Hospitals are really caught between a rock and a hard place when it comes to prices. Faced with decreasing revenue, they are also pressured to lower prices.

The problems are identified, but the authors are not hopeful of a solution anytime soon. One reason is that maybe there has been too much complaining about the undervalued E&M codes:

Although the resource-based relative-value scale may have better aligned fees with costs than the old method based on the Blue Shield system, the cost of new procedures often decreases over time. In principle, any such decreases are to ...

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Reasons why it won't take off:

We are a six-doctor internal medicine practice, and we have no intention of offering the zoster vaccine.

It is a huge burden for a primary care practice, mostly because of the cost, but also because of the storage requirements. As a Medicare Part D reimbursement methodology, it is a given that reimbursement will be inconsistent.

We find it outrageous that this sort ...

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Or how hard it is to do so. Charity Doc with the latest insane situation in his ER.

Physicians are under recent attack from their relationship with Big Pharma, but Julie Deardorff wonders if patients are partly to blame:

Congress is considering legislation to force the drug industry to delay advertising newly approved prescription drugs to give physicians more time to review safety and efficacy.

But delays won't address ad content -- often deliberately vague about who is at risk of disease -- nor the fact ...

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An ER nurse tells a recent story of how delayed notification of blood culture results led to this outcome:

Now the family has hired an attorney to look into the matter. Could that man have been saved if he had been told to come back to the hospital and was admitted and treated sooner? Hard to say. Maybe.

The military is telling pain management specialists to brace for an influx of chronic pain patients from the war.

"Why me?"

A woman diagnosed with breast cancer tries to answer the question:

The only answer to the question "Why me?" is this: Because bad stuff happens to everyone, and this is what happened to me. One of my closest friends struggled with infertility. That's her short straw. Another friend's marriage fell apart. Another friend gave birth to a stillborn child. Look closely enough and you'll see that everyone has a ...

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An against-the-grain study suggesting that health courts actually would be tougher on physician defendants:

A jury's lack of medical expertise, Peters says, tends to favor the doctor, not the patient.

"Critics assume that the 'battle of experts' frees juries to award unjustified recoveries," he writes. "The data suggest that it is more likely to shelter negligent physicians."

One proposed solution -- to turn cases over to specialized ...

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The NHS drifting away from universal care? Slowly, but surely:

Nigel Edwards, director of policy at the NHS Confederation, said: "We need to confront the reality that if the public do not want cost to be a factor in NHS decisions than they may have to prepared to pay more in order to have every treatment funded."

Reverse cost-shifting. Some companies are eliminating copays on drugs:

Desperate for ways to curb soaring health-care costs, a groundswell of employers and health insurers are turning to a radically different approach: motivate patients to take not just the cheapest medicines, but the ones they need the most.

Over the past decade, health plans have sought to save money by shifting costs onto workers and encouraging them to ...

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A colleague turns against Flea in his upcoming trial.

The future continues to look grim for OB as this specialty is dying a quick death:

Losses rise with the number of patients - especially when those patients are poor. The culprits are high expenses for malpractice insurance and relatively low reimbursements from health insurers, the experts said. In recent years, as obstetricians threatened to leave the state because of high premiums, many hospitals took on the extra expense of ...

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This is a pretty good list.

Gaming and EHRs

Interfaces for many role-playing computer games like World of Warcraft are light-years ahead of any EHR technology:

Really good role-playing games--such as Dungeon Siege, Neverwinter Nights, or World of Warcraft--have what is commonly referred to in game design circles as a "paper-doll/drag-and-drop interface," which graphically depicts the state of your character and allows you to drag and drop information. I envision the patient's information in the PHR appearing like this.

UK physicians are forced to admit the inevitable truth about Government-run health care:

British doctors will take the historic step of admitting for the first time that many health treatments will be rationed in the future because the NHS cannot cope with spiralling demand from patients.

In a major report that will embarrass the government, the British Medical Association will say fertility treatment, plastic surgery and operations for varicose ...

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An nurse quite accurately the issue of practice variation in the ER:

This goes back to the free for all nature of medicine. One doctor practices one way and another, a different way. I see it in ER everyday with tests being ordered. There are the people who order a myriad of tests and those that don't. There doesn't seem to be a standard. I never have understood it. ...

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Are they becoming a necessity for radiology recruiting?

Convenience, value for recruiting, and efficiency were named as key factors in radiologists' use of "nighthawk" services according to a recent study.

Apparently not, as physicians see themselves as being taken advantage of:

"It used to be that doctors felt they were fairly well rewarded for their work and they owed something back to society in free care," Stoner said. He cites the decreasing payments that doctors get from Medicare, Medicaid and insurance companies. "Increasingly, doctors are feeling that society is making so many demands on them . . . they are ...

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The patient thought he had only 6 months left, and subsequently lived it up:

When doctors diagnosed cancer and told John Brandrick that he had less than a year to live, he resolved to make the most of the time he had left.

The 62-year-old council worker quit his job, sold his car, stopped paying his mortgage and dug into his life savings so he could treat himself ...

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