If you believe what most people are saying about health care reform and future practice models, you or your physician, will soon be part of an accountable care organization (ACO). Health policy experts tell us that as physicians, we'll be embarking on a wonderful journey that bears no resemblance to the HMO/managed care heyday of the early 1990s.  Of course, there'll be similarities, like limited networks, top down implementation of health protocols, and ...

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It’s impossible to watch the news these days. Whether you’re conservative, liberal, independent or non-committed, it’s impossible to avoid the political bickering these days as the US Presidential campaign enters its final countdown. As a physician, seeing the video of Granny being pushed off a cliff is about all I can handle. Seriously? No politician I know has to deal directly with Granny, but I do. I have to look ...

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A guest column by the American Medical Association, exclusive to KevinMD.com. Physicians contribute significantly to both the health of our patients and the economic health of our nation, and a new report shows that the 2 percent Medicare spending sequestration cut will put the jobs supported by the health care industry in jeopardy. The AMA recently teamed up with the American Hospital ...

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“The specialist rescheduled me again,” the patient told me, looking embarrassed.  ”I think he doesn’t want to see me any more.” “I’m sure that it isn’t that he doesn’t want to see you,” I replied.  ”This has to be a miscommunication with the front desk.  It happens all the time; it drives doctors crazy.” “I don’t know,” he continued.  ”I just got on Medicare, and I wonder if maybe he doesn’t want ...

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When I was traveling around the country interviewing for a residency spot in family medicine in the fall of 2008, I was eager to find a patient-centered medical home (PCMH). At every interview, I asked whether the program's clinic was a certified PCMH or whether it was moving in that direction. "Well, we don't yet know what that looks like" was the answer that I heard at nearly every destination. ...

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Greg Smith, formerly of Goldman Sachs, has described a positive organizational culture as being the “secret sauce of greatness.” What is the nature of this secret sauce? A simple, popular definition is that “organizational culture is the way we do things here.” The relationship between organizational culture and organizational success is unassailable. In our commercial dealings, has not each of us easily recognized when a business culture is truly customer-focused, and ...

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If you think health care is expensive now, wait until you see what it costs when it’s free. -P.J. O’Rourke I distinctly remember that in first grade I had an idea of breathtaking wisdom and profundity. Candy should be free. You may have had a similar thought at the same age. This idea was supported by an incontrovertible rationale, namely that I really liked candy. Tragically, it only took a moment for ...

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Excessive health care spending is overwhelming America’s economy, but the subtler truth is that this excess has been largely facilitated by subjugating primary care. A wealth of evidence shows that empowered primary care results in better outcomes at lower cost. Other developed nations have heeded this truth. But US payment policy has undervalued primary care while favoring specialists. The result has been spotty health quality, with costs that are double ...

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A staple of conservative critiques of universal coverage is that having health insurance doesn’t equal access. The corollary is that the uninsured already have access to care—from doctors and hospitals willing to take care of them on a charitable basis and from "safety-net" institutions. This argument isn’t new, having been made years before the Affordable Care Act became law. In 2007, the Council for Affordable Health Insurance opined that universal coverage ...

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Us and Them And after all we’re only ordinary men The wanna-be congressman appeared with his neat hair and pressed suit, a competent yet compassionate expression on his face.  ”The first thing I am going to do when I get to congress is to work to repeal Obamacare,” he said, expression growing subtly angry.  ”I will do everything I can to give you back the care you need from those who think big ...

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