mikailov:

// Great visual reason to think carefully about where we donate…

mikailov:

// Great visual reason to think carefully about where we donate…

Evolution of Medicine Summit (Sept 8-15 2014)

Check it out

Highly recommend

(Source: youtube.com)

Surely there is something absurd when a nation pays a primary care physician poorly relative to other specialists and then wrings its hands over a shortage of primary care physicians.

Uwe Reinhardt, Princeton University economist (via numberneededtotreat)

(Source: The New York Times, via wayfaringmd)

Why did it take 30 Years?

glynthincs:

What I learned in med school was wrong. Cholesterol / LDL is not the evil culprit despite what pharma/AHA want us to believe.

What a Scorpion Sting Teaches Us about Hospitals and Insurance

matthewdipaolamd:

I recently treated a patient who had a chronic ligament tear in the shoulder. It was a technically involved case that required a tissue graft and a few small implants but was an outpatient procedure (it did not require an overnight stay in the hospital). I have privileges at a few hospitals and surgery centers in the cities where I work and we chose the hospital at which to perform the case based on proximity to the patient’s home.  She was coming a considerable distance for care. 

The day before the surgery the hospital called her to say that the facility fee for her case would be $45,000 and she would have to pay it up front. She has insurance through a third party administrator from her husband’s job. But the hospital administrators decided that they would not accept her plan (even though it pays higher than Medicare rates).

We quickly moved her case to another facility about 30 minutes away that accepted her insurance and got her case done as scheduled.

Now any hospital system can accept or deny any insurance plan that they want. That’s their business decision. But $45,000 is their cash price? That seems a bit over the top for an outpatient surgery with only 2 hours of anesthesia time and about $3500 in implant costs.

After doing some research online and at other local surgery centers I was unable to find a price for the exact procedure that I was performing.  The procedure that I was performing actually involved 4 smaller procedures in one: 1) an open ligament reconstruction with graft tissue, 2) an open distal clavicle excision, 3) an arthroscopy and bicep tenotomy and 4) an open bicep tenodesis.  I found prices for some common shoulder procedures online at http://bit.ly/1mEEgVn.  The exact procedures that I needed to perform were not listed here but do not differ too significantly (except for the ligament reconstruction) from some of the ones listed.  And none of these shoulder procedures costs more than about $6260. 

Even if you quadrupled this price (which is unrealistic as the anesthesia fee and surgeon’s fee is included in all of these prices), at most you would wind up with a price tag of $25,040- almost half the price the hospital wanted to charge. 

Since anesthesia time would be about the same or conservatively half again as much as a rotator cuff repair for my patient’s case, I would estimate that the case that I was to perform would cost at most $10,000 to $13,5000 in a surgery center like The Surgery Center of Oklohoma to which I have linked. 

The bottom line is that these astronomical cash rates that hospitals charge can’t last.  Surgery centers around the country are starting to post their prices transparently online.  More patients are using high deductible plans and learning about pricing.  And the word is getting out. 

The simple fact is that hospitals contract with Medicare and large insurers for 20-25% of what they charge cash paying patients.  In other words, if my patient had a plan through one of the large insurers the hospital would likely have accepted  $10,000 to $15,000 for the case.  The message: if you are not in our club, we will charge you break-the-bank rates. 

When your business model is based on these practices, you might want to consider changing your business model.

healthuncensored:

Calmer than You?
I’ve been thinking a lot about the nature of energy. There are different kinds. Calm energy. Hyper energy. Stressed energy. Aggressive energy. Lustful energy. I see a lot of people - friends, patients, people on the street - in NYC who have tons of energy, but they don’t have calm energy. 
I also see a lot of people who have to exhaust and deplete themselves to find a sense of calm. 
It’s so important to find something that energizes you AND makes you feel calm at the same time. For me it’s yoga, meditation and cooking. All three make me feel alive, without revving me up into a state of stress. 
Where do you find your calm energy? If you’re not sure, explore. It’s so important for your body, your mind, and your health. 

