Engage with Grace is a project I learned about a month ago at the Health 2.0 Conference. Alexandra Drane presented the very personal story of her sister-in-law's death, at home and in direct opposition to the recommendations of her physicians. About 1000 people in the room and you could hear a pin drop--except for occasional sobs--mine included.
----
Several dozen bloggers in the health care field and beyond are engaged in a blog rally* this weekend, simultaneously posting the one slide and Alexandra Drane's post to
encourage conversation about a topic that's often avoided but every family ought be discussing: How we want to die.
Please try it, using the slide above as a discussion guide. It's not
that hard to have the conversation with your loved ones once you get
started.
---
We make choices throughout our lives - where
we want to live, what types of activities will fill our days, with whom
we spend our time. These choices are often a balance between our
desires and our means, but at the end of the day, they are decisions
made with intent. But when it comes to how we want to be treated at the
end our lives, often we don't express our intent or tell our loved ones
about it. This has real consequences. 73% of Americans would
prefer to die at home, but up to 50% die in hospital. More than 80% of
Californians say their loved ones “know exactly” or have a “good idea”
of what their wishes would be if they were in a persistent coma, but
only 50% say they've talked to them about their preferences.But
our end of life experiences are about a lot more than statistics.
They’re about all of us. So the first thing we need to do is start
talking. Engage With Grace: The One Slide Project
was designed with one simple goal: to help get the conversation about
end of life experience started. The idea is simple: Create a tool to
help get people talking. One Slide, with just five questions on it.
Five questions designed to help get us talking with each other, with
our loved ones, about our preferences. And we’re asking people to share
this One Slide – wherever and whenever they can…at a presentation, at
dinner, at their book club. Just One Slide, just five questions. Lets start a global discussion that, until now, most of us haven’t had.Here is what we are asking you: Download The One Slide
(that's it above) and share it at any opportunity – with colleagues,
family, friends. Think of the slide as currency and donate just two
minutes whenever you can. Commit to being able to answer these five
questions about end of life experience for yourself, and for your loved
ones. Then commit to helping others do the same. Get this conversation
started. Let's start a viral movement driven by the change we
as individuals can effect...and the incredibly positive impact we could
have collectively. Help ensure that all of us - and the people we care
for - can end our lives in the same purposeful way we live them. Just One Slide, just one goal. Think of the enormous difference we can make together.
(To learn more please go to www.engagewithgrace.org. This post was written by Alexandra Drane and the Engage With Grace team.)
---
* In case you are wondering, "blog rally" is a term invented this past weekend.
A blog rally is the simultaneous presentation of identical or similar
material on numerous blogs, for the purpose of engaging large numbers
of readers and/or persuading them to adopt a certain position or take a
certain action. The simultaneous natu re of a blog rally creates the
ironic result of joining the efforts of otherwise independent bloggers
for an agreed-upon purpose. As far as we can tell, this is the first
recorded use of a blog rally -- occurring from November 26 through
November 30, 2008, in support of a viral movement called 'Engage with
Grace: The One Slide Project' -- organized to encourage families to
discuss end-of-life care issues while gathered together for the
Thanksgiving holiday weekend. This particular blog rally also has a
parallel component on Facebook, where many people are donating their
status to bring attention to Engage with Grace.
----
I must credit Paul Levy, President and CEO of Beth Israel Deaconess Medical Center in Boston whose blog, Running a Hospital is where I learned of the weekend "blog rally". Levy is also on Twitter as PaulFLevy.
I meet once a month for breakfast with our EM residents. I learned this from my mentor, David Wagner, who started it well after I was no longer his resident and was serving on his faculty. I know the residents loved having his ear for an hour and there was a lot of give and take. I've been doing this now for five years and our sessions have never had much give and take. The ground rules for the hour are that I have to be able to act on information that I hear, but that nothing I hear will be attributed to the individual. Sometimes more is said than other times, but last year it finally occurred to me that some structure might be useful, particularly if focused around content not usually part of the core residency educational program. While all residents get some exposure to administrative topics, it seemed logical to focus more on these areas.
So as with many things, "Breakfast with the Chair" at my shop in 2008 has become more structured than what I fantasize Dave's were, back in the day. I'm using these sessions to talk to the residents about "life, the Universe and everything." Or at least to discuss some of the basics of selecting life, disability, travel and other sorts of insurance and what's on every senior resident's mind at this time of year: getting a job.
