Blaming the American Medical Association’s Relative Value Scale Update Committee (RUC) for everything has become the latest fashion. The RUC is causing climate change. The entire health care cost problem comes from RUC decisions. Alex Rodriguez took performance enhancing drugs because of the RUC.
But the RUC did not create the system. They try hard to balance a system that is designed to achieve the wrong outcomes. The RUC has become …
Recently I read an interesting article on leadership published at Inc.com. Although most of the journal is focused on those in business, many of the pieces on leadership are very applicable to those of us in medicine. In this article, author Curt Hanke writes about the inspiration and leadership positives found in the three simple words: “I don’t know.”
On first blush, we may think that a leader speaking these words may no longer …
Admit when you fall short: The power of “I don’t know”
After you finish medical school classes, the night before graduation, they take you to a dark, quiet room. There, among leather bound tomes 300 years old, diseased skeleton trophies swinging behind glass, as you sip 50-year-old port in ancient crystal, they tell you the secrets.
This is the wisdom passed not in lectures, rounds or at the operating table; it is the hallowed legacy of thousands of healers over the millennia; …
When treating male patients, watch the wife
He seemed a bit grumpy when he came into the office. I am used to the picture: male in his early to mid-forties, with wife by his side leading him into the office to “finally get taken care of” by the doctor. Usually the woman has a disgusted expression on her face as he looks like a boy forced to spend his afternoon in a fabric store with his mother. …
A new tagline for direct primary care
Over one year ago my office implemented an EHR (electronic health record). I’ve not done a note on paper since.
Last week, a Transition of Care (TOC) document was placed on my desk with a sticky note stating: “Dr. Nieder please fill out this form so we can bill a 99496 for your visit with Mrs. Jones yesterday.”
I pick up two sheets of paper with multiple questions including:
Forms do not keep patients out of hospitals
A new class of health care management organization is emerging that thrives by taking advantage of health care’s rampant and institutionalized waste. These firms mine the market dysfunction that has developed over decades, which will almost certainly yield enough fuel to drive a new way to manage care and cost.
The founders of these organizations have deep health care experience, and they understand the mechanisms of excess. More important, the ones …
Emerging enterprises of health care management
I gave a patient my cell phone number today. I have been toying with the idea for a while and talking to various other physicians about how they handle it. We have a 24/7 chain of coverage so that a patient can call at any time of the day or night and reach a pulmonary/critical care physician. But not necessarily their physician, because, like everyone else, even doctors get days …
Do you share direct contact information with patients?
Among other misassumptions in medicine, we apply standard economic principles to healthcare and often assume consumer rationality in the utility maximization of health care. So why have we seen so much “market failure” in healthcare? Why are consumers of health care not making “smart” decisions for health care as they do for their choice of hotels and restaurants? Why have we not seen the expected benefits from …
Why are health care consumers not making smart decisions?
The hype over mobile health is deafening on most days and downright annoying on some. So it is with some reluctance that I admit that mobile has the potential to be a gamechanger in health. I’ve professed enthusiasm before, but that was largely around the use of wireless sensors to measure physiologic signals and SMS text as a way to deliver messages to patients and consumers. For several years, the …
Patient care appears to be catching up with mobile technology
Flu season has begun, which means that it’s flu shot time.
I see lots of different responses when I talk to families at our clinic about the flu shot. Some are happy to get it. Others are unsure, worried about side effects. Others plain old refuse.
Plain old refusal isn’t an option for me — as a doctor and an employee of Boston Children’s. I need to get it — and I …
Getting the flu shot isn’t about you
In case you haven’t heard, Malcolm Gladwell recently released his book, David and Goliath. I’m just about finished reading it.
Just as interesting as the book are its reviews. In a recent post from Slate, Gladwell himself responds to the criticism. He freely admits that his books should not be held as pinnacles of academic rigor, but should be considered “intellectual adventures stories.”
He further elaborates on the power …
Why doctors need to be more like Malcolm Gladwell
There is a lot of talk these days about changing our health care system from “pay for volume” to “pay for value.” The idea is that we currently reimbursement doctors and hospitals according to the number of services delivered rather than how well they make us. This perverse system of incentives results in runaway health care spending that doesn’t necessarily result in a more healthy citizenry.
There is certainly truth in …
Pay for performance: Not everything that can be counted counts
Historically, the “do more, bill more” fee-for-service model of healthcare measured success by increased billings. In the fee-for-value era, we need a new framework for assessing healthcare results. Quality indicators are logical but they are mostly geared towards measuring actions taken. We can borrow a concept from the energy sector for an additional metric. We need a concept for removing waste and unnecessary care that could be inspired by a concept …
Patient engagement is the blockbuster drug of the century
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A guest column by the American College of Physicians, exclusive to KevinMD.com.
It seems to begin earlier and earlier each year — displays are up in stores in late July, newspaper and radio ads start appearing in August, and the media reports on it before the kids even go back to school. Yes, flu vaccine season is in full motion. Last year I …
ACP: Making the most of opportunities to get people immunized
Primary care physicians (PCPs) have been marginalized by Medicare for decades with low reimbursement rates for routine office visits which has led to the 15-20 minute office visit with 10-12 minutes of actual “face time” and a panel of patients that well exceeds 2000.
Is there a good solution to the Medicare cost and quality issues? Setting aside either the Democrats’ approach to basically enact price controls by ratcheting down reimbursements or …
How Medicare can fix the shortage of primary care physicians
A piece recently appeared in the New York Times entitled “Who Will Heal the Doctors?”
The piece is written by Donald Borstein and I encourage all to read it. Mr. Bornstein offers a solution to the doctor burnout problem in health care, a course called “The Healers Art,” now being promoted in US medical schools that uses “mindfulness” as his means of creating compassionate, caring doctors as a way forward.
I should say …
Hostile dependency: The real reason for physician burnout
Even in its purest form, in the most perfect patient-centered medical home we can create, patients will sometimes need to move beyond the confines of primary care.
Each of us in primary care has a point that we choose not to venture beyond, into the realm of subspecialty medicine where we lack the experience and tools and support to fully implement complete care for patients with these particular problems.
It may be …
When patients move beyond the medical home
365.
That’s how many days I’ve been away from our health care system. A year ago was my last day in my old practice. Here’s what I wrote in my journal:
This is it. This is the last day of work at Evans Medical Group. It’s more weird than anything. I am sad to leave the comfort of my old job, but happy to be able to spread my wings and be …
One year after being away from our health care system
I was spiking a fever.
It was as if someone flipped a light switch inside my body. I could feel the sensation rise through the chest, and trample the dazed contents of my skull. Light, however, was a poor, lazy metaphor. There was no heat, only stimulation.
My belly ached from the repetitive heaving that preceded the fever. I envisioned the sandwich I had eaten that afternoon. I pictured small bacteria crowding …
Being the kind of doctor that I would want to care for my loved ones
For most of us, we have never experienced the current pandemic of senseless violence that we read about and visualize every day. I challenge you to find a newspaper tomorrow morning, or listen to a news broadcast, that will not report on dark and pernicious inclinations and accomplishments of evil practitioners.
If that challenge is not sufficient, then find an American over the age of 70 to attest that the world …
Targeting gun owners is an easy target, but off the mark
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