Posts by Vineet Arora

Healthcare Costs: Now what are we supposed to do?

by Vineet Arora MD MAPP, Chris Moriates MD, and Neel Shah MD MPP By now we have heard the stories about unconscionable medical bills causing financial harms for patients. We have read about more Americans than ever before on high-deductible health insurance plans. Some of us even helped our parents navigate the deceptively simple-looking bronze, silver, and gold tiers of the insurance exchanges, weighing the gamble of increasingly unaffordable monthly premiums against catastrophically high deductibles and out-of-pocket costs. We have accepted that healthcare costs are out of control and causing real constraints on every level from individuals to communities to businesses to states to our nation. OK, but now what are we supposed to do about it? “Remarkably given the importance of this issue, until now, we lacked a roadmap to attack it,” wrote Dr. Bob Wachter in the foreword to our new book, Understanding Value-Based Healthcare. “Now we have…

Medicare at 50: Fixing the Status Quo

Several years ago, I was talking with a hospitalized patient whose kidneys were failing about the difficulties she faced accessing care.  She was reluctant to see a primary care physician because she did not have insurance so preferred to wait until things got really bad.  During that hospital stay, I had to give her the bad news that she would need dialysis.  Unexpectedly, she actually smiled… she knew she could now get insured.  After I left her room, I had a conversation with my residents about how Medicare, the landmark legislation that has stood the test of time, is much more than just health insurance to some people.  It was hope for a cure. Medicare turns 50 years old this year.  For half a century it has been our nation’s insurance plan for our seniors and those with end stage renal disease on dialysis.   While Medicare has been the primary…

Teaching on Today’s Wards: All You Need Is 1 Minute, So SNAPPS to It?

During my eight-year tenure as Associate Program Director for our Internal Medicine Residency, I read countless letters of recommendation for aspiring residents, and many were signed by familiar hospitalist friends from all over the country.  If you think about how many students and residents come into contact with hospitalists, making sure hospitalists are great teachers is more than just a pride issue, it's also critical to training the next generation of physicians, no matter what specialty they go into. Unfortunately, there are many barriers to teaching on the wards today for hospitalists.  First and foremost, time is of the essence.  Less time worked by residents has increased the clinical workload of teaching attend ings…and what has been squeezed out is time for teaching.  Therefore, methods to teach trainees efficiently on the wards are must-have skills for any academic hospitalist. Fortunately, there are two new articles in the Journal of Hospital…

Hospitalists “Seeing Wisely”: A High Value Proposition

I remember being a third year medical student and reading Bob Wachter’s piece in the New England Journal of Medicine that made the term “hospitalist” mainstream. I was intrigued. I matched at the University of Chicago, which was one of the few programs in the country at the time that had a hospitalist program.  When I rotated on the academic hospitalist service as an intern, I distinctly remember being taught about the possibility of influenza in a febrile older diabetic patient who had been started on broad-spectrum intravenous antibiotics. I immediately ran to fetch a viral swab and sent it to the lab. Bingo…Later that afternoon, the patient had been diagnosed with influenza A. What’s even more exciting is that we could stop the broad-spectrum intravenous antibiotics, which were both unnecessary and potentially harmful. Moreover, I could remove the “culture if spikes” recommendation on his sign-out, since the daily cultures…

Time to Toss Twitter? Not before Trying It out

A recent article in the Atlantic went so far as to eulogize the popular 140-character microblogging service.  This was met with mixed feelings on Twitter, with some agreeing and others lamenting and saying it ain’t so.  Knowing that all technology has a life cycle curve, could it be Twitter would be retired and go the way of MySpace or Friendster?  It seems hard to believe, especially in medicine.  After all, it seems like doctors are just starting to adopt Twitter. This was readily apparent since after attending the typical series of medical conference this Spring, including Hospital Medicine 2014, where the backchannel of Twitter was a flutter with real-time reactions to plenaries and the best places to eat in a particular locale.  Many presenters often had their Twitter handle proudly on display and invited further interaction through Twitter after their presentations.  While it is true that Twitter now is not…