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Designing Successful Bundled Payment Initiatives
Bundled payment initiatives are a growing form of value-based payment. The use of bundled payments can align reimbursement with the health care triple aim of improving experience of care, improving population health, and reducing total costs of care. Successful bundled payment initiatives have demonstrated an ability to both lower costs and improve health care quality. However, bundled payments also change financial incentives because the model shifts risk from payers to providers. This may result in unintended consequences, including underutilization of needed but costly services or avoiding caring for the sickest patient...
Source: Health Affairs Blog - April 20, 2016 Category: Health Management Authors: Michael Ciarametaro and Robert Dubois Tags: Costs and Spending Featured Insurance and Coverage Medicare Payment Policy Population Health Quality Bundled Payments chronic disease High-Cost Patients triple aim Source Type: blogs

Why I stopped prescribing narcotics, and never looked back
I was never a big prescriber of narcotics.  I grew up “country,” in a tougher world where your parents taught you to accept pain as a part of life.  Pain is how you know you’re still alive. They’d tell me, “if you’re hurtin’ you ain’t dead yet.” You fell down; it was going to hurt.  You learned not to fall.  Twisted your ankle doing something stupid (and it was always while doing something stupid, like jumping off the roof), well we’ll wait a day or two and see how it goes.  Put ice on it, and next time think harder before you jump off the roof.  Just because everyone else was doing it, yada y...
Source: Kevin, M.D. - Medical Weblog - April 10, 2016 Category: Journals (General) Authors: Tags: Physician Pain management Source Type: blogs

CDC Chronic Pain Guidelines: Not so bad, but...
by Tom QuinnIn case you didn’t notice, the US Centers for Disease Control published their long-awaited (dreaded?) “CDC Guideline for Prescribing Opioids for Chronic Pain.” It made a pretty big splash: Five editorials plus the full Guideline in the online Mar 15 JAMA, front page New York Times feature article, the first hour on NPR’s “Diane Rehm Show,” (Mar 17) and multiple others. It is specifically aimed at primary care prescribers, who write about half of the scripts for opioids in the US. It is intended to “support clinicians caring for patients outside the context of active cancer care or palliative or en...
Source: Pallimed: A Hospice and Palliative Medicine Blog - March 30, 2016 Category: Palliative Care Tags: CDC ethics opioids pain quinn The profession Source Type: blogs

I ’m a doctor. I worry every time I prescribe painkillers to a patient. - Vox
& quot;Please, I need my Oxycodone! & quot; my patient, M, pleaded with me. My eyes met his. I observed every fleeting facial expression, hoping to gauge his intentions. The discussion about whether to continue to prescribe this medication was one I & #39;d had too many times with too many patients over the past few months. & quot;My arthritis is always worst in the winter, & quot; he said, rubbing his lower back. It was a snowy afternoon in clinic, and M and I were in the midst of a debate. Oxycodone is an opioid medication, and, like other painkillers such as Oxycontin, Percocet, and Vicodin, it carries a significant ...
Source: Psychology of Pain - March 16, 2016 Category: Anesthesiology Source Type: blogs

I’m a doctor. I worry every time I prescribe painkillers to a patient. - Vox
"Please, I need my Oxycodone!" my patient, M, pleaded with me. My eyes met his. I observed every fleeting facial expression, hoping to gauge his intentions. The discussion about whether to continue to prescribe this medication was one I'd had too many times with too many patients over the past few months. "My arthritis is always worst in the winter," he said, rubbing his lower back. It was a snowy afternoon in clinic, and M and I were in the midst of a debate. Oxycodone is an opioid medication, and, like other painkillers such as Oxycontin, Percocet, and Vicodin, it carries a significant risk of ...
Source: Psychology of Pain - March 16, 2016 Category: Anesthesiology Source Type: blogs

A life-threatening condition cannot dampen the human spirit
My patient was an elderly farmer with severe vascular disease. He had advanced leg artery narrowing, had survived multiple heart attacks, and was admitted to the hospital after a large stroke. He was incredibly cheerful, vibrant, and optimistic. He had a very large, loving family who took turns attending to him, and encouraging him with each small improvement in his leg and arm strength. They knew his neurological exam better than his doctors. I was amazed at his recovery, given the size and location of his stroke (and his advanced age), I had suspected that he would end up wheelchair bound. But he was determined to walk a...
Source: Kevin, M.D. - Medical Weblog - January 10, 2016 Category: Journals (General) Authors: Tags: Physician Hospital Neurology Source Type: blogs

Stealth Public Relations and Health Advocacy, Special Pleadings and the Opposition to Guidelines Discouraging Overuse of Narcotics
As I have written before as a physician who saw too many dire results of intravenous drug abuse, I was amazed how narcotics were pushed as the treatment of choice for chronic pain in the 1990s, with the result that the US was once again engulfed in an epidemic of narcotic abuse and its effects.  In mid-December, 2015, as reported in the Washington Post,The nation continues to suffer through a widespread epidemic to prescription opioids and their illegal cousin, heroin. The CDC estimated that 20 percent of patients who complain about acute or chronic pain that is not from cancer are prescribed opioids. Health-care prov...
Source: Health Care Renewal - January 4, 2016 Category: Health Management Tags: CDC Cephalon conflicts of interest deception Endo Health Solutions Johnson and Johnson narcotics public relations Purdue Pharma stealth health policy advocacy Source Type: blogs

