Every once in a while, I’m forced to engage the health care system in a more personal way. Yesterday was one of those days. First, one of my children (who shall remain nameless), decided to take a stroll in the mulch on Monday without any shoes. He managed to lodge an enormous splinter in his foot which I couldn’t get out. By the time I saw it that night, it ...

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Catherine Rampell recently wrote up an often-overlooked aspect to the doctor shortage debate:

Thousands of foreign-trained immigrant physicians are living in the United States with lifesaving skills that are going unused because they stumbled over one of the many hurdles in the path toward becoming a licensed doctor here. The United States already faces a shortage of physicians in many parts of the country, especially in specialties where foreign-trained physicians are most ...

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A study in JAMA suggested that physicians feel that other players (lawyers, insurance companies, hospitals, etc.)  are more responsible than doctors for reducing healthcare costs.  Furthermore, they are hesitant to promote reforms that eliminate the current fee for service payment system. Although I would bet the no one would be surprised by these findings, a scathing editorial by Ezekiel Emanuel and Andrew Steinmetz caught my eye.  Before I get to ...

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Sophie's Choice is a novel by American author William Styron, whose plot ultimately centers around a tragic decision Sophie was forced to make upon entering the Nazi concentration camp: on the night that she arrived at Auschwitz, a sadistic doctor made her choose which of her two children would die immediately by gassing and which would continue to live, albeit in the camp. While not of the same gravity,  I have seen the discussion by policy wonks about physician payment reform ...

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The time has come to drive a stake through the heart of an oft-repeated assertion. How often have you heard something like the following when those of us in healthcare who want to stimulate quality and safety improvements draw analogies to the airline industry? "Well, in an airplane, the pilot has an extra incentive to be safe, because he will go down with the ship. In contrast, when a doctor hurts a ...

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ACO -- for accountable care organization -- is by now a familiar acronym within the healthcare industry and among all Americans who have followed the steady implementation of the Affordable Care Act. Easily described but very challenging to operationalize, ACOs rely on effective partnering among healthcare providers of all shapes and sizes -- health systems, hospitals, clinics, physician practices, urgent care centers -- to collectively share responsibility for the health of ...

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One of the greatest challenges when it comes time to affect major change in any system is figuring out who the stakeholders are, who has a vested interest in seeing a project rise or fall. Without knowing who all the players are from the word go, there is almost no way to move things forward. But recognizing that we can't keep everyone happy is also a big part of this process. So ...

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In an environment of increasing regulation, government mandated red tape, and shrinking reimbursement, health care practitioners find themselves caught between a rock and a hard place. They are being forced to see more patients to make ends meet and both parties are poorer for the process. Not necessarily in just a monetary way. Patients  are beginning to feel frustrated and disengaged from their mutually frustrated and disengaged providers. Both parties ...

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With the recent release of two mainstream exposes, one in the Washington Post and another in the Washington Monthly, the American Medical Association’s (AMA) medical procedure valuation franchise, the Relative Value Scale Update Committee (RUC), has been exposed to the light of public scrutiny. “Special Deal,” Haley Sweetland Edwards’ piece in the Monthly, provides by far the more detailed and lucid explanation of the mechanics of the RUC’s arrangement with the ...

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We have done it. We have decreased the increase in the cost of health care. Let us explain. For three decades (1980-2009), the cost of health care has been increasing each year at an average rate of 7.4 percent -- double the rate of inflation.  However, over the past three years, the increase in health care expenditure has remained at a low 3.1 percent. Is this decline ...

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