Tomorrow morning I'll discuss the various models of employment offering complete descriptions and trying to avoid judgments, though commenting on the strengths and pitfalls of each as I understand these. On the list will be the following:
- Hospital Employed
- Corporation Employed including single owners, small and large ownership groups, publicly traded corporations
- Independent Contractor models with and without your own Professional Corporation
- Locum Tenens
- Democratic Group grant/earn-in/buy-in models
I'm going to point them to this page with the suggestion that they pose their comments and questions here, too.
Fard Johnmar at HealthcareVOX nicely summarizes and explores some of the concerns I've been feeling as I've vacillated over attending the Health 2.0 Conference next month in San Francisco. I do think the fundamental concept is valuable, I'm concerned by the sound of hype inherent in the term: language does create its own reality. Nonetheless, I'm headed for San Francisco for the conference on my way to Chicago (I'm starting from Brooklyn, NY) for the annual ACEP Scientific Assembly.
I'd like to suggest that consistent with his theme, he could sharpen both his diagram of the four "clogged arteries" and his explanation of its content. First the diagram itself could benefit from the third dimension, I envision a cone the base covering the entire diagram and drawing to a point at a figure/avatar representing the user-consumer-patient-community of users.
I suggest this blanketing user-consumer-patient-community of users input not to hold this central aspect (We used to call it "patient-centered" and "family-centered" care.) outside or orthagonal to the concept embedded into the diagram, but rather to respect the underlying thoughts while refining the concept. For I see in all four of the "clogged arteries" components of purely professional endeavor and components of professional interaction with user-consumer-community of users.
Medical Decisions seems especially fraught. Perhaps that's just me, a physician-educator-executive, responding to the term in this context when my efforts over the past 30+ years in this realm are best crystallized by Jerome Groopman in How Doctors Think where the focus is really on how doctors make medical decisions. The user-consumer-patient-community of users certainly does as well, differently and at many different levels. Johnmar in conflating physician prescription practice with managing end-of-life care cost rather crosses many more boundaries than I can comfortably traverse within the core concept--at least so long as I'm devoting the attention I am to young physicians learning the practice of making medical decisions.
The implications of Molly Coye's (HealthTech) observation that hospital expenditures are shifting away from labor expenditures and towards capital, both facility and technological, seems fundamental to this transition time as well. I don't know if any hospital has asked its community if the user-consumer-patient-community of users would prefer a new MRI machine or a patient navigator program. Both is too glib an answer, which while not unrealistic today in many environments, may soon become so.
The exposure to these various constructs is provocative and mind-expanding. I'm looking forward to meeting some of the progenitors of the Health 2.0 concepts and the entrepreneurs who are seeking to bring it to fruition. There has to be a pony in there somewhere.
Yesterday I received notice of the CCHIT's next steps in certifying PHRs. The message was broadly addressed, I'm sure the entire CCHIT mailing list received it. Note the request for help in spreading the word. It's somewhat ironic that this organization--with which I participate as an ED Workgroup member--whose mission is "to accelerate the adoption of health information technology by creating an efficient, credible and sustainable certification program" seeks to speak to consumers through its marketing director.
I guess this calls for redoubling my own efforts from the inside.
Today we are launching a program to increase the consumer participation in our personal health record (PHR) certification program development. And we could really use your help in spreading the word. If your organization has a communication channel to consumers, we would really appreciate it if you could carry the included information to them. I have attached a Word and PDF version of our invitation for your use (editor note: Same content as this post.) I would be happy to expand on this if you need more or customize it for your use if that would help.
We have several new activities in which consumers can participate:
· The Commission has completed its first step, the creation of draft criteria for testing PHRs. Beginning Monday, Sept. 29, the criteria will be posted to http://cchit.org/participate/public-comment/ and available for a 30-day public comment period.
· A new Web site and blog dedicated to furthering the conversation about PHRs, www.phrdecisions.com, will launch on that same date. A consumer’s guide to certification of PHRs will also be available there.
· On Friday, Oct. 10, the Certification Commission will host a special free Town Call teleconference that will allow consumers and consumer representatives to gain a better understanding of PHR certification and how they can play a role in the process. The Town Call will include a presentation by Dr. Mark Leavitt, chair of the Commission, and Dr. Jodi Pettit, the staff leader of the PHR Work Group. It can be downloaded by Oct. 9 at www.phrdecisions.com.
