Under Obamacare program, doctor visits would become data points

Perhaps the most important non-access related element of the ACA was the creation of PCORI.  Over time, their research has the potential to transform the way medicine is practice.  Research that is long overdue.


Under Obamacare program, doctor visits would become data points: "“Right now, were spending trillions on health care and 99.9999 percent doesn’t contribute anything to medical knowledge,” says Farzad Mostashari, national coordinator for health information technology at Health and Human Services. “That’s the real vision, that we actually take routine care, the heallth care happening in the real world, and have that contribute to knowledge.”"

We still have a health-care spending problem - The Washington Post

Disappointing but not surprising news.

We still have a health-care spending problem - The Washington Post: "most of this slowdown, 77 percent, has been due to years of a weak economy, which causes people to put off health services when they can and prompts employers and states to reduce health spending"

Want to cut health costs? Show doctors a price tag.

Want to cut health costs? Show doctors a price tag.:

It's the little things... the big things help too but don't underestimate the impact of small steps like this.

"Keep in mind, nothing changed for the doctors. The hospital would not penalize them for ordering more expensive tests; the costs would just get billed to the insurance provider. Still, the simple display of information suggests that “physicians can act in a cost-conscious manner even without direct incentives.”"

When your surgery goes wrong, hospitals profit

When your surgery goes wrong, hospitals profit: "“Part of what we have been trying to unravel is why some of the simple quality control measures that we know work are very slow to penetrate,” Gawande told me in an interview. “This puts in perspective how weak the incentives are [to improve quality]. Complications produced massively higher profits.”"

Hospitals In 5 States Clamp Down On Delivering Babies Before 39 Weeks – Capsules - The KHN Blog

Some low hanging fruit in our health care system - we know that babies born at 37 and 38 weeks are at a higher risk of death and other problems.  None-the-less an estimated 10-15 percent of US babies born every year are delivered early without medical cause.  This work shows that many of those elective early births can be delayed.

Hospitals In 5 States Clamp Down On Delivering Babies Before 39 Weeks – Capsules - The KHN Blog: "A study published Monday in the journal Obstetrics & Gynecology showed a group of 25 hospitals in five states were able to cut their rates of elective early deliveries from nearly 28 percent to under 5 percent in one year. "

Dying - avoiding the conversation is not the answer

I try and write about different aspects of health care (all of which can stand to be improved); Access, quality and cost is one of the traditional paradigms I use.  But today I want to briefly focus instead on a topic that transcends those categories, how our health care system deals with death.  This topic is incredibly important to me for two reasons - First, I have been through the passing of my parents and in-laws - four unique deaths that each taught me different lessons; and second, the use of the term "death panels" in the health care debate that made it even harder to have these vital conversations.

I'm no expert, but I do know that as we approach the end, or even better before we approach the end, we should as patients think about these issues.  Additionally, our providers should be prepared to help guide us through the process.

For your consideration, I share three recent articles.  Note that the first two link to additional classic articles on the topic that I encourage you to click through to.  The third article is a bit of a primer - just knowing what you want to do with respect to codes when you go into the hospital goes a long way towards addressing these issues, or at least helps start the conversation.

A duty to guide patients through the process of death: "Even in theses extremely devastating cases, We can still make a huge difference in the lives of our patients in the way in which we help them handle their own death."



Are physicians more afraid of death than the general population?: "If we aspire to become effective escorts to the patients whom we are privileged to shepherd in our medical ministries, then we might consider revising Luke’s well-known proverb to read: “Physician, emotionally heal thyself.”"


5 essential concepts to know about code status: "a few important and often unrecognized considerations that patients and their families should be aware of when discussing code status with their healthcare team."

The Republican plan for replacing Obamacare doesn’t replace Obamacare

Clear analysis of what the choice between the two approaches really comes down to.

The Republican plan for replacing Obamacare doesn’t replace Obamacare:

"...Or, to put it differently, Obamacare is trying to solve the problem of too little insurance. The Republican ideas are trying to solve the problem of too much insurance."

Now can we move on and work on how to implement the thing in the best possible way?

It's our duty as physicians to avoid needless tests

It's our duty as physicians to avoid needless tests: "But it’s not just the fact that our duty as citizens should force us to be good stewards of health care resources. It’s our duty as physicians to avoid needless tests that could add to potential morbidity."

Another voice in the growing chorus to "Choose Wisely".