At the end of my interview with Chip Heath, co-author of the New York Times bestsellers “Made to Stick” and “Decisive,” I asked him what topic he’d like me to cover in the future. “I’m impressed by the culture you’ve created at Kaiser Permanente in Northern California,” he said. “You’ve generated quarter-to-quarter change that I think would have taken three years elsewhere. I don’t think most organizations know how to ...

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If you read my articles, then you likely know about the scam known as pay-for-performance (P4P).  This program not only fails to deliver on its stated mission to improve medical quality, but it actually diminishes it. In short, P4P pays physicians (or hospitals) more if certain benchmarks are met.  More accurately, those who do not achieve these benchmarks are penalized financially. I do not object to this concept.  Folks who perform ...

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A physician I have known for many years recently told me about his decision to enter the world of concierge medicine. His reasoning was telling, saying that it came down to a very simple decision on staying independent or becoming a hospital employee. He liked being an independent solo practitioner, and that was his primary motivation: to maintain independence in a time of consolidation. Richard Gunderman, writing for the Atlantic, tackled ...

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“It is immoral that the wealthiest nation on the planet does not provide affordable, high-quality health care to all of its citizens. Despite being the only global ‘superpower’ still standing, we trail much of the industrialized world in life expectancy, infant mortality, and countless other indicators of health. Until we fix our broken, prohibitively expensive delivery system, things will only get worse.” I’m not sure if anyone has used those ...

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I’m not sure if you’ve heard the parable of the tall man and the cat. Maybe not, since I had to make it up in light of health care’s unending cost increase. In this allegorical village, there was a group of citizens who were very upset with a man who lived there. This man was very, very tall, and he made all the villagers feel uneasy (they were insecure about the crowns of their heads, ...

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I saw the caller-ID and immediately picked up the phone; it was an old friend from college. “I want to sue a doctor and I want to sue the hospital,” said Karen. Sadly, I hear those words all too often.  I’m a newly-minted lawyer -- after a 35-year career as a publisher -- working at one of New York’s top medical malpractice plaintiff’s firms.  What made this particular call so unusual, was ...

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We all know about the increase in Medicaid patients resulting from Obamacare, and how this is exacerbating the shortage of providers who accept Medicaid. I see Medicaid patients in Denver, where there is a reason for the shortage that is often overlooked: managed care Medicaid. The managed care concept peaked decades ago, a failed attempt to reduce health care spending by forcing patients to go to only one doctor or ...

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Overwhelmingly, doctors’ reimbursement has been the target of government programs and insurance companies.  The idea underlying this movement has been, pay doctors less and curtail their incentive to see patients and the cost of medical care will decrease.  As a result of this faulty reasoning, we have ushered in the era of unhappy doctors, those retiring early, and those asking for extra payments to justify the hours needed to give ...

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As our nation struggles with the mind-boggling algebraic-like task of reigning in on health care expenditures while increasing provider access and high-quality medical care, provider payment structures are in flux between traditional payment methods and relatively new financial structures. While I am no means an expert of health policy nor medical business and financing, I think it's important for medical trainees and enthusiasts alike to understand the very general basics of ...

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So you think there is a war on doctors, don’t you? It certainly looks that way from your particular vantage point. The government is deftly intruding into your professional life with a computerized fifth column that is extracting information on your every move, and to add insult to injury, it forces you to actually collect the data which is to be used against you in the court of public opinion. ...

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