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Showing posts from April, 2010

What the health care reform bill is actually doing

Lately I have been attending various administration level functions at our hospital, as the doctor who has ideas about reducing costs.  I suspected, when I began rabble rousing, that the hospital administration would passively or even actively oppose open discussion of where money was being wasted, since most of that wasted money seemed to go directly into the hospital's accounts.  Apparently the hospital associations have been reading the writing on the wall for some time, and have realized that there will be cuts in their revenue. The administration was already interested in cost transparency when I began to push for it, and the CEO as well as members of the board have been very receptive to various ideas that would improve quality and efficiency, even to the point of considering options for providing a health care package to our whole community.

In a meeting lately, a representative of the corporation that owns our hospital spoke, during a talk I gave, on the corpo…

What is the problem with "fee for service"?

When I first started to the hear the mantra "the problem is fee for service" in the discussion of health care reform, I couldn't quite wrap my head around it.  What exactly did this mean?  I had worked for an HMO, received a salary, and now that I no longer work for a salary, and make money based on the amount of work I do, I feel more free to practice the way that works best for my patients, me, my family and my friends. Sure, higher performing systems like the Mayo Clinic work with salaried physicians, but doesn't that take away those physicians' incentives to provide the best service?

The problem with fee for service is that the services for which I charge a fee are not the services which are of value to my patients.  What patients want, mostly, is good health with a minimum of time, effort and money spent to get it. What I charge them for is face to face time in the office.  What I spend most of my time doing is solving problems in a context that…

Options for reform of the medical malpractice system

This article, in the New England Journal, offers some truly innovative ways to deal with the fact that suing for medical malpractice rarely serves the purpose of compensating the injured party or improving the dysfunctional system or practitioner. I intend to propose an institutional "disclose and offer" option at the hospital where I work, since it seems unlikely that a better option will replace medical malpractice as it now exists, at least during my lifetime.

Here is the article, in full, because it is all good:

by Michelle M. Mello, J.D., Ph.D., and Thomas H. Gallagher, M.D.

In February 2010, the Illinois Supreme Court ruled that thestate’s cap on noneconomic damages in medical malpractice casesviolated the Illinois constitution.1This development has contributedto growing pessimism about traditional approaches to medicalliability reform. In some quarters, interest is shifting toinnovative reforms that can be implemented by health care institutionsand liability ins…

More indications of positive change from the Journal of the AMA

Who would have thought that the Journal of the AMA would be an agent of positive social change? The AMA has, for me, symbolized the most frighteningly powerful aspects of organized medicine, and its trade journal, the JAMA has been one of the big 3 (with the New England Journal and the Annals of Internal Medicine) vehicles for presentation of relevant cutting edge clinical research. But since health care reform has been in the news the JAMA has offered many well considered opinion articles about how best to make American medicine serve the people.

The lead article this week presented research in the area of surgical treatment for spinal stenosis.  Spinal stenosis is a common and disabling subset of what people think of as "a nerve pinched in my back".  Patients with spinal stenosis have bony growth or disc protrusion into their spinal canal in such a way that the spinal cord is crowded, leading to pain down a leg, or both legs, with exertion or in certain postures.  It has …