The observation versus inpatient distinction is rightly getting more media and public attention with each passing month. In a nutshell, for anyone reading who is not familiar with what this is all about, it’s essentially a way of categorizing people when they get admitted to hospital. You are either deemed an inpatient (basically a more complex case) or an observation (a less serious case). The individual reasons and checkboxes that have ...

Read more...

Because hospitals are expensive and often cause harm, there has been a big focus on reducing hospital use.  This focus has been the underpinning for numerous policy interventions, most notable of which is the Affordable Care Act’s Hospital Readmissions Reduction Program (HRRP), which penalizes hospitals for higher than expected readmission rates.  The motivation behind HRRP is simple:  the readmission rate, the proportion of discharged patients who return to ...

Read more...

Health care in America is fracturing right down the middle, and doctors are going to have to figure out if or how long they can straddle the divide between what patients want and what the government and corporate America want them to have. Up until this point, the momentum has been with the payers, Medicare, and the insurance industry. But the more heavy-handed they become, the more inevitable the public backlash ...

Read more...

All of us who care for the poor, the illiterate, the poorly educated, the immigrant, the frail, and the abused know this: caring for them involves many challenges that aren’t picked up by Medicare computers or big data. Simplistic calculations about quality metrics such as hospital readmission rates have been way off the mark at capturing the complexities of caring for these patients. A recent study from researchers in Boston ...

Read more...

Dear patients, This is a hard letter to write, but it is important that you know about a major change that is coming for both of us in 2017, just a short year away. As you recall, last year I left a large hospital group practice and opened my own office, and I want to thank you for your faithfulness in following me to my new location.  With the newfound freedom of ...

Read more...

Transparency in medicine is a good thing When the Center for Medicare and Medicaid services (CMS) publically disclosed the 2012 CMS reimbursements to physicians, the response was immediately felt throughout the medical community.  As a practicing physician, we were warned of this day.  Can’t say we prepared for it, but we sure did brace for it. And sure enough, on April 9, 2014, the New York Times published on their website a ...

Read more...

A long, long time ago, hospitals existed to admit patients when they were sick, treat them with medicines or surgery and good nursing care, and discharge them after they became well. Hospital care was at one time a charity, which evolved into a nonprofit service, before it became a very big business. In olden days, nonprofit hospitals charged patients straightforward fees for their services. Then, when you were just a young whippersnapper ...

Read more...

If she had been eligible for Medicare, the hospital would have charged the government $10,000 for the services it provided to her, with Medicare picking up most of the tab. But lacking insurance, she was billed directly from the hospital, and not for a mere $10,000. The total charge: $120,000! That 1,200 percent markup is extreme. But out of the 50 U.S. hospitals with the largest price markups, 49 are for-profit ...

Read more...

Toxoplasma gondii is a parasite that causes opportunistic infection in helpless people. It may have met its match. The cost of treating toxoplasmosis, a rare but extant infection, just shot up exponentially. Drug-resistant strain, you ask? Have physicians in infectious disease gone mercenary, you wonder? No. A change in ownership. Daraprim (pyrimethamine) is a nifty drug that kills parasites. It’s been around for eons. I still recall its name from my ...

Read more...

A recent CMS proposal to bundle payments for doctors and hospitals for hip and knee replacements in 800 model centers has hit a roadblock. The five-year program would have begun January 1, 2016, and nearly 300 comments were received by CMS earlier this month. Apparently most of the comments were not, shall we say, favorable. Even the Federation of American Hospitals protested For those who are unaware, "bundled payments" means that ...

Read more...

Most Popular