The triple aim of health care, as defined by the Center for Medicare and Medicaid Services (CMS) is: improving the experience of care, bettering the health of populations, and reducing the per capita costs of health care.This struck me as odd when I first read it. Why should the stated aim of any system become to decrease the costs associated with that system?Which led to the next logical questions: What should be the stated aim of ...
Kohar Jones, MD
The positive effects of palliative care on quality of life
“I’ve been a fighter all my life,” said my new patient, a middle aged man with thinning hair, a worried wife, and a dismal prognosis. He had worked all his life as a plumber with no health insurance. When he was healthy, it was okay. But now he was sick.I was meeting him for the first time in the community health center where I work as a family physician, tending ...
How Medicare undermines primary care
When I was a family medicine intern, I met a diabetic patient in the hospital who had stopped seeing his regular doctor after he lost his job and his health insurance. His untreated diabetes made his feet go numb. He stepped on a nail and didn't realize it until he noticed a smell that cost him his foot.He spent thousands of dollars on the surgery and subsequent hospital stay—far ...
Pay for performance doesn’t work in difficult patient populations
Pay for performance. It’s a lovely sounding concept. If you’re a good doctor, defined by having healthy patients who meet predetermined quality indicators, then you get paid more.What could be simpler, right?Wrong.Not all patients are created equal. Some are highly educated, highly literate, highly motivated to prioritize health. They have good jobs with health insurance, so critical medical care isn’t prohibitively expensive. They don’t need to choose between paying ...
Helping with the psychosocial needs of patients
The psychosocial needs of patients can feel overwhelming for a doctor.Our rite of passage as medical students, after all, is anatomy, not sociology. Even now, after a family medicine residency specializing in the biopsychosocial approach to medicine, I still brace myself for surprises before asking routine mental health screening questions of the patients in ...
Preventing disease saves the crippling costs of tertiary care
When I was a family medicine intern, I met a diabetic patient in the hospital who had stopped seeing his regular doctor after he lost his job and his health insurance.His untreated diabetes made his feet go numb. He stepped on a nail and didn't realize it until he noticed ...
The National Health Service Corps impact on primary care doctors
Before I had even begun medical school, I already knew that I would enter primary care when I finished. I had successfully applied for and received a scholarship from the National Health Service Corps Scholars program. By the time I graduated, I knew that after my three years of residency training, I would practice in an underserved area for at least four years, one year of service to America for ...
Legal tobacco and illegal marijuana are historical accidents costing billions
"What do you think of medical marijuana?" my mother, who has never smoked a thing in her life, of the tobacco or cannabis variety, asked me one day as we drove through beautiful upstate New York woods. We had just passed a sign saying "We will destroy your crops," with a marijuana leaf beneath. "It has its place," I said. "No reason to be against it." "But isn’t marijuana a ...
Doctors who order tests for their own financial gain
“What a shame,” said my eighty eight year old Armenian grandmother, shaking her head with sorrow, and I had to agree. “US officials charge 73 people, mostly Armenians, over a massive fraud against the country’s medical insurance system,” read the BBC headline.A (mostly) Armenian crime syndicate set up 115 sham clinics in the United States, using real doctors’ names and real patient information, stolen from different systems, to generate false ...
