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Latest Posts

Accountable Care And Doctor-Patient Communication Go Hand In Hand

Accountable Care Organizations (ACOs) figure prominently in the new Patient Protection and Affordable Care Act (PPACA). The concept behind ACOs is that by tying both physician and hospital compensation to outcomes via a bundled fee (say for pneumonia) we can expect to see an improvement in quality and value.

In principal, accountable care makes a lot of sense. Practicality speaking, however, doctors and hospitals must address a huge challenge before they can expect benefit financially. Before doctors can be held accountable for the care they deliver, they must first be held accountable for the quality of their communication with patients.

Take hospital readmissions, which are a big healthcare cost driver today. According to a recent study in the New England Journal of Medicine, 20 percent of all Medicare patients discharged from hospitals were readmitted within 30 days, and 34 percent percent within 90 days. The Joint Commission and others rightly believe that inadequate communication between physicians — as well as between physicians and patients – is a major contributing factor. Read more »

*This blog post was originally published at Mind The Gap*

Who Pays For Healthcare? When Doctors And Patients Don’t Care

The essence of the moral hazard experience through a nice neighborly conversation:

Neighbor: These allergies are killing me.
Happy:  That’s terrible. I hope you feel better.
Neighbor:  I tried Zyrtec but it wasn’t doing anything for me, so my doctor prescribed ’x.’ (inaudible drug name )
Happy:  Does it start with an ‘x?’ (The drugs name is Xyzal.)
Neighbor:  Yes, it does.
Happy: Oh, that drug (Xyzal) is nothing more than Zyrtec, which the company slightly changed the formula of and now they get to sell it as a patented medication at 10 times the price for the next 10 years.
Neighbor: Oh, I didn’t know that. But you’re right. It was  $110. 
Happy:  Did it help you with your allergies?
Neighbor: Nope.
Happy: I guess you just wasted $100.
Neighbor.  I didn’t waste anything. My insurance company paid for it.
Happy:  Actually, we all paid for it with higher premiums.
Neighbor: (Walks away.)

The doctor doesn’t care — he’s not paying for it. The patient doesn’t care — she’s not paying for it. But everyone complains that their insurance rates are out of control. It’s not insurance company profits that are making healthcare too expensive, it’s patients and doctors who don’t care. 

Bundled care solves this problem because the doctor won’t prescribe a $110 medication and offer therapies with no proven benefit over less-expensive options.

*This blog post was originally published at The Happy Hospitalist*

Primary Care: Will NPs replace MDs?

More unhealthy people are being herded into our healthcare system and more doctors are exiting. That’s the perfect formula for chaos.

I’d like to welcome the nursing profession here to save the day. Nurses have taken up the call for providing that missing link of access as doctors disappear. The expansion of nursing care to replace medical care in primary care is just the beginning of the next phase of American medicine. It all depends on how you define primary care. What can be cheaper must be done cheaper. Read more »

*This blog post was originally published at The Happy Hospitalist*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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