Thinking About ACOs Again For the First Time
Jan10

Thinking About ACOs Again For the First Time

I am proud to be a member of Whittier Street Health Centers Foundation Board and was delighted when our very able CEO, Frederica Williams, recently asked me to talk to the organization about ACOs at their Grand Rounds. Whittier Street is an exceptional example of a practice that will be sorely tested by the chaos that Jonathan Oberlander describes in his “Perspective” article, “The End of Obamacare”, in the January 5, 2017 issue of...

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Lean Supports Healthcare Service and Leadership
Feb02

Lean Supports Healthcare Service and Leadership

It is paradoxical that despite all of the opportunities for professional satisfaction in healthcare,  one of the issues of greatest concern that challenges the Triple Aim is the emotional health and happiness of healthcare professionals. Healthcare is populated by very competent and caring people who chose their profession because of their desire to contribute to better care. Many of those same people are becoming disillusioned, angry...

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The Moral Injury of Avoidable Death
Jun25

The Moral Injury of Avoidable Death

Last week I passed on a story my friend Dr. Doug Beers told me about a case of avoidable death as a result of medical “overkill.” It was a distressing story, but Doug recently told me another story that disturbed me more. We were sitting on the dock at my place on Little Lake Sunapee, chatting with my neighbor who had just given us a tour of the lake on his boat. The conversation turned to my long-term friendship with Doug, and to the...

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Overkill Can Be Deadly
Jun18

Overkill Can Be Deadly

Dr. Doug Beer, my former colleague and longtime friend, told me a story about the way healthcare overkill can actually kill a patient. Doug, who practices internal medicine at Emanuel Hospital in Portland, Oregon, and I were talking about cancer treatment during a recent visit he and his wife, Leslie, paid to my wife Nancy and me in New Hampshire. Doug confused me when he said he had a patient who died because he was treated too soon...

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Everyone Gains from Lean
Jun05

Everyone Gains from Lean

Everyone, whether they are senior management, middle management, line management or the hands-on employee has much to gain from Lean. Lean can buffer the impact of chronic issues of emotional fatigue and performance pressure. It also helps with the stress of accountability in the face of difficult external and internal factors and and unrealized personal aspirations. Lean can combat the cynicism that arises from the pettiness of...

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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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Healthcare Is a Civil Right
Apr14

Healthcare Is a Civil Right

I see the current efforts to extend healthcare to all Americans to be an extension of the issues of equality of opportunity that were expressed by President Obama in his speech marking the 50th anniversary of the Civil Rights movement. Ironically, it is hard to imagine a great country with more than an eighth of its population denied access to one of the fundamentals necessary to be a productive member of society. Statistics often...

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