December 31st, 2011 by DrWes in Health Policy, Opinion
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It is tough playing man-to-man when coaches on the sideline keep insisting your team plays zone.
Such is it with health care.
For doctors, the man-to-man defense never ends. Stay with them. Glue to them. Move with them. Run with them. Defend against the bounce pass, or the dribble to avoid the admission. Hands up! Watch their waist, ignore the head fake. You shift your coverage to accommodate their needs. One on one, mana-a-mano.
But for the business of medicine, it’s all about the zone. Defend the admission basket against as many people as possible with the least number of defenders. Stay in your position. Work it 2-1-2, 2-3, or if you’re really adventurous: 1-2-2. Stick to Read more »
*This blog post was originally published at Dr. Wes*
June 10th, 2011 by Happy Hospitalist in Health Policy
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Hospital costs are out of control. We have an aging population living longer with more complicated presentation of disease. We have an insurance driven platform instead of a health driven accountability. The long term sustainability of that architecture is one of guaranteed insolvency.
One way or another hospitals are going to find their lifeline cut off. Medicaid is bankrupt. Hospital profit margins from Medicare have been negative for almost a decade. In addition, the rapid rise in private insurance premiums and industry’s gradual but accelerating exit from the health insurance benefit market all tell me that hospitals must find a way to reduce the cost of providing care.
There are many ways hospital costs can be reduced. Administrators are paid handsomely to make it happen. Either they do or they don’t succeed. Either they survive the coming Armageddon of hospital funding or they don’t. The hospitals least able to reduce their expenses in a market of decreasing payment will fold and other hospitals will become too big to fail. You want to be too big to fail. That’s the goal. If you can survive the coming tsunami, you will be saved and bailed out when you are the only one left standing. That is what history has taught us.
So, how can hospital costs be reduced? One way is to Read more »
*This blog post was originally published at The Happy Hospitalist*
June 2nd, 2011 by Toni Brayer, M.D. in Health Policy, Opinion
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It is my job at EverythingHealth to steer the reader to great information. For this reason I am providing you with a Link to The New England Journal of Medicine article titled “The $650 Billion Dollar question – why does cost effective care diffuse so slowly?” I have retitled it “Why Health Care Costs So Much”.
The United States spends much more on health care than other industrialized nations with no improvement in outcomes or health status of it’s citizens. If we enacted some of the policies that other nations use, we would have $650 Billion to spend on education, infrastructure, social security and other societal needs. Why can’t we get there?
Read here to understand the barriers. It isn’t simple. Resistance to change and instituting cost effective care has many stakeholders including legislators, doctors, hospitals, drug and equipment manufacturers, academic training centers, insurance companies and even the media. We, the public, are also to blame for not understanding that reform which lowers costs would benefit all of us. There is no free lunch. When the cost of care goes up for employers, that keeps our wages stagnant. When millions are uninsured, the cost of their care is born by everyone and it is inefficient care.
The article authors tell us: Read more »
*This blog post was originally published at EverythingHealth*
May 7th, 2011 by Happy Hospitalist in Opinion
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So I’m rounding in the ICU the other day when I came upon this new hospital medical device. It’s called a pupillometer. What does this pupillometer do? It measures subtle changes in the light reflex of the pupil to help take the physical exam to the next level of precision.
Or eliminate it, depending on how you look at it. What used to be a basic physical exam skill is now being replaced by a $6000 piece of medical technology that can distinguish tiny changes in pupil size. Now the real questions remain. Has this pupillometer device gone through the rigors of randomized trials in the ICU to define whether a $6000 flashlight changes outcomes or mortality? And if not, how do we allow medications to require such testing but not the technology that often changes nothing and simply makes health care more expensive.
The way I see things, if I’m trying to decide whether someone’s pupils constrict 1% vs 3% vs 10%, I’m getting a palliative care consult instead and putting the pupillometer back in my holster.
First the vein light. Now the pupillomter. And I thought the super bright LED pen light was all the rage.
*This blog post was originally published at The Happy Hospitalist*
