Monday, December 31, 2007
Friday, December 28, 2007
Pay For Performance: Physicians Pay For Insurers Better Financial Performance?
- Categories: Health Care Finance
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I've always been suspicious of the pay for performance movement. Thinking cynically (which I do more and more these days), it seemed to me that pay for performance has the backing of the insurance industry because they could use it as an excuse to pay physicians less. Show me a pay for performance program that actually increases costs to insurers and I'll show you an out-of-work actuary.
Mark Vonnegut, a pediatrician, has a perspective article in the December 27, 2007 issue of the NEJM titled Is Quality Improvement Improving Quality? A View from the Doctor's Office. I found the following a much better statement of the issue than I could ever come up with:
"I can't help suspecting that underneath all these quality-improvement and pay-for-performance initiatives lies yet another scheme that will work out very well for insurers and very badly for providers and patients."
Unfortunately, it's not free full text, but it should be (meaning you'll need a subscription to read the whole piece).
Thursday, December 27, 2007
NIH-Funded Research to Be Free (After One Year)
I was browsing the Wall Street Journal Health Blog and ran across this item regarding the new federal budget:
"The results of NIH-funded research must be made available for free online one year after they’re published in an academic journal. That’s a big deal, because the NIH is one of the biggest funders of medical research and subscriptions to the academic journals where that research is published can cost thousands of dollars a year.
Some researchers and academic institutions have been pushing for this for years, and the multibillion-dollar journal-publishing industry hired a PR guy known as “the pit bull of public relations” to fight the change."
Some researchers and academic institutions have been pushing for this for years, and the multibillion-dollar journal-publishing industry hired a PR guy known as “the pit bull of public relations” to fight the change."
Medscape CME: An Introduction to the Surgical Care Improvement Project (SCIP)
Surgical Care Improvement Project (SCIP) Module 1: Infection Prevention Update
Maximum of 1.5 AMA PRA Category 1 Credit(s)™ for physicians
Medscape CME: Systemic Lidocaine Good
Annals of Surgery: Systemic Lidocaine Shortens Length of Hospital Stay After Colorectal Surgery: A Double-blinded, Randomized, Placebo-controlled Trial.
1.0 AMA PRA Category 1 Credit(s)™ for physicians
Tuesday, December 18, 2007
Health Care Reform Distilled
GruntDoc has an excellent distillation of the choices to be made in health care reform:
"Price.
Quality.
Access.
Pick any two"
Quality.
Access.
Pick any two"
Sort of a permutation of C. Everett Koop when he said that Americans want the best medical care in the world, they want it for free, and they want it now.
Sunday, December 16, 2007
Patients pay only 14% of health care costs? Wow.
Free the market; Government interference hampers healthcare reform
"In a system in which medical care seems free or is artificially inexpensive, with someone else paying for one's healthcare, medical costs spiral out of control because we are encouraged to demand medical services without having to consider their real price. For every dollar's worth of hospital care a patient consumes, that patient pays only about 3 cents out of pocket; the rest is paid by third-party coverage. And for the healthcare system as a whole, patients pay only about 14%."
This article has several nice pieces of data.
Saturday, December 15, 2007
Saving 2660 Megabytes On Your New MacBook
A friend asked me to set up a new Macbook he bought for his wife. With recent Apple laptop sales being what they are, I bet many people will be doing the same thing, so I thought I'd pass along one thing I've learned: always erase the hard disk and re-install OS X.
As loaded by Apple, a new MacBook running Leopard has a hard drive that contains 18.4 gigabytes of software. That 18.4 GB includes language translations and fonts you will probably never actually need. Reinstalling OS X and not installing language translations saves 1.9 GB. Skipping foreign language fonts saves another 141 MB. Not installing X11 saves more, so that skipping all these things saves 2.6 GB (or 2660 MB) of disk space.
NYT: Google Gets Ready to Rumble With Microsoft
- Categories: Software, Technology
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Pennsylvania's Ed Rendell Playing Games With Mcare Abatement
- Categories: Medical Malpractice, Policy, Politics
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The Governor of my state, Ed Rendell, has decided he wants to spend any surplus from the catastrophic malpractice insurance fund (which pays awards and settlements over $500,000) on providing insurance for uninsured adults in Pennsylvania. He wants this so much that that he's threatened not to renew the Mcare program unless he gets what he wants. Thought he State Senate has voted to extend the abatement, the House adjourned before voting.
Here's an interesting quote from Rendell:
"We're not going to go through the pain initially of having the doctors send in their checks, and then having to return them if we continue the (subsidy)," Rendell said after speaking at a nurses' conference in Hershey."
