The changes to health care -- not just in policy, regulation, and payment but also the tectonic shifts in how we define, evaluate, report and are paid for care -- can make us all feel like we’re on a runaway train. Alongside the runaway train are the significant improvement opportunities in health care we must somehow address -- less variance, improved patient engagement, coordination of care, adherence to evidence, waste reduction ...

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I dialed the number to return the call of the nursing home. The nurse who answered the phone was relieved to hear my voice on the other line: “Dr. Mass, thank God you called back! She has been pacing since she woke up, and she refuses to take her meds. We’ve kept her away from Catherine, so they don’t get into another fistfight. But we can’t handle her here anymore. ...

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My dad was recently diagnosed with cancer. Overnight, he found himself faced with tough care decisions, small insurance crises, and the overwhelming bureaucracy of cancer. He was also about to become tasked with managing a daily care routine far outside the scope of his usual morning ritual. Since his diagnosis, he has returned to the hospital twice with pneumonia. While many cancer patients become prone to bacterial infections due to a ...

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It is possible that in a few months from now, only Nate Silver’s prediction models will stand between Donald Trump and the White House. I will leave it to future anthropologists to write about the significance of that moment. For now, the question, “What will President Trump be doing when he is not building a wall?” has assumed salience. This is relatively easy to answer when it comes to health policy. ...

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Policy makers who are responsible for shaping how the federal government (the country’s biggest payer of health care services) pays physicians are pushing CMS on a rapid path away from traditional fee-for-service (FFS). As I discussed last year, CMS intends to have 50 percent of its payments flow through “alternative payment models” such as ACOs and bundled payments by 2018, with nearly all of the rest of the ...

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What is happening in medicine?  How will these changes affect our patients? How will they affect how we deliver health care?  These seem to be the questions asked most often amongst physicians across the country.  I do not profess to have a crystal ball nor can I state with any certainty what the profession we chose to dedicate our lives to will look like in the near future.  However, there ...

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American businesses hold a solution to one of the most fundamental flaws of American health care: misalignment of incentives. We live in a nation where profit-seeking behavior can be more alluring than high-quality patient care. To date, major health care reform efforts have paid little attention to the business community’s potential to address this issue. Status quo Currently, the status quo is such that health insurance companies and health care providers act ...

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The United States far outspends peer countries on health care. When American politicians complain about these high health care costs, they often vilify pharmaceutical and insurance companies for profiting at the expense of the general public. As I wrote earlier, such vilification is misguided, pushing too much of the blame on individual actors rather than on the system that incentivizes individuals to act those ways. So what it is ...

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Just as the U.S. health care system is about to make performance measurement a central feature of … well, just about everything doctors do … some prominent and highly influential physicians are asking for a pause and reassessment. Writing for the New York Times, Dr. Bob Watcher argues that, "Two of our most vital industries, health care, and education, have become increasingly subjected to metrics and measurements. Of course, ...

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May I whine for a few sentences, please? My staff and I have a high-deductible medical insurance plan. As the costs of coverage increased each year, we had to find a product that we could afford for our small private practice. As any small business owner knows, margins are tight, revenue is declining and expenses inexorably rise. And physicians, unlike other retailers, cannot raise our fees. Would you want to ...

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