Posts by Brad Flansbaum

The Last Days: Cash or Credit?

How often do you hear the following: the average senior utilizes  25% of their lifetime health spend during their last six months of life.  Too much. All that service use in such a concentrated period suggests possibilities. ICUs and inpatient care have great costs.  Our acute and post-acute institutions also do not hold up as models of efficient care delivery.  Most of them at least. What to do? I see the above observations as something akin to an emperor with no clothes. Because leaders with checkbooks have a focus on areas that will generate cost reductions, they seek opportunities they can wrap their arms around.  The more disadvantaged and disjointed ambulatory practices cause too many headaches.  Hospitals then seem like the right place.  Hospitalists and inpatient practitioners seem like the right people. The logic goes, with advanced directives and creative thinking, the right docs and facilities can make a dent…

What Kind of Car Will A Specialist Be Driving in 2030?

(Something I sent along to my PGYs.  Thought you might enjoy.  And think about where hospitalists fit into all of this) A Porsche or a Prius? Have a look at the two figures below and see if you can spot the dilemma: See it? I knew that you could. Here's the thing.  We have lived with an arrangement that reimburses specialists more than generalists for greater than fifty years.  You would think because that is so, the progenitors of the system knew what they were doing and assigned the right amount of compensation to each type of physician.  Specialists and proceduralitsts do stuff so pay them more. On one level, that makes sense.  After all, you can see the results specialists achieve quickly given all those high tech thingies they use that come with instruction manuals.  They produce big levels of patient satisfaction and often, get that instant cure.  Folks…

No Words Needed. A Pictorial On Why I Punt On Hospital Report Cards.

  If I was in flyover country without a contact and needed emergency services how would I research the best hospital in a pinch?  If you read Consumer Reports or a major newspaper, of course, you would run to the nearest handy dandy hospital report card and pick out the facility with the A grade. Me?  Yeah, I would look, but unless the hospital were a bottom dweller, say a D or F (less than 10% of facilities I muster), I would not think much of barreling through the ER doors to get whatever creaky tissue like substance that needs fixing taken out. It's not that I don't believe there are excellent performers.  Of course, I do.  It's just that we don't have good enough measurements to stack them out all proper in the here and now.  And I know that because I live on the front lines--just like most of you. I see…

AMA: Unbeloved and Overvilified

  CMS just released their proposed MACRA regs (Cliff Notes version), and as you could expect, every specialty society and interested party dug in and critiqued.  The rule runs a thousand pages and will have a substantial effect on the future of provider payment. In case, you have not heard. Each organization will cut their sections of interest out, parse them, synthesize their analysis, and return a long letter to CMS. They will offer the correct paths on which the agency should proceed--lest they go forward uninformed taking down entire blocks of the healthcare system on account of willful neglect and ignorance.  The letters will start with a friendly salutation along the lines of, "We commend the Secretary on her wisdom and hard work....BUT, we have an eensy weensy problem on some issues," and so the turn goes. The inpatient docs will hit the rough patches as they relate to…

I left a pharma-sponsored research project. My reasons for doing so may be instructive.

  Not long back, I departed a pharma-sponsored research project.  I based my decision to leave in something I occasioned over a decade ago.  I thought it was time to share the episode and the lessons learned given the attention being paid to physician conflict of interest nowadays (as well as the annual Open Payments review and dispute period approaching). When I finished training, very few docs practiced hospital medicine—or even knew what the term hospitalist meant.  Several forward-thinking medical centers hitched their wagons to the hospitalist model, as did some astute information technology and staffing companies. However, few healthcare players embraced the hospitalist movement in a serious fashion like the pharmaceutical industry.  They realized hospitalists prescribed a narrow band of products, in big lots, within a centralized location.  The higher ups in the pharma sector saw the benefits in directing reps our way. Consistent with those goals, a physician…
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