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Doubts About Value-Based Hospital Programs

0
October 16, 2017

Two recent studies raise doubts about Medicare programs aimed to improve hospital outcomes. One study evaluated voluntary participation in Medicare’s Hospital Readmission Reduction Program, which included 3 “value-based” reforms: meaningful EMR use, bundled care initiatives, and pioneer and shared saving accountable care organization programs. It reported lots of outcomes, and its...
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The High Costs of Hospitalists

1
October 9, 2017

Hospitalists, doctors who only see patients in the hospital, almost always in a shift work model, are the fastest growing “specialty” in medicine, from nothing about 15 years ago to about 50,000 today. There were some studies that I won’t review much here that showed some benefits from hospitalists compared to...
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More Disappointing News on the PCMH

1
September 6, 2017

First, I recognize that the whole PCMH experiment was not a total failure. There were some successes. The Patient Centered Primary Care Collaborative (PCPCC) puts out an annual review on PCMH demonstration sites that is always positive. On the other hand, the AAFP PCMH National Demonstration Project was mostly a failure....
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Family Physician Quality – A New Way Forward

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August 22, 2017

Wrapping up my series on our recent paper criticizing how industrial Quality Improvement has been misapplied to primary care, (and sorry for the gap in wrapping this up), I want to share my own thoughts on a way forward. First, in our paper, we proposed very aspirational measurements such as missed days...
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Ways to Improve Family Physician Quality – Measure Other Aspects of Primary Care Capacity Associated With Better Outcomes

4
July 9, 2017

In our recent paper criticizing how industrial Quality Improvement has been misapplied to primary care, we didn’t just complain, we made suggestions for a better way forward. This was under the assumption that regulators and payers will continue to insist on some kind of numeric reporting of outcomes by physicians or...
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Ways to Improve Family Physician Quality – Measure When Physicians Do Not Order Tests or Treatments

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June 29, 2017

In our recent paper criticizing how industrial Quality Improvement has been misapplied to primary care, we didn’t just complain, we made suggestions for a better way forward. This was under the assumption that regulators and payers will continue to insist on some kind of numeric reporting of outcomes by physicians or...
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Ways to Improve Family Medicine Quality – Target Ranges without Absolute Goals

1
June 18, 2017

In our recent paper criticizing how industrial Quality Improvement has been misapplied to primary care, we didn’t just complain, we made suggestions for a better way forward. This was under the assumption that regulators and payers will continue to insist on some kind of numeric reporting of outcomes by physicians or...
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Ways to Improve Family Medicine Quality – Shared Decision Making

1
June 7, 2017

In our recent paper criticizing how industrial Quality Improvement has been misapplied to primary care, we didn’t just complain, we made suggestions for a better way forward. This was under the assumption that regulators and payers will continue to insist on some kind of numeric reporting of outcomes by physicians or...
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Trumpocare/Obamacare – Visa/Mastercard

1
May 9, 2017

Our national useless dialogue on the future of healthcare in the U.S. continues. Trumpocare has a long way to go before it potentially becomes law, so no one knows  what it will finally look like. Obamacare is in a death spiral anyway. I’ve written about it before, and still believe this...
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Industrial QI Does Not Work in Primary Care

1
March 15, 2017

Traditional industrial QI does not work in primary care. A recent publication brilliantly makes this case on both theoretical and practical levels ;-). On a theoretical level, primary care is best thought of as a complex adaptive system, not a simple linear mechanical system. Think of complex adaptive systems as kind...
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