Emergency Medicine Under Fire
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Emergency Medicine Under Fire

Perhaps it is a coincidence of timing, but it sure seems like the practice of emergency medicine has been taking it on the chin lately, from state legislatures, local and federal regulatory agencies, the press, the insurance companies, government health care program administrators, and consumer advocates.  Ever since EMTALA laws turned emergency physicians and hospitals into mandated providers, the safety net for a tattered health care safety net; the practice of emergency medicine has come … Continue reading

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Posted in Health Care Reform, Payment Reform, Rants | Tagged , , , , , , , , | 1 Comment

How to Break the Congressional Logjam in the SGR ‘Doc-fix’
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Breaking the Congressional 'Doc-fix' Logjam

For 11 years, Congress has failed to reform the Medicare physician payment system, and appears prepared yet again (for the 17th time) to fall back on another one-year patch for the unpopular sustainable growth-rate (SGR) formula to avoid a 24% cut in payments to doctors.  As House Minority Leader Nancy Pelosi said recently: “Instead of reforming the Medicare physician payment system, Congress seems intent on imposing yet another round of arbitrary provider payment reductions to … Continue reading

Posted in Health Care Reform, Medicare, Payment Reform, Rants | Tagged , , , , , , | 1 Comment

CPOE and Order Sets in the ED, and Cost Effective Care
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CPOE and Order Sets in the ED, and Cost Effective Care

A recent study by Terrence Adam, MD, PhD et al published in the AMIA Annual Symposium Proceedings Archive on the Implementation of Computerized Provider Order Entry in the Emergency Department: Impact on Ordering Patterns in Patients with Chest Pain revealed a perhaps unexpected impact on the cost of care:  CPOE seems to increase the use of some diagnostic tests, though not others.  The overall impact of CPOE on the cost of care, patient safety, and … Continue reading

Posted in Bending the Cost Curve, Health Care Reform | Tagged , , , , , , , , | Leave a comment

Negligent Delegation: Implications for Capitation
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Centinela v. Health Net : A Case of Negligent Delegatoin

Recently, an emergency physician group in California successfully appealed a prior Superior Court ruling and won an important case that held Health Net responsible for payment when the plan’s delegated payer, La Vida Medical Group, went bankrupt, leaving the out-of-network claims of the emergency physicians unpaid.  The principle at issue was negligent delegation, the failure of the health plan to properly oversee the financial viability of the IPA/Medical Group to which the plan had made … Continue reading

Posted in Bending the Cost Curve, Health Care Reform, Managed Care Contracting, Payment Reform | Tagged , , , , , , , , , , , , | 2 Comments

Why Don’t Patients Trust Their Doctors Anymore?
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Why don't patients trust their doctors anymore?

I came across a really good post on The Daily Beast written by a pediatrician in New England, griping (appropriately) about parents who were unwilling to trust his judgment about vaccinating their children.  The led me to ask:  why have so many patients lost trust in their doctors?  You might challenge the assumption that patients used to trust their doctors more, and that would be a fair question.  I haven’t found any peer-reviewed studies on … Continue reading

Posted in Rants, The ER Experience | Tagged , , , , , , , | 6 Comments