What about the pain of the physicians who will have to figure out how to get the money to pay the full amount in January rather than April? Does the Governor think it's harder for the State to issue a refund than it is for doctors to get their hands on that kinds of money?
There should be no linkage between renewal of Mcare abatement and funding of the Cover All Pennsylvanians insurance program. Mcare funds should be used to cover the program's unfunded liability and make it easier to privatize later. The Governor's Cover All Pennsylvanians should get funding in a way that does not impact Mcare's ability to retire unfunded liability and he should stop playing political games to fund it otherwise.
Schneier: How to protect your laptop and portable disks
Bruce Schneier writes an excellent security newsletter called Crypto-Gram. This week there's something especially important for physicians who keep patient data on portable computers or drives: How to Secure Your Computer, Disks, and Portable Drives.
"The reason you encrypt your entire disk, and not just key files, is so you don't have to worry about swap files, temp files, hibernation files, erased files, browser cookies or whatever. You don't need to enforce a complex policy about which files are important enough to be encrypted. And you have an easy answer to your boss or to the press if the computer is stolen: no problem; the laptop is encrypted."
Wednesday, December 5, 2007
On 'Waking'
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Haven't seen it. Will probably wait for the DVD. My national society, the America Society of Anesthesiologists, has a very nice patient education page on anesthesia awareness here and the referenced video is on YouTube here. No, I don't think Congressional hearing would solve anything. Aspect stock has not done as well as I thought it would in the last five days....
Saturday, December 1, 2007
Anesthesiology: Predictors of Postoperative Acute Renal Failure
- Categories: Medical Articles
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Predictors of Postoperative Acute Renal Failure after Noncardiac Surgery in Patients with Previously Normal Renal Function
"Background: The authors investigated the incidence and risk factors for postoperative acute renal failure after major noncardiac surgery among patients with previously normal renal function.
Methods: Adult patients undergoing major noncardiac surgery with a preoperative calculated creatinine clearance of 80 ml/min or greater were included in a prospective, observational study at a single tertiary care university hospital. Patients were followed for the development of acute renal failure (defined as a calculated creatinine clearance of 50 ml/min or less) within the first 7 postoperative days. Patient preoperative characteristics and intraoperative anesthetic management were evaluated for associations with acute renal failure. Thirty-day, 60-day, and 1-yr all-cause mortality was also evaluated.
Results: A total of 65,043 cases between 2003 and 2006 were reviewed. Of these, 15,102 patients met the inclusion criteria; 121 patients developed acute renal failure (0.8%), and 14 required renal replacement therapy (0.1%). Seven independent preoperative predictors were identified (P < 0.05): age, emergent surgery, liver disease, body mass index, high-risk surgery, peripheral vascular occlusive disease, and chronic obstructive pulmonary disease necessitating chronic bronchodilator therapy. Several intraoperative management variables were independent predictors of acute renal failure: total vasopressor dose administered, use of a vasopressor infusion, and diuretic administration. Acute renal failure was associated with increased 30-day, 60-day, and 1-yr all-cause mortality.
Conclusions: Several preoperative predictors previously reported to be associated with acute renal failure after cardiac surgery were also found to be associated with acute renal failure after noncardiac surgery. The use of vasopressor and diuretics is also associated with acute renal failure."
Methods: Adult patients undergoing major noncardiac surgery with a preoperative calculated creatinine clearance of 80 ml/min or greater were included in a prospective, observational study at a single tertiary care university hospital. Patients were followed for the development of acute renal failure (defined as a calculated creatinine clearance of 50 ml/min or less) within the first 7 postoperative days. Patient preoperative characteristics and intraoperative anesthetic management were evaluated for associations with acute renal failure. Thirty-day, 60-day, and 1-yr all-cause mortality was also evaluated.
Results: A total of 65,043 cases between 2003 and 2006 were reviewed. Of these, 15,102 patients met the inclusion criteria; 121 patients developed acute renal failure (0.8%), and 14 required renal replacement therapy (0.1%). Seven independent preoperative predictors were identified (P < 0.05): age, emergent surgery, liver disease, body mass index, high-risk surgery, peripheral vascular occlusive disease, and chronic obstructive pulmonary disease necessitating chronic bronchodilator therapy. Several intraoperative management variables were independent predictors of acute renal failure: total vasopressor dose administered, use of a vasopressor infusion, and diuretic administration. Acute renal failure was associated with increased 30-day, 60-day, and 1-yr all-cause mortality.
Conclusions: Several preoperative predictors previously reported to be associated with acute renal failure after cardiac surgery were also found to be associated with acute renal failure after noncardiac surgery. The use of vasopressor and diuretics is also associated with acute renal failure."
