Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Latest Posts

Will A Market Driven Healthcare System Be Most Effective?

Mechanism Design has demonstrated that the most efficient systems are created when everyone’s vested interests are aligned.

“An example is defense contracting. If you agree to pay on a cost plus basis you have created incentive for the contractor to be inefficient.

The defense contractor will build enough extra into a fixed price system to account for cost overruns.  The cost overrun would be permitted in the rules if the price was transparent. If there were no cost overruns the contractor’s profit would be increased. It would provide incentive to be efficient.

“If you agree to pay a fixed price, you can come close to an efficient price if you have all the truthful information.”

A reader wrote,

Stanley:

History has proven over and over again that only the market mechanism of willing sellers and willing buyers is the optimal way to allocate economic resources. This presumes an informed buyer, and a willingness of sellers to compete for buyers. Adam Smith was clear on this in the Wealth of Nations.

If incentives are aligned and truthful price information is available an efficient system is created.  Most stakeholders think they can do better by not sharing truthful information. If the rules of the game require truthful information the system can become an efficient market driven solution.

The healthcare system must become market driven. At present Read more »

*This blog post was originally published at Repairing the Healthcare System*

The Best Doctors Are Constantly Learning

Monday’s New Yorker has a story, Personal Best, by Atul Gawande. It’s about coaching, and the seemingly novel idea that doctors might engage coaches – individuals with relevant expertise and experience — to help them improve their usual work, i.e. how they practice medicine.

Dr. Gawande is a surgeon, now of eight years according to his article. His specialty is endocrine surgery – when he operates it’s most often on problematic glands like the thyroid, parathyroid or appendix. Results, and complications, are tracked. For a while after he completed his training he got better and better, in comparison to nation stats, by his accounting. And then things leveled off.

The surgeon-writer considered how coaches can help individuals get better at whatever they do, like playing a sport or singing. He writes:

The coaching model is different from the traditional conception of pedagogy, where there’s a presumption that, after a certain point, the student no longer needs instruction. You graduate. You’re done. You can go the rest of the way yourself…

He wonders about how this might apply in medicine: Read more »

*This blog post was originally published at Medical Lessons*

Does Having An Advanced Degree Make A Better Nurse?

Here is Clara Barton, posing with a new class of graduate nurses who received their nursing education through a correspondence course offered by the Chautauqua School of Nursing. Did you know that some of Clara Barton’s contemporaries did not view her as a legitimate nursing leader because she supported alternative ways of getting a nursing education? It’s kind of ironic that many nursing leaders back then didn’t view the founder of the American Red Cross as an equal. Some things never change.

It’s an old discussion. Are nurses with an advanced degree better nurses? Do they make better leaders and does getting a degree elevate the profession? My blog mother, Kim McAllister, from Emergiblog brought my attention to an article that appears at HealthLeadersMedia.com. The article contains Read more »

*This blog post was originally published at Nurse Ratched's Place*

Medicare’s Use Of Claims Data: Finding The Outliers

I have opposed Medicare’s use of claims data to evaluate the quality of medical care. Quality medical care is the goal that must be achieved. However, no one has described the measurement of quality medical care adequately.

Physicians recognize when other physicians are not performing quality medical care. Physicians recognize when another physician is just testing and performing procedures to increase revenue.

These over testing physicians are a small minority of physicians in practice.

Quality medical care is not about doing quarterly HbA1c’s on patients with Diabetes Mellitus. Quality medical care is about helping patients control their blood sugars so their HbA1c becomes normalized. It is about the clinical and financial results of treatment.

The clinical and financial results depend on both patients and physicians. Patients must be responsible for Read more »

*This blog post was originally published at Repairing the Healthcare System*

Challenges And Opportunities Of Health Care Social Media

I spoke on health care social media and regulatory compliance at the Health Care Compliance Association’s New England Regional Annual Conference last week.  As you may expect, the room was full of the folks who, generally speaking, are the folks who block social media sites on health care organization networks.  I sent a link to an online bio to one of the session organizers in advance, and even that site was blocked by his facility’s network.  Clearly, we have a long way to go in educating health care compliance professionals about the risks and benefits of using health care social media, and an appropriate approach to balancing these risks and benefits so as to establish an appropriate social media presence for each health care organization.

My talk was followed by a presentation by two federal prosecutors, one of whom reminded the audience that they may need to produce copies of all online postings in response to government document requests or subpoenas.  We may quibble about the scope of material that might be covered by such a production request, but the key takeaway from this comment should be Read more »

*This blog post was originally published at HealthBlawg :: David Harlow's Health Care Law Blog*

Latest Interviews

Caring For Winter Olympians In Sochi: An Interview With Team USA’s Chief Medical Officer Dr. Gloria Beim

I am a huge fan of the winter Olympics partly because I grew up in Canada where most kids can ski and skate before they can run and partly because I used to participate in Downhill ski racing. Now that I m a rehab physician with a reconstructed knee I…

Read more »

How Do Hospital Executives Feel About Locum Tenens Agencies And Traveling Physicians?

I recently wrote about my experiences as a traveling physician and how to navigate locum tenens work. Today I want to talk about the client in this case hospital side of the equation. I ve had the chance to speak with several executives some were physicians themselves about the overall…

Read more »

See all interviews »

Latest Cartoon

See all cartoons »

Latest Book Reviews

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…

Read more »

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…

Read more »

Unaccountable: A Book About The Underbelly Of Hospital Care

I met Dr. Marty Makary over lunch at Founding Farmers restaurant in DC about three years ago. We had an animated conversation about hospital safety the potential contribution of checklists to reducing medical errors and his upcoming book about the need for more transparency in the healthcare system. Marty was…

Read more »

See all book reviews »