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Health policy
An excerpt from Reshaping Health Systems: What Drives Health Care and How You Can Change It. Copyright © 2024, Wolters Kluwer. Clinical case Jessica is a 67-year-old woman having her very first visit with her new primary care clinician, Dr.…
An excerpt from Reshaping Health Systems: What Drives Health Care and How You Can Change It. Copyright © 2024, Wolters Kluwer.
Clinical case
Jessica is a 67-year-old woman having her very first visit with her new primary care clinician, Dr. Jackson. Jessica is accompanied by her husband, Daniel, and comes in with recent laboratory results from her previous clinician, whom she could no longer see because her clinic stopped accepting Jessica’s …
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How fee-for-service shapes your doctor’s decisions
Health policy
Value remains one of the most widely invoked and variably interpreted concept in American health care delivery. Beyond patients, stakeholder groups across the health care ecosystem are undertaking value-based initiatives, including payers (e.g., value-based insurance design and payments), provider organizations…
Value remains one of the most widely invoked and variably interpreted concept in American health care delivery. Beyond patients, stakeholder groups across the health care ecosystem are undertaking value-based initiatives, including payers (e.g., value-based insurance design and payments), provider organizations (e.g., value-based care redesign), pharmaceutical companies and pharmacy benefits managers (e.g., value-based pricing and formularies), and private companies (e.g., value-based technology assessment).
This trend highlights a critical point: Discussions about value …
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Lessons from the meeting of different value-based concepts
Conditions and diseases
The last few years have been marked by public outcry over the costs of novel prescription drugs, such as the hepatitis C medication sofosbuvir (brand name Sovaldi), which are highly efficacious but extremely expensive. On the one hand, sofosbuvir produces…
The last few years have been marked by public outcry over the costs of novel prescription drugs, such as the hepatitis C medication sofosbuvir (brand name Sovaldi), which are highly efficacious but extremely expensive.
On the one hand, sofosbuvir produces cure rates of >90%, a figure that seemed unthinkable a few decades ago. On the other, it is priced at approximately $1000 per pill ($60,000–$90,000 for a treatment course), making it …
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Are hepatitis C drugs too expensive? Analyzing the pros and cons.
Health policy
In a research article published in Annals of Internal Medicine, investigators studied performance in Medicare’s Value-Based Payment Modifier program (VM) -- a prominent pay-for-performance (P4P) program that adjusts providers’ Part B payment rates on the basis of their performance on…
In a research article published in Annals of Internal Medicine, investigators studied performance in Medicare’s Value-Based Payment Modifier program (VM) — a prominent pay-for-performance (P4P) program that adjusts providers’ Part B payment rates on the basis of their performance on a set of quality and cost measures. The authors were interested in 2 questions: Is engagement in VM associated with changes in provider performance on quality or cost measures? Does …
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Pay for performance: Have we gotten what we’ve paid for?
Health policy
In a recent article in Annals of Internal Medicine, physicians from the University of Missouri described their experience helping to create a “professionalism charter” for health care organizations. As the authors note, the need for such a charter is heightened…
In a recent article in Annals of Internal Medicine, physicians from the University of Missouri described their experience helping to create a “professionalism charter” for health care organizations. As the authors note, the need for such a charter is heightened by the troubling health climate, with millions of patients at risk of losing insurance coverage, scores of physicians experiencing burnout, and health care organizations grappling with how to preserve …
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Professionalism charters for health care organizations are needed now
Health policy
As clinicians continue to debate the merits and limitations of retail clinics, it is increasingly clear that they are here to stay. These nontraditional sites have proliferated around the country, appealing directly to patients' desires for convenience in ways that…
As clinicians continue to debate the merits and limitations of retail clinics, it is increasingly clear that they are here to stay. These nontraditional sites have proliferated around the country, appealing directly to patients’ desires for convenience in ways that many traditional primary care practices do not. A report by the Robert Wood Johnson Foundation found that retail clinics have increased by 900 percent over the last decade, an expansion …
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What economic theory can teach physicians about retail clinics
Medical education
Despite convincing results for many health care interventions, translating evidence from research into clinical practice is often challenging. Implementation barriers are myriad and complex, but a number may arise from core design issues. While real-world environments are clearly vital to…
Despite convincing results for many health care interventions, translating evidence from research into clinical practice is often challenging. Implementation barriers are myriad and complex, but a number may arise from core design issues. While real-world environments are clearly vital to the success of any intervention, many traditional research efforts are structured to remove them from the proverbial equation.
