Sorry. Health Care Reform Can ’t Wait for Quality Measures to Be Perfect
By BINDER, MARCOTTE, FILDES and THOMPSON
There’s a debate in the United States about whether the current measures of health care quality are adequate to support the movement away from fee-for-service toward value-based payment. Some providers advocate slowing or even halting payment reform efforts because they don’t believe that quality can be adequately measured to determine fair payment. Employers and other purchasers, however, strongly support the currently available quality measures used in payment reform efforts to reward higher-performing providers. So far, the Trump administration has not weighed in.
The four ...
Source: The Health Care Blog - October 6, 2017 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized AHRQ CMS PSI Quality measure value-based care Source Type: blogs
A 50-something with chest pain and minimal precordial ST elevation
A 50-something with diabetes presented with 3 hours of sharp chest pain radiating to the left hand, with dyspnea and diaphoresis; it was worse with exertion and with lying flat.He had this second ECG, which was texted to me and I looked at it on my iPhone. At the time of this ECG, the patient had received NTG and the pain was decreasing.ECG-1:There is 1 mm of ST elevation at the J-point in both V2 and V3 (within normal limits).Computer interpretation is normalCardiologist overread is normalWhat do you think?More description: There is also poor R wave progression, with small R waves in V4. The T waves are sli...
Source: Dr. Smith's ECG Blog - September 26, 2017 Category: Cardiology Authors: Steve Smith Source Type: blogs
The High Cost of Public Reporting
ANISH KOKA MD
In an age where big data is king and doctors are urged to treat populations, the journey of one man still has much to tell us. This is a tale of a man named Joe.
Joseph Carrigan was a bear of a man – though his wife would say he was more teddy than bear. He loved guitar playing, and camp horror movies. Those who knew him well said he had a kind heart, a quick wit and loved cats.
I knew none of these things when I met Joe in the Emergency Department on a Sunday afternoon. I had been called because of an abnormal electrocardiogram – the ER team was worried he could be having a heart attack. ...
Source: The Health Care Blog - September 18, 2017 Category: Consumer Health News Authors: anish_koka Tags: Uncategorized Cardiac surgery High-risk Quality Reporting Source Type: blogs
The Cost of Public Reporting
ANISH KOKA MD
In an age where big data is king and doctors are urged to treat populations, the journey of one man still has much to tell us. This is a tale of a man named Joe.
Joseph Carrigan was a bear of a man – though his wife would say he was more teddy than bear. He loved guitar playing, and camp horror movies. Those who knew him well said he had a kind heart, a quick wit and loved cats.
I knew none of these things when I met Joe in the Emergency Department on a Sunday afternoon. I had been called because of an abnormal electrocardiogram – the ER team was worried he could be having a heart attack. ...
Source: The Health Care Blog - September 18, 2017 Category: Consumer Health News Authors: anish_koka Tags: Uncategorized Source Type: blogs
Bifurcation snakes : Which side its going to sting ?
If human coronary artery is comparable to live wire , attempting bifurcation (BFL) stenting is akin to tame a live snake .True BFL (with Medina 1, 1, 1) being the most complex of all .The fact is ,we have atleast a dozen strategies for BFL with varying loads of metal abutting the ostia ,side branch and carina.This would essentially Imply we are still struggling with these lesions .
While current science tends to vouch PCI* for most BFLs . . . wisdom might whisper CABG in atleast some of us !
Who should do complex PCI ?
Obviously, not every interventional cardiologist can. Confidence is one thing , but , f...
Source: Dr.S.Venkatesan MD - September 4, 2017 Category: Cardiology Authors: dr s venkatesan Tags: bifurcation pci Cardiology -Interventional -PCI Cardiology -unresolved questions Tips and tricks in cath lab bbc 2 study bifurcation lesion dapt after bifurcation stenting european bifurcation club Proximal optimisation pot single vs dou Source Type: blogs
Sinus rhythm with a new wide complex QRS
This is another case written by Pendell Meyers, a G2 at Stony Brook. As I mentioned before, Pendell will be helping to edit and write the blog.CaseA middle aged female with type 2 diabetes presented to her endocrinologist for a regularly scheduled follow up appointment for diabetes management. Her history included ischemic cardiomyopathy (CM) with placement of an AICD, CAD s/p CABG, and recent elective LAD stent complicated by ischemic colitis requiring hemicolectomy and colostomy.During the appointment she complained of several days of off and on dizziness and bilateral leg weakness, and she also told the endocrinolo...
Source: Dr. Smith's ECG Blog - August 28, 2017 Category: Cardiology Authors: Pendell Source Type: blogs
Fight Aging! Newsletter, August 14th 2017
Fight Aging! provides a weekly digest of news and commentary for thousands of subscribers interested in the latest longevity science: progress towards the medical control of aging in order to prevent age-related frailty, suffering, and disease, as well as improvements in the present understanding of what works and what doesn't work when it comes to extending healthy life. Expect to see summaries of recent advances in medical research, news from the scientific community, advocacy and fundraising initiatives to help speed work on the repair and reversal of aging, links to online resources, and much more.
