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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We’re ready to work on cost savings, just not for patients. There is a tremendous amount of culture change needed to move from fee-for-service to value-based health care.  One of the paradigm shifts is for hospitals to embrace the strategy of cost reduction as opposed to the traditional focus on top-line revenue.  In a system that focuses on value rather than volume, increasing the amount of hospital resources a patient consumes ...

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Dear ACO General Hospital: Thanks for contacting me about my most recent blog post.  I'm sorry to scare your administration about HIPAA information, but I am equally concerned about that and will always do my best to respect the privacy of my patients.  At your request I hid even more of that information. I know it's kind of embarrassing to have that kind of thing made public, and I am overall ...

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The observation status problem has continued to grow both larger and worse. My hospitalist colleagues and I are caring for patients in hospital beds in the exact same way as other patients in the hospital, but we are told that we must give them the designation called observation status.  CMS recognizes observation status as outpatient care, like seeing a patient in a walk-in clinic. We don’t decide to make a patient observation ...

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Among reams of coverage on the Ebola outbreak, Politico just published a characteristic story with the headline, “In the world of Ebola, no room for error.” The only problem is that is as soon as you introduce a human element to any system, there will be error. That’s the reality that health care leaders across the United States are grappling with now in a simultaneous effort both to tighten the health ...

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Patient satisfaction: Should that be the real mission of health care? As the patient satisfaction movement races full steam ahead, the time is perfect to regroup and define what this whole thing is really all about. Anyone involved in health care, and particularly hospital care, knows that the term “patient satisfaction” has become a buzz phrase recently. Sadly too it’s also evolved into a bit of a bumper sticker in hospital administration circles ...

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Health reform: Great for patients, but this doctor lost his job As an employed physician specialist working in an underserved community, I am thrilled with the Affordable Care Act (ACA). I was initially a skeptic of the program because of the cost to taxpayers, but I have since witnessed first hand the tremendous benefits. People with limited resources and real problems can now get help without suffering financial harm. Those with chronic ...

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Too many cooks in the kitchen can spoil medical care There are times when a common cliché may be the best way to describe academic medicine in today’s medical centers.  In fact, I have heard patients and their families complain about this, way too often.  Simply put, there are many occasions when it seems that there are too many cooks in the kitchen. When someone gets admitted to the hospital, chronic problems ...

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A physician undergoes hip surgery: 10 observations from bedside It finally happened. After years of sitting at John’s bedside through multiple serious bike crashes, I had one of my own. I’ve had plenty of time to build up a ridiculous amount of smugness about why he crashes and I don’t. “John is reckless; Staci is cautious. John rides like an airplane engine on a shopping cart; Staci uses her head.” I ...

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What can be said about the Generation Y physician? Tech-savvy.  Attention-craving.  Lazy, good-for-nothings. These are a few of the many traits that have been commonly bestowed upon those born around the last two decades of the 20th century.  Commonly known as Generation Y, this demographical cohort of 20- to 30-somethings has certainly sparked mixed reviews from its Gen X and Baby Boomer elders. But what defines the particular subgroup of young ...

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