Walter White and the narrow networks of Obamacare As we behold the continued wonders of Obamacare, we receive another reminder of the president’s empty promise: “If you like your doctor, you can keep your doctor.”  The New York Times observed, “No matter what kind of health plan consumers choose, they will find fewer doctors and hospitals in their network -- or pay much more for the privilege of going to any provider ...

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Health care is but one element of what makes the biggest difference in health outcomes: Social factors play a far more significant role. Income and its distribution, education, employment, social supports, housing, nutrition, and the wider environment -- what we have come to know as the social determinants of health -- are the most powerful predictors of wellness and longevity. This has been understood for centuries, and empirically validated in ...

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There’s a war being waged on one of America’s most revered institutions, the emergency room. The ER, or emergency department (ED for the sake of this post) has been the subject of at least a dozen prime-time TV shows. What’s not to love about a place where both Doogie Houser and George Clooney worked? Every new parent in the world knows three different ways to get to the closest ED. It’s the ...

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The fate of the Affordable Care Act (ACA) will be the big issue in the upcoming mid-term congressional elections, with Republicans and their allies continuing to press for repeal, believing that it is a winning issue with voters (or at least the base voters who lean Republican). Opinion polls are not as clear-cut, though. Although more Americans continue to have a less favorable than more favorable view of the law, ...

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Better outcomes and lower costs: The perioperative surgical homeWhether it’s a knee replacement avoided for years or an urgent life-saving tumor removal, when the decision for surgery occurs, too often the patient begins a journey into a complex system of fragmented medical care. Perioperative care, which generally refers to the three phases of surgery -- preoperative, intraoperative and postoperative -- can be variable and fragmented. ...

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I just realized what all these new insurance intermediaries, programs and organizations remind me of: derivatives. And we all remember how well that worked out for stocks a few years back. Let me explain. A few years back, a bunch of Wall Street financiers came up with a bunch of new ways to package various stocks and securities that were intended to be too convoluted for anyone to figure out that they were nothing ...

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Rwanda: The little country that couldRwanda: The little country that could An excerpt from Pharmacy on a Bicycle. One of the more impressive success stories in health improvement in a low-income country is Rwanda. This small landlocked country of 11.37 million was devastated by genocide in 1994 that left 800,000 people dead, affecting everyone in the country. The tragedy occurred ...

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Implementing lean: A hospital case studyImplementing lean: A hospital case study An excerpt from Beyond Heroes: A Lean Management System for Healthcare. Lean was a serious initiative from the beginning. It was energetically championed by our CEO at that time, John Toussaint, MD, who began his own lean investigations in 2002. By this time, I was a vice president with operational responsibilities ...

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Health care reform is a reality.  The ACA and its associated mandates have forever changed the landscape of medicine in the U.S. today.  The Obama administration touts the goals of reform as providing affordable, cost effective, high quality care for all Americans.  Certainly these are noble and lofty goals: But have we completely missed the mark? Today, many remain uninsured and the majority that have signed up for the exchanges are simply ...

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Improving health care: Are physicians knights or pawns? How do we motivate physicians and other health professionals to work at their best? How do we create systems of high performance? Is it by a series of top-down highly specific mandates or by setting up general guidelines and providing tools? I believe it comes down to one’s vision of physicians. Are physicians knights to be empowered in their service of patients ...

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