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How does it feel knowing the clinical decisions our physicians make effect their pocketbook? MIPS, or the Merit-based Incentive Payment System, is now the law of the land.
We all want a high quality, technically correct health care experience. From a population perspective, unnecessary variations in care must be diminished.
As our nation’s baby boomer population grows, the concept of “aging in place” is moving front and center.
Care coordination is one of the most popular solutions to saving Medicare. But, while it may be a useful tool, it has limitations.
On Tuesday, April 19, 2016 the Older Americans Act (OAA) was reauthorized for three years – an important bipartisan accomplishment.
Over the past few years, I have enjoyed teaching first- and second-year medical students about the art of interviewing patients. While it’s certainly good to give back, it has also been an eye-opening experience.
Most American families and even health policy experts have never heard of the Aging Network (AN), a loosely organized, community-embedded aggregation of service organizations that provide elders with vital services such as housing repairs, food, and transportation.
One of the hallmarks of the 21st century—increased longevity of the population—will increasingly drive federal, state, and local health care programs to focus on optimizing coordination of services across a range of medical care and community services providers. Discharge planning will play a central role in these efforts, particularly discharge to home.
Is it idealistic to want older adults to get the best possible medical treatment? If our health care system is not doing a good job in this regard, is it appropriate to set a low bar for improvement?
The litany of catastrophes that occur in our poorly organized medical care system—preventable, avoidable suffering—is overwhelming. So far, though, no one is listening.
Working in a big emergency room as part of a team that tries to intercept unnecessary hospital admissions of frail elderly people, I seem to find there are fewer elderly people who call an ambulance themselves and are brought to the emergency room, than elderly people who turn up because somebody else thinks they should be there.
When I took my medical ethics course in medical school many years ago, I learned about the concept of patient autonomy, which is basically the right to make one’s own decisions.
Around the country, people at more than 600 “watch parties” gathered to tune into a livestream of the White House Conference on Aging (WHCOA) on Monday, July 13.
Nurses Jennifer Meindel and Chad Ditlevson stand in front of monitors in a small room at the Mayo Clinic reading vital signs and occasionally calling up video images of patients lying in beds. All of the 40-some patients cycling across the screens are in intensive care in the Mayo Clinic Health System. But none of them are actually at Mayo.
The Voices for Better Health project at Community Catalyst, a Boston-based national consumer health advocacy organization, has released a new video highlighting an important strategy to improve the health and well-being of vulnerable older adults
It should not be surprising that how we pay for a service can drive how those services are delivered.
Basically my wife Robin’s mum Liz and dad Nigel became quite frail over the last several years, at roughly the same time, with all sorts of health, psychological, and general care problems.
In December, California entered another two-year legislative cycle, with almost 40 new lawmakers arriving in Sacramento ready to tackle pressing issues facing our state.
A member of my family was a target for criminal fraud a while back. She’s my oldest sibling at 67. She received a telemarketing call announcing her winnings of a free cruise!
Sylvia Burwell, Secretary of Health and Human Services, recently wrote an article in the New England Journal of Medicine about how Medicare is moving toward a “value-based” payment system.
The Centers for Medicare and Medicaid Services (CMS) has quietly put out two evaluations of the readmissions work– and both documents are remarkable for their failure to evaluate the programs fairly or to provide insights as to what works in what circumstances.
The Stabilize Medicaid and CHIP Coverage Act Lays the Groundwork for Quality Improvement in Medicaid and CHIP
Taken together, Medicaid and the Children’s Health Insurance Program (CHIP) cover more than one in four Americans, mostly children, pregnant women, seniors, families, and persons with disabilities.
Such outrage about awful healthcare! Too many mistakes, too many adverse drug reactions, hospitals making people sick, accidents in the operating room, arrogant doctors, costs going through the roof. What’s the matter? Everyone wants answe
Good news! We will, most of us, live to a ripe old age!
The Medicare Readmission Reduction Program (MRRP) encourages hospitals to reduce readmissions within 30 days of discharge by imposing substantial financial penalties on hospitals with more readmissions than would be expected if the same patients were discharged from an average hospital.
Several years ago, one of my delightful and independent 93-year-old patients had chest pain while in my office.
As a physician, I’ve witnessed firsthand the plight of so many families whose lives are thrown into turmoil as an older parent or grandparent takes a fall, suffers an injury, and experiences a sudden health decline.
Age-related issues, including family caregiving, must become integral to the domestic policy agenda. Until now, they have received lip service.
"Bob" is 87. He is a proud and accomplished man who was born in the 1920s in small-town Saskatchewan with birth injury to his arms and legs.
In early July, Sen. Bob Casey (D-PA) will introduce a novel policy proposal that could be life changing for the millions of Americans who quietly worry and wonder who they can call on for help and steady companionship when a loved one becomes ill, disabled, or very old.
