Healthcare Policy

Pay-for-Performance: The Future of Medicine?

September 26, 2007
Pay-for-Performance: The Future of Medicine?

Commentary by Sandeep Mangalmurti MD, JD PGY-2 

“Pay-for performance” is the broadly encompassing term used to describe recent efforts to restructure physician compensation so that rewards are commensurate to performance. Initially limited to small pilot programs, pay-for-performance has rapidly expanded over the past decade; currently over half of all HMOs have implemented some form of it1, and plans are underway to introduce pay-for-performance measures into Medicare and Medicaid2.

There are various versions of pay-for-performance, and each presents its own advantages and disadvantages. The…

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Medicare Changes and their Implications

September 18, 2007
Medicare Changes and their Implications

Commentary by Zackary Berger MD PhD, PGY-2

A recent article in the New York Times publicized changes in Medicare subsidies. In the article’s own words, “Medicare will no longer pay the extra costs of treating preventable errors, injuries and infections that occur in hospitals, a move could save lives and millions of dollars.” This change was widely discussed, no less so in our hospitals.

But the devil is in the details. What is a preventable error? How was the list modified,…

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An Update on Domestic Violence

September 6, 2007
An Update on Domestic Violence

Commentary by Sean Cavanaugh MD, Associate Editor, Clinical Correlations

Most doctors are aware that Domestic Violence, or Intimate Partner Violence (IPV), is a serious health care issue, but the statistics are still startling to most of us. Some surveys have reported that IPV affects up to 30% of women and up to 7.5% of men. These numbers are highly variable and depend on the type of survey being conducted and the population being surveyed. Actual report-statistics of IPV are widely acknowledged as…

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The Discharge Summary: A Prerequisite for Quality Care

August 24, 2007
The Discharge Summary: A Prerequisite for Quality Care

Commentary by Cara Litvin MD, Executive Editor, Clinical Correlations

I frowned as my patient handed over some papers to me at a regularly scheduled follow-up clinic visit. For the second time in a row, he had been admitted to an outside hospital for syncope in the interval between his visits with me. The cryptic discharge summaries provided very little information about his work-up. “Follow-up with primary MD” was scribbled on the latest discharge summary, without any test results provided. My initial instinct was to be…

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Health Care Reform: An Overview of Recent Proposals

August 9, 2007
Health Care Reform: An Overview of Recent Proposals

Commentary by Zackary Berger MD PhD, PGY-2 

In the political arena, reforming health care is continually a major domestic issue. It’s no surprise that the lead 2008 democratic contenders cite the same statistic on each of their websites, “Nearly 45 million Americans, including 9 million children, are without health insurance.” Moreover, on each of their sites, the candidates ambitiously describe plans that would provide universal and affordable healthcare for all Americans. Their tactics largely entail expanding Medicaid, holding employers more accountable to providing…

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$50,000: The price of a car or the price of life?

June 14, 2007
$50,000: The price of a car or the price of life?

Commentary by Vlad Fridman MD, PGY-2

$50,000. This is the price of a new (and cheap) model BMW, and also a price the US government is willing to spend to prolong your medically trained (or everyone else’s for that matter) life by one year. Before describing why $50,000 was chosen it’s necessary to describe what this number stands for.

For years, health economists have been struggling to determine a way to ration health care. Since resources are limited, who is…

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Clinical Commentary: The Travesty of Grinding Axes with Science: Rosiglitazone and Cardiac Risk

June 12, 2007
Clinical Commentary: The Travesty of Grinding Axes with Science: Rosiglitazone and Cardiac Risk

Welcome to our first blog commentary. One of the purposes of the blog is to generate discussion about issues in health care. This “Clinical Commentary” section is an invitation to our housestaff and faculty to submit their own thoughts and viewpoints on current issues. The views expressed in this section are soley those of the authors and do not necessarily represent the views of Clinical Correlations.

Commentary by Gregory Mints MD and Nirav Shah MD, MPH

The meta-analysis of Rosiglitazone’s effect on cardiovascular events…

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Conflicts of Interest

March 21, 2007
Conflicts of Interest

The debate about the ethically questionable relationship between physicians and the pharmaceutical industry opened up again this morning on the front page of the New York Times. Although the article is heavy on interview and anecdote and a little short on evidence, it is difficult to avoid casting a critical eye on this relationship. The impetus for the article is the new laws in a handful of states requiring drug makers to disclose all payments made to doctors. These laws have made public previously…

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The Vioxx Wars

February 23, 2007
The Vioxx Wars

Commentary By: Sandeep Mangalmurti MD, JD PGY-1

The continuing legal battles over Vioxx remain at the center of a fascinating intersection of law and medicine. Most physicians are well acquainted with the basics of the case, but like most complicated health care issues, the deeper one probes, the more interesting it becomes.

The Vioxx saga begins in 2000, with the VIGOR trial. (1) This study was a randomized control trial comparing the gastrointestinal toxicity of Vioxx to naproxen, and was notable for…

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Medical Malpractice 101

January 19, 2007
Medical Malpractice 101

Commentary By: Sandeep Mangalmurti, MD, JD PGY-1

For many physicians, medical malpractice is like paying taxes; inevitable, but incomprehensible.  This is unfortunate, since most physicians offer unique insights into the current debate on malpractice reform.  Hopefully this article will begin to familiarize the reader with the general landscape of current trends in medical malpractice law.

When a physician complains of the current “malpractice crisis,” the complaint is usually about rising premiums.  The concern is generally not only over their…

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As Power Shifts in Washington…

December 5, 2006
As Power Shifts in Washington…

In the summer of 2002, I worked in DC for the Pharmaceutical Researchers and Manufacturers of America (PHRMA), which is an umbrella organization that represents the largest pharmaceutical companies.  It was the height of Republican power and PHRMA lobbyists were at the forefront of influencing the policy debate.   One of the crowning achievements of the Bush’s domestic policy was the Medicare prescription drug benefit.  Passed in 2003 at an initial cost of…

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