As media coverage of the 50th anniversary of Woodstock shifted into high gear earlier this month, two articles in the "Arts and Medicine" section of JAMA called attention to another anniversary that transported me back in time. It has been 40 years since the publication of The House of God -- an unabashedly irreverent (some would say "borderline pathological") fictionalized account of author Stephen Bergman's ...

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When I hear the term "charity hospital," my thoughts turn to the grand bastions of 20th century public hospitals -- Bellevue Hospital in New York City, Cook County Hospital in Chicago, and San Francisco General Hospital. These hospitals were generally affiliated with medical schools and relied on government appropriations, rather than fees, to provide care for the poor. Decades of legislation have brought about sweeping changes in hospital financing, accounting, and social ...

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I am a long-time proponent of measuring provider performance and aligning it with payment as an effective means for improving the quality of care and with it, patient outcomes. Because of this, I welcomed the value-based purchasing concepts and quality improvement initiatives that are fundamental to the Affordable Care Act (ACA). But, as in so many things, the devil is in the details and, despite their best efforts, measure designers can't always ...

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Back in 1986, the Health Care Financing Administration launched the brave new era of quality reporting in this country by releasing "report cards" that detailed hospital-specific, risk-adjusted mortality rates for coronary artery bypass graft (CABG) surgery. Since that time, the number and type of publicly reported quality outcomes has grown exponentially with the goal of helping patients make informed decisions when selecting doctors, thereby driving quality improvement by doctors and hospitals. Has ...

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As an educator, I've come across some recent news stories that call to mind Dorothy's observation, "we're not in Kansas anymore." Consider the following two. 1. Sara Volz, a high school student from Colorado, won the top prize ($100,000) in the 2013 Intel Science Talent Search for her research of algae biofuels. She accomplished this outside of school in a home lab under her loft bed, sleeping on the same light cycle as ...

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How do we keep the well people well while managing the devil out of the 1%? This is one of our most complex and challenging questions, and there is no simple answer -- but we needn't look far to see that progress is being made. Judging from the unprecedented groundswell of interest in health and wellness -- and the corresponding emergence of a "wellbeing economy" -- I think it's fair to say ...

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As deliberations over how to make healthcare more cost-effective continue to play out in forums across the country -- from the U.S. Congress to state governments to health systems and hospitals -- it strikes me that we are paying insufficient attention to what should be an obvious consideration – the cost of supplies. Supplies run the gamut -- from operating tables, artificial knees, intravenous solutions, and wound dressings to bed linens, ...

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In 2008, a couple of years before the Affordable Care Act became the law of the land, Donald M. Berwick, MD, and his colleagues at the Institute for Healthcare Improvement (IHI) introduced the Triple Aim concept and set to work on ways to (1) improve population health, (2) increase patient satisfaction and (3) reduce per capita healthcare costs. In pursuit of these goals, IHI encouraged the exploration of a variety of ...

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ACO -- for accountable care organization -- is by now a familiar acronym within the healthcare industry and among all Americans who have followed the steady implementation of the Affordable Care Act. Easily described but very challenging to operationalize, ACOs rely on effective partnering among healthcare providers of all shapes and sizes -- health systems, hospitals, clinics, physician practices, urgent care centers -- to collectively share responsibility for the health of ...

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A good recipe is one that combines high-quality ingredients in appropriate quantities to produce a savory main course or a decadent dessert. It strikes me that, in order to answer the Affordable Care Act's call for us to aggressively pursue population health, we must first understand what the recipe calls for. Dichotomous as it may seem, the primary ingredient for population health is accurate, comprehensive data on the individuals who comprise the ...

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I recently took part in a "civil discourse," an unusual occurrence in this era of media pundit-orchestrated shouting matches. Unlike a debate with winners and losers, a civil discourse begins with the premise that, when there are different points of view on a topic, it is better to understand those with whom we disagree than to turn off the sound. By listening and asking probing questions, we come to understand how such ...

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We recently marked the third anniversary of the passage of the Affordable Care Act by reflecting on the positive changes it has brought about and by mulling over the multifaceted challenges that stymie our efforts to build more accessibility, equity, quality, safety, and cost-effectiveness into one of the most complex healthcare systems in the world. Reining in healthcare costs, a central element in the reforms we seek, is inextricably linked to ...

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dreamliner If you think that medical errors are a thing of the past, you are mistaken. It has been 14 years since the Institute of Medicine's report "To Err Is Human" shattered the myth that most, if not all, physicians are all-knowing practitioners with flawless skills and infallible judgment. The story of what happened in the report's wake was predictable:

shutterstock_113363803 Health information technology (HIT) has had a tremendous – and mostly positive -- impact on our systems for recording, delivering, monitoring, and reporting the healthcare and services we deliver. Like most of my colleagues, I can tick off at least five or six large "pioneer" corporations – companies like Epic, Cerner, Allscripts, Siemens – in the forefront of the technology explosion that yielded ...

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Not long after posting a recent column which, admittedly, was somewhat critical of healthcare providers in and around New York City following Super Storm Sandy, I decided to get a clearer picture from someone intimately connected to the disaster – my own brother. A few months ago, Ira Nash, MD, was appointed Medical Director for Physician and Ambulatory Network Services at North Shore Long Island Jewish Health System (NSHS), a ...

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Of all the complex, costly, and downright intimidating issues in U.S. healthcare today, Super Storm Sandy tops my list as the scariest. Even though hospitals from the Carolinas to Maine deployed their emergency plans and had extra providers on site to deal with the expected influx of patients, those in the hardest hit areas couldn't withstand such a powerful storm surge. Like many ...

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At the heart of healthcare operations are their processes – processes that must run correctly all the time to avoid unnecessary risk to patients' lives and health. Once the healthcare industry acknowledged the fact that we all make mistakes – even physicians – it began to look into methodologies used by other industries to structure more "perfect" organizations. Two such process improvement methodologies -- LEAN and Six Sigma -- are now being ...

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I have been beating the population health drum for more than 20 years, and I think the rest of the band is finally catching on to the rhythm. From healthcare reform efforts at the very top of the heap to the healthcare industry to large and small communities, there is a heightened awareness that the physical and mental health of our diverse population is linked to our continued health and success ...

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The decision is in – and it is likely to have a substantial impact on this year's elections, the Congress, the Court, the healthcare industry, and all Americans. Of all the commentary I've read in the wake of the recent Supreme Court decision, Time Magazine's "Special Report: The Health Care Decision" struck me as the most balanced and comprehensive. In the lead article, "Roberts Rules," author David Von Drehle skillfully dissected the ...

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My initial reaction to the Supreme Court’s ruling to uphold The Affordable Care Act was to breathe a sigh of relief.  The law, particularly the individual mandate – the cornerstone provision – is constitutional and now we can get on with the real task at hand of transforming the U.S. health care system into one in which high-quality and safe care is delivered in an effective, timely, and patient-centered manner. ...

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