I think horses can teach us some things about health promotion. We invoke them routinely, although I suspect we are unaware of it much of the time. Three of the more salient themes in modern health promotion involve incentives, disincentives, and what/how much people drink -- with a particular emphasis, of course, on less soda, and more water. I hear hoofbeats in all of them. Incentives are particularly prominent in worksite and ...

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I hope my patients are satisfied. This is everything. Improving the lives of people is why doctors do what they do. How much we help our patients is the metric. It’s the peg we hang our self-esteem on. So yes, of course, patient satisfaction is really important. But that doesn’t mean it’s a good idea to link it with dollars. In fact, on a list of well-meaning but really dumb reform ...

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The Bipartisan Policy Report titled “What is Driving US Health Care Spending? America’s Unsustainable Health Care Cost Growth” issued in September lists seven factors increasing American health care costs. The “fiscal cliff” debates include many of these arguments. While these factors do indeed play roles in American health care, almost all are at work in other industrialized countries, all of whom provide better care to more people for half what we ...

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When the marketing of ObamaCare began in 2009, I always believed that the end game was for a federal single payer system. Since the present Affordable Care Act, (ACA), was passed in 2010, there has been nothing to convince me otherwise. The only reason single-payer wasn’t passed two years ago was because it was hard enough to arm-twist and bribe even ...

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As millions of Americans gain health care coverage under the Affordable Care Act, we have an unprecedented opportunity to work on eliminating health disparities based on race, income and insurance status. Several states, including California, soon will begin marketing their Health Benefits Exchanges (in our state it’s called “Covered California”). Through these exchanges, millions will enroll in health plans and expanded Medicaid programs for coverage that takes effect in January ...

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The 21st century challenge for the American health care delivery system is to deliver higher quality care for less money.   Republican and Democratic experts agree that payment reform involving transitioning from fee-for-service to global, value-based systems is necessary for us to achieve that goal.  Accountable care organizations (ACOs) are the new entities that will receive the new global payments and distribute them to the doctors, allied health professionals, hospitals, and ...

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Prior to heading out West for my postgraduate medical training, I spent four amazing years in Chicago absorbing everything I could about becoming a doctor.  Throughout this time in medical school, I was taught everything from the smallest components of atoms to the largest organs of the human body.  Academic physicians spent countless hours teaching me the art of bedside patient care and the scientific evidence behind clinical decision-making. Despite this ...

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“Passed by corruption, aided and abetted by the purest man in America” is how anti-slavery Congressman Thaddeus Stevens described President Lincoln’s successful effort to enact the 13th amendment, banning slavery.   This historically accurate quote, which runs counter to the public image of “Honest Abe” Lincoln, is among the many  fascinating  stories recounted in the Steven Spielberg’s masterpiece  “Lincoln” playing  ...

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I wanted to expand on something I wrote recently, which relates to my other sort-of-recent post on upcoding. I wrote, about scribes and compliance:

Knowing that the scribe cannot document a complete ROS unless I actually did that ROS, I am more compulsive about making sure I hit all ten systems. (Even when it's not clinically relevant. Such is the Kafkaesque world we live in.) And I ...

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The difference between a job and a profession is a matter of ownership. Anyone who is applying for employment understands that the job they seek actually belongs to someone else. It is typically offered by an individual or a corporation who defines the job and determines who is qualified to perform it. If the job holder is unable or unwilling to do the work, the owner takes the job back ...

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