Last month at the annual meeting of the American Geriatrics Society, I heard an interesting presentation on the value of reducing a certain class of medications with potential side effects in people with dementia.
Medicare 2014 has achieved the main goal of Medicare 1965: Access to medical treatment for older Americans. That, and advances in medicine, public health, and technology, have led to long lives and better health. Nevertheless, the system designed for the priorities of 1965 does not match the needs of 2014, and beyond.
We’ve watched it many times on television or in a movie: The patient lies in the intensive care unit, gravely ill, with the family at the bedside.
If you were in a car crash today or become so sick you could not speak for yourself, would anyone in your family know what you’d want the hospital to do?
Getting on in a medical career, especially caring for elderly people whose priorities don’t tend to be technically-based or even specific, I sometimes suspect that my value to people if any is sort of symbolic.
Family caregivers make long-term services and supports work, and yet the risks and challenges to their own health and well-being are often unseen or disregarded.
A recent visit to a very sick friend (let’s call her Ellen) coincided with the weekly visit from her hospice nurse. Having worked for many years on projects to improve care for the end of life—including hospice programs, which are good but not perfect—I was happy to see ideas that we had promoted actually in place.
For all of us, the start of the new year brings an opportunity for reflection and the chance to chart a bold path forward.
It’s difficult coming to terms with the inevitable loss of a loved one, but conversations aimed at preparing friends and family members can alleviate the stress, grief, and confusion that accompanies death and dying
National Family Caregiver Month: Center for Elder Care and Advanced Illness Work to Make Life Better
November is National Family Caregiver Month, in which the nation turns, however briefly, to honor and reflect on the role of family caregivers in delivering essential care to millions of adults.
On one level, discussion at the Altarum Institute’s Sept. 26th Policy Roundtable described familiar ground – a dysfunctional health care system that is blind to the needs of vulnerable older Americans. But on another level, the answers and solutions offered were clear and bold.
When it comes to aging with dignity and independence, the enduring dilemma of how people and society should pay for needed long-term care services often grabs the spotlight. But when money is not a primary focus, what are the most important elements to determine whether people are satisfied with the care they receive?
My 55-year-old brother-in-law, Vince, had arrived at Howard County General Hospital’s intensive care unit late Saturday night. Sunday morning, the police called us: Vince was in critical condition, and we needed to come to the hospital. This is the story of how the journey of my brother-in-law's death led to organ donation and hope for many others.
A couple of months ago Gertrude woke up with a pain in her right groin. I was pretty sure it was a pulled hip-flexor muscle from a forgotten awkward turning-over in bed, and for a while she was fine with some Tylenol. But then it got worse.
It is no secret that Americans are aging, but what is too often lost in this fact is that most people will need help as they grow older. Unfortunately, America does not have a strategy to deal with this growing demand.
The Area Agency on Aging 1-B (AAA 1-B), seeks to meet care transitions needs for elders in two of their counties, Oakland and Macomb, with an innovative multilayer strategy.
Two recent studies demonstrate the tension between efforts to bring the benefits of hospice to patients and their families earlier in the course of a final illness and the requirement that hospice patients die on regulators’ schedules and without expensive drugs or procedures that affect the bottom line.
Quality Improvement Project Shows Major Improvements in Hospital Use for Medicare Beneficiaries in Communities
The Journal of the American Medical Association (JAMA) has published a report describing how communities nationwide applied quality improvement (QI) methods to reduce readmissions.
Beyond the usual talk about a more coordinated and accountable health care system, we must provide new tools to help individuals responsibly plan for their needs as they grow older.
Dr. Victor Montori and his colleagues have begun to call for an approach to medicine that they describe as “minimally disruptive medicine.”
The Academic Consortium for Complementary and Alternative Health Care (ACCAHC), has steadily aligned the work of those disciplines with other groups in health and medicine who are starting to act on the belief that the only way to truly improve care will be through better, much deeper professional relations and collaboration.
Many of the issues that emerge in the chasm between a hospital discharge and full reentry at home are things that are beyond the hospital walls.
"Money and Medicine" talks honestly about the incentive of profit in health care while juxtaposing the actual financial costs of various treatments and procedures with the profound human costs of undergoing those treatments.
We need to rally to demand changes—and fast—if we are to have a medical and social system that can help us to live well and meaningfully in late old age, without bankrupting our families and our society.
More than 40 percent of medication errors arise during care transitions when various possible medication lists are not brought together in a process called reconciliation.
Knowing the details of your diagnosis and likely course, and how your care should happen at every step along the way, is critical.
Everyone is jumping on the bandwagon, implementing evidence-based solutions to problems in transitions, launching new programs and applying for funds.