Let food (and calm energy) be thy medicine…

healthuncensored:

Calmer than You?

I’ve been thinking a lot about the nature of energy. There are different kinds. Calm energy. Hyper energy. Stressed energy. Aggressive energy. Lustful energy. I see a lot of people - friends, patients, people on the street - in NYC who have tons of energy, but they don’t have calm energy. 

I also see a lot of people who have to exhaust and deplete themselves to find a sense of calm. 

It’s so important to find something that energizes you AND makes you feel calm at the same time. For me it’s yoga, meditation and cooking. All three make me feel alive, without revving me up into a state of stress. 

Where do you find your calm energy? If you’re not sure, explore. It’s so important for your body, your mind, and your health. 

Let food (and calm energy) be thy medicine…

(Source: healthuncensored)

New health law will ban hospital employment of MDs

matthewdipaolamd:

Just kidding.

But after this study the government might have to consider it.

"Healthcare integration" is the fashionable term being used to justify the trend of hospitals employing an increasingly larger number of MDs. Have all doctors (or providers as they generically like to refer to us) work for the same master, under the same tent and ‘voila!’ let the magic of care coordination kick in and make costs plummet.

Until they don’t. Reality sure is a bummer.

This study looked at over 2 million patient claims (that’s a lot) and found that costs actually increased as physician employment by hospitals increased.

Employing MDs works well for hospitals as it locks down coveted patient revenue streams from labs, tests, surgeries etc. It creates more vertically integrated regional oligopolies.

But these data suggest that it may not work well for the system as a whole.  Are employed MDs incentivized to rack up more tests, procedures and codes because it increases the overall revenue they bring into the hospital, (their employer)?  I don’t know. 

I know a bunch of MDs who have become hospital employees recently. Their motivations vary but usually come down to better money or more security. Others acknowledge that the regulatory burden from the government has pushed them to become employed. I’ve never heard one say it was because they believed it was better for patients

They often say something like, “it’s the trend,” or “I just want to get paid for what I do.”

What if more loosely integrated doctor- hospital relationships keep costs lower and work better for patients? What if better care coordination could happen through new technology without the need for everyone to work for the same institution.

If so, shouldn’t health policy discourage hospital employment of physicians?

Not surprisingly, a representative from the American Hospital Association criticized the study as “outdated.” Maybe the AHA should take “evidenced based” practice more seriously and respect the “big data” from this study (when was the last time you saw a medical study with over 2 million patient encounters?)

We need to keep examining these issues. If the big promises of cost savings through systems integration (monopolization?) are not panning out then it’s time to question the assumptions upon which they rest.

Moore’s Law will continue to put downward pressure on the cost of information and new technology.  Standardization of care via common pathways is possible through good communication among doctors, administration, and by means of shared technology.  The shared technology is becoming so cheap and widespread that it is not necessary for doctors to all be employed by the hospital to make standardization processes work (consider that Practice Fusion is a FREE office based EMR- do you need a hospital to support an EMR for you when you can get one for free?).

While hospital employment of physicians is today’s trend, I don’t think it is necessarily the wave of the future (unless doctors are doing it solely for money and security). Cheaper and better technology tends to produce decentralizing effects on systems favoring more loosely integrated networks (and likely cheaper care).  There is more than one way. 

Please support your local private primary care physician :)

Anonymous said: Hello. I was hoping to make an appointment. I am a 28 yo female with 3 days of headache, nausea, and neck pain following a day of yoga inversions.

Hello!

Yes, I can see you quickly.  To schedule an appointment, find me on ZocDoc.com, schedule appoinment, and show up :)

Why Runners Can't Eat Whatever They Want - WSJ.com

mikailov:

// can’t out run a shitty diet

(via reddit)

Burnout is caused when you repeatedly make large amounts of sacrifice and or effort into high-risk problems that fail. It’s the result of a negative prediction error in the nucleus accumbens. You effectively condition your brain to associate work with failure.

reddit (via mikailov)

So true. Welcome to conventional, third-party-driven Primary Care Medicine.