The optimism of those emergency physicians who have supported the expansion of Medicaid through the Affordable Care Act is built on the assumption that ‘some pay’ is better than ‘no pay’. And, of course, if it were that simple, they would be correct. But I would humbly submit that we need to take the problem apart a little more to see the details before drawing such conclusions.
If emergency physicians are going to have a chance at influencing
healthcare policy in Washington, they’re going to need to get serious
about organizing and fundraising.
We have always been clinicians, but modern emergency physicians have also become the most skilled managers in the healthcare system. It’s time we capitalize on those talents and proactively learn from the management industry.
In talking with physicians from all over the country, I have found that
most say that charting via an electronic medical record system is the
invention of the devil. Only rarely will an emergency physician say that
they go faster with an EMR than with what they were charting with
previously. And whenever I hear a physician assert this, I generally
wonder how efficient they were in the first place.
Indication creep seems to be the natural course for medical advancement
in the United States. The FDA gives an inch of approval, and we take a
mile. tPA is no different. But this article is not about the controversy
surrounding the efficacy and safety of tPA. The issues with tPA have
gone way beyond professional disagreements about efficacy, safety and
In January, it was reported that 29 children had died from influenza
nationwide1. More recently, the CDC reported that through February 2
pediatric deaths had increased to 59. Such numbers cause the public to
cry out that the medical community do more to prevent these
catastrophes. But can these cases be prevented? As awful as it sounds, I
have to say that I doubt it.
With Washington embroiled over whether to cut entitlements, it can be easy to lose sight of sensible ways to cut major healthcare waste. Here are six cost-cutting solutions presented by Donald Berwick which could save the healthcare system upwards of a trillion dollars.
It may take 700 LPs to find a subarachnoid hemorrhage, but it’s a needle-in-a-haystack worth finding. Dr. Klauer challenges Dr. David Newman’s cost-effective approach in the SAH workup.
A recent article in the NY Times pointed to the belief that “the move to
electronic health records may be contributing to billions of dollars in
higher costs for Medicare, private insurers and patients by making it
easier for hospitals and physicians to bill more for their services,
whether or not they provide additional care”.
A walk down memory lane reminds us that we have yet to see a stroke
study of sufficient size to end the tPA debate. And even when we had
such data, it was largely ignored. Let’s study our history to avoid