Reducing Practice Variation At Crystal Run Healthcare
Research has shown wide variation in per capita spending among different states and among different counties within the same state. Some of this variation can be explained by the health status of the population, local pricing, patient cultural and demographic factors, and the local liability environment. However, the vast majority of variation in spending is unexplained and likely due to a failure of health care providers to follow established best practice guidelines. This type of variation is associated with unnecessary over-utilization, while reducing variation leads to reductions in utilization and improvements in qua...
Source: Health Affairs Blog - July 23, 2015 Category: Health Management Authors: Scott Hines, Jonathan Nasser and Linda Green Tags: Costs and Spending Equity and Disparities Health Professionals Innovations in Care Delivery Medicaid and CHIP Medicare Organization and Delivery Population Health Quality ACOs chronic conditions Crystal Run Healthcare NCQA Physic Source Type: blogs

Legislation that Could End Unwanted Medical Treatment
By Daniel R. Wilson Roughly 25 million Americans have been subjected to unwanted medical treatment at some point in their lives, and that means we have a healthcare system that is not listening to patients. We all say we believe in patient-centered health care, and now we have a bill in the U.S. Congress that would put our money where our mouths are. Literally. Senators Mark Warner (D-VA) and Johnny Isakson (R-GA) introduced legislation this month that would make sure Medicare recipients and their doctors know how much or how little treatment those patients would want as they approach the end of life. The Care Planning Act...
Source: The Health Care Blog - June 24, 2015 Category: Consumer Health News Authors: John Irvine Tags: THCB Care Planning Act of 2015 Compassion and Choices Isakson Mark Warner Source Type: blogs

The Core Quality Measures Collaborative: A Rationale And Framework For Public-Private Quality Measure Alignment
Editor’s note: The full list of authors for the Core Quality Measures Collaborative Workgroup is included at the end of the blog post. In today’s health care system, physicians are faced with an unprecedented number of quality measures required by different entities. Payment is pivoting away from traditional reimbursement models toward value-based health care, where value is a function of both quality and cost. Patients are making an about-face from traditionally passive receivers of health care to informed consumers with expectations of transparency. Payers and employer groups are demanding accountability for how thei...
Source: Health Affairs Blog - June 23, 2015 Category: Health Management Authors: Patrick H. Conway and the Core Quality Measures Collaborative Workgroup Tags: Featured Hospitals Organization and Delivery Payment Policy Population Health Quality 3Rs AHIP AHRQ CMS health outcomes National Quality Forum Source Type: blogs

When Health Care Transformation Fails
Last year was tough for the transformation of health care from volume to value. Two major medical home studies (Friedberg and Rosenthal) and two major readmission prevention studies (Goldman and Dhalla) had negative to underwhelming results. Thirteen of the original 32 Pioneer Accountable Care Organizations (ACOs) have dropped out of the program. Of the original 220 Medicare Shared Savings Program ACOs, only 53 held spending enough below their targets to receive performance payments. Given the significant investments these ACOs made in the infrastructure needed to manage risk, and that the top 12 ACOs were responsible for...
Source: Health Affairs Blog - April 27, 2015 Category: Health Management Authors: Stuart Pollack Tags: Featured Health Professionals Hospitals Organization and Delivery Quality ACOs adaptive reserve Health Reform National Demonstration Project PCMH triple aim Source Type: blogs

Who gets to call themselves family physicians?
Who is a PCP? (And does that second “P” stand for “physician” or “provider”?) Who gets to say? Does it matter? Perhaps we should start with some basic qualifications: The degree of MD or DO, the satisfactory completion of an accredited residency in family medicine, and successfully passing the written examination of the American Board of Family Medicine (ABFP, an organization distinct and independent of the AAFP). Hard to argue with those. Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - April 26, 2015 Category: Journals (General) Authors: Tags: Physician Primary care Source Type: blogs

More Barbarians at the Gates: Private Equity Puts Primary Care in Play
There are still some idealistic physicians who enter primary care practice as a calling.The usual informal definition of primary care is care which is continuous, coordinated, comprehensive and compassionate.  The official definition used by the American Academy of Family Physicians (AAFP) is:Primary care is that care provided by physicians specifically trained for and skilled in comprehensive first contact and continuing care for persons with any undiagnosed sign, symptom, or health concern (the 'undifferentiated' patient) not limited by problem origin (biological, behavioral, or social), organ system, or diagnosi...
Source: Health Care Renewal - April 26, 2015 Category: Health Management Tags: corporate physician primary care private equity You heard it here first Source Type: blogs

As Vaccination Rates Dip, Parents Walk A Tightrope Between Doubt And Risk
The recent re-emergence of measles in the United States following a 15-year period of occasional cases provides a compelling example of an unresolved societal tension in public health: that between the value of autonomous decision-making and the need for social responsibility. The outbreak---more than 700 cases since January 2014---reveals not only this tension, which also plagues other arenas of health care reform. It also reveals the tenacity of doubt about vaccine safety that has led to a tipping point in undermining herd immunity. (That is, within a community, high rates of immunization protect both individuals and th...
Source: Health Affairs Blog - April 23, 2015 Category: Health Management Authors: Sharon Kaufman Tags: Featured Population Health Public Health autism risk awareness vaccines Source Type: blogs

