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The value of shared clinician-patient decision-making in the ED


“There is tremendous potential for driving value-based care in the emergency department through shared decision-making,” wrote Edward Melnick, M.D., assistant professor of emergency medicine at the Yale School of Medicine, and Erik Hess, M.D., associate professor of emergency medicine and research chair for the Department of Emergency Medicine at the Mayo Clinic, in a Health Affairs blog post: “As we continue to build incentives for value-based care into our healthcare system, we should not leave the ED out.”

The post reported on the value of decision-aids to encourage shared decision-making during a randomized control trial at six EDs across the U.S.  The pilot program used a decision aid, “Chest Pain Choice,” developed by Dr. Hess and his research team. Chest pain, a frequent cause of patient visits to the ER, often leads to unnecessary admissions. So Dr. Hess’s team wanted to know what would happen if clinicians took the time to inform patients of their options.

The results, they write, were increased patient engagement and a reduced number of  what turned out to be unnecessary hospital admissions for cardiac testing. Doctors Hess and Melnick see this as a “multibillion-dollar opportunity” to reduce waste in the healthcare system. The findings were so promising that the researchers are developing decision aids to discuss CAT scans for people with minor head trauma.

To read more, please hit this link.

‘Chasing our tails’ on healthcare costs


Richard Embrey, M.D., is chief medical officer and vice president for population-health management of Fishersville, Va.-based Augusta Health. He was interviewed by Becker’s Hospital Review. Some of the interview is below:

“Question: If you could eliminate one of the healthcare industry’s issues overnight, which would it be?”

“RE: The complexity of healthcare. Healthcare has become so complex that it is difficult to identify areas to improve. In fact, I would say we’re trying so hard to reduce costs that we may actually be adding costs to healthcare. We’re chasing our tails — as we try to solve our problems, we’re creating more problems.”

“Q: What do you see as the biggest population health challenge facing the Fishersville, Va., area?

“RE: Identifying patients with chronic diseases. A lot of people aren’t very compliant and don’t like to use the healthcare system, so it’s hard to find the patients who need our help. They wait until it’s too late and then come in with problems that are much more severe than they would be if we’d found them earlier.”

“Q: What keeps you up at night?”

“RE: Is healthcare sustainable? Are the costs of healthcare going to escalate so fast that people are going to lose value?”

“Q: The session you’re leading in April is called ‘Kenneth Arrow Fifty Years Later: What Has Changed and What Has Remained the Same?’ Could you give a brief preview of the session?

“RE: In 1963, a famous economist named Kenneth Arrow wrote a paper called ‘Uncertainty and the Welfare Economics of Medical Care.’ He was commissioned by the Ford Foundation to do this before the launch of Medicare. At the time, there were a lot of concerns about socialized medicine and whether insurance would lead to more utilization of healthcare.

“In the paper, Dr. Arrow wrote about uncertainty and made a point that everybody has forgotten in the past 50 years regarding uncertainty and not knowing whether someone’s going to get sick. The incidence of disease and efficacy of treatment cause all kinds of abnormalities in the market of healthcare, and those problems also cause an increase in cost.

“It was the first paper on which the field of healthcare was founded, but Dr. Arrow didn’t stay in healthcare. “Uncertainty and the Welfare Economics of Medical Care’ was the most important paper in healthcare that nobody in the industry has ever read. I plan to go back and review it for people. I hope a refresher will help people focus on what we’re trying to do in healthcare today.”

To read the whole Becker’s piece, please hit this link.

Investigating physician-owned distributorships


The U.S. Senate Finance Committee held a meeting Nov. 17 to discuss if physician-owned distributorships (PODs) hurt patients and payers.

A POD is a medical-device business that physicians invest in and operate,  Critics argue that they can create a conflict of interest that hurts the healthcare system if physicians use the devices they sell in their own practice.

But John Steinmann, D.O., an orthopedic surgeon, testified  for PODs. citing a model he has developed for surgeon ownership in PODs “that reduces conflicts of interest, ensures cost savings and protects patient safety,” Becker’s Hospital Review reported.



Patients hit with high prices of hospital-employed physicians



More research, this from the Harvard Medical School, shows that patients pay considerably more to see their physicians when those doctors work for hospitals.

Researchers found that when small  practices of physicians join large hospitals, their patients pay an average of $75 more every year for such outpatient services as check-ups, although  the number of appointments stays the same.

The Boston Globe reports that:
“With data from cities across the United States, the study is the first to document the cost of physician acquisitions by hospitals on a national scale.”

“Economists have known for decades that when hospitals merge, prices go up. If you’re the only shop in town, you can charge whatever you like, and insurance companies have no choice but to accept those prices. But it wasn’t clear what happens when smaller doctors’ offices join hospitals.”

“{I}f  a hospital employs most of the doctors in a city, then insurance companies don’t have much choice but to accept the hospital’s prices, even if they are higher than what Medicare is willing to pay.”

“The same goes for physicians who join big hospitals. They suddenly gain the institution’s bargaining power, and can charge more.”

Physicians’ march into hospitals probably will  continue because of the Affordable Care Act. That law encouraged integrating different parts of the healthcare system in the hope that it would eventually reduce costs. But  some worry that providers will simply reorganize to deal  lucratively with new payment models.



The heart of a heart doctor


Ileana L. Pina, M.D., a cardiologist specializing in transplant and  heart-failure patients, and  associate chief of cardiology at Montefiore Medical Center, in New York City, talks about what’s good and bad about practicing medicine these days.

She answered these questions from MedPage Today:

1. “What’s the biggest barrier to practicing medicine today?

2. “What is your most vivid memory involving a patient who could not afford to pay for healthcare (including meds, tests, etc.) and how did you respond?

3. “What do you most often wish you could say to patients, but don’t?

4. “If you could change or eliminate something about the healthcare system, what would it be?

5. “What is the most important piece of advice for healthcare providers just starting out today?

6. “What is your ‘elevator’ pitch to persuade someone to pursue a career in medicine?

7. “What is the most rewarding aspect of being a healthcare provider?

8. “What is the most memorable research published since you became a physician and why?

9. “Do you have a favorite medical-themed book, movie, or TV show?

10. “What is your advice to other physicians on how to avoid burnout?”


‘Personalized medicine’s’ benefits and costs


Joe Randolph,  president and  CEO of the Innovation Institute,  looks at the implications of “personalized medicine,” which will probably allow many more people to live much longer and thus cause an big expansion in the number of elderly people.

He raises these questions:

  • “What will the cost be for living longer?
  • “Who will have access to the advances?
  • “What other problems does extending life create?
  • “If people live longer, will they work longer? What’s the impact on retirement and Social Security?”

“The healthcare system and society need to prepare and think about the impacts these advances will have so that the benefits can be shared by all and not just those with means to afford the advances.”


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