She was a stressed-out mother of six, working a grueling job as a kitchen manager that required her to wake up at 4am every day. She came to her doctor for her headaches: searing, throbbing pain that made her vomit. She slept fewer than five hours a night. She had tried every over-the-counter pain medication I had heard of, and she had maxed out all of those doses. I met ...

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Blaming the American Medical Association’s Relative Value Scale Update Committee (RUC) for everything has become the latest fashion. The RUC is causing climate change. The entire health care cost problem comes from RUC decisions. Alex Rodriguez took performance enhancing drugs because of the RUC. But the RUC did not create the system. They try hard to balance a system that is designed to achieve the wrong outcomes. The RUC has become ...

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Former South Carolina Senator, and current Heritage Foundation president, Jim DeMint recently angered supporters of the Affordable Care Act by stating that uninsured patients will "get better healthcare just going to the emergency room," than they will receive through Obamacare. That’s a sweeping assertion.  However, the ACA supporters offended by Sen. DeMint need to understand the supreme irony that without America’s emergency departments and their dedicated personnel, the ACA will fall ...

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Standing in the dimly-lit cave-like radiology reading room, I was looking at a CT scan which was done in the emergency room on a man in his 40s who had a testicular mass — likely a cancer — which had spread through out his body. It wasn’t that the man did not know the mass was present — earlier CT scans from the emergency room clearly showed the mass in ...

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There was some recent buzz on Twitter about a proposal from a retired plastic surgeon in San Diego who has developed a plan to retrain retired specialists as family practitioners. The idea is that this could alleviate the shortage of primary care physicians that exists now and is predicted to worsen as more people become insured. The 15 module course created by some faculty at the University of California at San ...

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A new class of health care management organization is emerging that thrives by taking advantage of health care’s rampant and institutionalized waste. These firms mine the market dysfunction that has developed over decades, which will almost certainly yield enough fuel to drive a new way to manage care and cost. The founders of these organizations have deep health care experience, and they understand the mechanisms of excess. More important, the ones ...

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Among other misassumptions in medicine, we apply standard economic principles to healthcare and often assume consumer rationality in the utility maximization of health care. So why have we seen so much “market failure” in healthcare? Why are consumers of health care not making “smart” decisions for health care as they do for their choice of hotels and restaurants? Why have we not seen the expected benefits from ...

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There is a lot of talk these days about changing our health care system from “pay for volume” to “pay for value.”  The idea is that we currently reimbursement doctors and hospitals according to the number of services delivered rather than how well they make us.  This perverse system of incentives results in runaway health care spending that doesn’t necessarily result in a more healthy citizenry. There is certainly truth in ...

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Historically, the “do more, bill more” fee-for-service model of healthcare measured success by increased billings. In the fee-for-value era, we need a new framework for assessing healthcare results. Quality indicators are logical but they  are mostly geared towards measuring actions taken. We can borrow a concept from the energy sector for an additional metric.  We need a concept for removing waste and unnecessary care that could be inspired by a concept ...

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Primary care physicians (PCPs) have been marginalized by Medicare for decades with low reimbursement rates for routine office visits which has led to the 15-20 minute office visit with 10-12 minutes of actual “face time” and a panel of patients that well exceeds 2000. Is there a good solution to the Medicare cost and quality issues? Setting aside either the Democrats’ approach to basically enact price controls by ratcheting down reimbursements or ...

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