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Direct Primary Care: One of Healthcare’s “Big Ideas?”

A Graham Center Policy One-Pager in the April 1st issue of American Family Physician uses historical data to project the effect of the 2010 Primary Care Residency Expansion Program (PCRE). By its conclusion in 2015, the PCRE program will have funded an additional 900 residency trainees in family medicine, general internal medicine, and general pediatrics above the current cap on Medicare-supported residency positions.

Based on historical trends, though, only 39 percent of internists in these particular programs will end up practicing primary care, compared to 51 percent of pediatricians and 92 percent of family physicians. As a result, only about two-thirds of these residents are likely to enter the primary care workforce. Of course, 600 new primary care physicians are better than none, but at an estimated $100,000 per year per resident, this well-intentioned federal program will also spend $90 million to train additional internal medicine and pediatric subspecialists that are already in plentiful supply. Read more…

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Redesigning the Patient Experience

Last week, I was privileged to attend a very exciting, forward-thinking event hosted by the NYC Health Business Leaders at NXT Health’s Patient Room 2020, called “Redesigning the Patient Experience to Improve Safety and Outcomes.” The panel discussion was really robust (not always the case), the model room thought-provoking, and the energy and creativity of the gathered attendees from across the healthcare spectrum was palpable. In short, it was the kind of event I think we all need more of, and it inspired me to consider how we can most fruitfully direct the modern pursuit of “patient satisfaction” – and why this endeavor is about so much more than beautiful lobbies and hospital rankings. Read more…


Context Intelligence and the Public Physician

It used to be clear where we were. When we were in a patient room we carried ourselves one way. In church or temple, we behaved a different way. With old friends and family, the limitations and boundaries were different.

How we should be has traditionally been defined by where we were and who we were with.

Public communities change that. Doctors and patients swim in the same pool. Employers and residency directors have access to the same search results. Context is increasingly ill-defined so it’s easy to find yourself unintentionally breaking the rules. Read more…


Five Ways Psychologists and Physicans Can Work Together to Fight Patient Stress

Stress continues to be a problem for many adults, with high stress and ineffective coping mechanisms all but ingrained in the day-to-day of American culture. In a recent survey from the American Psychological Association, 42 percent of adults reported that their stress level has increased over the past five years.

Physicians know the effects of stress on the body. These are seen regularly during office visits, manifested through physical health symptoms and complaints: trouble sleeping, trouble eating, eating too much, and feeling sad or irritable, among other things. Read more…


Tracking Outcomes with Wearables

There are few certainties in medicine. But treating rotator cuff injuries has revealed one to me: people with rotator cuff tears don’t sleep well. If you want a glimpse into the life-altering symptoms of shoulder pain, just ask one of these patients how many times a night he or she wakes up with pain. Hearing the answer, it’s easy to see that improving the ability to sleep through the night would be one of the major goals of treatment.

With pay-for-performance on the horizon, interest in demonstrating that treatments are providing value to patients is peaking, and with it, patient-centered outcomes research. Yet how much should we actually trust the results of studies using these results? If you see patients’ faces as they fill out the health-related quality of life (HR-QoL) questionnaires and disease/joint specific questionnaires, you may detect a bit of skepticism. Read more…


HIPAA Privacy and Security Compliance: Should You Care?

The HIPAA/HITECH Omnibus Rule became effective just over one year ago, and the compliance date was just over six months ago. Within about another six months (plus or minus), federal regulators at the Office for Civil Rights at the US Department of Health and Human Services will begin a new round of HIPAA compliance audits. They are already actively involved in complaint investigations governed by the new HIPAA rules.

Other Federal, state, and territorial authorities are also involved in HIPAA and related health data privacy and security enforcement activity: the Federal Trade Commission, the Secret Service, the Puerto Rico Health Insurance Administration, and state attorneys general. The “Wall of Shame” on the OCR website adds information about newly disclosed data breaches on a regular basis. Read more…


The Value of Kindness in Medicine

Recently, a friend sent me a link to an article titled “Recognizing the Value of Kindness in Health Care. It was written by Gary Greensweig, D.O., the chief physician executive of Dignity Health in San Francisco. In the piece, Dr. Greensweig describes the results of a survey his organization commissioned from Wakefield Research. The findings are interesting:

  • 87 percent of Americans feel that kind treatment by a physician is more important than other key considerations in choosing a healthcare provider.
  • 64 percent have experienced unkind behavior in a healthcare setting, including failure to connect on a personal level (38 percent), staff rudeness (36 percent), and poor listening skills (35 percent).
  • ~75 percent of survey respondents indicated that they would be willing to pay more to visit health care providers that practiced kindness.
  • 88 percent said they would be willing to travel farther to receive kinder care.

Read more…

Drs Elder and Gilbert

The Invisible Man in Healthcare

In recent years, a growing body of research has shown that for men of color, access to healthcare can be profoundly challenging. Indeed, currently nearly 30 percent of black men lack any form of health insurance, according to a study in the International Journal of Men’s Health. In response to data like this, the article’s authors, Keith Elder, head of the Department of Health Management and Policy at Saint Louis University’s School of Public Health, and Keon Gilbert, an assistant professor in the school’s department of Behavioral Sciences and Health Education, have teamed up with the Robert Wood Johnson foundation to help bring black men into more public conversations about health, healthcare, and health reform.

“Our published research is important, but the people we need to reach aren’t in the academic world. They are in the barbershop, on the basketball court, and in communities that are medically underserved,” says Elder. Accordingly, after the jump, you’ll find an infographic developed by the foundation that draws on Elbert and Gilbert’s data. Read more…


The Cost of Illness

Mrs. Sandra Jackson knew that she was no Warren Buffet. She knew that she was no Bill Gates. Instead, Mrs. Jackson knew that she worked two jobs, seven days a week to support her family. So she hid her breast condition for a better time, another day. She would ask herself which was more important: going to a doctor or buying her children dinner? For a true mother, the answer was easy, but the consequences were not.

Months passed and Mrs. Jackson worked harder. She was working against a clock that was hidden from her view and yet, somehow instinctively, she knew the time. She came to the ER at the end of the last shift she ever worked. Read more…


Digital Health at SXSW: Takeaways from the 2014 Conference

Earlier this week, I was down in Austin, TX, where I was involved in an interactive session at the annual SXSW conference. My question going into the experience: Is big data in healthcare at the top of its hype cycle? And how do we humanize it, making it relevant and useful for our everyday life? In other words, can data truly help us hack our lives and health for the better?

I had this in mind as I attended a panel discussion called Hacking Your Life For Better Health (#hacklife on Twitter). The session was led by Fred Trotter, who is one of the great minds thinking about health data these days. Read more…