In studying the impact of a new medication, for instance, a group might …
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The challenge of translating research to clinical practice
Health policy
Amid ongoing health care transformation, clinicians will increasingly face the tension that the late physician and health services researcher John M. Eisenberg, MD, MACP, described over 30 years ago: providing high-value care with simultaneous commitments to patients and society. Physicians…
Amid ongoing health care transformation, clinicians will increasingly face the tension that the late physician and health services researcher John M. Eisenberg, MD, MACP, described over 30 years ago: providing high-value care with simultaneous commitments to patients and society.
Physicians have always been charged as patient agents to advocate for patients’ best interests. Simultaneously, however, they are tasked with considering the societal good by using resources wisely. While these commitments often …
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Value to patients and value to society: How can doctors balance the tension?
Health technology
The U.S. health care system is headed toward a profoundly digital future. Provider organizations around the country are adopting and updating their health information technology (HIT) infrastructures. Many have begun requiring that clinicians gain proficiency in electronic health records (EHRs)…
The U.S. health care system is headed toward a profoundly digital future. Provider organizations around the country are adopting and updating their health information technology (HIT) infrastructures. Many have begun requiring that clinicians gain proficiency in electronic health records (EHRs) in order to provide clinical care. A proliferation of start-ups and HIT companies in health care is poised to disrupt (innovatively or …
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Strong ethical principles should guide EHR implementation
Medical education
I recently had an interesting conversation with several co-residents about how our health care system should evaluate physician performance. If nothing else, the discussion highlighted how challenging this issue has been for almost all medical specialties, including internal medicine, where…
I recently had an interesting conversation with several co-residents about how our health care system should evaluate physician performance. If nothing else, the discussion highlighted how challenging this issue has been for almost all medical specialties, including internal medicine, where the controversy has been punctuated by debates about maintenance of certification (MOC) and licensure. It remains to be seen what will develop after the American Board of Internal Medicine recently …
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Digital natives: Implications on physician evaluation
Medical education
Amid the many ongoing changes to health care, it's clear that better teamwork is needed in American medicine. Calls for stronger interdisciplinary collaboration have permeated position statements and policies, and organizations have begun redesigning care processes to include novel team-based…
Amid the many ongoing changes to health care, it’s clear that better teamwork is needed in American medicine. Calls for stronger interdisciplinary collaboration have permeated position statements and policies, and organizations have begun redesigning care processes to include novel team-based approaches. Emerging data continue to affirm that strong teamwork and communication can increase the value of care.
Of the many efforts to improve teamwork, however, one potential area for significant improvement …
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Improve teamwork with better selection of medical trainees
Medical education
Tech-savvy. Attention-craving. Lazy, good-for-nothings. These are a few of the many traits that have been commonly bestowed upon those born around the last two decades of the 20th century. Commonly known as Generation Y, this demographical cohort of 20- to…
Tech-savvy. Attention-craving. Lazy, good-for-nothings.
These are a few of the many traits that have been commonly bestowed upon those born around the last two decades of the 20th century. Commonly known as Generation Y, this demographical cohort of 20- to 30-somethings has certainly sparked mixed reviews from its Gen X and Baby Boomer elders.
But what defines the particular subgroup of young …
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What can be said about the Generation Y physician?
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