Participants in the Town Call can ask questions during the call or online at www.phrdecisions.com. The questions and answers will be posted online following the teleconference.
The dial-in information for the Town Call is:
4:00 pm ET/ 3:00 pm CT/ 2:00 pm MT/ 1:00 pm PT
Participant Dial-In Number: 1 (877) 313-5342
Conference ID Number: 65204557
C Sue Reber
Marketing Director, CCHIT
Certification Commission for Healthcare Information Technology
503.288.5876 office | 503.703.0813 cell | 503.287.4613 fax
sreber@cchit.org
Published: June 24, 2008
If this country does not accelerate the conversion from paper to electronic health records, many health care reform promises will become irrelevant.
Yes. So?
American physicians are still paid on piece-work; productivity matters to them and their families. Seeing patients pays the mortgage and feeds the family.
I've successfully implemented an electronic medical record that has served more than one-half million patients since 2002, yet I know that we've accomplished this only by sacrificing physician productivity even as we've improved overall productivity in our emergency department. Optimizing an entire system often requires that components of the system operate at less than optimum in some fashion.
We can do this at my hospital because our physician staff is only partially compensated by piece-work and the alternative subsidies could be adjusted.
The
NY Times got it wrong this time. Private physicians behave as they do in response to the totally distorted payment system--even the term "reimbursement" so common in this context is evidence of this distortion.
My Dad, an internist, used to say that the head-bone is connected to the foot-bone. He practiced internal medicine and gastroenterology and empirically experienced connectedness of the head-bone and the gut long before we had the science proving it.
It's not the private physicians who must be dragged out of the paper age. It's the payment system and the financing of healthcare in 21st century America.
The NY Times should castigate our policymakers, not our practitioners.
ER: Season 11, Episode 177861, 1/20/2005
[ . . . ]
A personal injury lawyer sets up a mobile office outside the ER, infuriating Lewis as he tries to turn dissatisfied patients into clients.
[ . . . ]
It turns out that the post on the Mobile Lawyer who showed up at our hospital and ER last spring caught some notice in the blogosphere. Overlawyered picked up the post and I had thousands of hits in a few days. A colleague referred another contact and somehow the story reached the writing staff at the ER production company to appear in the fictionalized version on tomorrow's show. Imagine that.
An Influential Federal advisory panel has voted to recommend lower 2006 Medicare payments than expected by physicians and hospitals, as well as other policy actions affecting both. (emphasis added)
While reimbursement levels are a concern, it's the other "policy proposals" that really scare me.
The Medicare Payment Advisory Commission voted to recommend a 2.7 percent increase in Medicare payments to doctors, which is less than the expected increase in doctors' costs, but substantially more than doctors would get under current law, under which payments would be cut five percent next year if Congress takes no action, reported the New York Times.
[. . . ]
The commission expressed concern about the proliferation of imaging equipment and services in doctors' offices, and urged Congress to direct the secretary of health and human services to set national standards for doctors who perform or interpret diagnostic imaging studies billed to Medicare - a move which would alter the historical role of states and medical specialty boards in physician licensing and certification, the Times noted. The standards would cover the training and education of doctors who bill Medicare for X-rays, CAT scans, PET scans, magnetic resonance imaging, ultrasound, (emphasis added) echocardiography and other imaging. The panel maintained that poor quality diagnostic imaging can lead to repeat tests, misdiagnoses and improper treatment, the Times added.
[. . . ]
So this proposal could entrench delayed reads as the standard for all radiography as a consequence of the requirement that only those meeting federal standards for "training and education" interpreted imaging studies. Also CMS could easily decide that bedside ultrasound imaging was merely a component of the evaluation and management (E&M) service and not separately compensable.
http://www.nytimes.com/2005/01/18/politics/18medicare.html?oref=login&pagewanted=print&position=
Link: WSJ.com - California Hospitals Open Books, Showing Huge Price Differences. (subscription required)
A new law in California mandates that hospitals there do what few hospitals in America will: open up their "chargemasters," books that show thousands of list prices for medical goods and services. An examination of chargemasters at several hospitals shows that pricing strategies fluctuate wildly -- on everything from brain scans to painkillers to leeches. Depending on a hospital's pricing method, the charge for the same commodity or service, such as a blood test, can vary by as much as 17-fold from one institution to another.