Drawing Lines
Who is a Family Physician? Who is a PCP? (And does that second “P” stand for “physician” or “provider”?) Who gets to say? Does it matter? Perhaps we should start with some basic qualifications: the degree of MD or DO, the satisfactory completion of an accredited residency in Family Medicine, and successfully passing the written examination of the American Board of Family Medicine (ABFP, an organization distinct and independent of the AAFP). Hard to argue with those. How about going by what we do: Primary Care medicine consists of caring for patients as their first contact with the health...
Source: Musings of a Dinosaur - April 13, 2015 Category: Primary Care Authors: notdeaddinosaur Tags: Medical Source Type: blogs

Are cardiac risk calculators accurate?
After more than a decade of titrating medications to low density lipoprotein cholesterol targets, family physicians who have transitioned to the 2013 American College of Cardiology / American Heart Association cholesterol treatment guideline now base treatment decisions on a patient’s estimated 10-year risk for a cardiovascular event. Although it endorsed the ACC/AHA guideline last year, the American Academy of Family Physicians expressed concern that the guideline’s new risk calculator had not been validated in contemporary U.S. populations and could potentially overestimate risk compared to the venerabl...
Source: Kevin, M.D. - Medical Weblog - March 23, 2015 Category: Journals (General) Authors: Tags: Conditions Heart Source Type: blogs

Quote of the Day
Family physicians are the pluripotential stem cells of American health care.  -Dr. Wanda Filer Well said. Dr. Filer (I get to call her Wanda because I’m special; also, she’s really nice) did hands-down one of the best talks I’ve ever heard on the long term effects of childhood trauma, which probably affects more than a third of my patients, and I don’t even know it. (Look for upcoming post on asking established patients — some of them decades-long — new patient questions.) She is also the President-elect of the American Academy of Family Physicians, which means that even though I ju...
Source: Musings of a Dinosaur - March 21, 2015 Category: Primary Care Authors: notdeaddinosaur Tags: Medical Source Type: blogs

Interpreting the new sore throat article
First, this study required the work of a large team. The main work happened in two places – a research microbiology laboratory and our college health clinic. They took an idea and translated it into an opportunity to collect and analyze data. Second, the accompanying editorial (written by a friend and excellent researcher Dr. Jeffrey Linder) raises some questions that I will work to answer. He writes that we do not have enough evidence to change practice yet. He postulates that Fusobacterium necrophorum might not actually cause pharyngitis and that linking positive PCR testing to the risk of suppurative complicat...
Source: DB's Medical Rants - February 23, 2015 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs

24-Hour tPA Stroke Window Making Physician Lives So Much Better Now.
Dallas, TX - Twenty years of  physician suffering ended abruptly Monday after the American Stroke Association (ASA) announced a dramatically expanded 24-hour tPA stroke window protocol to better accommodate doctors' increasingly hectic schedules. "Recent apologies by the American Board of Internal Medicine forced us to reevaluate our priorities as an organization.  We now understand just how disruptive our three hour tPA window has been on doctors' lives and for that we are deeply sorry,"  said ASA President Dr. Jan Fleming. With the new 24-hour window, ASA officials are hoping to give doctors much grea...
Source: The Happy Hospitalist - February 12, 2015 Category: Internal Medicine Authors: Tamer Mahrous Source Type: blogs

Top stories in health and medicine, January 27, 2015
From MedPage Today: PCP Flying High on Corporate Wellness. In 2008, E. Brooks Wilkins, MD, was faced with a hard choice: shutting down a wellness and weight-loss center designed for people who had tens of thousands of dollars to spend on a 30-day intensive treatment program or toughing it out through a devastating recession. Kids’ Vaccination Schedule Updated. An updated childhood and adolescent immunization schedule was released Monday by the CDC, following recommendations from the Advisory Committee on Immunization Practices, the American Academy of Pediatrics, the American College of Obstetrics and Gynecologists...
Source: Kevin, M.D. - Medical Weblog - January 27, 2015 Category: Journals (General) Authors: Tags: News Obesity Pediatrics Primary care Source Type: blogs

HIT Newser: An Epic Loss for Cerner & GE + Google Glass Confusion
By MICHELLE RONAN NOTEBOOM An Epic Loss for Cerner and GE Mayo Clinic announces it will replace its existing Cerner and GE systems with Epic’s EHR and RCM system. The prestigious Mayo Clinic name and clinical reputation make the win especially sweet for Epic, which is in the running for the DoD’s $11 billion EHR […] (Source: The Health Care Blog)
Source: The Health Care Blog - January 26, 2015 Category: Consumer Health News Tags: THCB AAFP AMA Augmedix Cerner eClnicalWorks EHR certification Epic GE Healthcare Google Glass HITNewser Meaningful Use NextGen ONC Orion Health Pristine Source Type: blogs

A (Global) Cornucopia Of Clues To Optimize Medication Use
The most common patient care intervention, issuing a prescription, is fraught with continuing challenges for patients, their caregivers, and practitioners. Patients rely on medications across a continuum of care, with expectations for self-management; some experience unintended problems along the way. For older patients, such problems often result in emergency hospitalizations, many of which could be prevented. Historically, integration to support safe and appropriate medicine use across the U.S. health care ecosystem has been sporadic, including within our siloed Medicare Part D benefit. Other countries, however, are well...
Source: Health Affairs Blog - January 6, 2015 Category: Health Management Authors: N. Lee Rucker, Michael Holden, Parisa Aslani, and Rana Ahmed Tags: All Categories Global Health Health Care Costs Health Care Delivery Pharma Policy Public Health Source Type: blogs