The realization that the American health care system must simultaneously decrease per-capita cost and increase quality has created the opportunity for the United States to learn from low and middle-income countries. "Reverse innovation" describes the process whereby an inexpensive innovation is used first in countries with limited infrastructure and resources and then spreads to industrialized nations like the United States. The traditional model of innovation has involved the creation of ...

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AMA: A new opportunity to fix the SGRA guest column by the American Medical Association, exclusive to KevinMD.com. Every year since 2001 the threat of severe physician payment cuts, imposed by Medicare’s failed sustainable growth rate formula (SGR), have jeopardized the stability of the Medicare system and compromised access to care for patients. And every year – sometimes several times a year – Congress has put in place short-term ...

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The current reorganization of health care could make it better and cheaper for everyone, harnessing real creative and competitive energies to build the "next health care" —or it could lead to local monopolies, higher prices and less real competition where it matters. The many and various moves toward accountability, competition and transparency could defeat themselves. The theme of the reorganization is clear: new types of cooperation between physicians, hospitals and other ...

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ACP: Current and future payment and practice trends in medicineA guest column by the American College of Physicians, exclusive to KevinMD.com. In April 2011 I finished seven years on the Board of Regents of the American College of Physicians (ACP) including two years as Chair of the ACP Health and Public Policy Committee and serving during the last year as President. During that time I had the opportunity to ...

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In the September 2011 issue of Harvard Business Review, Harvard Business School professors Robert Kaplan and Michael Porter argue that a better understanding of the actual cost of care patient-by-patient can have a dramatic impact in the effort to control health care costs. They maintain that actual costs are poorly understood, that there is a mistaken belief that many costs are too complex to allocate accurately, and that ...

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Robert Brook, MD, health services researcher extraordinaire, wrote a provocative commentary in JAMA – as he is accustomed to doing – entitled “What If Physicians Actually Had to Control Medical Costs?” In his piece, Brook challenged physicians to take a lead role in addressing the cost dilemma and called on physicians to find alternative strategies to rationing. No matter how spot on Brook was in his call to physicians to ...

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Almost everyone I know considers the American healthcare system to be a horrible mess, although some that are deeply into it are quite happy with it. It serves their interests well. Many do have big-time power. There are lots of candidates for the "most powerful" title. How about Regina Benjamin, the Surgeon General of the United States Public Health Service? Maybe Kathleen Sebelius, the Secretary of Health and Human Services? Consider Howard Koh, the Assistant ...

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Medicare needs to be reformed, but there's no easy solution to the problem.  As the average life expectancy increases, more-and-more politicians have proposed an increase in the Medicare eligibility age.  This increase in life expectancy, however, is an issue that only affects the wealthiest half of America -- the people that need Medicare the least -- because the life expectancy has only increased significantly in the richest half of ...

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Here are my next two principles of affordable healthcare reform. First, medicine must be practiced in a manner and in a place that is consistent with economic efficiencies, evidence based outcomes and the needs of the specific community that it serves. In healthcare delivery, quantitative must be balanced by qualitative. Specific community needs and the culture of that particular community must have equal and in certain cases, greater value than the ...

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An interesting legal case brewing in the medical world that's worth sharing. A group of six physician plaintiffs from Georgia are suing the government (the Secretary of Health and Human Services) in a federal district court claiming damages from the fact that Medicare, the massive program that covers the elderly and disabled, fails to execute due diligence by rubber-stamping a reimbursement structure that overvalues procedural medicine over cognitive services. Huh? Some background ...

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