This content is...
Source: Fight Aging! - August 13, 2017 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs
A Perhaps Surprisingly Large Degree of Age-Related Frailty is Self-Inflicted
No-one can choose not to age, at least not until reliable, low-cost rejuvenation therapies are developed, but some aspects of aging can be accelerated through simple neglect - and one can therefore choose to avoid that burden. Frailty is one of these aspects: a condition of weakness and lack of resilience found in many older people. Losses of muscle mass and bone strength, immune system and organ function all play their part. There are various formal definitions of frailty as a medical condition, but there is no bright dividing line here: it is a continuum of decline. Frailty is an end state of aging, and everyone will get...
Source: Fight Aging! - August 12, 2017 Category: Research Authors: Reason Tags: Medicine, Biotech, Research Source Type: blogs
Choice: The Hidden Curriculum in Palliative Care
By Paul CarrThank you to Dr. Naheed Dosani and the excellent team at William Osler Health Centre for inspiring this post.What three words describe the essence of palliative care for you? When I asked my friends, family, and colleagues, the most common answers are: pain management, personal and spiritual support, and end of life planning. Those are all key components. But what quickly became apparent to me during my palliative care elective is that excellent palliative care providers embrace the role of enabling patients and families to make well-informed choices.I have taken a long and untraditional route to arrive in the ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - July 17, 2017 Category: Palliative Care Tags: choice communication goals palliative paul carr Source Type: blogs
More Dumb Things Politicians and Political Appointees Say About Health Policy
As wepreviously discussed, the fierce debate about whether to revise, or " repeal and replace Obamacare " , more formally, the Affordable Care Act, continues in the US. The legislators in the US House of Representatives, and then the US Senate who have written " repeal and replace " bills have done so without any obvious input from health care professionals, health care policy experts, or patients, much less legislators from the opposition party, and so far have impeded any consideration of these bills by legislative committees. Nonetheless, many of the politicians involved in the debates, and other politicians...
Source: Health Care Renewal - July 7, 2017 Category: Health Management Tags: health care reform ill-informed management logical fallacies Source Type: blogs
A 50-something woman with chest pain and dyspeoa (an Aussie)
This case comes from Max Nelson, a paramedic in Australia.See also this post:40-something with severe CP. True + vs. False + high lateral MI. ST depression does not localize.CaseI was dispatched to a middle age woman (~50YO) with chest pain and nausea.Exam: pt is huddled around toilet bowel, naked and shivering. Pt appears “well” but with pallor.Hx: pt was woken from sleep after midnight with chest aching, dyspnoea and significant nausea. Pt moved to the toilet and had one bilious vomit. The ambulance was called and arrived approx 20 minutes later.Signs and symptoms: nausea, dyspneoa, cold, pallor.Now states chest pain...
Source: Dr. Smith's ECG Blog - July 3, 2017 Category: Cardiology Authors: Steve Smith Source Type: blogs
Health Affairs Web First: Significant Racial Disparities Found In Hospital Readmissions
This study will also appear in the July issue of Health Affairs.
(Source: Health Affairs Blog)
Source: Health Affairs Blog - June 21, 2017 Category: Health Management Authors: Lucy Larner Tags: Elsewhere@ Health Affairs Web First Source Type: blogs
Repair of moderate ischemic mitral regurgitation at the time of CABG
(Source: Notes from Dr. RW)
Source: Notes from Dr. RW - June 1, 2017 Category: Internal Medicine Tags: cardiovascular Source Type: blogs
Florida Has a Transparency Database
We have long been known to deride the national Open Payments database, believing that it does more harm than good. Recently, it was brought to our attention that the State of Florida has their own transparency database. FloridaHealthFinder.gov is a website run by the Florida Agency for Health Care Administration (AHCA) and attempts to provide patients with healthcare provider information. The website has been around since 2000 and has continued to be updated and expanded, gaining national recognition as a leader in health care transparency. Through health care quality comparison tools, the health encyclopedia, and many oth...
Source: Policy and Medicine - May 16, 2017 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs
MKSAP: 68-year-old man with new-onset ascites
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 68-year-old man is evaluated for new-onset ascites with lower-extremity edema. Symptoms have increased gradually over the past 4 weeks. He has consumed three alcoholic beverages per day for many years. His medical history is notable for coronary artery bypass graft surgery 8 months ago and dyslipidemia. His medications are low-dose aspirin, atorvastatin, and metoprolol.
On physical examination, temperature is 36.8 °C (98.2 °F), blood pressure is 122/84 mm Hg, pulse rate is 64/min, and respiration rate is 16/...
Source: Kevin, M.D. - Medical Weblog - April 22, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions GI Source Type: blogs