Continue reading "WSJ.com - California Hospitals Open Books, Showing Huge Price Differences" »
So the VA Chief, Prinipi, is quitting. It probably doesn't have much to do with the $900 Million plus cut anticipated in the DVA budget which will mostly fall on healthcare since that's the largest part of the DVA budget. This at the time when our military men and women will be returning from Iraq. Just a small precursor of the coming cuts in Medicare. Stay tuned.
Bloomberg Dec 9 2004 1:24AM GMT [Moreover - moreover...]
I don't know why they picked this one article out of the entire November 2004 issue of Academic Emergency Medicine devoted to Healthcare Technology and IT in the ED, but it's very cool that we made the California Healthcare Foundation's iHealthBeat.
Link: iHealthBeat.org.
Recommended Reading: Suggestions for ED Clinical Documentation Systems
November 10, 2004
An article in the current issue of Academic Emergency Medicine outlined eight recommendations for improving emergency department clinical documentation systems.
. . .
"As technology is implemented, standards and requirements for documentation systems need to be established," according to the article. Electronic clinical documentation eventually will "improve immediate care, promote efficiency, and permit ready communication of critical patient information" (Davidson, Academic Emergency Medicine, November 2004).
2008.11.27
Engage with Grace
Engage with Grace is a project I learned about a month ago at the Health 2.0 Conference. Alexandra Drane presented the very personal story of her sister-in-law's death, at home and in direct opposition to the recommendations of her physicians. About 1000 people in the room and you could hear a pin drop--except for occasional sobs--mine included.
----
Several dozen bloggers in the health care field and beyond are engaged in a blog rally* this weekend, simultaneously posting the one slide and Alexandra Drane's post to
encourage conversation about a topic that's often avoided but every family ought be discussing: How we want to die.
Please try it, using the slide above as a discussion guide. It's not
that hard to have the conversation with your loved ones once you get
started.
---
We make choices throughout our lives - where
we want to live, what types of activities will fill our days, with whom
we spend our time. These choices are often a balance between our
desires and our means, but at the end of the day, they are decisions
made with intent. But when it comes to how we want to be treated at the
end our lives, often we don't express our intent or tell our loved ones
about it. This has real consequences. 73% of Americans would
prefer to die at home, but up to 50% die in hospital. More than 80% of
Californians say their loved ones “know exactly” or have a “good idea”
of what their wishes would be if they were in a persistent coma, but
only 50% say they've talked to them about their preferences.But
our end of life experiences are about a lot more than statistics.
They’re about all of us. So the first thing we need to do is start
talking. Engage With Grace: The One Slide Project
was designed with one simple goal: to help get the conversation about
end of life experience started. The idea is simple: Create a tool to
help get people talking. One Slide, with just five questions on it.
Five questions designed to help get us talking with each other, with
our loved ones, about our preferences. And we’re asking people to share
this One Slide – wherever and whenever they can…at a presentation, at
dinner, at their book club. Just One Slide, just five questions. Lets start a global discussion that, until now, most of us haven’t had.Here is what we are asking you: Download The One Slide
(that's it above) and share it at any opportunity – with colleagues,
family, friends. Think of the slide as currency and donate just two
minutes whenever you can. Commit to being able to answer these five
questions about end of life experience for yourself, and for your loved
ones. Then commit to helping others do the same. Get this conversation
started. Let's start a viral movement driven by the change we
as individuals can effect...and the incredibly positive impact we could
have collectively. Help ensure that all of us - and the people we care
for - can end our lives in the same purposeful way we live them. Just One Slide, just one goal. Think of the enormous difference we can make together.
(To learn more please go to www.engagewithgrace.org. This post was written by Alexandra Drane and the Engage With Grace team.)
---
* In case you are wondering, "blog rally" is a term invented this past weekend.
A blog rally is the simultaneous presentation of identical or similar
material on numerous blogs, for the purpose of engaging large numbers
of readers and/or persuading them to adopt a certain position or take a
certain action. The simultaneous natu re of a blog rally creates the
ironic result of joining the efforts of otherwise independent bloggers
for an agreed-upon purpose. As far as we can tell, this is the first
recorded use of a blog rally -- occurring from November 26 through
November 30, 2008, in support of a viral movement called 'Engage with
Grace: The One Slide Project' -- organized to encourage families to
discuss end-of-life care issues while gathered together for the
Thanksgiving holiday weekend. This particular blog rally also has a
parallel component on Facebook, where many people are donating their
status to bring attention to Engage with Grace.
