Hospital Problems

“Since the early 2000s, hospitals have been developing metrics to define high-quality care. In addition to readmission rates and the incidence of various iatrogenic infections, reducing hospital length of stay has been a popular target. Most people prefer nonhospital days to hospitalized days, and insofar as effective treatments hasten the return to health, it seems plausible to assume that shorter stays correlate with effective stays. As an ancillary benefit, shorter stays may cost less and increase “throughput,” resulting in more revenue for hospitals. Because tallying the length of stay is easier than quantifying high-quality care for heterogeneous “hospital problems,” patients … Read More

The Medicare Physician Fee Schedule and Unethical Behavior

“The Medicare Physician Fee Schedule (MPFS) directly determines nearly $200 billion in Medicare spending and indirectly affects an additional $600 billion or more in payments to physicians by other payers. Yet the fee schedule has widely recognized flaws: paying whether the service rendered is medically necessary, is performed efficiently, or meets acceptable quality standards. At its core, clinician fee schedules attempt to pay for clinicians’ time and effort, not whether the care maintains or improves patients’ health. Many hoped that value-based payment models would make MPFS flaws moot. Paradoxically, virtually all the alternative payment models that the Centers for Medicare … Read More

Reinventing the E.R. for America’s Mental-Health Crisis

“In 2012, Scott Zeller, who was then the head of psychiatric emergency services at the Alameda Health System, in Oakland, California, was growing frustrated with the status quo. Many observers blamed long wait times for psychiatric patients on a sharp decline in the number of psychiatric beds in public hospitals. Zeller thought they were missing a more fundamental point. “Why is mental illness the only emergency where the treatment plan is, Let’s find them a bed somewhere?” Zeller asked. “If someone comes in with an asthma attack, we don’t say, ‘We’ve got a gurney here in the back for you. … Read More

Daniel Ellsberg Never Ran Out of Secrets

“Mr. Ellsberg, who died on Friday at 92, copied the military’s secret 7,000-page history of the Vietnam War and gave it to The New York Times and The Washington Post in 1971. The government sued to stop publication, but the Supreme Court defended the First Amendment right of a free press against prior restraint. [..] [New York Times] The number of people with the security clearances to view classified material has expanded, perhaps exponentially, since the leak of the Pentagon Papers, and I wonder, aside from a few people like Edward Snowden and Chelsea Manning, why haven’t there been more … Read More

I Studied Five Countries’ Health Care Systems. We Need to Get More Creative With Ours.

“Discussions of [health care system] reform here in the United States seem to focus on two options: Either we maintain the status quo of what we consider a “private” system, or we move toward a single-payer system like Canada’s. That’s always been an odd choice to me because true single-payer systems like that one are relatively rare in the world, and Canada performs almost as poorly as we do in many international rankings. [..] Universal coverage matters, not how we get there. [..] We have spent the last several decades fighting about health insurance coverage. [..] The only thing we … Read More

At Work, Expertise Is Falling Out of Favor

“Minimal manning—and with it, the replacement of specialized workers with problem-solving generalists—isn’t a particularly nautical concept. Indeed, it will sound familiar to anyone in an organization who’s been asked to “do more with less”—which, these days, seems to be just about everyone. Ten years from now, the Deloitte consultant Erica Volini projects, 70 to 90 percent of workers will be in so-called hybrid jobs or superjobs—that is, positions combining tasks once performed by people in two or more traditional roles. Visit SkyWest Airlines’ careers site, and you’ll see that the company is looking for “cross utilized agents” capable of ticketing, … Read More

Beyond the ‘Matrix’ Theory of the Human Mind

“Already, we are being told that A.I. is making coders and customer service representatives and writers more productive. At least one chief executive plans to add ChatGPT use in employee performance evaluations. But I’m skeptical of this early hype. It is measuring A.I.’s potential benefits without considering its likely costs — the same mistake we made with the internet. I worry we’re headed in the wrong direction in at least three ways. One is that these systems will do more to distract and entertain than to focus. Right now, the large language models tend to hallucinate information: Ask them to … Read More

Why Frenemies May Be Hazardous to Your Health

Excerpt – We often think about relationships on a spectrum from positive to negative. We gravitate toward loving family members, caring classmates and supportive mentors. We do our best to avoid the cruel uncle, the playground bully and the jerk boss. But the most toxic relationships aren’t the purely negative ones. They’re the ones that are a mix of positive and negative. We often call them frenemies, supposed friends who sometimes help you and sometimes hurt you. But it’s not just friends. It’s the in-laws who volunteer to watch your kids but belittle your parenting. The roommate who gets you … Read More

“The Perfection Trap” decries what it calls a “hidden epidemic”

Thomas Curran finds some unusual culprits for the scourge of perfectionism “Mr [social psychologist at the London School of Economics Thomas] Curran distinguishes between three sorts of perfectionism. The first, which looks inward, is the relentless self-scolding of the workaholic or punctilious student. A second version, directed towards others, is commonly found in bosses who have unrealistic expectations of their staff and decry their supposed failings (he cites Steve Jobs as an example). The third and most troublesome kind is the form imputed to society: “an all-encompassing belief that everybody, at all times, expects us to be perfect”. Its victims … Read More

How to Find a Missing Person with Dementia

Excerpt – On the day she disappeared into Los Angeles, Paulikas was one of nearly five and a half million people in the U.S. with Alzheimer’s disease, the most common cause of dementia. (Today, that number is more than six million.) In becoming lost, she experienced one of the disease’s most common symptoms: the unravelling of the brain’s navigational systems. According to some estimates, more than sixty per cent of people with Alzheimer’s disease will wander away from home or a caregiver, or become lost when an abrupt bout of confusion propels them from an otherwise familiar setting. Such episodes … Read More