By  | February 20, 2018 |  6
“We Need Creative Solutions” When I read or hear the sentence above, I think of one thing and one thing only. The solution is long in coming, involves input from multiple parties, has no obvious fix, is costly–in either money or time, and we undergird it by a whopper of a collective action problem. How […]
By  | February 1, 2018 |  0
By: Win Whitcomb, MD, MHM Hospitalist groups have been among the highest volume participants in Medicare’s Bundled Payments for Care Improvement (BPCI) demonstration project, initiating almost 200,000 episodes representing over $4.7B in spending since the model began1. On January 9, the Centers for Medicare and Medicaid Services (CMS) announced BPCI’s follow-on model, ‘BPCI Advanced’,2 which starts […]
By  | October 2, 2017 |  0
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 […]
By  | September 11, 2017 |  0
You all think you know hospice. You don’t, and I will tell you why. Hospice is a bastard child of the Medicare system. It went live in 1983 as a standalone entity during the Reagan administration and remains a disjointed program today. I would characterize its evolution as such: the road to hell is paved with good intentions. […]
By  | August 16, 2017 |  0
There are few experiences in my medical training that felt more intimidating, and ultimately more impactful, than our Mortality and Morbidity (M&M) conferences. The patients whose diagnoses I missed. The times I should have called my attending or pushed harder for the cardiologist to come in overnight. They stick with me and I believe ultimately […]
By  | August 9, 2017 |  2
For several decades, providers working within hospitals have had incentives to reduce stay durations and keep patient flow tip-top. DRG-based and capitated payments expedited that shift. Accompanying the change, physicians became more aware of the potential repercussions of sicker and quicker discharges. They began to monitor their care and as best as possible, use what measures […]