Accountable Care Organizations (ACOs) and “bundled payments” are set to play a central role in the Affordable Care Act.  Under accountable care, physicians and hospitals would be paid out of a “single payment” from CMS or health insurers for all the care needed to treat a clinically defined “episode of care” like a heart attack.   The premise is that bundle payments will incentivize physicians and hospitals to deliver more efficient, ...

Read more...

Eric Topol wrote a post on The Health Care Blog where he looks to a future enabled by emerging technology: "Just as the little mobile wireless devices radically transformed our day-to-day lives, so will such devices have a seismic impact on the future of health care. It’s already taking off at a pace that parallels the explosion of another unanticipated digital force — social networks. Take your electrocardiogram on your smartphone and ...

Read more...

The patient had a large abscess surrounding his spleen. On a large screen in the middle of the operating room, I watched a surgeon drain the fluid collection and remove the organ with small metal tools. I remember the surgeon navigating the complex anatomy with alacrity, handling the laparoscopic equipment with expert finesse, and quickly and confidently answering the battery of questions from the assisting medical student. To a young and ...

Read more...

I'm a physician. I'm not a "health care provider."  I hate that term. The insurance companies call me a "provider."  In a sense, it's true.  I provide health care services.  However, over the past few years I've noticed that the lines between different types of "providers" are getting more and more blurred.  Sometimes they're blurred to the point that patients don't even know what kind of "provider" they are seeing. I often have ...

Read more...

“Look left, look right”, our group leader told us. No, I was not learning to cross the street. Rather it was my first day of employee orientation at the IBM Software Lab over a decade ago. I was fortunate that our CEO was Lou Gerstner, arguably one of the greatest CEOs who has ever existed. Gerstner stepped into IBM in the early 1990s when the company was struggling. One of ...

Read more...

Not long ago I fractured my shoulder and needed surgery. After the operation, my husband of 30 years did all the things a loving spouse would be expected to do: He fluffed my pillows and put toothpaste on my toothbrush (try doing that with one arm!) and overlooked my crankiness. My husband also helped me in ways so fundamental to our status as a married couple that I barely registered them. ...

Read more...

Every patient is the only patient. - Arthur Berarducci Each person in need brings to us a unique set of qualities that require unique responses. - Don Berwick Disease-ify: To generalize and then classify a unique person's health complaint in order to match them with an effective remedy that ends to encounter; often done out of convenience, expedience, or for profit. Unique is a funny word. Every time I come across it, I am reminded of ...

Read more...

Here is the setup.  You're working in the ICU.  You want to communicate a prognosis to the family of a patient who is so ill he cannot make decisions.  You sensitively state the facts: the patient has less than a 5% chance of survival.  Or perhaps you say "he will definitely not survive." The family confers, and decides that they want to focus on keeping him alive as long as possible. ...

Read more...

Think about your own experiences—you’re at a party or a restaurant, and someone you’re with says something obviously racist. You cringe, but given the setting, you can’t decide how to react; after a pause, you probably decide to say something. Now imagine you’re at meeting for work, and a senior partner says something racist. You want to say something, and you even know that under some circumstances there are laws ...

Read more...

Primary care is ever the Cinderella-esque tragedy. Ever so maligned, ever engulfed in misery and never really the belle of the ball like she rightfully deserves to be. There may be reasons galore to this. Not least of which is the way primary care work is perceived in this country. Let me illustrate. The primary care attending I work with recounted a story from the early 2000s. As is usually the case with visits ...

Read more...