Is it high-value and patient focused or is it disruptive and lawsuit prone?
Twenty years ago, physicians who chose a career in primary care did not imagine a professional life restricted to the outpatient setting. Primary care physicians were trained to care for patients in the inpatient and outpatient settings, encompassing care for the healthy, acutely ill, and chronically ill patients. These physicians could not imagine transferring their patients to other doctors for a limited period of time when they were admitted to a hospital or to a nursing home. Physicians would not have envisioned temporarily transferring the care of their patients to another unaffiliated doctorat a time when these patients were the sickest and vulnerable and in most need of someone who knows them, their health problems, and their preferences for care. It did not make sense to these physicians that a patient would want to see them when they were well, but be transferred to another doctor whom they did not know when they got sick.
The trend toward hospitalists caring for inpatients has grown exponentially over the last 20 years. In 1990, there were about 7000 hospitalists in the United States and in 2011, there are approximately 30,000. Hospitalists are said to improve both the efficiency of care, mostly through reducing length of stay, and its quality. Primary care physicians initially resisted this change in professional responsibilities, but now prefer the new system because they perceive that hospital visits were not efficient use of their time. Continue reading
The unexpected announcement by Pope Benedict XVI that he will step down from his pontifical duties on Feb. 28 came as a stunning surprise to the Catholic faithful and to the Christian world. I am inclined to take the Pontiff at his word, and to assume that this decision is based on his declining physical abilities, or declining health, and that these are severe enough to warrant this highly unusual decision. There are some who suspect a conspiratorial interpretation of his announcement, suggesting that his departure confirms that the pope is “giving up” in the wake of all the scandals that have beleaguered his papacy for so many years.
A more important concern for Christianity and the Catholic Church is who will succeed Pope Benedict XVI. As Roman Catholic cardinals prepare to gather in Rome to elect a new pope, there is much speculation as to whether they will select an Italian cardinal or a Third World Cardinal, or even an American Cardinal. Several American clergymenare popping up regularly in the press as possible candidates, including New York’s Cardinal Timothy M. Dolanand Boston’s Cardinal Sean O’Malley.
It is the opinion of the author, that the selection of the next pope is critical to the ongoing success of Christianity and the Catholic Church in the world. It seems clear that the next pope should not only be a holy man, but should be a strong leader, able to bring the two billion Christians and one billion Catholics into the 21st century and into modernity.
Christianity and Catholicism face a number of challenges; particularly in developed countries were Christians are deeply divided concerning the proper way to respond to modernity. It seems that Christianity is entering the fourth stage of its evolution. Theologians define the first stage as the initial 250 years after the birth of Christ, when Christianity was truly an intentional religious community forced to negotiate its identity in a pluralistic world without the support of culture and without the support of state. The second stage is the long 13 centuries after Constantine, when Christianity was an established religion and the main form of culture as well as state in the West. The third stage, approximately the last 200 years, is one in which Christians struggled with cultural marginalization and political disestablishment after the French Revolution, the Russian Revolution, and the American Revolution. As Christianity enters into the fourth stage of its evolution, Christians find themselves at a dramatic turning point of self-definition as they seek to discover which of the stages of its story best prepares it for the future in this post-enlightenment modern era…Read more
Will physician/hospital integration lead to litigation and lawsuits as reimbursement dwindles?
Medical practices have been aligning and integrating with hospitals over the last several years to form Integrated Delivery Systems. This is primarily the result of the desire to comply with the demands of the Accountable Care Act. The all-important question, however, is will such alignment and integration last. Many predict that such alignments will begin to disintegrate over the next few years as reimbursement decreases and hospital leaders began to exert unreasonable financial expectations on practitioners. Many similar alignments of the early 90s failed, as hospitals and physicians were unable to work together…Read more
Since the Supreme Court upheld the Affordable Care Act in June 2012, there have been numerous lawsuits by religious organizations and religious employers as a result of objections to the so-called contraceptive mandate. ACA requires that most employers, including religious organizations, provide insurance without co-pays or deductibles to cover a range of contraceptives including birth control pills, the morning after pill, and sterilization.
One of these challenges involves HIPPA compliance, as the healthcare industry rapidly migrates from a paper focused system to an electronic health record system. The HIPPA Privacy Rule, which governs paper health records, has been around since the late 90s. The HIPPA Security Rule which governs collection and storage of electronic patient records has been around for about a decade. In spite of this, HIPPA breaches, litigation, and lawsuits have not declined. Continue reading
Is it the ultimate solution for increasing quality and reducing the cost of healthcare for Americans?
Will it result in litigation, lawsuits, and patient care disruption?
Healthcare reform (Affordable Care Act) encourages providers to create larger delivery organizations that can coordinate care in pursuit of greater quality and efficiency at less cost. In most cities across America, hospitals are merging together to form large systems. Expanded hospital networks are purchasing physician practices at an alarming rate. Continue reading
Will ACA succeed? Will It Result In Renewed Recession? Will there be more lawsuits, Supreme Court decisions, and patient care disruption?
The Affordable Care Act is now the law of the land. Its implementation has begun and will continue for the next few years. The ACA also referred to as “Obamacare” has survived much turmoil, political wrangling, state’s lawsuits, and a Supreme Court decision about constitutionality. The issue of state sponsored Medicaid programs is still far from certain, as many states are reluctant to implement such programs due to cost. Clearly there number of positive elements to the affordable care act including health insurance coverage for the vast majority of Americans, inability of insurance companies to deny coverage for pre-existing conditions, and the ability to maintain children on parents policy until age 25.