The pressures mounting on most institutions as the years trudge by are mounting. They are mired in mountains of regulations, the need to implement millions of dollars of IT "improvements," streamline their most productive service lines, strip down their front-line staff to dangerous levels … and all this while their reimbursements are being crushed. Consider that a profitable hospital currently operates on a 1% margin. Consider that the hospital is considered the most costly ...

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The next time I receive medical care, I want to know how much it will cost before I agree that it will be done -- and that includes no matter who pays the bill. And, doctor, I want you to know and I want you to care how much what you prescribe is going to cost me or somebody. You say it is beyond your control to know? I say, insist. Rise up, ...

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Recently I had the privilege of travelling to Vancouver, British Columbia to attend the inaugural BC Forum of the Canadian Coalition for Global Health Research. We had a wonderful host in the Department of Global Health of Simon Fraser University (and especially from Drs. Craig Jones & Vic Neufield). It was a challenging and pivotal conference for me. That is not what I want to share now. The conference started with ...

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If you have a brain and work in healthcare, you know chances are good that David Houle and Jonathan Fleece’s prediction that “one third of hospitals will close by 2020” is on the money.  Until a recent marriage and move took me to St. Louis, my job was to sell a Texas hospital system’s plans for the future to major donors; and throughout my five-year tenure, the looming and pervasive ...

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Have you ever owned a dog? If so, did you ever take him to the vet? I’m sure that even if you don’t own a pet, you understand the gist of the question, but now I’d like to ask it again in a different way. Before taking your animal to the doggie doctor, do you ask the little guy which vet he wants to see, or what treatment he wants ...

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Back in 2000, a group of experts convened by the Agency for Healthcare Research and Quality (AHRQ) reported that, although substantial medical error and injury was occurring in the ambulatory setting, very little research had been done to understand the reasons why. To address what they recognized as a serious issue, this expert panel made 11 specific recommendations that were intended to stimulate research in this area. Fast forward to the present ...

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Here’s something I read recently in a blog post (The Limits of (Neuro)science at Neuroskeptic) that started me thinking: "Will science ever understand the brain? … The notion that humans are complex and hard, while nature is easy, is an illusion created (ironically) by the successes of reductionist science. Some of the biggest questions facing mankind for eons have [been] answered so well, that we don’t even ...

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More chronic illnesses, more diseases of old age, consumers demanding more quality and safety, physicians no longer in typical private practice, and high deductible health care polices are each about to cause major changes in the practice of medicine and how it is delivered to patients. Will this come about smoothly or, more likely, with some serious hand wringing? Health care delivery will change substantially in the coming years. This is ...

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A recent survey by Deloitte of physicians opinions on health care reform has drawn some very differing conclusions from partisan commentators. The 501 physicians answered a number of questions, the most notable of which included a dichotomous question on whether the Affordable Care Act was "A good start" or "A step in the wrong direction." The question was split 44% to 44%. All respect for Mr. Pollack and Dr. Murthy writing ...

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Medicare needs to cut costs. It has chosen methods to cut costs that will damage the basic health care services needed by most Medicare patients. And instead of calling this cost cutting, it uses terms such as "shared savings." Even worse, the “shared savings” will result in even less health spending in United States locations that already have lowest health spending. Innovative designs are not the problem. The problem is ...

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