I have spent a good portion of his career working to come up with ways to make healthcare better, faster and cheaper through the appropriate use of computer and information technologies.  Given the vitriol that I have periodically heaped upon many of the electronic medical record systems commonly deployed and mandated by the government, this enthusiasm for computers and telecommunications may come as a bit of a surprise to some ...

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Just when American healthcare system seems so dysfunctional that it seems impossible to imagine how it could be screwed up further, a decision is made that restores one’s faith in the creativity of Man.  But before you run out of guesses as to which particular decision we’re talking about today, we’ll just blurt it out.  We are referring to a recent decision by Washington State Medicaid to deny payment for ...

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If you’ve ever been sick, especially with anything serious, you quickly realize that doctors, nurses and their ilk are an unusual and precious resource. First you have to find smart people with personalities willing and able to put up with a lot of guff in the service of their fellow man.  Then they have to be willing to (usually borrow, and) spend tens or hundreds of thousands of dollars for ...

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The Justice Department decided to weigh in on the topic of clinical guidelines. As if to underscore Dr. Rich’s assertion that “guidelines are no longer guidelines," the Federal government has raised the prospect of fining your doctor and/or sending her to prison for the crime of not strictly following guidelines of care. As reported by MedPage Today:

“Federal prosecutors are looking into physicians’ prescribing practices relating to implantable ...

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An excerpt from Overhauling America’s Healthcare Machine: Stop the Bleeding and Save Trillions, published by Financial Times Press (2011).  Reprinted with permission of FT Press, and imprint of Pearson. In recent years, more and more of the revenue collected by U.S. healthcare facilities ends up paying for costs that have nothing to do with providing actual healthcare goods and services: things such as administration, billing, documentation, and the cost ...

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Medical guidelines are well on their way to becoming the Law of the Land.  Dr. Rich over at The Covert Rationing Blog featured a recent post that highlighted this point. When a study published in the Journal of the American Medical Association showed that nearly 23% of patients receiving implantable cardioverter-defibrillators (ICDs) received them under circumstances that did not match up with the recommended “guidelines” for doing so, this ...

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The other day, I happened to be talking to Mark, a sales representative from one of the pharmaceutical companies.  He’s the type of rep that many doctors don’t mind seeing – someone who is careful of your time, is happy to hunt down the answers to questions that come up on the medications his company makes, and brings by useful information about new drugs that seem to be practice-appropriate.  He ...

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Recently, Dr. Scot Silverstein over at Health Care Renewal published this update to the ongoing story of electronic medical records that are so simple, intuitive and easy to use that doctors and hospitals everywhere are being forced to hire "scribes" to run them. We'd looked at the resurgence of scribes in a previous post, and Dr. Silverstein's article seems to confirm that the phenomenon is is here to ...

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Like it or not, “garbage in, garbage out” is the rule rather than the exception for the vast majority of bureaucratically dictated “quality control” programs that we’re ever likely to launch.  There are three primary reasons for this. First and foremost, there’s Goodhart’s Law:

“Originally, an economic theory stating that if a particular definition of the money supply were to be used as the basis for monetary policy, the stability ...

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Thinking is hard work.  This is why so few people bother.  At least voluntarily.  So whenever it seems like the threat of brainwork looms in modern American medicine, we can thank our lucky stars for the geniuses behind healthcare reform and guidelines of care. This comes up as a result of a conversation that I had with a patient the other day.  A pleasant, obese gentleman.  He had been struggling with ...

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