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In the era of health care reform, two words consistently are employed to describe the strategy being used to cut cost: quality and value. What do these words mean? We have discussed their use many times in these blogs, and have shown that they often diverge sharply from their purpose. In fact, nothing wastes physician time, and gets in the way of the doctor-physician interaction, more than having to focus on adhering to Medicare’s report card of quality. How effective are Medicare’s (and for that matter, Blue Cross’s and virtually all other insurance companies) quality indicators? Do they help improve outcome and cut cost? Is paying doctors for their “quality performance” an effective
In previous blogs and in my book, we have discussed the value of primary care to the health care delivery system. Primary care doctors—the lowest paid of all physicians, sometimes earning as much as $200,000 per year less than their more specialized colleagues—provide the highest value of all physicians. In areas of the country with a higher proportion of primary care doctors to specialized doctors, outcomes are better, costs are lower, and satisfaction is higher. Patients who have a primary care doctor do better and cost the system less than patients who do not have regular primary care. The benefits of primary care are even more pronounced when practitioners have enough time and resour
We are at a Rubicon moment in the battleground of health care reform. The ACA has expanded insurance coverage to millions of Americans, but it has not altered the basic flaws inherent to our health care delivery system. Now with its elimination hovering over us, we have an opportunity to come together and enact changes in medical care that are universally endorsed and can evade partisan bickering. Can conservatives develop a free market health care system that also achieves the patient-centered goals of progressives? Can insurance companies and hospitals help promote a system that enables them to reduce waste and improve profit at the same time patients have more choice and access to bet
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