Public Health

If I Were You, I Would Not Be Bullish on Long-Term Care

Last week I was in Dunkin' Donuts and noticed something odd—although the oddness did not strike me immediately.  The woman who was serving me could have been my grandmother. Ditto that when I was at Home Depot in the lighting aisle yesterday.  And ditto it again in Walmart this morning. I would never dream of seeing that as a kid. Ever. (more…)

Want To Keep Your Patient Out of the Hospital? Here Is Your Crystal Ball.

If I told you I planned to close a quarter of the country's cardiac catheterization labs, how would you react? You would probably express outrage and accuse me of mismanagement of our entire health system.  And that is to say nothing of all the harm that would come to patients.  But as docs, we reason in a prejudiced fashion.  We do medicine.  We write prescriptions.  We look at blood test results.  That is our profession after all.  It is how we extend lives and improve people’s well-being.  If we can measure, see, or manipulate a variable, anything attached to it must have value.  We have been trained to infer from that ethos with everything else taking a back seat. However, what if I then said I would reinvest every dime saved from those closures above and direct them towards all the people in our communities.  How many more lives might…

The Next Hospital Decade: Broken Hips Versus Band-Aid Strips

  I had planned on writing on MACRA and the inability of those who criticize the law to offer up alternatives to fix the flaws.  I got tired of the conclusions from the skeptics: let providers be and they will do the right thing.  That is a recipe for the pendulum to swing too far in one direction.  The "right thing" will wind up costing the Treasury a ton of dough.  History has already born that out. I am one of the skeptics as well, though.  I had no idea how CMS was planning to stitch this whole thing together--and I was waiting for hints from Andy Slavitt, top dog at CMS, based on his testimony last week on the Hill. Well, if you shorted Kleenex stock, pat yourself on the back. You can put your hankies away because it looks like CMS may postpone the start date.  My screed…

The Last Days: Cash or Credit?

How often do you hear the following: the average senior utilizes  25% of their lifetime health spend during their last six months of life.  Too much. All that service use in such a concentrated period suggests possibilities. ICUs and inpatient care have great costs.  Our acute and post-acute institutions also do not hold up as models of efficient care delivery.  Most of them at least. What to do? I see the above observations as something akin to an emperor with no clothes. Because leaders with checkbooks have a focus on areas that will generate cost reductions, they seek opportunities they can wrap their arms around.  The more disadvantaged and disjointed ambulatory practices cause too many headaches.  Hospitals then seem like the right place.  Hospitalists and inpatient practitioners seem like the right people. The logic goes, with advanced directives and creative thinking, the right docs and facilities can make a dent…

Recidivism

  You might wonder why “recidivism” in the subject line. In the context of readmissions, the word comes up often—and in particular, those who cycle from shelters to the street to the ER. Rinse. Repeat.  I focus on the Northeast, but my guess is your regional experience is like mine. You have noticed over the last two to three years, big cities, and NYC in particular, have seen a marked uptick in the number of people sleeping on the sidewalks. The causes of the increase stem from budget cuts, the economy and myriad other factors you can probably surmise. (more…)
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