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Showing posts from May, 2016

The Heart and Soul of MACRA

Ms. Jeannie is a 65 years old woman, slightly overweight with mild hypertension that is perfectly controlled. Ms. Jeannie is the office manager at Dr. Abrams, the pediatrician down the hall, who’s been taking care of your kids since you moved here. Ms. Jeannie called earlier because her allergies are killing her today and she’s out of refills for her blood pressure meds anyway. After an uneventful 15 minutes, and a brief chat in the hallway, Ms. Jeannie pays her $15 copay and heads back to work. Medicare will pay you another $60 in a few weeks. On to Bob Burns who is here for his DOT physical and his BP is through the roof… again… Somewhere in our nation’s capital, someone has decided that when you go about your day like this, you’re doing a lousy job, because you provide very little bang for the buck they pay you. Maybe Jeannie could have seen your nurse instead of wasting your time with trivial things. Maybe she could have just stayed at her desk in Dr. Abrams’ office and talked to y

Health Care is Not a System

The Merriam-Webster dictionary has many definitions for the term system, but the most straightforward, and arguably the most applicable to our health care conversation is “a regularly interacting or interdependent group of items forming a unified whole”. The common wisdom is that our health care system is broken and hence our government is vigorously attempting to fix it for us through legislation, reformation and transformation. We usually work ourselves into a frenzy arguing how the government should go about fixing the system, but I would like to take a step back and question the assumption that health care is, or should be, a system. This is not about splitting the hairs of semantics. This is about proper definition of the problem we wish to solve. You could argue that we use the term system loosely to refer to everything and there are no nefarious implications to calling health care a system. We have a transportation system, an education system, a legal system, a financial system