----
I must credit Paul Levy, President and CEO of Beth Israel Deaconess Medical Center in Boston whose blog, Running a Hospital is where I learned of the weekend "blog rally". Levy is also on Twitter as PaulFLevy.
November 27, 2008 in Medicine.Policy, Medicine.Practice | Permalink
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Posted by sjdmd on November 27, 2008 in
Medicine.Policy
,
Medicine.Practice
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Permalink
2008.09.23
Employment Arrangements for Emergency Physicians
I meet once a month for breakfast with our EM residents. I learned this from my mentor, David Wagner, who started it well after I was no longer his resident and was serving on his faculty. I know the residents loved having his ear for an hour and there was a lot of give and take. I've been doing this now for five years and our sessions have never had much give and take. The ground rules for the hour are that I have to be able to act on information that I hear, but that nothing I hear will be attributed to the individual. Sometimes more is said than other times, but last year it finally occurred to me that some structure might be useful, particularly if focused around content not usually part of the core residency educational program. While all residents get some exposure to administrative topics, it seemed logical to focus more on these areas.
So as with many things, "Breakfast with the Chair" at my shop in 2008 has become more structured than what I fantasize Dave's were, back in the day. I'm using these sessions to talk to the residents about "life, the Universe and everything." Or at least to discuss some of the basics of selecting life, disability, travel and other sorts of insurance and what's on every senior resident's mind at this time of year: getting a job.
Tomorrow morning I'll discuss the various models of employment offering complete descriptions and trying to avoid judgments, though commenting on the strengths and pitfalls of each as I understand these. On the list will be the following:
- Hospital Employed
- Corporation Employed including single owners, small and large ownership groups, publicly traded corporations
- Independent Contractor models with and without your own Professional Corporation
- Locum Tenens
- Democratic Group grant/earn-in/buy-in models
I'm going to point them to this page with the suggestion that they pose their comments and questions here, too.
September 23, 2008 in Medicine.Practice | Permalink
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Posted by sjdmd on September 23, 2008 in
Medicine.Practice
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Permalink
2008.09.21
Farad Johnmar Discusses Health 2.0: Fad or Fundamental?
Fard Johnmar at HealthcareVOX nicely summarizes and explores some of the concerns I've been feeling as I've vacillated over attending the Health 2.0 Conference next month in San Francisco. I do think the fundamental concept is valuable, I'm concerned by the sound of hype inherent in the term: language does create its own reality. Nonetheless, I'm headed for San Francisco for the conference on my way to Chicago (I'm starting from Brooklyn, NY) for the annual ACEP Scientific Assembly.
I'd like to suggest that consistent with his theme, he could sharpen both his diagram of the four "clogged arteries" and his explanation of its content. First the diagram itself could benefit from the third dimension, I envision a cone the base covering the entire diagram and drawing to a point at a figure/avatar representing the user-consumer-patient-community of users.
I suggest this blanketing user-consumer-patient-community of users input not to hold this central aspect (We used to call it "patient-centered" and "family-centered" care.) outside or orthagonal to the concept embedded into the diagram, but rather to respect the underlying thoughts while refining the concept. For I see in all four of the "clogged arteries" components of purely professional endeavor and components of professional interaction with user-consumer-community of users.
Medical Decisions seems especially fraught. Perhaps that's just me, a physician-educator-executive, responding to the term in this context when my efforts over the past 30+ years in this realm are best crystallized by Jerome Groopman in How Doctors Think where the focus is really on how doctors make medical decisions. The user-consumer-patient-community of users certainly does as well, differently and at many different levels. Johnmar in conflating physician prescription practice with managing end-of-life care cost rather crosses many more boundaries than I can comfortably traverse within the core concept--at least so long as I'm devoting the attention I am to young physicians learning the practice of making medical decisions.
The implications of Molly Coye's (HealthTech) observation that hospital expenditures are shifting away from labor expenditures and towards capital, both facility and technological, seems fundamental to this transition time as well. I don't know if any hospital has asked its community if the user-consumer-patient-community of users would prefer a new MRI machine or a patient navigator program. Both is too glib an answer, which while not unrealistic today in many environments, may soon become so.
The exposure to these various constructs is provocative and mind-expanding. I'm looking forward to meeting some of the progenitors of the Health 2.0 concepts and the entrepreneurs who are seeking to bring it to fruition. There has to be a pony in there somewhere.
