In these early days of pay for performance (P4P) reimbursement, as the size of your paycheck begins to reflect your patient satisfaction scores, let's have a frank discussion about three important topics all healthcare providers and organizations must understand going forward.

  1. How your performance will be measured
  2. How to get the highest patient satisfaction scores and be a happier doctor at the same time
  3. The first step to improving performance (in a healthy ...

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The Saturday after Sandy hit, I was the medical student in a Cambridge, Massachusetts emergency room.  Around the time my shift started, Andrew, a man about my age, couldn’t bear the pain in his nose any longer.  The ED nurse still talks about the “huge booger” bulging from his nose.  A few days before coming to the ED, he’d left behind his flooded, powerless Brooklyn apartment seeking refuge in his ...

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shutterstock_106351961 A few months ago I wrote a post about the 159 page digital fax that I received, containing records for a patient's recent lengthy hospitalization. I've now discovered something even more time-consuming and annoying: a 202 page paper record mailed to me by a major medical system. (I won't name names right now; suffice to say this system uses
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asco-logoAn email was waiting for me one morning from my wonderful nurse, Laura. "Very sad day," it said in the subject line. I opened the email quickly upon receiving it and read that one of my patients had died. This age-old dilemma again made me wonder what I should do: Should I call the family? Send an email or a card ...

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Are there really too few primary care physicians? And if so, what can we do to solve the PCP shortage? The standard answer to the first question is “yes, we have too few PCPs.” And the standard solution is to train more such docs, or allow more foreign-trained primary care docs into the country or, better yet, simply pay PCPs more money, so that graduating medical students will be more ...

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I have it on good authority that it’s not easy being green. But I’m willing to wager that it’s a whole lot easier when you have a lovable name like “Kermit.” Imagine being green (or brown) with a name like “Ramachandran”? Growing up with a name like mine certainly had its disadvantages. While most neighborhoods have a local bully who kicks ass and takes names, in my case, he would ...

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Amour 2 If you haven't seen the movie, "Amour", but are planning to, you might want to skip this commentary - but by all means do go! It starts and ends with love, but not in Hollywood's usual youthful romantic fashion.  It also starts and ends with death after much caring, love and suffering.  The agonizing toll on the patient and caregiver are equally ...

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acp-logoA guest column by the American College of Physicians, exclusive to KevinMD.com. Whether we call them “unnecessary,” “not indicated,” “inappropriate,” or “overused,” certain tests and procedures add little or no clinical benefit to patients and in some cases they cause harm. They also contribute to the cost of care without improving care. At a time when payers are challenging payment ...

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A reader recently wrote:

My [spouse] and I are 63 and childless. We are thinking of spending $99 to get genetic screening on the theory that it could help us plan a little better for our old age. Just as a random example, if I knew my chances for getting Alzheimer’s disease were high, I might want to move into assisted living sooner rather than later. We have many questions. Is ...

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shutterstock_111665426 A collision is coming. Scratch that. The collision is here. I'm not quite sure how to describe this, but I'll try. Every day, I look at a computer screen for health care delivery with an increasing number of menu options.  I tried counting these menu options once and after scrolling through them, I never reached all of them after counting up to 275 items. Yes, there are ...

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