Medicare punishes hospitals for taking care of poor people Such a no-brainer: If patients who receive care at hospital A are more likely to get readmitted to the hospital 10, 20 or 30 days after discharge than patients in hospital B, then hospital A must be doing something wrong. Perhaps clinicians at that hospital are less adept at diagnosing and managing patients’ problems. Perhaps the follow-up care at hospital A ...

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Not long ago, the Joint Commission established that patients with pneumonia should receive antibiotics within four hours of diagnosis. Timely diagnosis and treatment can be the difference between life and death in patients with this illness. In fact, some people believe this kind of quality measure should play a large role in how we pay for medical care. After all, doctors should not be paid solely on the basis of ...

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I have written a couple of pieces documenting the high percentage of physicians who refuse to take Medicaid patients, and some of the reasons for their refusal. One of my pieces prompted a physician to email me with his take on this matter. I am going to quote from that email, but take out identifying information to protect his anonymity. Here’s what he ...

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In health policy circles (yes, those exist!), experts often refer to three aims for a modern health care system: to offer 1) universal access to 2) high quality medical care at 3) an affordable cost. Access, quality, and cost: a possibly unachievable set of goals, certainly in the U.S., where the quality of our care is decent (but uneven), while access to care and the high cost of our care compare dismally to ...

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Thanks to the popularity of medical television shows, most people have witnessed hundreds of fictional cardiac arrests in their lifetime. In most of these scenes, the patient loses consciousness, and the medical team rushes to the bedside: “He’s in v-fib.” “Get me the paddles.” The team performs urgent chest compressions for a few seconds.  Then they place the metal paddles on the victim’s chest: “Clear!”  Kathump. The patient’s heart is back to normal again, tragedy ...

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The first time scientists sequenced a person’s entire genome, it took more than a decade and cost hundreds of millions of dollars. Currently, such sequencing takes less than twenty-four hours and costs less than $5,000. To put that into perspective, Myriad Genetics charges $3,000 to test for mutations in just two genes associated with breast cancer. The days of affordable genomic sequencing are rapidly approaching. But will such testing bankrupt us? In most consumer ...

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I must not be the only person to wonder how pharmaceutical companies succeed with direct to consumer advertisements when, stuck in the middle of all their TV ads, are those long lists of side effects.  You know what I mean.  After watching a smiling and attractive person running through a field after receiving some wonder pill, the narrator tucks his voice down an octave and intones that the medication “could ...

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It all comes down to willpower, right?  Strength of purpose.  Muster the resolve to skip dessert, and you have a shot at losing that spare tire hanging off your belly.  Succumb to your temptations, however, and you are simply being weak. But is it just weakness that causes us to overeat? A study in Psychological Science suggests that our inability to resist that mouthwatering looking chocolate cake doesn’t arise simply because our ...

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I have been writing a bit lately on the need for health care providers to talk with their patients about health care costs, if for no other reason than to enable patients to determine whether they can afford to pay for the healthcare that their doctors are recommending them to receive.  I have been criticized for this position, on the grounds that I am rationing care from people with ...

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People have criticized the Affordable Care Act for amounting to a large transfer of wealth, from wealthy Americans to those not as well-off. But the real transfer of wealth has been from United States to other developed nations, whose health care costs we have subsidized for many years by paying so generously for many of our health care services. No better example of this comes to mind than the price ...

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