Years ago, I was contacted by a health plan about an elderly nursing home patient who had not been screened for osteoporosis. While brittle bones are a big problem in skilled nursing settings, the real problem for this health plan was its low HEDIS score for “osteoporosis testing and management.” Because of the underlying
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I remember when one of my patients with coronary artery disease suggested that he be given a course of an antibiotic to lower his future risk of a heart attack. The patient quoted literature that pointed to a possible infectious link to atherosclerosis. He also was aware of the theory that aspirin’s benefit had less to do with blood thinning than reducing underlying inflammation. Fast forward to the Economist ...

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If you get sick, health insurance should cover all the “stuff” necessary to make you better, right? While that sounds good in principle, Uncle Sam has made it a lot more complicated than that.  As we continue to struggle with health reform, this New England Journal article on “Medicare’s Enduring Struggle to Define Reasonable and Necessary Care” is very timely. According to Drs. Neumann and Chambers, Medicare has always covered medical services that ...

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If you're a fan of star surgeon overachiever Atul Gawande, then reading his New Yorker article "Big Med" is a must. The rest of us skeptics should still use the article to signal our health care adroitness by knowingly referring to the "Cheesecake Factory" in our policy medical meetings, conferences, PowerPoints and bloggery. What he wrote Dr. Gawande uses the successful restaurant chain to extract lessons and draw health system parallels, ultimately ...

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Years ago, if you were elderly, had diabetes, high blood pressure, low back pain, needed a yearly flu shot and came to see this electronic health record-enabled physician (now with the nom de plume "Disease Management Care Blog"), you would have had your diabetes, high blood pressure and low back pain reassessed, you would have been given a flu shot and, for good measure, the DMCB would have tossed in a discussion ...

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In this enlightened era of evidence-based medicine, you'd think that the progressive academics, viziers, and mandarins who are cluttering the policy making commentariat would pay more attention to what was tried before. That should be doubly true if those lessons come from that health care nirvana called Europe, where enlightened central bureaucracies wisely allocate health care for its caffè sipping, plaza strolling and beret adorned citizenry. Case in point is ...

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The Disease Management Care Blog attended a professional hockey game recently and it must say it was quite the spectacle. While the athleticism on the ice was quite remarkable, the real wonderment involved the hometown fans. Questionable referee calls prompted thousands of all ages to chant phrases that the DMCB has not recently read in any medical journals, while the willingness of grown men to display, in stereo fashion, obscene gestures ...

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The Disease Management Care Blog would like to introduce you to two alternate realities. In the first reality, physicians own the bricks and the equipment that make up their clinics. They hire and fire their office staff members. They don't mind fee-for-service payment systems, because the harder they work, the greater the reward. "Pay-for-performance" generally results in greater practice income because they're ...

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Oh, those Millennials. Also called "Generation Y," this is the American demographic group born during and after the '70s, that was vicariously raised by "learning is fun" Sesame Street and became accustomed to getting awarded for any effort. They don't know about bomb shelters, walking to school, tape decks or having to get up to change a TV channel. Well, they're now entering the workplace and their informality, disregard for rank, ...

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The Disease Management Care Blog received this posting from an experienced nurse with a background in clinical and administrative medicine. We’ve all seen them. Those vacuous workplace posters exhorting teamwork, creativity and other forms of inspiration and accomplishment. A version has begun to creep into our nation’s health care facilities. reminding everyone of the need for privacy, how infections can be spread and the importance of patient service. And if my ...

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Somewhere in the Obama Administration, there is an elitist central cabal that operates with the support of the highest organs of our central government. It conspires in windowless basement rooms to plot the gun control, mass vaccinations and the nationalization of key U.S. economic sectors like automobile and chardonnay manufacturing. Healthcare, however, is its maximum target. Much like pieces on a chess board, and with the support of renegade organizations like ...

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According to the Washington Post, it is highly unlikely that Congress will undo the planned "sustainable growth rate formula" (SGR) mandated Medicare fee schedule cuts. While there's an outside chance of a fix, the American Medical Association, as well as other organized physician groups, can't be happy about the constant threat of the 20% payment reductions. Recall that the SGR was signed into law back in 1998. It was designed to ...

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Is the Patient Centered Medical Home (PCMH) the panacea for all that ails health care? Have we exhausted all the allegories related to the term “home?” The answer to both questions apparently is no, thanks to this American Journal of Managed Care article by Timothy Hoff titled The Shaky Foundation of the Patient Centered Medical Home. Dr. Hoff appropriately shelves PCMH policy and looks at the topic with a market-based perspective. From ...

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When the Disease Management Care Blog saw the flurry of news reports about the Patient Centered Medical Home (PCMH) "saving money," it couldn't wait for the full print version of Health Affairs to arrive at the DMCB World Headquarters. The DMCB had previously reviewed Group Health's negative "no statistically significant.... cost differences" one year study and was looking forward to seeing researchers Robert Reid et al's reportedly positive two ...

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As a former New Yorker, the Disease Management Care Blog has always had an abiding respect for the Big Apple's taxi drivers. That increased considerably after it left its wallet in a Manhattan cab and it turned up in Virginia a year later -- in the possession of an individual allegedly involved in organized crime. This and other evidence of the cabbies' shrewd business acumen makes the DMCB wonder why Hizzoner ...

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"Detritus." Not only was that a chance for the Disease Management Care Blog to refamiliarize itself with an underused noun (and, er, its spelling), that was the telling term used today by a DMCB colleague to describe the output from a local health system's electronic health record (EHR). He had received a copy of a lengthy consultant-physician's documentation involving one of his patients and was astonished by the blob of past ...

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