September 21, 2008 in Medicine.Policy | Permalink
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Posted by sjdmd on September 21, 2008 in
Medicine.Policy
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Permalink
2008.09.17
Certifying Commission for Health Information Technology (CCHIT) and the Personal Health Record (PHR)
Yesterday I received notice of the CCHIT's next steps in certifying PHRs. The message was broadly addressed, I'm sure the entire CCHIT mailing list received it. Note the request for help in spreading the word. It's somewhat ironic that this organization--with which I participate as an ED Workgroup member--whose mission is "to accelerate the adoption of health information technology by creating an efficient, credible and sustainable certification program" seeks to speak to consumers through its marketing director.
I guess this calls for redoubling my own efforts from the inside.
Today we are launching a program to increase the consumer participation in our personal health record (PHR) certification program development. And we could really use your help in spreading the word. If your organization has a communication channel to consumers, we would really appreciate it if you could carry the included information to them. I have attached a Word and PDF version of our invitation for your use (editor note: Same content as this post.) I would be happy to expand on this if you need more or customize it for your use if that would help.
We have several new activities in which consumers can participate:
· The Commission has completed its first step, the creation of draft criteria for testing PHRs. Beginning Monday, Sept. 29, the criteria will be posted to http://cchit.org/participate/public-comment/ and available for a 30-day public comment period.
· A new Web site and blog dedicated to furthering the conversation about PHRs, www.phrdecisions.com, will launch on that same date. A consumer’s guide to certification of PHRs will also be available there.
· On Friday, Oct. 10, the Certification Commission will host a special free Town Call teleconference that will allow consumers and consumer representatives to gain a better understanding of PHR certification and how they can play a role in the process. The Town Call will include a presentation by Dr. Mark Leavitt, chair of the Commission, and Dr. Jodi Pettit, the staff leader of the PHR Work Group. It can be downloaded by Oct. 9 at www.phrdecisions.com.
Participants in the Town Call can ask questions during the call or online at www.phrdecisions.com. The questions and answers will be posted online following the teleconference.
The dial-in information for the Town Call is:
4:00 pm ET/ 3:00 pm CT/ 2:00 pm MT/ 1:00 pm PT
Participant Dial-In Number: 1 (877) 313-5342
Conference ID Number: 65204557
C Sue Reber
Marketing Director, CCHIT
Certification Commission for Healthcare Information Technology
503.288.5876 office | 503.703.0813 cell | 503.287.4613 fax
sreber@cchit.org
September 17, 2008 in Medicine.IT, Medicine.Policy | Permalink
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Posted by sjdmd on September 17, 2008 in
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2008.07.08
Is it time to drag private physicians out of the paper age?
Published: June 24, 2008
If this country does not accelerate the conversion from paper to electronic health records, many health care reform promises will become irrelevant.
Yes. So?
American physicians are still paid on piece-work; productivity matters to them and their families. Seeing patients pays the mortgage and feeds the family.
I've successfully implemented an electronic medical record that has served more than one-half million patients since 2002, yet I know that we've accomplished this only by sacrificing physician productivity even as we've improved overall productivity in our emergency department. Optimizing an entire system often requires that components of the system operate at less than optimum in some fashion.
We can do this at my hospital because our physician staff is only partially compensated by piece-work and the alternative subsidies could be adjusted.
The
NY Times got it wrong this time. Private physicians behave as they do in response to the totally distorted payment system--even the term "reimbursement" so common in this context is evidence of this distortion.
My Dad, an internist, used to say that the head-bone is connected to the foot-bone. He practiced internal medicine and gastroenterology and empirically experienced connectedness of the head-bone and the gut long before we had the science proving it.
It's not the private physicians who must be dragged out of the paper age. It's the payment system and the financing of healthcare in 21st century America.
The NY Times should castigate our policymakers, not our practitioners.
July 8, 2008 in Medicine.Policy | Permalink
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Posted by sjdmd on July 8, 2008 in
Medicine.Policy
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Permalink
2005.01.19
Mobile Lawyer and "ER" the TV show
ER: Season 11, Episode 177861, 1/20/2005
[ . . . ]
A personal injury lawyer sets up a mobile office outside the ER, infuriating Lewis as he tries to turn dissatisfied patients into clients.
