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Outpatient Cardiology Services And An “Out” For Hospitals

It’s no surprise that hospitals are acquiring cardiology and primary care groups groups in droves lately. It seems there’s a signficant financial incentive to do so for now, but doctors (and especially cardiologists) should read the tea leaves ahead. From Becker’s Hospital Review:

While hospitals are limited to paying fair market value for practices, they can gain an edge over competing hospitals by offering longer employment contract terms or better electronic medical record systems and management services. If hospitals move forward with a transaction, Ms. Kaplan suggests they limit employment contracts to no more than two years if possible and rebase compensation annually based on productivity.

“In healthcare you shouldn’t assume anything is permanent,” says Ms. Kaplan. She cautions that the revenue increases that are currently available to hospitals through expanding outpatient cardiology services may not last forever, which is why she urges hospitals to limit employment contracts and other agreements to only a few years. Doing so will afford an “out” for the hospital if the service line goes from a money-maker to a money pit.

-WesMusings of a cardiologist and cardiac electrophysiologist.

*This blog post was originally published at Dr. Wes*

Healthcare Spending: Slowest Growth Since The Great Depression

Healthcare spending grew in 2009 at its slowest rate since 1938, according to a report published in Health Affairs.

The last time America saw such a slow growth rate on health spending it was still emerging from the Great Depression and hadn’t yet entered World War II. The most recent recession is also the cause for the health spending figures, according to the annual report, released by the Centers for Medicare and Medicaid Services.

The report shows that the recession left a deeper impact than previous ones.

Healthcare spending grew 4 percent to $2.5 trillion, outpacing the rest of the still recovering economy. Authors wrote that the recession contributed to slower growth in private health insurance spending and out-of-pocket spending by consumers, as well as a reduction in capital investments by health care providers. Enrollment in private health insurance fell by 6.3 million people.

That’s still 17.6 percent of the U.S. economy in 2009, which reflects the effects of the recession on the economy and the effects of more Medicaid spending, which rose nearly 22 percent last year as part of the economic stimulus and to cover state deficits. (Health Affairs, Washington Post, New York Times, Wall Street Journal)

*This blog post was originally published at ACP Internist*

The Business Of Anticoagulation

This is a guest post by Dr. Juliet Mavromatis:


The emergence of a new generation of anticoagulants, including the direct thrombin inhibitor, dabigatran and the factor Xa inhibitor, rivaroxaban, has the potential to significantly change the business of thinning blood in the United States. For years warfarin has been the main therapeutic option for patients with health conditions such as atrial fibrillation, venous thrombosis, artificial heart valves and pulmonary embolus, which are associated with excess clotting risk that may cause adverse outcomes, including stroke and death. However, warfarin therapy is fraught with risk and liability. The drug interacts with food and many drugs and requires careful monitoring of the prothrombin time (PT) and international normalized ratio (INR).

Recently, when I applied for credentialing as solo practioner, I was asked by my medical malpractice insurer to detail my protocol for monitoring patients on anticoagulation therapy with warfarin. When I worked in group practice at the Emory Clinic in Atlanta I referred my patients to Emory’s Anticoagulation Management Service (AMS), which I found to be a wonderful resource. In fact, “disease management” clinics for anticoagulation are common amongst group practices because of the significant liability issues. Protocol based therapy and dedicated management teams improve outcomes for patients on anticoagulation with warfarin. Read more »

*This blog post was originally published at ACP Hospitalist*

The Twelve Days of Healthcare Reform

Today’s blog will be my last for 2010, as I will be taking a break to spend the Christmas and New Year’s holidays with family and friends.

In keeping with a tradition I started two years ago, I again have taken the liberty of mangling a beloved holiday song, story, or rhyme to give a humorous (I hope!) perspective on current politics. In December, 2008, I adapted “Twas the Night Before Christmas” to convey President-elect Obama as being a not-so-jolly old elf besieged by lobbyists demanding stimulus gifts. Last year, I depicted the GOP as the Grinch trying to stop “ObamaCare” from coming.

Today, I’ve re-written the “Twelve Days of Christmas” carol so that it is the government bestowing “gifts” (based on actual provisions of the Affordable Care Act) that the new Congress may later take away. (Of course, in the real world, the ACA’s changes won’t take place over 12 days, but over many years.) Read more »

*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*

Judge Rules Healthcare Reform “Unconstitutional”

A federal judge in Virginia has ruled that healthcare reform is unconstitutional and expects the Obama administration to honor that ruling while it’s being appealed. But states and private companies are continuing to plan and budget for it nonetheless.

The court ruled that Congress exceeded its constitutional powers in compelling Americans to buy health insurance. Judges elsewhere have ruled the law is valid or dismissed the cases on procedural grounds, while a judge in Florida will hear another case later this week.

In the meantime, though, employers and healthcare companies have to continue adjusting to the reform law’s many provisions. States will continue to set up their health insurance exchanges, and they’ve already budgeted for the additional 16 million people who will qualify for Medicaid under the law. And the Obama administration is unlikely to stop what it’s doing, since many of the provisions won’t take effect until 2014.

A key of the lawsuit is “economic inactivity.” The ruling says that while Congress can regulate interstate commerce, it can’t regulate…well, non-commerce, in this case the decision not to buy health insurance. The judge’s decision is online. (Politico, Wall Street Journal, Associated Press, MSNBC)

*This blog post was originally published at ACP Internist*

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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