Medicine & Healthcare

Sen Lamar Alexander (R), Howard Dean (former head of DNC), Newt Gingrich (former Speaker of House), John Podesta (headed Obama transition), w/ Chris Wallace (FOXnews)

Given the success of the coverage expansion, Massachusetts policymakers are turning to the next phase of health reform - reigning in health care costs.

This July 2009 report considers different populations in need of care coordination, summarizes current evidence of effectiveness, describes the various entities that can serve as focal points for coordinating care, and details the possible financing and payment options that can support these approaches.

Flat prices for coronary artery bypass surgery ranged from $19,000 to $59,279, and for total hip replacement from $9,900 to $29,005.

A non-institutional, patient-centered educational plan would produce an abundant supply of compassionate, innovative, prevention-oriented doctors at an extremely low cost. Additionally, the pace of medical research would be sharply accelerated.

Conservatively speaking, there are thousands of people with chronic illnesses who have educated themselves about their conditions via the internet. They quickly managed to become more familiar with their diseases than the physicians who treat them.

Doctors may be particularly vulnerable to shame, since they are self-selected for perfectionism when they choose to enter the profession. Moreover, the use of shaming as punishment for shortcomings and "moral errors" committed by medical students and trainees such as lack of sufficient dedication, hard work, and a proper reverence for role obligations probably contributes further to the extreme sensitivity of doctors to shaming.

Patient Centered Learning: The solution is to permit alternatives to rigid institutions, utilize free internet programs, and have medical students assist practicing physicians by assisting practicing physicians in taking patient histories. These students would offer valuable, free services to doctors. At the same time, they would have a vivid learning experience by spending several hours each day interacting with actual patients. The Cost Of Medical Education Would Be Negligible. The expense of healthcare is directly proportional to the cost of the doctor's education. With the institutional bottleneck gone, there would be a greater number of doctors, and the cost of healthcare would plummet.

Fewer than half of all clinical trials recently published in journals with high impact factors are adequately registered, and about a third of those that are registered properly show discrepancies between the registered primary outcome and the one that actually gets reported.

Can health care organizations and physicians be incented to deliver the highest quality, safest, most reliable, most patient-centric care at the lowest possible cost without Atul Gawande reading the findings of the Dartmouth Atlas into the Congressional Record? I think they can, if they have a strong hospitalist program.

The HHS Agency for Healthcare Research and Quality (AHRQ) has announced plans for spending its $300 million share of the $1.1 billion Congress appropriated for comparative effectiveness research (CER) under the American Recovery and Reinvestment Act of 2009 (ARRA or Recovery Act for short). AHRQ plans to solicit grant applications this fall and award grants and contracts by spring 2010. The $300 million must be encumbered by end of FFY 2010.

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