Over the last couple of years, we have been witnessing the start of a seismic shift in healthcare philosophy. For far too long, the system has been totally focused on rewarding quantity: The more patients seen, tests performed, procedures completed -- the higher the incentives. Now, instead of rewarding healthcare providers for quantity in the “fee-for-service” model, we are moving towards a system that rightly focuses on the quality of care ...

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I was hired in 2011 by the Veterans Health Administration (VHA) to direct the Office of Patient Centered Care and Cultural Transformation and charged with ensuring that the VA transforms from physician-centered care to personalized, patient-centered care that is based on relationships, built on trust, and committed to positive results over the veteran’s lifetime. This undertaking represents one of the most massive changes in the philosophy and process for healthcare delivery ...

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Congress is closer than ever to repealing Medicare’s sustainable growth rate (SGR) formula. Competing plans, with traction, are on the table. The leaders of American medicine are convening this weekend in our nation’s capital. The Coalition of State Medical Societies -- representing nearly 160,000 members in nine states -- calls on Congress to act decisively, but not rashly. Congress must act now to repeal the flawed SGR formula used to pay physicians ...

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Recently, the New England Journal of Medicine published a perspective by Lawrence Casalino, MD titled, “Professionalism and Caring for Medicaid Patients – The 5% Commitment.” In the piece, Casalino argues that physicians should commit a portion of their practice to the Medicaid population as a matter of professional obligation. Yet this got me thinking: if physicians don’t respond to the professionalism argument and, instead, insist on being completely market-driven actors, then how can ...

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If you are a staunch conservative who believes that free markets should solve health care, or that poor people should work harder and have more skin in the game, or that governments should stick to building armies, you don’t need to read this post, unless of course you enjoy being aggravated by liberals. If you are one of the talking heads posing as a progressive, while repeating the slogans of Obamacare ...

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Recently, I was among a dozen people who sat privately to talk about the Affordable Care Act (ACA), aka Obamacare, with the embattled Health and Human Services Secretary, Kathleen Sebelius. Dressed in a light green blazer, sitting alongside Memphis Mayor AC Wharton and Congressman Steve Cohen, who had nudged her to visit Memphis, Secretary Sebelius listened to our feedback and shared her insights. First and foremost, addressing the issue of the ...

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Recently, the chairs and ranking members of the Senate Finance and House Ways and Means committees released a bipartisan, bicameral plan to repeal the Medicare SGR and reform physician payments.  And this time, it looks like the effort could actually succeed: never before has there been agreement between the House and Senate, Republicans and Democrats, on a plan to repeal the SGR, never mind on what they would replace it ...

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It is hardly an understatement to characterize the health insurance exchange rollout as a big disappointment. A botched website poses a serious problem and threatens to dampen enthusiasm for the new law -- especially among the coveted “young invulnerables” who need to sign up for coverage to keep premiums affordable for all. In the short term, the website troubles put the Obama administration firmly back on the defensive, scrambling to ...

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If you are a healthcare provider -- physician, administrator, or some other leader at a healthcare site -- then you know that you face many challenges.  Some seem overwhelming and you may be thinking that you may not be able to handle some of them well.  Perhaps the transition to ICD-10 coding is your main concern right now. The solution to difficult challenges begins with the first step.  I am taking ...

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Providers in all parts of the health care system recognize that troublesome social conditions drive much of their work and costs. Major challenges in people’s social circumstances -- layoffs, foreclosures, accidents, violence -- can create horrific health care needs, many of which become chronic and carry high price tags. These extreme needs are omnipresent in the nation’s hospitals, which care for about 37 million admissions at a medical expense of ...

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