Born Too Soon for Lean
May29

Born Too Soon for Lean

Lean arrived a little late for me. Even now, the Triple Aim is still more of a goal than a reality. When I think back over the system of waste in which I practiced medicine, I am left with the regret of the lost time spent licking envelopes, making calls for approvals, make calls to cajole a consult when the system had not been staffed to meet expected demands, and using my one-off problem solving skills to make it through the day. I...

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Pioneer ACOs’ Successful Efforts
May21

Pioneer ACOs’ Successful Efforts

Recently the Boston Globe published the much-anticipated results of the independent actuarial accounting of the results of the first two years of the Pioneer ACOs program of CMMI.(Click here to read the whole article.) I find it impossible to read this without wanting to comment. Many may not remember that the first accountings of the Pioneer ACO program were somewhat different. In 2013 there was an article in the Globe and in papers...

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Medical Practice & the 8 Wastes
May14

Medical Practice & the 8 Wastes

As I reflect in early retirement on my years of practice, I am a little surprised that I am losing the names of many of my patients. I saw thousands of patients in more than a hundred thousand office visits and stood at the bedsides of thousands more in hundreds of tours of duty as the hospital-based cardiologist on call for my practice; but now, without the refresher of a recent visit, even some of the most active patients are...

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Fostering Healthcare Innovation in Vermont
May05

Fostering Healthcare Innovation in Vermont

In my recent encounters with leaders who are fostering healthcare innovation in Vermont, I have observed that leadership within the ACOs, The Vermont Medical Society, forward-looking and socially oriented members of Faculty at the UVM Medical School, the leadership of state health agencies, members of the legislature, the governor and the local leadership of the regional health areas all have a high degree of understanding of the...

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