[ . . . ]
It turns out that the post on the Mobile Lawyer who showed up at our hospital and ER last spring caught some notice in the blogosphere. Overlawyered picked up the post and I had thousands of hits in a few days. A colleague referred another contact and somehow the story reached the writing staff at the ER production company to appear in the fictionalized version on tomorrow's show. Imagine that.
January 19, 2005 in Television | Permalink
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Posted by sjdmd on January 19, 2005 in
Television
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Permalink
Could CMS demand only delayed reads of imaging studies and take Ultrasound billing away from EM?
An Influential Federal advisory panel has voted to recommend lower 2006 Medicare payments than expected by physicians and hospitals, as well as other policy actions affecting both. (emphasis added)
While reimbursement levels are a concern, it's the other "policy proposals" that really scare me.
The Medicare Payment Advisory Commission voted to recommend a 2.7 percent increase in Medicare payments to doctors, which is less than the expected increase in doctors' costs, but substantially more than doctors would get under current law, under which payments would be cut five percent next year if Congress takes no action, reported the New York Times.
[. . . ]
The commission expressed concern about the proliferation of imaging equipment and services in doctors' offices, and urged Congress to direct the secretary of health and human services to set national standards for doctors who perform or interpret diagnostic imaging studies billed to Medicare - a move which would alter the historical role of states and medical specialty boards in physician licensing and certification, the Times noted. The standards would cover the training and education of doctors who bill Medicare for X-rays, CAT scans, PET scans, magnetic resonance imaging, ultrasound, (emphasis added) echocardiography and other imaging. The panel maintained that poor quality diagnostic imaging can lead to repeat tests, misdiagnoses and improper treatment, the Times added.
[. . . ]
So this proposal could entrench delayed reads as the standard for all radiography as a consequence of the requirement that only those meeting federal standards for "training and education" interpreted imaging studies. Also CMS could easily decide that bedside ultrasound imaging was merely a component of the evaluation and management (E&M) service and not separately compensable.
http://www.nytimes.com/2005/01/18/politics/18medicare.html?oref=login&pagewanted=print&position=
January 19, 2005 in Medicine.Policy | Permalink
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Posted by sjdmd on January 19, 2005 in
Medicine.Policy
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Permalink
2004.12.27
WSJ.com - California Hospitals Open Books, Showing Huge Price Differences
Link: WSJ.com - California Hospitals Open Books, Showing Huge Price Differences. (subscription required)
A new law in California mandates that hospitals there do what few hospitals in America will: open up their "chargemasters," books that show thousands of list prices for medical goods and services. An examination of chargemasters at several hospitals shows that pricing strategies fluctuate wildly -- on everything from brain scans to painkillers to leeches. Depending on a hospital's pricing method, the charge for the same commodity or service, such as a blood test, can vary by as much as 17-fold from one institution to another.
Continue reading "WSJ.com - California Hospitals Open Books, Showing Huge Price Differences"
December 27, 2004 in Medicine.Policy | Permalink
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Posted by sjdmd on December 27, 2004 in
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2004.12.08
VA Chief, Prinipi, Quits with Budget Cuts Looming
So the VA Chief, Prinipi, is quitting. It probably doesn't have much to do with the $900 Million plus cut anticipated in the DVA budget which will mostly fall on healthcare since that's the largest part of the DVA budget. This at the time when our military men and women will be returning from Iraq. Just a small precursor of the coming cuts in Medicare. Stay tuned.
Bloomberg Dec 9 2004 1:24AM GMT [Moreover - moreover...]
December 8, 2004 | Permalink
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Posted by sjdmd on December 8, 2004 |
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2004.11.22
iHealthBeat.org
I don't know why they picked this one article out of the entire November 2004 issue of Academic Emergency Medicine devoted to Healthcare Technology and IT in the ED, but it's very cool that we made the California Healthcare Foundation's iHealthBeat.
Link: iHealthBeat.org.
Recommended Reading: Suggestions for ED Clinical Documentation Systems
November 10, 2004
An article in the current issue of Academic Emergency Medicine outlined eight recommendations for improving emergency department clinical documentation systems.
. . .
"As technology is implemented, standards and requirements for documentation systems need to be established," according to the article. Electronic clinical documentation eventually will "improve immediate care, promote efficiency, and permit ready communication of critical patient information" (Davidson, Academic Emergency Medicine, November 2004).
November 22, 2004 in Medicine.IT | Permalink
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Posted by sjdmd on November 22, 2004 in
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