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

Latest Posts

Nurse Prompts Are Key To Successful Implementation Of ICU Safety Measures

Over the last few years, you may have heard a lot about the value of checklists in ICU medicine and their ability to reduce mortality, reduce cost and reduce length of stay.   But a recent study took the concept one step further and suggested that checklists by themselves may not be  effective unless physicians are prompted to act on the checklist.

As reported in the American Journal of Respiratory and Critical Care Journal, a single site cohort study performed at Northwestern University Feinberg School of Medicine’s medical intensive care unit compared two rounding groups of physicians.  One group was prompted to use the checklist.  The other group of physicians had access to the checklist but were not prompted to use it.

What they found was shocking.  Both groups had access to the checklist.  However, patients followed by physicians who were prompted to use the checklist had Read more »

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

Accountable Care Organizations (ACOs): HMOs With Lipstick?

Thousands of articles have been written about forming ACOs. Millions of dollars have been spent by hospital systems to try to form an ACO. Healthcare policy consultants have discovered a new cash cow.

Hospitals systems are wasting their money. They think the return from owning salaried physicians’ intellectual property will be more than worth the cost.

  1. Thousands of physicians have been confused by the concept of ACO.
  2. Many have felt ACOs are an attack on their freedom to practice medicine the best they can.
  3. Many have rejected the concept because they feel they will have to be salaried by hospital systems.
  4. Many physicians do not trust President Obama or Dr. Don Berwick.
  5. The Stage 2 ACO regulations are not easy to understand. They are more ominous than the stage 1 regulations.

The two core stated objectives for ACOs are:

(1) Reducing healthcare costs.

(2) Preserving and improving quality.

The stated objectives are laudable. The government regulations and controls are confusing. Read more »

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

The “I Get It” Moment In Direct-Pay Primary Care

After seven years, my wife has finally stopped asking me for “The Power of DocTalker” story of the day. Now when I start with the details of the latest case report justifying the model, she stops me with “I get it, I get it! Go write the case report up and post it on your website for others to ‘get it,’ too.”

Case reports center on the mission of our medical practice, with points regarding care that include quality, accessibility, convenience, affordability, empowerment, trust, and price transparency. Because our patients pay us directly for the service and don’t necessarily expect any insurance “reimbursement,” we are a very unique practice. We adhere to the points in our mission and also outperform all our local competition — i.e. medical offices that accept insurance payment for service in order to survive as a business.

To the patient, our services cost a lot less than services available via the insurance model. About 40 percent of our clientele have no insurance, and the other 60 percent have insurance yet chose to use our services because they believe it’s worth paying directly in order to assume control of their care. (As a quick aside — my favorite clients in this group are health insurance executives and CEOs of large companies, who have the best health insurance in the country.) Read more »

Does Pay For Performance Improve Healthcare Quality?

The Jobbing Doctor, a primary care doctor in the UK, writes about the British version of what Americans call “Pay for Performance,” or “P4P.”

He says something I’ve said many times before (like here, here, and here).  Which is this: incentives fail because they try to treat medicine as an assembly line process, when it’s not.

But what’s most interesting about his post is that it could have been written by a doctor from anyplace on the planet Earth.

The Jobbing Doctor talks about a UK program that started in 2004 called the Quality and Outcomes Framework, or “QoF.”   Now, the American “P4P” is a much more catchy name, so score one for American marketing.  But it doesn’t matter what you call it – that which we call a rose would, by any other name smell as sweet. Read more »

*This blog post was originally published at See First Blog*

AHRQ Says It Will Take 20 Years To Close Healthcare Quality Chasm

As one would expect from such a diverse group, comparisons were a common topic at the co-located National Medical Home Summit, National Retail Clinic Summit, and Population Health and Disease Management Colloquium this week.

During an opening session, Carolyn Clancy, head of the AHRQ, updated us on some of the comparison work her agency has been doing. Last year’s stimulus bill dedicated a lot of funds ($300 mill directly, more through the Secretary of HHS) to the agency’s work on comparative effectiveness. Read more »

*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…

Read more »

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…

Read more »

See all interviews »

Latest Cartoon

See all cartoons »

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…

Read more »

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 »

See all book reviews »