Practicing Medicine While Black (Part II)

By KIP SULLIVAN Managed care advocates see quality problems everywhere and resource shortages nowhere. If the Leapfrog Group, the Medicare Payment Advisory Commission, or some other managed care advocate were in charge of explaining why a high school football team lost to the New England Patriots, their explanation would be “poor quality.” If a man armed with a knife lost a fight to a man with a gun, ditto: “Poor quality.” And their solution would be more measurement of the “quality,” followed by punishment of the losers for getting low grades on the “quality” report card and rewards for the winners. The obvious problem – a mismatch in resources – and the damage done to the losers by punishing them would be studiously ignored. This widespread, willful blindness to the role that resource disparities play in creating ethnic and income disparities and other problems, and the concomitant widespread belief that all defects in the US health care system are due to insufficient “quality,” is difficult to explain. I will attempt to lay out the rudiments of an explanation in this essay. In my first article in this two-part series, I presented evidence demonstrating that “pay-for-performance” (P4P) and “value-base purchasing” (VBP) (rewarding and punishing providers based on crude measures of cost and quality) punish providers who treat a disproportionate share of the poor and the sick. I be...
Source: The Health Care Blog - Category: Consumer Health News Authors: Tags: Uncategorized CMS Kip Sullivan value-based care Source Type: blogs

Related Links:

ConclusionsHypothalamic EPO plays a role in the central regulation of muscle and metabolic physiology while its decline contributes to aging and obesity physiology in a manner which is independent of peripheral EPO.
Source: Molecular Metabolism - Category: Endocrinology Source Type: research
Authors: Lee YH, Jang HW, Park CH, An SM, Lee EK, Choi BM, Noh GJ Abstract BACKGROUND: The aim of intraoperative fluid therapy is to avoid both hypovolemia and hypervolemia; however, the patient's exact volume status is difficult to determine during surgery. Fluid optimization guided by stroke volume variation (SVV) has been widely used in patients undergoing major open abdominal surgery. The aim of this study was to evaluate the changes in plasma volume before and after surgery following SVV-guided fluid therapy. METHODS: Patients were randomly allocated into one of two groups according to the SVV criteria for...
Source: Minerva Anestesiologica - Category: Anesthesiology Tags: Minerva Anestesiol Source Type: research
In conclusion, the role of the anesthetist should be to supervise endoscopy activities at every level. PMID: 31808663 [PubMed - as supplied by publisher]
Source: Minerva Anestesiologica - Category: Anesthesiology Tags: Minerva Anestesiol Source Type: research
Authors: Lionetti V, Barile L Abstract Over the last 20 years increasing number of patients with multimorbidity and polypharmacy underwent different types of elective non-cardiac and cardiac surgery. Despite surgery is safer today than in the past, rate of perioperative major adverse cardiovascular events is still attracting significant attention from both clinicians and researchers. The perioperative myocardial infarction (PMI), a permanent damage of the heart, is a major cause of short and long term morbidity and mortality in current surgical populations. Although it is primarily the result of local myocardial is...
Source: Minerva Anestesiologica - Category: Anesthesiology Tags: Minerva Anestesiol Source Type: research
This study is focused on comparison of the dissolution behavior of matrix tablets (based on hypromellose and/or glyceryl behenate as retarding agent) of the same composition containing different type of drug – ionizing tramadol hydrochloride (TH) and non-ionizing pentoxifylline (PTX). The dissolution tests were performed in acidic medium (pH 1.2) and in alcoholic medim (20%, 40% of ethanol) and the changes of tablets were observed also photographically.It was found that the alcohol resistence of the hydrophilic-lipophilic formulations with TH and the hydrophilic-lipophilic formulations with PTX containing a higher am...
Source: Saudi Pharmaceutical Journal - Category: Drugs & Pharmacology Source Type: research
Publication date: Available online 7 December 2019Source: Saudi Pharmaceutical JournalAuthor(s): Kinga OstrowskaAbstractA number of psychiatric disorders, including anxiety, schizophrenia, Parkinson’s disease, depression and others CNS diseases are known to induce defects in the function of neural pathways sustained by the neurotransmitters, like dopamine and serotonin. N-arylpiperazine moiety is important for CNS-activity, particularly for serotonergic and dopaminergic activity. In the scientific literature there are many examples of coumarin-piperazine derivatives, particularly with arylpiperazines linked to a coum...
Source: Saudi Pharmaceutical Journal - Category: Drugs & Pharmacology Source Type: research
In conclusion, this systematic review and meta-analysis found that compared to non-nicotine/smoking, non-alcohol, non-substance use burn patients, patients using nicotine/smoking, alcohol, and/or substances were associated with more burn related operations, higher rates of graft loss/failure, longer hospital LOS (length of stay), higher rates of intubation, longer ICU (intensive care unit) LOS, increased mortality, and increased wound/local skin infections. Patients using nicotine/smoking were associated with higher rates of intubation and wound/local skin infections. Patients consuming alcohol were associated with more da...
Source: Burns - Category: Dermatology Source Type: research
Functional coupling of M1 muscarinic acetylcholine receptor to Gαq/11 in dorsolateral prefrontal cortex from patients with psychiatric disorders: a postmortem study. Eur Arch Psychiatry Clin Neurosci. 2019 Dec 05;: Authors: Odagaki Y, Kinoshita M, Meana JJ, Callado LF, García-Sevilla JA Abstract Accumulating studies have implicated intracellular signaling through muscarinic acetylcholine receptors (mAChRs) in psychiatric illness. In the present study, carbamylcholine chloride (carbachol)-induced Gαi/o and Gαq/11 activation was identified in postmortem human prefrontal cortical ...
Source: European Archives of Psychiatry and Clinical Neuroscience - Category: Psychiatry Tags: Eur Arch Psychiatry Clin Neurosci Source Type: research
CONCLUSIONS: Prenatally initiated CBT did not improve maternal symptoms or child outcomes among non-help-seeking women with antenatal depression or anxiety. Our findings are not in line with present recommendations for universal screening and treatment for antenatal depression or anxiety, and future work may include the relevance of baseline help-seeking. PMID: 31806071 [PubMed - as supplied by publisher]
Source: The British Journal of Psychiatry for Mental Science - Category: Psychiatry Tags: Br J Psychiatry Source Type: research
CONCLUSION: Altogether, ultrasonographic severity of fatty liver shows good correlation with that of clinical parameters and hepatic pathology. PMID: 31808322 [PubMed - in process]
Source: Journal of Korean Medical Science - Category: Biomedical Science Tags: J Korean Med Sci Source Type: research
More News: Addiction | Agency for Healthcare Research and Quality (AHRQ) | Alcoholism | American Health | Blindness | Blogging | Blood Transusion | Cardiology | Congestive Heart Failure | Depression | Eating Disorders & Weight Management | Electronic Medical Records (EMR) | Epidemics | Epidemiology | Expenditures | Harvard | Health | Health Management | Heart | Heart Attack | Heart Failure | Hospitals | Learning | Legislation | Malpractice | Managed Care | Medicaid | Medicare | Men | Nurses | Nursing | Obesity | OBGYN | Opthalmology | Pneumonia | Rural Health | Stroke | Study | Suicide | Tax | Unemployment | Universities & Medical Training | Urinary Tract Infections | USA Health | Warnings