The September 2012 issue of the AARP Bulletin has a story about a woman who sued an elder-law attorney for legal malpractice. Bear with me. It’s an interesting tale. In 2004, a man consulted an elder-law attorney to set up a trust that would distribute his assets fairly. He had a daughter from his previous marriage and his wife had five children from her previous marriage. The story is ...

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How many businesses do you know that want to cut their revenue in half? That’s why the healthcare system won’t change the healthcare system. -Rick Scott, Governor of Florida Former CEO, Hospital Corporation of America The Washington Post recently reported that health plan lobbyists, charts at the ready, are working to convince legislators that unreasonable health care costs are everyone else’s fault. Karen Ignagni, the Executive Director of America’s Health Insurance Plans (AHIP) declared: ...

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The ultimate cure to the perversions inherent in U.S. health system economics is cracking the risk code – optimizing the financial risk allocation for any given disease across payer, health system, physician and patient. After years of payer and more recently health system effort, the heat is increasing on doctors and patients. Despite vigorous effort on wellness and prevention, it’s fair to say the industry has so far missed the mark ...

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When someone is arguing that our health system needs an overhaul, one of the most common reasons they cite is because it is "built on a flawed foundation of fee for service." Of course we blame fee-for-service reimbursement for the rampant overtesting, overtreating, and fragmentation (among other things) in our health system, but this doesn’t mean that it is inherently bad, and here’s why. First, a little contextualization will help. Fee ...

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We physicians like to think that we are really different from other workers.  We physicians, perhaps thinking back to that medical school application essay we all wrote, really believe that we went into this career to simply help others.  We physicians truly believe that we always put our patients first. Because we sincerely believe all of the above, we are shocked when someone like Uwe Reinhardt points out that collectively we ...

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The Patient Protection and Affordable Care Act cleared two major hurdles in 2012: the Supreme Court ruling on constitutionality and the reelection of President Barack Obama. However, in 2013 there is a very good chance that Courts will see much more of the health care reform law due to objections regarding the contraception mandate. Despite the bills legal successes in the past, there are (at publication) more than
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A recent New York Times headline read that "Medicare Is Faulted on Shift to Electronic Records."  The story describes an Office of Inspector General (OIG) report, released November 29, 2012, that faults the Centers for Medicare and Medicaid Services (CMS) for not providing adequate oversight of the Meaningful Use incentive program. Going after “waste, fraud, and abuse” always makes good headlines, but in this case, the story is not ...

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Today, I come back to the tragedy of medical economics in this country. And I would apply that word "tragedy" in at least two ways. The first tragedy is that we are headed for fiscal disaster in this country because of healthcare costs. We now spend twice as much per person on healthcare as the average per person cost of all developed countries. During the past several decades, the inflation rate for ...

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Not long after posting a recent column which, admittedly, was somewhat critical of healthcare providers in and around New York City following Super Storm Sandy, I decided to get a clearer picture from someone intimately connected to the disaster – my own brother. A few months ago, Ira Nash, MD, was appointed Medical Director for Physician and Ambulatory Network Services at North Shore Long Island Jewish Health System (NSHS), a ...

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Some physicians will make over 7 times what the average college dropout will earn over a lifetime. Even within medicine there are significant differences in lifetime earnings between primary care, surgery, and specialty care. With the recent Powerball lottery jackpot at a record high, there was a lot of daydreaming going on recently for many Americans, maybe even some doctors: What would you do if you actually won it all? ...

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