In the post-Affordable Care Act health care landscape, sweeping hospital closures have created new barriers to access in a system already criticized for its fragmentation and saturation. Looking back over the past 20 years, urban hospitals, and urban trauma centers in particular, bore the brunt of this impact, closing at the highest rates in the country. Now, evidence suggests the impact of urban hospital closures may disproportionately ...

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One of the most subtle deceptions hidden inside the cracks of our sick care system is the lie told to doctors: that health is our primary goal for our patients. I began to understand this paradox clearly when I listened to my friend’s anguish. She’s been working as a full-time medical assistant in a busy nephrology practice, supporting two sometimes three full-time sub-specialty doctors. The practice is located in a small town ...

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CMS recently announced it would begin next January to pay physicians for care coordination activities. It’s about time. As physicians have been saying for some time, any payment system that hopes to encourage value (better patient outcomes) has to start by paying physicians to coordinate the care of their patients.  When physicians follow up on referrals or communicate with patients outside of the office, healthoutcomes improve, costs shrink and the patient ...

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If a foreign government took the United States surgeon general hostage, I’m confident we’d be pretty upset. I think we would be working on reprisals, and maybe even prepping a SEAL team. I don’t know if it’s better or worse that we need no help from a foreign power to take our surgeon general hostage. Our own political system manages, all on its own. Admittedly, it’s not quite the surgeon general who ...

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shutterstock_160922276 By decisively taking control of the U.S. Senate and increasing their majority in the House of Representatives, the Republicans now have a chance to force some modest changes in the Affordable Care Act, but they will not be able to repeal or reverse it.  But Republican gains in state legislatures and governorships may put the brakes on Medicaid expansion, leaving millions ...

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good hospital Nearly every day a press release from a health care provider or health care technology vendor shows up in my inbox urging me to look at what they offer and to write about it. Most of the time I don't find their news worth passing along, but occasionally a pitch sparks a column idea. That's the case with the press ...

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It is well known that Medicare expenditures threaten the financial solvency of the U.S. government. And it is pretty well agreed upon that some of our Medicare spending goes towards wasteful medical care. But which medical care is wasteful and how much is such care costing us?  A study in JAMA Internal Medicine provides a sneak peek at answers to these important questions. The research, led by Aaron Schwartz, a graduate student ...

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We have heard ad nauseum that the data collection mandated by Medicare and Medicaid is to improve quality of care. Significant taxpayer dollars have been expended as bonuses in the name of PQRS (Physician Quality Reporting System). With all this investment and mandating, one would assume that the PQRS must be highly indicative of better quality of patient care, right? Not so fast. Two recent reports demonstrate how ineffective this program is and how much ...

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I think it’s fair to say Jonathan Gruber will not be offered the role of Pinocchio. Although intelligence agencies, in search of the truth serum, might have an interest in the ingredients of what he drinks. Please put away the pitchforks. Gruber deserves credit for honesty and bipartisanship. Plus a complete rejection of Disneyland economics. If you’re looking for transparency, the other face of honesty, Gruber is ground zero. Stupidity, though, was ...

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To me, Medicaid is Obamacare’s sleeping giant -- the enabler of federal power and control over the health system. It is a far more powerful enabler than health exchanges, which have gotten most of the publicity. It surpasses the number of uninsured and underinsured that the exchanges have enrolled. In the next year, four million more Americans will joing Medicaid’s rolls. It already covers one third of America’s uninsured. Under Obamacare, ...

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