The Disease Management Care Blog received this posting from an experienced nurse with a background in clinical and administrative medicine. We’ve all seen them. Those vacuous workplace posters exhorting teamwork, creativity and other forms of inspiration and accomplishment. A version has begun to creep into our nation’s health care facilities. reminding everyone of the need for privacy, how infections can be spread and the importance of patient service. And if my ...

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by James Baker, MD Once the recession is over (maybe that should be "if the recession is ever over"), it’ll be time to do something about the deficit. The way to do that is to get healthcare costs under control. But I don't see how containing fee-for-service medical practice does the trick because, outside of family practice, I cannot see how to get away from fee-for-service, for the most part. I think ...

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Among the many provisions in the Patient Protection and Affordable Care Act are elements intended to assure that every American has access to healthcare that is patient-centered, affordable, and of the highest clinical quality. In my mind, one of the act's most essential goals is to establish a National Health Care Quality Strategy -- one that integrates disparate federal and private sector initiatives, building on and expanding current quality assessment and ...

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Legend tells of an Athenian named Pheidippides who, in 490 B.C., ran from the battlefield at Marathon to Athens, telling of the victory over the Persians. Proclaiming the news that Athens would be spared pillage and fire, the Athenian dropped dead. The story is a myth. But the marathon, like most things worth doing, does offer both risks and rewards. Because it gives a chance to go beyond usual boundaries, with ...

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The Futurama exhibit from the 1939 World’s Fair, although pretty in exhibition form, looks like a terrible place to live. It’s a world of machines, concrete, and efficiency. How boring! Futurists have always imagined the “what can we do?” scenarios. They’ve never really asked the questions:

  • What should we do?
  • What do people want that would make them feel more alive and more happily human?
Jane Jacobs, in her excellent book
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I like reading Maggie Mahar’s Health Beat. She usually gets it, from the function of insurance to the complexities of assorted payment systems, I get the sense that she is generally rational when it comes to paying for health care. This doesn’t mean there aren’t times when she gets it wrong. Her embrace of primary care provided by nurse practitioners shows a truly spectacular ...

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The New England Journal of Medicine analyzed Medicare statistics from the beloved Dartmouth Atlas of Health Care study revealing a wide disparity in the number of coronary bypass procedures in Golden Colorado compared to other areas. The report reveals a 60% reduction in the number of procedures as compared to Miami, Florida.  The Dartmouth Atlas Study has been used to justify changes in payment systems by Medicare. The ...

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A guest column by the American Medical Association, exclusive to KevinMD.com. Medicare physician payment cuts are once again looming in the immediate future, with a cut of 25 percent now threatening to hurt access to care for seniors and military families. As many doctors know all too well, the looming cut is forcing physicians to make difficult decisions about the continuing role Medicare can play in their practices. The AMA is working on ...

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I’m going to take the time to review a topic that is one my pet peeves, one you hear bandied about all the time in discussions of more consumer directed health care.  It’s a topic I came back to repeatedly on my old blog – the moral hazard. Basically, the moral hazard is the idea that people insulated from risk behave differently than people exposed to risk.  For instance, ...

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Well it's that time of year again. No, not Thanksgiving or Christmas, or even the venerable Interim Meeting of the AMA. It's the time that physicians nationwide anticipate another mandatory cut in Medicare reimbursement rates. This time the recurrent temporary fix will result in a cut of 23.6 percent on December 1st. Assuming political gridlock the rate will fall another fraction of 6.5 percent on ...

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