Managing Managed Care

Our inequitable, inefficient, oftentimes uncaring health care "system," revealed. -- Jeffrey G. Kaplan, M.D., M.S.

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Healthcare Reform/Economic Imperative

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Is health care reform merely cost-minimization, an opaque attempt to force economic responsibility? Simplifed, Here's the essence of health care reform and how to restore equity in access.... 1)    To reform care we must manage the care a)   The fact that delivery models vary or that they are evolving should not distract us from our goal to have effective care that is efficient and thereby cost-effective.  At the end of the day, however, it must be about the patient!

Rethinking Cancer

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Cancer; Just who invited you? Many cases of cancer are just caused by "bad luck" as two scientists "suggested in an article published last week in the journal Science. The bad luck comes in the form of random genetic mistakes, or mutations, that happen when healthy cells divide."  

Cancer and Nutrition

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It's often difficult to maintain a good appetitie and nutritional status when fighting cancer. Here are some tips from cancer experts and dietitians that may help: Fresh ginger (not ginger flavoring), taken about 1/2 hour before eating can lessen or even eliminate nausea, but  common in many sodas. Eat more protein and less fat and/or fiber; eat smaller meals more frequently throughout the day--maybe 5-6 Drink more between meals than during them

Ear Wax

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The use of a bulb syringe at home may help relieve earwax blockage more effectively than a professional ear irrigation procedure. 240 adults in the U.K. got either ear drops and a bulb syringe to use at home or ear drops and then irrigation by a clinic nurse. Patients were reassessed after 2 weeks, and those with persistent blockage had their ears irrigated professionally.

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When's "Good" Quality, Good Enough?

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A payer judges a physician or a practice organization by the proportion of patients for which the physician adhered to one or more practice measures. Those in quality measurement seem to be attempting to align the clinical quality measures that are relevant to the Electronic (EHR) Incentive Program.  Isn't that artificial and once removed from the patient's care?

Timely or Delayed Breast Cancer Decision-Making

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"[Is] it true that early detection/screening will save your life? The answer to this is complicated, in part, because not all cancers are the same. In general, it is likely that screening will detect slow growing tumors better than fast growing ones. My favorite analogy is of a building with a security guard that takes an hour to circle the building.

The Real Cost of Not Immunizing

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Measles is back and people will be getting ill, harmed or worse because someone is refusing immunizations. OTOH, routine childhood immunizations may reduce the risk of leukemia. [1]

Reducing Dx Errors

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It's vital to address safety concerns in primary care, especially that which comes from making diagnostic errors (i.e., missed, delayed, or incorrect diagnoses), and the patient-centered medical home (PCMH) is a good environment of setting in which to start focusing on this. Indeed, diagnostic errors are unfortunately all too frequent and they are the largest contributor to "ambulatory malpractice claims (40% in some studies)"; they "cost approximately $300 000 per claim on average."

The EHR—on the Road Where a Cottage Industry Lived

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Improving doctors' quality, effectiveness and cost-benefit requires meaningful communication at all levels and settings. To cure health care's ills, there's an obvious remedy that is difficult, but not impossible to implement—make cogent information* available at the point of contact with the patient, regardless of setting and within HIPAA constraints.