Showing posts from April, 2017

Pay for Performance Delays Needed Health Reform

There are many areas within health care design that need to be addressed. Unfortunately the current designers prefer to persist with approaches that will not address the outcomes improvements needed. The pay for performance bandwagon marches on, but the evidence basis has long fallen short. Those truly dedicated to improvements in health care outcomes must review the evidence and move on to areas that do need to be addressed.

A Quick Summary: Pay for Performance
Has failed to deliver on promised improvements in health outcomes (strong evidence including major reviews)Has been costly (EHR, digitalization, management, administration, maintenance, and security for data collection)Has consumed delivery personnel workforce (nurses for example) with conversion to non-delivery personnelHas resulted in further discrimination against the providers where health care delivery is most needed and is already least supported (evidence consistent in dozens of studies)Has distracted health care from the…

Killing Our Residents Softly

As stated by many, a return to abusive work hours during residency is a setback for "health" care. It is another indication that health care is not really about health or care or caring. One would think that health care leaders would not want to expose such truths or how insensitive they are.

Today with yet another article indicating the increased health risks for those with even 1 hour less sleep a day, there is more than just another bad mental health day at stake. There is a large body of evidence, but then evidence basis denied is apparently OK for those who lead health science efforts.

Residents are dying, most assuredly they are dying. 

Some die in accidents. Others die in family tragedies. Yet others have long lasting sleep disruptions. Mental health issues are increasing. Their lives are dying and drying up. 

The title of a blog can make all the difference. 

Killing Our Residents Softly was an easy title to choose. The singing of Roberta Flack is easily heard in the back…

Worsening Costs Quality and Access with Telehealth

It has become common to promote innovations as solutions without sufficient testing and without really considering the possibility that the intervention might not work as planned. After decades of failure to resolve cost, quality, and access woes across medical error focus, managed care, managed cost, EHR/HIT, PCMH, alternatives to physicians, insurance expansion, and numerous forms of Pay for Performance - the cost, quality, and access problems remain. Telehealth deserves to be critically examined as a solution for rural or underserved populations.

First of all, telehealth will be priced in a way that supports expensive medical personnel, managers, CEOs, and investors. There is no intent for service for those low or no pay or with worst insurance. This will require payment.

Medicare and Medicaid patients will play a major role as they are concentrated in places with lowest concentrations of physicians. Indeed this is a major reason for shortages. These are the places receiving lowe…

Mourning for Teachers Across Education and Health Care

My heart is heaviest when my family members are treated poorly, especially by those who are supposed to support them. As a nation we should have heavy hearts for teachers, nurses, physicians, and others prevented from teaching by the basic designs of our nation.

Hopefully the school in question will come to its senses and support my remaining family members who are still teachers. There are few left as most have been driven away from teaching by a combination of chronic poor support, lack of backup, and acute events that resulted in departure. Our family, your family, and students lose by design. Schools and school districts must support teachers. During this time period near the end of the school year, it is critically important to support teachers.

It is a time when many teachers and their family members wonder whether it is worth it for all the additional efforts that are not supported, including the efforts that can make a difference in the lives of students.

As a primary care phy…

Science Denial Also Seen in Health Care

Science denial is a popular topic right now. It is convenient to punish some who deny some scientific findings while preserving the right to disagree with science in other areas. Sadly there is science denial rampant in health care. Many treatments have no evidence basis, others are significant but not relevant, but mostly there is ever higher cost for little gain in outcomes. New innovations have been some of the worst distractions because the evidence basis is ignored.

In the name of better health, our designers are shaping worse health outcomes.
It is difficult to tell which is worse - Science Denial that profits Big Business or Science Denial that profits Health Care Business. Science denial works for higher profits for both. 
Business Profit Focus destroys the external environment that shapes future human health largely by impacting environments negatively.Health Care Profit Focus destroys the internal human environments and interactions between people and their environment that sh…

Americans Stand in the Gaps

Discussions of state or federal budgets draw much attention, but it is the American people who make America work, fill in the gaps, and accomplish far more than the dollars expended. 

Ideally the designs for dollars, people, and services all align for best result. A divided nation will accomplish far less, and this will often result in a widening gap impacting most people. M Scott Peck wrote a book on "community" and noted that you knew community existed when it happened. Happening worth having is togetherness.

We are not together. Our inefficiency rocks the core of our nation, what we hope to accomplish, and how we can accomplish it. Infrastructure is a popular word. Embedded in infrastructure is the ability to facilitate more efficient and effective function. There are multiple types of infrastructure in a nation. America is made up of physical infrastructure, spiritual infrastructure, and human infrastructure. Rarely have these all aligned except for major wars and for a pe…