceptions

Policy
February 4, 2013

To treat observation care as simply a loophole that allows hospitals to avoid the Medicare penalties from readmissions — as Brad Wright, an assistant professor of health management and policy at the University of Iowa did earlier this month — is to take a short-sighted approach to a complex health issue.

Observation care in fact aims to address several of healthcare’s thorniest challenges head on. In the process, …

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Your doctor has sold his practice: 6 tips for patients

Physician
January 3, 2013

The Affordable Care Act comes with the promise of a dramatic overhaul in what many see as a broken health care system. It promotes the potential for “better all around” – better care, easier access to hospitals, and affordable treatment. It also comes with a price. For one reason or another, the turbulence within the American health care system is causing doctors to shut down, downsizing or sell their practices …

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Common criticisms of concierge medicine that deserve to be answered

Physician
December 30, 2012

The idea that patients are better off paying their doctor directly and using their insurance only for unaffordable catastrophes is gaining some traction. With implementation of the Affordable Care Act looming in 2014 many patients are looking at their doctor’s already crowded waiting room and wondering how their care will be impacted when their doctor is responsible for even more patients. And doctors who even now are swamped and frustrated …

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The volume of low acuity patients in the ER is not a myth

Physician
November 8, 2012

I had an interesting twitter chat the other day with one of my colleagues, a young ER grad studying healthcare policy by the name of Seth Trueger. The Twitter conversation wound up involving about a dozen ER docs and nurses. You can review an edited summary over at Storify.

The point in contention is an interesting one: we know the nation’s ERs are overwhelmed and overcrowded. That’s old news. We also …

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The growing culture of hostile dependency towards doctors

Physician
November 8, 2012

Let’s start with a disclaimer: I am not complaining; I’m just stating the facts.

Honest fact: The morale of doctors in the real world is low–and sinking lower.

I know what you are thinking. “Come on Mandrola, you are nuts if you expect us to feel sympathy for doctors–of all professions.”

Well, you can think that if you wish, but I’m calling it as I see them. And here is why it matters:

Because …

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Reasons why doctors overtreat and overtest

Physician
November 7, 2012

The New York Times recently had an important and provocative piece, “Overtreatment Is Taking a Harmful Toll.”

The title is a bit misleading. The article focuses more on overtesting. We test too much and we treat too much.

The article, while mostly accurate, does not really explain the reasons for the problem. Unless we can accept and understand the underlying reasons for these problems, we cannot successful correct these problems.

Let …

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The micro level of health reform cannot be ignored

Policy
November 5, 2012

Much of what passes for debate on health care during this election year is focused on the macro side, on big issues like how do we cover the uninsured or restructure Medicare and Medicaid financing.  But for all of the talk about vouchers and block grants and insurance mandates, the candidates are missing the micro issues that really matter most to doctors and their patients, which is how health care …

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Having our own doctor treat us in the hospital is a thing of the past

Physician
October 19, 2012

Health care reform is a locomotive barreling down America’s tracks. In two years, the Affordable Care Act (ACA) will cover some 30 out of 50 million of us that currently lack health insurance. Political beliefs aside, it would seem that supplying insurance to protect the health of more people is a societal good. Though the costs of reform will be debated for years to come, one major question remains that …

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How America’s healthcare system will keep you sick

Physician
October 7, 2012

Have you ever worried about how you’re going to get healthy these days? Has your doctor recommended diet and exercise? Well, if you’re like millions who are struggling to find health, you’re going to need a lot more than just diet and exercise. You’re going to have to fight like crazy against a mind-set of disease that’s paradoxically disguised as health care.

America’s healthcare system – health insurance companies, government health …

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Practices are getting larger to provide micropractice service

Physician
September 13, 2012

Medicine has gone down Alice in Wonderland’s rabbit hole. Looking at the size of practices today, it seems like some of them have taken red pills and the rest have taken blue ones: most of them are getting bigger and bigger and bigger, while some are getting smaller and smaller. As the giant practices gobble up their competition to become ever more gargantuan, others are shrinking down into micropractices.

Everyone has …

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Why doctors complain: A history of physician income

Physician
September 2, 2012

We’re not going for sympathy here. Doctors as a whole enjoy less sympathy than many other professional groups (members of Congress enjoy the least, I would think), and that’s probably appropriate. They have high incomes and many prerogatives and rank highly in esteem polls as individuals, if not as a group. It’s not where they are that is causing the grieving, it is where they are coming from.


Let’s deal with …

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Take the time to educate yourself before forming an opinion

Physician
July 5, 2012

Student loan debt is at an all-time high at a little over 1 trillion dollars, a figure that now, for the first time ever, exceeds our nation’s credit card debt. Higher education has never cost more, the rate of rise of college tuition having exceeded in recent years the rate of rise of many other services. Perhaps as a result of this, as well as of the difficulty in obtaining …

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What does an ACO mean in small town America?

Policy
June 9, 2012

At the end of long days I often stand gazing out my window at the beautiful, timeless Rocky Mountains in Colorado Springs and am taken by their sense of permanence. I recently returned from Nampa, Idaho, where I presented hospital Grand Rounds on Accountable Care Organizations.

The parallels between the timeless mountains and the physicians I met in Nampa struck me. Strange, you say? Maybe, but I am accustomed to the …

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Healthcare reimbursement will change dramatically in the future

Policy
April 22, 2012

Based upon the past and the current state of affairs in healthcare, healthcare reimbursement will change dramatically in the future.  I believe that reimbursement based upon fee-for-service will gradually disappear and be replaced by models based upon the ability to better manage patient diseases and conditions.  That is, reimbursement will be based upon the quality of service delivered by the provider.  For insurers, whether private or governmental, I believe that …

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The future of medicine for aspiring young doctors

Physician
April 11, 2012

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March 29, 2012

Calhoun Lecture Series
Strom Thurmond Institute, Clemson University

Thank you for the invitation to speak tonight. I’m very humbled to stand before you. And what a delight to speak to people who are neither bleeding, intoxicated nor asking for Percocet! And in a setting where no one will burst through the back door on a stretcher!

As you know, I’m an emergency physician …

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Does contracting with third party payers compromise ethics?

Policy
April 9, 2012

Physicians have historically been fairly well compensated for their efforts and thus have enjoyed many of the comforts of modern life. Most would agree this is the result of years of hard work, perseverance, intellect and dedication. In general these are also traits along with professional integrity, which raised physicians to a position of relative prominence and trust within our society. But in recent years that social position and economic …

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