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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ShortCuts-This Week in the Journals

September 23, 2007
ShortCuts-This Week in the Journals

Commentary by Cara Litvin MD, Executive Editor, Clinical Correlations

The sensation of déjà vu was likely very common this week. First, we experienced a flashback to 1994 when we saw OJ in handcuffs again…and then Hillary unveiled her new plan for universal health care. Her plan would require everyone to buy insurance, but emphasizes choices, including both the currently existing private options in addition to a public plan similar to Medicare. The plan also includes tax credits for families and small businesses to…

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Breaking News: FDA Issues New Warnings for Haldol

September 21, 2007
Breaking News: FDA Issues New Warnings for Haldol

Commentary by Helen Kourlas, PharmD

On September 17th 2007, the FDA issued an advisory warning healthcare professionals to avoid the use of higher than recommended doses of haloperidol, marketed as Haldol, Haldol Decanoate and Haldol Lactate. In addition to this warning, the FDA also emphasized that the injectable form of haloperidol is only approved to be administered as an intramuscular injection. Common off – label intravenous administration of haloperidol has led to numerous case reports of QT prolongation, Torsades de Piontes (TdP) and sudden death.…

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Recent Legionella Outbreak in the Bronx

September 20, 2007
Recent Legionella Outbreak in the Bronx

Commentary by Elizabeth Hackett MD, PGY-3

On July 25th, 2007, the NYC Department of Health released an advisory requesting that all New York City physicians maintain a high index of suspicion for Legionnaires’ disease in patients presenting with community acquired pneumonia. This advisory was prompted by 27 cases of Legionella pneumonia reported in the Parkchester neighborhood of the Bronx during the fall of 2006 (zip code 10462 ). This cluster of cases represented an increase in incidence of the disease to 16.6 cases/100,000 in 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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ShortCuts-This Week in the Journals

September 17, 2007
ShortCuts-This Week in the Journals

Commentary by Henry Tran, MD

There continues to be accumulating evidence of the beneficial effects of statin therapy.  Coming on the heels of the SPARCL trial, which demonstrated that high-dose atorvastatin reduces the incidence of recurrent ischemic strokes in patients with recent TIA or stroke, is a randomized trial examining the effects of statin withdrawal.  Many patients with acute strokes have medications temporarily discontinued upon hospitalization, for instance due to dysphagia or apsiration risks.  Blanco et al. found that patients who continued statin…

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Inpatient Diabetes Management: Case 2

September 14, 2007
Inpatient Diabetes Management: Case 2

Commentary by Mary Vouyiouklis MD, Fellow, and Ann Danoff MD, Director, Division of Endocrinology, Diabetes and Metabolism, NYU Medical Center 

Welcome to Case 2 of our special diabetes series intended to highlight the essentials of diabetes care in the inpatient setting. For the next several weeks, we plan to present individual cases followed by some management questions and answers.

Case 2: The case of Mr. Jones
Mr. Jones is a man with (insulin requiring) type 2 diabetes who is admitted…

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Tumor Lysis Syndrome and the Role of Urinary Alkalinization

September 13, 2007
Tumor Lysis Syndrome and the Role of Urinary Alkalinization

Commentary by Bani Chander MD, PGY-2, and Sergio Obligado MD, Attending Physician, Nephrology

Tumor lysis syndrome (TLS) is characterized by a group of metabolic abnormalities including hyperkalemia, hyperuricemia, and hyperphosphatemia with secondary hypocalcemia, following the initiation of cytotoxic therapy. Although there is no well established definition for this syndrome, the Cairo-Bishop definition is a commonly used classification system that stratifies the degree of severity by utilizing specific laboratory data and clinical features. The constellation of abnormalities that occurs in TLS is due…

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