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High Blood Pressure – The AAFP Stands Firm

December 23, 2017

I have criticized the AAFP many times in previous posts. As a member-driven organization, I guess I’ve essentially criticized U.S. family physicians in general, though I also think there is an inner circle in the AAFP ranks that have an inordinate influence on policies. From gatekeepers in the HMO era, to...
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How the American Medical Association Represses Family Medicine

December 10, 2017

In a very unique study, researchers have tabulated how often family physicians provide patient care that is not covered with a CPT code. This is a little complex, for the non-physicians and even for many physicians to grasp, so I will provide a little more background first. CPT stands for Current...
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EMRs and Medication Errors

November 26, 2017

A study from the Pennsylvania Patient Safety Authority found that in half of the medication errors in healthcare facilities, the leading factor was the computerized physician order entry (CPOE) function of the EMR and how it interacted with the pharmacy system. A majority (69%) of the errors reached the patient, though few...
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The Myth of Student Debt and Family Medicine

November 14, 2017

OK, “myth” is a bit of an exaggeration. A study from 2014 by the Robert Graham Center found a U-shaped relationship between medical student debt and the likelihood of students going into family medicine. Actually, it was more of a saucer-shaped curve. Students who had debt > $150,000, but also those with...
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For Colon Cancer, Time is Not of the Essence, Much

October 29, 2017

There are some questions in healthcare that can’t be answered with a randomized controlled trial. We can’t randomize babies to inhale secondary tobacco smoke or not to test its health effects. We can’t randomize people to different number of hours sitting the ER before receiving antibiotics after the decision is made...
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The Waste of Freestanding ERs and Retail Clinics

October 22, 2017

I have written about both issues before: freestanding ERs and retail clinics. Two recent studies continue to show how useless they both are in helping create a better more efficient healthcare system. The freestanding ER study  examined the number of these facilities and population characteristics where they locate. They identified 360 freestanding...
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Doubts About Value-Based Hospital Programs

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

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

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

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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