As I finish my post-operative care routine for my 9-day-old patient, I notice that the cerebral oximetry machine is not picking up a strong signal. Despite troubleshooting, I am unable to figure out how to fix the problem, and I head to the Pixus to get a new sensor. Unfortunately, this one does not work either, and we must use a smaller sensor to pick up an adequate signal on ...

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Patients are being stuck with huge and unexpected medical care bills in circumstances where they have no say in selecting the physician who is billing them, and no way for them to know in advance which services the physicians would render or what it would cost them, says the New York Times. Mr. Peter Drier received a “surprise $117,000 medical bill from a doctor he didn’t know” for services relating to ...

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Around the country, for every health system that is successfully navigating the early years of value-based health care, there are several others that are failing -- even though many don’t yet realize it.   These failing organizationscan’t or won’t restructure themselves to deliver effective, efficient and affordable care. I’ve come to the conclusion, after observing struggling systems, that two basic characteristics are necessary for systems to transform themselves in response to external pressures: execution and motivation. Successful systems have ...

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Physicians, whether practicing medicine or not, should not be involved in clinical research. They should never be consulted on development of new drugs and medical devices. Doctors should not invent new treatments, and should never supervise clinical trials. They should not travel to or speak at conferences either, and they should banish all entrepreneurial notions out of their heads. If they insist on engaging in these activities, they should do ...

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Insurance is without a doubt the best business on earth. Every month, insurance companies from many industries collect premiums from thousands of clients, relying on the statistical likelihood the companies themselves will collect more than they pay out. If the company has a poor year, they raise the premiums for the next year. It is a beautiful business model and a way to guarantee consistent profits year after year. Even ...

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What happens when the federal government and the states have split responsibilities for caring for Medicaid beneficiaries? Not much, other than casting blame on one another or on doctors for not providing the care. Buried on page 26 of the front section of a recent New York Times is a story about Medicaid patients not finding doctors or having to traveling long distances to find one. It says a federal inquiry finds ...

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Its time to talk trade offs in health care An advantage of being a foreigner, or a recent immigrant to be precise, is that it allows one to view events with a certain detachment. To analyze without the burden of love, hate or indifference for the Kennedys, the Clintons or the Bushes. To observe with both eyes open, rather than one eye looking at the events and the other looking ...

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The recent independence referendum in Scotland got me thinking. I must admit I was glued to the news over the last few days of campaigning. For those of you not following closely, it seemed as if the "no" camp had a comfortable lead right up until the last week when the opinion polls suddenly showed the "yes" camp pulling ahead. This rattled the establishment. The prospect of my country of ...

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Baseball fans like me take great joy in studying the way general managers assemble their rosters. The variations are fascinating. Some teams focus on pitching strength. Others go for speed or power-hitting. Each approach carries distinct advantages and disadvantages on the field. That same level of variation and strategic decision-making applies to health plans, as well. With the health care marketplaces reopening for enrollment on Nov. 15, anyone evaluating their coverage options should take ...

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We recently had a readmission -- a straightforward case, really.  Mr. Jones, a 64-year-old homeless veteran, intermittently took his diabetes medications and would often run out.  He had recently been discharged from our hospital (a VA hospital) after admission for hyperglycemia.  The discharging team had been meticulous in their care.  At the time of discharge, they had simplified his medication regimen, called him at his shelter to check in a few ...

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