"Educate the young, regulate the old." That quote has literally followed me around the world. I can vividly remember when first making the statement. I was one of five “safety experts” on the closing panel at an international safety and quality meeting in Sydney, Australia a number of years ago. The thought was that the five of us would somehow be able to share “pearls” of wisdom regarding what was ...

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The Supreme Court’s imminent decision on the Affordable Care Act will trigger a political firestorm whether they accept the legislation in its entirety, throw out every page of the 906-page bill or do something in between, which is the most likely outcome. If the high court follows the polls, it probably will rule the requirement that individuals purchase insurance – the mandate – is unconstitutional but leave the rest of “Obamacare” ...

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Healthcare costs keep rising. Your insurance premiums go up, your deductible and co-pays go up, pharmacy benefits go down. Despite the high cost you get little time with your physician, insurance statements are complex beyond belief and “customer service” seems to be a foreign concept. To combat high costs we are often told that rationing will be necessary. Is that true? Why are costs so high in this very dysfunctional healthcare ...

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Stranded capital is a new term, a derivation of the term stranded costs that emerged from the deregulation of electric companies. It refers to “the existing investments in infrastructure for the incumbent utility which may become redundant in a competitive environment.” Many academic medical centers are weighing the importance of meeting current demand while considering the risk that, in a future competitive environment, dramatic declines could occur in the need ...

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I was recently honored to attend a discussion at the White House, convened by Health and Human Services Secretary Kathleen Sebelius. It was one of those rare "clear my schedule immediately" invitations; I thank my patients and family for allowing me to take this last minute trip. Physician leaders from around the country were invited to the White House for a dialogue with lead government health officials (specifically administrators from the ...

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There is enormous waste in American healthcare delivery. One estimate is anywhere from 20% to nearly 50% of total expenditures are frankly unnecessary. What is this waste?  Is it real? Could it be eliminated or at least reduced? How difficult would such a reduction be to achieve? And what would be the unintended consequences? Donald Berwick, the former administrator for the Centers for Medicare and Medicaid Services, along with Andrew Hackbarth ...

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The Medicare physician payment formula is a case-study in failed policy. Physicians have long known that it is not working. Polls show that an overwhelming 94 percent of Americans believe the massive cuts it schedules are a serious problem for seniors. Even members of Congress from both parties agree – and that is no small accomplishment – that it is ...

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The medical profession has always been marked by division: town versus gown, primary care versus specialty medicine, states versus national. But the real fault line today is not defined by specialty, geography, or teaching versus practice, but by size of practice. Physicians in smaller practices, without regard to specialty or where they are located, are embattled and defensive—and therefore are more skeptical when someone tries to peddle the need for delivery ...

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At the end of long days I often stand gazing out my window at the beautiful, timeless Rocky Mountains in Colorado Springs and am taken by their sense of permanence. I recently returned from Nampa, Idaho, where I presented hospital Grand Rounds on Accountable Care Organizations. The parallels between the timeless mountains and the physicians I met in Nampa struck me. Strange, you say? Maybe, but I am accustomed to the ...

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While there is an extensive literature on how tired, overworked physicians provide lower quality medical care, one thing that has been ignored by advocates of quality improvement is that overwork financially harms hospitals as well. Just as tired physicians sometimes fail to attend to certain clinical details, they are also more likely to commit errors when writing the notes which ultimately are used during the coding process. If hospitals consider ...

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