Emergency Physicians Monthly has an important debate between ACEP President David Seaberg and EP Monthly founder Mark Plaster about the “Choosing Wisely” program. Choosing Wisely is being pushed by the ABIM Foundation as a way to get specialty societies to label certain tests as “unnecessary” or of questionable benefit. I side with Dr. Seaberg in this argument. I disagree with the concept some people advance that we ...

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Republicans and Democrats don’t agree on much about Medicare, except for getting rid of the fee-for-service system for paying doctors. “If reducing the growth of Medicare spending to sustainable rates and moving away from fee-for-service are ‘ending Medicare as we know it,’ then both parties have embraced that goal, writes former OMB Budget Director Alice Rivlin in a Daily Beast commentary. “Paying providers on a fee-for-service basis offers incentives to ...

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The gynecologist made several incisions and inserted the laparoscope. With the help of her surgical team of nurses, students and anesthesiologists, she removed the patient’s uterus, which had been bleeding uncontrollably for the past six months despite aggressive medical therapy. The price tag of the procedure? Around $6,000. Meanwhile in a nearby hospital, another gynecologist removes another woman’s uterus, in a procedure no more complicated or time consuming than the first ...

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Atul Gawande, MD, is a technophile and a believer in the checklist, and he yokes these ideologies to an attractive metaphor in his newest essay for the New Yorker. The article is worth reading in its entirety, but it can be easily paraphrased. The Cheescake Factory, like other successful restaurant chains, has "brought chain production to complicated sit-down meals." They've done it by far-reaching standardization of the best possible ...

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Recently, I discovered the statewide report on quality of stroke care in Massachusetts.  It’s a plain document, mostly in black and white, much of what you might expect from a state government report.  Yet, this 4-page document is a reminder of how we have come to accept mediocrity as the standard in our healthcare delivery system. The report is about 1,082 men and women in Massachusetts unfortunate enough to have ...

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I once thought that only the federal government in Washington could effect changes that would impact the cost of health care in the United States, especially with so much attention on the recent Supreme Court decision on the 2010 health care reform law. But now I think differently. Now I believe that emboldened employers in places like Memphis can use their clout. They can influence insurers and work directly with doctors ...

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I want to ration your health care. Well, I don't want to do it personally, and not to you specifically. And that's the problem. Policies on the individual and societal levels feel very different. We are not culturally prepared for "rational" rationing. We're happy to do it irrationally; if you don't have insurance, you're probably not going to get proton beam therapy for your prostate cancer. Someone might be willing ...

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“Health care costs are sky-rocketing!” “The percentage of the U.S. GDP devoted to heath care costs is the highest in the world.” “The cost of Medicare is unsustainable.” For most of us, the cost of health care (i.e., the dollars required by the system to produce and deliver care) isn’t what brings us the most anxiety. It’s when we’re patients or helping a loved one find care that so many of us are deeply ...

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Recently a neighbor backed into my car while I was leaving a food store. The damage was minimal, but she offered to have her insurance company pay for the repair. After contacting the company, I was offered several body shops, and chose the one closest to my home.  The work was completed in only two days, and while it was in the shop, I decided to also have some dents ...

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The American Academy of Family Physicians (AAFP) recently issued a new report describing its vision of primary care's future. Not surprisingly, the report talks about medical homes, with patient-centered, team-based care. More surprisingly, though, it makes a point to insist that physicians, not nurse practitioners, should lead primary care practices. The important questions are whether nurse practitioners are qualified to independently ...

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