We know that physicians (and their pens/keyboards) are some of the main drivers in health care spending. But which ones are the biggest offenders?
A recent study from the nonprofit RAND Corporation asked this question and found that newer doctors tend to run up higher health care bills for their patients than their more seasoned colleagues. The study, published in Health Affairs earlier this month, looked at insurance …
The age differential in medical care
Veteran analyst Vince Kuraitis recently reviewed a report from the consulting firm Oliver Wyman (OW), arguing that the trend toward reconfiguring health systems to deliver more accountable care is more widespread than any of us suspect:
The healthcare world has only gotten serious about accountable care organizations in the past two years, but it is already clear that they are well positioned to provide a serious competitive threat to traditional fee-for-service medicine. In …
Most ACOs are accountable in name only
You try to hide it.
You leave the scrubs in the locker-room, the shop-talk at the staff dining hall and the on-call phone consults outside in the cold, away from the highly-anticipated dinner date or holiday party.
But regardless how much effort you put into leaving your career where it belongs, it is so obvious that you work in a hospital.
And here are …
3 clear signs that you work in a hospital
The patient had arrived for a urology procedure with a blood glucose in the 400’s. He suffered from a recent stomach bug and had gotten off schedule with administration of his meds. While his GI symptoms had subsided, he was feeling crappy overall. I decided to cancel his case and went about initiating treatment to get his blood sugar under control. When I informed the urologist of my findings and …
The transition from resident to attending physician
I’ve been getting emails about the New York Times piece and my quotation that the penalties for readmissions are “crazy.” It’s worth thinking about why the ACA gets hospital penalties on readmissions wrong, what we might do to fix it—and where our priorities should be.
A year ago, on a Saturday morning, I saw Mr. “Johnson,” who was in the hospital with a pneumonia. He was still breathing …
Reducing medical errors should take priority over readmissions
Costs and revenue: This is the oxygen of any business, any organization. What are your revenue streams? How much does it cost you to produce them? Life is not just about breathing, but, if you don’t get that in-out equation right, there is nothing else life can be about.
Right now this enormous sector is turning itself inside out. It has turned the “transmogrification” setting to “warp.” Why? It’s all about …
Why cost and revenue will kill independent hospitals
It is no news a lot of doctors like to stick up a rather snotty nose to EMR. The defenders of the EMR tend to label such doctors as archetypal Luddites, sticking to their archaic ways and unbecoming of change and the new times. But as is usually the case with any two heated but opposite arguments, the truth likely lies …
Explaining the epic failure of EMRs
As a physician for 35 years, I have strived to live up to a quote I first heard from my father: the goal in medicine is to cure sometimes, to relieve often, and to comfort always. During my more than three decades of practice, I have learned that one must combine a willingness to care and ability to hear with an offer to help in order to comfort – let …
I work for my patient because I care for my patient
With notably few exceptions, the American health care system has been financed on the basis of volume rather than value. That means that we’ve been paying providers for everything that they do, rather than paying them for the outcomes they produce. This is not common in other fields.
For example, if you are in an accident and have to take your car to a body shop, you (or your insurance company) …
The loopholes around penalizing hospitals for readmissions
Physicians are being attacked in many ways and in many places. It is no longer about how able, available, and affable you are. It is about how well you toe the line when it comes to going along to get along while being watched by an ever increasing line up of watchdogs. Many of whom have sharp teeth.
Here are a few questions that might indicate you are headed for trouble:
Do …
How do you know if you’re a disruptive physician?
It is the holiday season, and all through the hospital, patients are being made “NPO.” This is the medical term for “no eating or drinking allowed.”
Mr. T, silver-haired and newly unemployed, is NPO on account of his pancreatitis. “We don’t want to upset your pancreas,” the team tells him when we pass through on morning rounds. It is nearly breakfast time. We hover around his bed in a half circle …
Accepting a promotion in the workplace is never easy task. One must take on a higher level of responsibility, carry out new job objectives, and must quickly form new working relationships with colleagues at the office.
Taking on the role as a newly-branded doctor after years of being a medical student is no different in this aspect from becoming a junior partner …
Doctors: How to improve your workplace relationship with nurses
One of the greatest risks I faced from surgery to repair a macular hole in my eye was from a hospital acquired infection. But when I tried to find data on the performance of various hospitals in New York City, there were no ratings for Manhattan Eye, Ear & Throat where I would have my surgery. My doctor had moved from a prestigious New York City hospital to Manhattan Eye, …
Patient safety requires a commitment from top management
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The crowded emergency department (ED): It has become a symbol for our fragmented, inefficient health care system.
In the wake of Hurricane Sandy, the visual has become more familiar than we’d like – the young and the old slumped forward on rigid plastic chairs in the waiting room, occupied stretchers lined up in tandem in the hallway. Some of these patients are sick enough to warrant a hospital admission but languish …
ED boarders: A new focus to mitigate overcrowding
She had only been in the hospital twice in her life: once when she was nine and now, 60 years later. She had gotten tonsils out then. She was getting tumors out now.
Her abdomen hurt when she was awake. Her abdomen would also hurt during exploratory surgery, although she wouldn’t be able to feel it under general anesthesia. Her body would feel it, though, and could respond by dangerously spiking …
How pain control comes from the front and back
The Dartmouth Atlas Project released a study on October 30, 2012, entitled, “What Kind of Physician Will You Be? Variation in Health Care and Its Importance for Residency Training.” The data, and the conclusions of the report’s authors, bear closer examination.
The data set focuses on the differences in the intensity of services that Medicare patients receive, and highlights the academic medical centers rated by U.S. News and World Report as …
When comparing teaching hospitals, context matters
It was unfortunate – but not very surprising – to see the news recently that Groupon laid off a portion of their 10,000 employees. If ever there was a predictable bubble, it was daily deals.
But it was fun while it lasted, and you can see why there was so much overinvestment in the space. Groupon’s pitch to merchants was to ask them to take a loss by making a super compelling offer …
What Groupon has to do with severe chest pain
I believe that when people are in a crisis situation small things can become magnified; good and bad, and especially in the healthcare field. A perceived small rudeness may just be the tipping point that causes a patient to leave a practice or go to another hospital. On the other hand, a smile, a kind word or gesture can impact someone more than you will ever know and leave a …
There are no small jobs in any organization
“Value” is the pot of gold at the end of the rainbow that health care professionals everywhere are seeking, but which few can seem to find.
Policy makers, hospital executives, physicians, consultants – all are looking for a means to pivot away from a system that rewards volume of services provided to one that rewards quality and cost effectiveness (i.e., “value”).
How far we are from achieving this goal can be gauged …
How physician executives will drive value for hospitals
The other night, a patient gave me a piece of his mind. Mr. Q was a middle-aged man debilitated by days of nausea, vomiting and intractable belly pain. That morning, his wife finally convinced him to get medical attention and drove him to our emergency department. On arrival, he sat in a cubicle in the waiting room and explained his story to a triage doctor: how he was doing well …
Repeated story syndrome: Finding the right balance for patients
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