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Accountable Care Organizations: Additional Barriers To Success

Accountable Care Organization(ACOs) are not going to decrease the waste in the healthcare system. Waste occurs because of:

1. Excessive administrative service expenses by the healthcare insurance industry which provides administrative services for private insurance and Medicare and Medicaid. A committee is writing the final regulations covering Medical Loss ratios for President Obama’s healthcare reform act. The preliminary regulations are far from curative

2. A lack of patient responsibility in preventing the onset of chronic disease. The obesity epidemic is an example.

3. A lack of patient education in preventing the onset of complications of chronic diseases. Effective systems of chronic disease self- management must be developed.

4. The use of defensive medicine resulting in overtesting. Defensive medicine can be reduced by effective malpractice reform.

A system of incentives for patients and physicians must be developed to solve these causes of waste. A system of payments must also be developed to marginalize the excessive waste by the healthcare insurance industry. Patients must have control of their own healthcare dollars.

By developing ACOs, President Obama is increasing the complexity of the healthcare system. It will result in commoditizing medical care, provide incentives for rationing medical care, decrease access to care, and opening up avenues for future abuse.

The list of barriers to ACOs’ success is long and difficult to follow. Read more »

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

Screening For Lung Cancer: New Findings And Continued Controversy

Lung cancer screening has been an area of considerable controversy. Before today, there had been no evidence that screening patients for lung cancer, either with a CT scan or chest x-ray, saved lives.

For years, doctors have been waiting for the results of the large, randomized National Lung Screening Trial (NLST), conducted by the National Cancer Institute.

[Yesterday] it was announced that the trial was stopped early, with a bold, positive finding:

All participants had a history of at least 30 pack-years, and were either current or former smokers without signs, symptoms, or a history of lung cancer.

As of Oct. 20, 2010, the researchers saw a total of 354 deaths from lung cancer in the CT group, compared with 442 in the chest x-ray group.

That amounts to a 20.3% reduction in lung cancer mortality — a finding that the study’s independent data and safety monitoring board decided was statistically significant enough to halt the trial and declare a benefit.

Previously, only breast, colon, and cervical cancer has had the evidence back up its screening recommendations. It’s still early in the game, but it appears that lung cancer may be following in that same path. That said, there are a variety of concerns before opening up the floodgates to screening chest CTs. Read more »

*This blog post was originally published at KevinMD.com*

November Is American Diabetes Month

November is American Diabetes Month, and in the video below I talk with a local TV news reporter about risk factors, complications, and ways to prevent diabetes. The interview was only about two minutes and there’s much more to be covered, so check out the American Diabetes Association’s website for more information.

If you find this video helpful, I invite you to view more of my TV interviews on my YouTube channel. Happy November!

*This blog post was originally published at Doctor Anonymous*

Patients Must Own Their Disease

It is important to listen to what physicians are saying. An article appeared in SERMO, a physicians’ social network, which expressed a physician’s frustration. It is appropriate to publish some of that physician’s thoughts:

“I first heard this statement over twenty years ago, when I was an intern in general surgery, struggling to find my professional self.”

“My chief resident said; “The patient owns the disease,” “You’re not trying to make them suffer, you’re trying to help. They’re sick, you’re not.”

“The human body is unpredictable. Disease complications happen.”

The author thought his chief resident was heartless and callous. In a way, he was but he was getting at the heart of the matter. What is the patient’s responsibility in the evolution of disease? Read more »

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

High-Dose Flu Vaccine For Older Adults

Dr. Novella  has recently written about this year’s seasonal flu vaccine and Dr. Crislip has reviewed the evidence for flu vaccine efficacy. There’s one little wrinkle that they didn’t address — one that I’m more attuned to because I’m older than they are.

I got my Medicare card last summer, so I am now officially one of the “elderly.” A recent review by Goodwin et al. showed that the antibody response to flu vaccines is significantly lower in the elderly. They called for a more immunogenic vaccine formulation for that age group. My age group. One manufacturer has responded. Read more »

*This blog post was originally published at Science-Based Medicine*

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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