Healthcare costs keep rising. Your insurance premiums go up, your deductible and co-pays go up, pharmacy benefits go down. Despite the high cost you get little time with your physician, insurance statements are complex beyond belief and “customer service” seems to be a foreign concept. To combat high costs we are often told that rationing will be necessary. Is that true? Why are costs so high in this very dysfunctional healthcare ...

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There is enormous waste in American healthcare delivery. One estimate is anywhere from 20% to nearly 50% of total expenditures are frankly unnecessary. What is this waste?  Is it real? Could it be eliminated or at least reduced? How difficult would such a reduction be to achieve? And what would be the unintended consequences? Donald Berwick, the former administrator for the Centers for Medicare and Medicaid Services, along with Andrew Hackbarth ...

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Are you a frustrated patient because you get little time with your physician each visit? Are you a frustrated physician who would like to spend more time but can’t make it work financially? Here are some developing approaches. Reimbursement rates for primary care visits are low, so primary care physicians (PCPs) need to see many patients to cover office expenses. There are many ways that PCPs are using to escape the ...

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America has this paradox of excellent biomedical science, innovative drug manufacturers and entrepreneurial device developers along with outstanding providers but at the same time has a dysfunctional care delivery system. A new vision is needed. Vision is a leadership concept that presents an idea, garners support and then develops the coalitions to bring it to fruition. America needs to envision what its care delivery system should be and then determine, as ...

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Technology to lower costs rather than accelerate them. Smart phones to increase physician and other providers’ productivity. Fewer primary care physicians but more involvement by nurse practioneers and others. And increasing appreciation of the value of integrative medicine. These are but a few of the disruptive changes in care delivery that are coming. I have posted concepts on how the health care delivery system will change in coming years – quite ...

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Ours is a provider-oriented system. Doctors like me and (former) hospital executives like me hate to admit it but it is true. Consumerism will slowly but surely drive it toward being a patient-oriented service model. What do patients and their families want from the health care delivery team? First and foremost is respect followed by service given in a high quality, very safe manner. Patients expect that the information gap ...

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There will be some very disruptive and some transformational changes in the way health care is delivered, not as a result of reform, but as a result of the drivers of change described in a previous post on KevinMD.com. They included an aging population, an obese society, shortages of doctors, and emerging consumerism, among others. I interviewed in depth about 150 medical leaders from across the United States to collect ...

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Fed up with our health care delivery system? Maybe even angry? What should a person do? What can a person do? I recently wrote a post on drivers of change in health care delivery such as the aging population, adverse lifestyle behaviors, shortages of physicians and developing consumer expectations. I planned to follow up today with what those drivers will produce as change in the delivery system. But a commentator responded ...

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More chronic illnesses, more diseases of old age, consumers demanding more quality and safety, physicians no longer in typical private practice, and high deductible health care polices are each about to cause major changes in the practice of medicine and how it is delivered to patients. Will this come about smoothly or, more likely, with some serious hand wringing? Health care delivery will change substantially in the coming years. This is ...

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Ever been put on hold when calling your insurance carrier? Or had so little time with your physician that you could not discuss everything you thought was important? Our care is generally good in the United States but not as good as it could be nor as good as it should be. There are multiple problems to consider. First, ours is a medical care system not a health care system. It is ...

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An excerpt from The Future of Health Care Delivery. We Americans like to pride ourselves on having the best health care system in the world, but unfortunately that is not the case. We have a medical (that is, sick) care system—a system that waits until we become ill before it kicks into action—instead of a health care system focused on helping us stay healthy. We give lip service to prevention and, ...

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As Americans we believe we have the best healthcare system in the world. But think again, it’s really not the truth. We do have superb medical schools, very well trained providers, superb science and technology but the delivery of medical care is just not what it should be. We spend more for healthcare than any other country does on a per capita basis. And yet when we compare ourselves to other ...

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We have a real paradox in American healthcare. On the one hand we have exceptionally well educated and well trained providers who are committed to our care. We are the envy of the world for our biomedical research prowess, funded largely by the National Institutes of Health and conducted across the county in universities and medical schools. The pharmaceutical industry continuously brings forth life saving and disease altering medications. The ...

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Over the last four weeks I have written about new technologies and their coming impact on medical care. We generally think of new technologies (and new, branded drugs) as pushing up the cost of healthcare. There is truth to this contention, of course, but often the real problem from a cost perspective is inappropriate use. And this happens all to often in medical practice today because the physician does not ...

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“To Err Is Human” is the title of the now famous book from the Institute of Medicine on patient safety published about a decade ago. From it we learned that anywhere from 44,000 to 98,000 individuals die each year of preventable medical errors (and other sources suggest the number might even be much higher). In this continuing series of posts on disruptive and transformational technologies, there are some that can ...

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Robotics has the potential to revolutionize the delivery of healthcare. It can help extend the delivery of information, expertise and clinical care across time and geographical space barriers. Robotics offers the opportunity to enhance quality of care through extension of clinical expertise and leveraging of integrated datasets and best practices. It can be used across the continuum--from the hospital setting (e.g. OR, ER, etc.) into primary care offices and even ...

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Distance medicine technologies can be disruptive in the way physicians and other care givers interact with patients and with each other and can fundamentally change how patients are able to interact with the entire health care system. This is of increasing relevance as medicine gravitates toward chronic illnesses where diagnosis and treatment are complex and require multi-specialist teams. It also has potential to alleviate some of the effects of the ...

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Incredible innovative and entrepreneurial skills have led to many new techniques and technologies in medicine. Some are both disruptive of the old way of doing things. Others are transformational. Over the next few weeks I will review some of those that I believe are among the most disruptive and transformational. Medical simulation is such an advance. It is dramatically transforming the way medicine, especially medical procedures, are taught and it ...

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Our children (and grandchildren) are the future and we are responsible for their growth and development. As responsible parties, we are clearly failing. That is my interpretation of the report issued a few days ago by the Centers for Disease Control (CDC) on seven criteria known to the associate with ideal cardiovascular health as part of the National Health and Nutrition Examinination Survey. They are defined, briefly, as 1) a diet ...

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Radiation therapy has advanced dramatically in the past few decades and the rate of change is increasing rapidly. Innovations as a result of engineering and computer advances along with conceptual advances are making a dramatic difference. Some of the new technologies include improved computer assisted treatment planning (smarter and faster and has more capability like auto-contouring, smart segmentation and improved algorithms) , continuous imaging guidance (fluoroscopic, stereoscopic, and cone beam CT), ...

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