Living Your Best Life, Even In The Hospital
This post first appeared on Better Health on October 6. My patient was an elderly farmer with severe vascular disease. He had advanced leg artery narrowing, had survived multiple heart attacks, and was admitted to the hospital after a large stroke. He was incredibly cheerful, vibrant, and optimistic. He had a very large, loving family who took turns attending to him, and encouraging him with each small improvement in his leg and arm strength. They knew his neurological exam better than his doctors. I was amazed at his recovery, given the size and location of his stroke (and his advanced age), I had suspected that he would ...
Source: Disruptive Women in Health Care - December 2, 2015 Category: Consumer Health News Authors: dw at disruptivewomen.net Tags: Aging Caregiving Source Type: blogs

Creating The Next Generation: The Payment Model We Need From Medicare
Four years of nation-wide testing by The Centers for Medicare and Medicaid Services (CMS) has now proven that the current shared savings payment models do not work effectively for low-cost Accountable Care Organizations (ACOs). High-cost ACOs have more room to improve and therefore more opportunity for savings. For those organizations that have already developed efficient, low-cost care delivery systems, Shared Savings is retrogressive. In this model, inefficiency is rewarded and lower-cost systems are penalized. In fact, we have lost about 40 percent of the members of the first cohort of ACOs—the Pioneer programR...
Source: Health Affairs Blog - October 5, 2015 Category: Health Management Authors: David Krueger and John Toussaint Tags: Costs and Spending Equity and Disparities Featured Hospitals Insurance and Coverage Long-term Services and Supports Population Health Quality ACOs Bellin-Thedacare HealthPartners CMS global payment payment schemes risk-adjusted p Source Type: blogs

PCORI is Starting to Click. Give It a Chance.
By STEVE FINDLAY Earlier this month the Center for Public Integrity (CPI) published a sharp-edged piece on PCORI—the Patient-Centered Outcomes Research Institute.  The piece raised some salient issues and it’s timely to take stock of PCORI at the half way point of its authorized funding.  (Unless renewed, PCORI sunsets in 2019.)  The Affordable Care Act created PCORI as an independent nonprofit (non-government) entity.  But PCORI’s funding and structure makes it more or less quasi-government.  It gets its money from the Medicare trust fund, treasury general funds, and a tax on private insurers and self-funded i...
Source: The Health Care Blog - August 26, 2015 Category: Consumer Health News Authors: John Irvine Tags: THCB Source Type: blogs

Helping Doctors Choose Wisely: Three Innovative Principles For Health Care Organizations
Achieving higher value, cost-conscious care that eliminates waste and optimizes quality is a crucial priority. Recent professional and policy initiatives aiming to spur individual physicians to achieve that priority include the American Board of Internal Medicine’s Choosing Wisely Campaign, the High Value Cost-Conscious Care Initiative from the American College of Physicians, and new content in the American Medical Association Code of Medical Ethics. Although professional organizations can be influential, physicians work in organizations, and evidence suggests health care organizations influence individual physician beh...
Source: Health Affairs Blog - April 30, 2015 Category: Health Management Authors: Jon Tilburt Tags: Costs and Spending Featured Health Professionals Hospitals Payment Policy Public Health ABIM ACOs ACP AMA Choosing Wisely delivery High-Value Care Innovation Physicians Source Type: blogs

Health Cooperation In The New U.S.-Cuban Relationship
Four months after the surprise announcement of his determination to normalize relations with Cuba, President Barack Obama is rapidly translating that wish into reality, with the cooperation of Cuban counterparts and widespread support among Americans. On April 11, the Summit of the Americas featured the first meeting of the two countries’ presidents in over fifty years. Three days later, even amidst a struggle with Congress over a possible nuclear deal with Iran, the Obama administration announced it will remove Cuba from the U.S. list of state sponsors of terrorism, a step Carl Meacham, Director of the Center for Strate...
Source: Health Affairs Blog - April 29, 2015 Category: Health Management Authors: J. Stephen Morrison Tags: Featured Global Health Bill Frist Cuba cuban health care Raúl Castro U.S.-Cuban relationship Source Type: blogs

Am I ready for the Suvivorship Clinic?
Sunday, April 19, 2015current mood: feeling left behind So I went for my first one year checkup the other day. I have to admit I was a little more nervous than usual because, let’s face it, it had been a year and not the norm of 6 months. And of course the fear of having my blood drawn always scares me. What if they find something abnormal? What if my cancer is back? And then of course there is the fear of the blood draw itself, cause it usually takes lots of poking to finally find my vein. Yes, I’m one of those people who are crazy and say…Damn I miss my port! But Elio, who I have come to know and ask for,...
Source: Sharing My Cancer Crapness - April 19, 2015 Category: Cancer & Oncology Source Type: blogs

Semantics and the $28 Million Unnecessary Test
There’s been an awful lot of Internet hullabaloo about “unnecessary testing” lately. The Choosing Wisely program keeps trying to assert that we should not perform any “unnecessary” tests. Recently, a paper was published in the Journal Academic Emergency Medicine alleging that “overordering of advanced imaging may be a systemic problem” since many emergency physicians believe that such testing is “medically unnecessary.” The paper was based on surveys that were presented to emergency physicians and the work was at least partially funded by the Veterans Administration and the National Institutes of Health...
Source: WhiteCoat's Call Room - April 10, 2015 Category: Emergency Medicine Authors: WhiteCoat Tags: Policy Source Type: blogs