Doctors are trying to rationalize our current story line:  the loss of autonomy and pay cuts are a necessary evil for the greater good.   We're taking one for the excess-health care cost team.  We're willing to take this personal sacrifice for our fellow man and woman.   It is the noble thing to do.   It will be good for America's healthcare system if we do our part, work harder ...

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T.Santo - Oregon Medicaid (media) An important article was recently published in the New England Journal of Medicine, titled The Oregon Experiment — Effects  of Medicaid on Clinical Outcomes. This study provides a rare look at the effects of expanding Medicaid coverage (specifically, Oregon Health Plan, Oregon’s version of Medicaid) to a population of previously uninsured patients. Having practiced medicine in Portland, ...

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How much to treat this pneumonia? The Centers for Medicare and Medicaid took a step towards answering such questions by publicly releasing how much each of 3000+ U.S. hospitals charged Medicare for 100 common medical issues in 2011 and how much Medicare actually paid them. The charges were remarkably variable, even among hospitals that share a zip code. Massachusetts hospitals tended to charge below the national average (eg. ...

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An excerpt from The Upstream Doctors: Medical Innovators Track Sickness to Its Source. There’s a story widely known in public health circles about three friends and a river. I retell it this way:

Three friends approach a wide, beautiful river leading to a waterfall. The idyllic scene is shattered by the cries of a small child in the water, flailing his arms while struggling to stay afloat. He’s fast approaching the ...

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In an ad-hoc poll among classmates, I recently inquired about the most important date (in 2013) to a 2nd year medical student. The overwhelming majority cited their respective USMLE Step 1 exam dates as most important, followed closely by the season finales of ABC’s Scandal and Grey’s Anatomy. While the top three responses all are worth their respective weights, the one date that should bear the most gravity in the minds ...

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If you have been paying attention to US healthcare policy debates lately, you know that hospitals have a price problem. Walk across the street from one hospital to a competitor hospital, and you could easily find yourself facing a $30,000 increase in your medical bills. At one extreme for instance recent information shows that replacing your hip with a surgical implant might cost anywhere from $5000 to ...

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One reason is to apply an extra “facility fee” to patients’ bills. Another reason is that primary care docs generate a ton of money for the hospital.  A new survey was sent to hospital chief financial officers across the nation and based on data submitted by 102 facilities, it found that PCPs generate more annual revenue than specialists do. PCPs (defined in the survey as family physicians, general internists, and pediatricians) generated a ...

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I always believed that, if we could harness the entrepreneurial spirit of the American physician, we could be capable of great things. Physician decisions drive much of what is good and bad about our health care system. Their pens are the biggest driver of cost and their vigilance is the most significant driver of quality. It is a shame that physician-owned hospitals are accelerating the creation of a two-tier system ...

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“There are two diagnoses you will never make: those you didn’t think about, and those you have never heard of.” This quote, ascribed to many an attending physician over the years, underlies what has become on some levels a vitriolic discussion of primary care delivery in the United States today. It was recently highlighted by a study published in the New England Journal of Medicine. This article showed a real ...

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Several physicians have reached out recently to discuss attractive employment offers from health systems. They are invariably conflicted. They understand the trade-offs, that they’ll give up the autonomy they’ve become accustomed to in exchange for more money and fewer practice management headaches. On the down side, they’ll be accountable for generating significant revenues, sometimes independent of care appropriateness. Most also are aware that the same care services they provide now will ...

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