The Affordable Care Act (ACA) has changed Medicare for the better, and produced higher quality of care for patients. But whether the new shifts in Medicare policy will lower the total cost of health care, remains unclear. And that could present the program with a major problem in the future. For the first 40 years of Medicare, most enrollees opted for the traditional fee-for-service Medicare program. The main reason for doing so was ...

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Paying someone to mow your lawn is a pretty straightforward affair. Ryan the lawn guy will look at the lawn size and maybe the hilliness of your yard, and you’ll settle on a price for mowing and trimming it. When you decide to contract for Ryan’s services on a more regular basis, payment might get a little more complicated. If you pay Ryan every time he mows your lawn he ...

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shutterstock_66054364 I am going to make a bold statement here. Are you ready for it? There is nothing wrong with health care providers thinking like businessmen. I know what you’re thinking, but I feel the word “business” gets a bad reputation in medicine. We immediately associate the term with profit-hungry, egocentric individuals, a preconceived notion probably rooted in their unfair depiction in popular ...

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Co-management agreements are growing in popularity as health care shifts to outcomes-based reimbursement models.  Physicians and hospitals contract with one another in quality-oriented pay-for-performance arrangements, in which physicians oversee and manage service lines (most commonly orthopedics, oncology, and cardiology). The overarching goal of these agreements is quality improvement, which benefits all parties involved -- especially the patient.  The hospital benefits financially in part from reducing costs and physicians receive a base ...

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shutterstock_173620244 This is one of those columns that will risk the respect and friendship of some of my closest colleagues in the health care world.  In addition to disagreeing with me, they may argue that I am giving aid and ammunition to "the enemy," where the enemy might be viewed as those forces in the health care world who really don't want ...

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“Dr. Vashist, I’m sorry to bother but you really need to look at this medication being taken by our patient.” My hospital pharmacist gently prodded me as he handed over the patient’s medication list along with cost information and side-effects of the offending medication. The issue with the list was a subcutaneous injectable form of calcitonin, Miacalcin, costing approximately $11,300 per day of treatment. The patient had been admitted about 11 days back ...

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My oldest son is almost a second grader. He attends a public elementary school in town, and very soon, he will start preparing for an exam known as the STAAR test. The STAAR test is an “assessment of academic readiness.” In my state, it gets administered to publicly-funded school children. Students must pass the exam to continue progressing in school, and ultimately, students must master the exit level test to graduate high school. There’s good ...

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I was incredibly impressed by the announcement that three top U.S. health systems -- Dartmouth-Hitchcock Medical Center, Johns Hopkins Medicine, and the University of Michigan Health System -- will be enforcing standards that prevent low-volume hospitals from performing certain surgeries. This comes on the heels of a major US News story which showed that patients who had surgeries at low-volume hospitals faced significantly higher risks of complications ...

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Dr. Atul Gawande is an American surgeon and public health extraordinaire. He is one of the most successful physician authors of this century, and he writes routinely for the New Yorker. His most recent article discussing unnecessary health care is, as expected, a good read. I applaud Dr. Gawande’s passion towards advancing medicine. And, yes, there is universal agreement that we need to be better in America at providing high-quality low-cost health care. ...

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american society of anesthesiologistsA guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. Earlier this year, I spoke to an audience of physician anesthesiologists about setting up a basic quality assurance (QA) program within their departments. At the end of the presentation, one physician anesthesiologist stated that his group “will not let anyone out of the operating room ...

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