In many communities around the country, hospitals are one of -- if not the -- largest employers. Consequently, there are undoubtedly economic issues that would befall an area if its hospital were to close. But this post isn’t about that. It’s about the health care consequences, and by extension, the health consequences that might arise in a community when a hospital closes its doors. The logic is fairly straightforward: If a ...

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shutterstock_132428099 There is a scene from the movie Dr. Zhivago that, no matter how often I see it, sends chills down my spine. Yuri returns home from World War I after the communist revolution in Russia and runs into his half brother. Yuri finds that not only has his house has been taken over , but being a doctor, he has been ...

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The Affordable Care Act (ACA) has changed Medicare for the better, and produced higher quality of care for patients. But whether the new shifts in Medicare policy will lower the total cost of health care, remains unclear. And that could present the program with a major problem in the future. For the first 40 years of Medicare, most enrollees opted for the traditional fee-for-service Medicare program. The main reason for doing so was ...

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shutterstock_141760741 If I had groused two years ago that we were getting doctored to death, you would’ve thought me obtuse. When I claim today, though, that every head bump doesn’t need an MRI, you get it. There’s a growing buzz about Americans receiving too much health care. In fact, overtesting and overtreatment are the main source of health care’s amazing expense. You can ...

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Paying someone to mow your lawn is a pretty straightforward affair. Ryan the lawn guy will look at the lawn size and maybe the hilliness of your yard, and you’ll settle on a price for mowing and trimming it. When you decide to contract for Ryan’s services on a more regular basis, payment might get a little more complicated. If you pay Ryan every time he mows your lawn he ...

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Co-management agreements are growing in popularity as health care shifts to outcomes-based reimbursement models.  Physicians and hospitals contract with one another in quality-oriented pay-for-performance arrangements, in which physicians oversee and manage service lines (most commonly orthopedics, oncology, and cardiology). The overarching goal of these agreements is quality improvement, which benefits all parties involved -- especially the patient.  The hospital benefits financially in part from reducing costs and physicians receive a base ...

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shutterstock_173620244 This is one of those columns that will risk the respect and friendship of some of my closest colleagues in the health care world.  In addition to disagreeing with me, they may argue that I am giving aid and ammunition to "the enemy," where the enemy might be viewed as those forces in the health care world who really don't want ...

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Dr. Atul Gawande is an American surgeon and public health extraordinaire. He is one of the most successful physician authors of this century, and he writes routinely for the New Yorker. His most recent article discussing unnecessary health care is, as expected, a good read. I applaud Dr. Gawande’s passion towards advancing medicine. And, yes, there is universal agreement that we need to be better in America at providing high-quality low-cost health care. ...

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shutterstock_134719667 Some months back I read an interesting interview with Jonathan Skinner, a researcher who works with the group at the renowned Dartmouth Atlas of Health Care. More than anyone else I can think of, the people at the Dartmouth Atlas have studied and tried both to understand and to explain the amazing variations we see in how ...

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Recently, I was back in the United Kingdom for a short trip home. It happened to be the week of the general election, and after a long campaign the country finally went to the polls on Thursday. For those of you unfamiliar with U.K. politics, for the last five years there’s been a coalition government between David Cameron’s Conservatives and the Liberal Democrats (the first coalition government for 70 years). The ...

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