Several years ago, a group of us concerned about health care costs and outcomes met with some local HR benefit managers. One was the head HR person of a city. In part of the conversation, she raved about a local chain of urgent care centers. She loved the fact that she could go to one after work to get her steroid shot for her colds. I had enough experience dealing ...

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I don’t mean to pick on McDonald’s. Insert any other large retail business where customer satisfaction massively trumps every other consideration of the relationship between employee and customer. Telemedicine companies have exploded the past few years. I suspect a lot of my readers have already seen this, but just in case not, a recent study in JAMA Internal Medicine measured the correlation between customers with a cold who called ...

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I am a huge fan of Britain’s National Health Service (NHS), but probably not for the reasons many people might assume. It’s not because it’s “socialist” (a horribly inaccurate description), or that it’s nationalized, or anything like that. I’m a huge fan because somehow the people of Britain have developed the courage to talk about health care using very adult language. In the U.S., we can rarely progress beyond the ...

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On a recent flight, I sat next to a woman of about 30 who was originally from France but has lived in London for a number of years for work. After exchanging the usual pleasantries, she found out I am a family physician and it became clear she wanted to give me her opinion of the British health care system. I didn’t dissuade her. For a little background, both the U.K. ...

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First, a history lesson. Back in the mid-2000 oughts, the AAFP launched a wholly owned subsidiary called TransforMed. It was originally started to help practices implement the "new model of care" from the Future of Family Medicine Report. Soon after it was launched, the joint principles of the patient-centered medical home (PCMH) were announced, so TransforMed pivoted to help practices implement the PCMH model of care. In one ...

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study from the National Bureau of Economic Research reports on the results of a large randomized controlled trial of a large employer with over 12,000 employees. Program eligibility and financial incentives were randomized at the individual level. Over 56 percent of eligible treatment group employees participated. The study found that in the first year, the employees who signed up were healthier and had lower medical costs, but, and ...

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In a very unique study, researchers have tabulated how often family physicians provide patient care that is not covered with a CPT code. This is a little complex, for the non-physicians and even for many physicians to grasp, so I will provide a little more background first. CPT stands for Current Procedural Terminology, which is the book written by the American Medical Association (AMA) since about 1965. This ...

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There are some questions in health care that can’t be answered with a randomized controlled trial. We can’t randomize babies to inhale secondary tobacco smoke or not to test its health effects. We can’t randomize people to a different number of hours sitting the ER before receiving antibiotics after the decision is made that the patient has a bacterial infection requiring antibiotics. There are some questions where the best available ...

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I have written about both issues before: freestanding ERs and retail clinics. Two recent studies continue to show how useless they both are in helping create a better more efficient health care system. The freestanding ER study  examined the number of these facilities and population characteristics where they locate. They identified 360 freestanding ERs, mostly in Texas, Ohio, and Colorado. This will come as no surprise; they were located in ...

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Hospitalists, doctors who only see patients in the hospital, almost always in a shift work model, are the fastest growing “specialty” in medicine, from nothing about 15 years ago to about 50,000 today. There were some studies that I won’t review much here that showed some benefits from hospitalists compared to “usual care” in highly controlled environments, outcomes such as a 0.4 per day decrease in length of stay with ...

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