Happy Birthday!

This someecard is absolutely 100% true.  The number of notifications from Facebook that pour in on one’s birthday is astronomically high.

And today they are all mine.


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Bundled payments – for hip and knee replacements

Hip and knee replacements are among the most common operations performed in the United States.  In 2013, there were over 400k performed, and the inpatient stays alone cost Medicare $7 billion.  The Medicare payout for each procedure – including surgery, hospital stay, and recovery (rehab) – ranges from $16,500 to $33,000, largely dependent on where in the country the procedure is performed.  That obviously adds up to a lot of dollars and says nothing about how well the patient does post-operatively.

Well, Medicare wants to change that.  On Thursday, officials at CMS proposed paying for hip and knee replacements as bundled payments – holding hospitals accountable for the full episode of care from surgery until 90 days post operation.  The idea? Having hospitals work with physicians, home health agencies, rehabs, and nursing facilities to coordinate the patient’s care and avoid unnecessary readmissions and complications.  The upside? Hospitals would be rewarded with extra payments if patients do well.  Hospitals with higher complications would have to partly repay the government.

The thought process behind the proposed changes is moving the nation’s health care system from a fee for service basis – in this case paying providers for each operation – to a pay for performance – rewarding quality of care rather than quantity of care.  Medicare has been testing different payment methods to improve quality and reduce costs, a concept that was solidified with the passage of the Affordable Care Act.

Officials chose hip and knee replacements because they are so commonly performed, but also because the number of procedures is projected to increase as the nation’s population ages.  Additionally, cost and quality vary widely across the country, where complications like implant failures and infections can be three times higher at some hospitals.

Of course, there are downsides and hidden incentives in any payment structure.  Ideally, the new payment rules would force hospitals to look at their processes, standardize treatment, and invest in care coordination and quality control.  Hospitals may begin to look at their own data and try to identify providers that have poor outcomes. Unfortunately, under performing hospitals will be hit hard with penalties, greatly affecting their bottom line.  This may incentivize some of them to select less-high risk patients or cease performing the operations all together.  As in physics, every action has an equal and opposite reaction.  Only time will tell what happens with this latest proposal (public comments are open until early September), but if this proposal can work on such a large scale, it won’t be long before the same concept trickles down to other operations as well.

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Pursuing your dreams?

Haha just kidding, I’m totally not quitting… but for those of you considering a job change…

quitting to dream not work here someecard

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toning it down at work

I’m not sure where this memo came from, but I found it on the internets and it’s funny.  Seeing as tomorrow is Monday, perhaps you might want to try some of the cleaner phrases at work.

Or maybe you dont give a flying f***.

not swearing at work

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We hold these truths to be self-evident…

… that the uninsured rate in the United States continues to decline.

The rate of uninsured Americans declined yet again in the 2nd quarter of 2015, according to the folks over at Gallup.  The uninsured rate across adults in the United States fell to 11.4%, the lowest the rate has been since Gallup began daily tracking in 2008.

While the decline in the overall rate is impressive, decreases in the uninsured rate were almost universal across the board.  Whites, African-Americans, and Hispanics all saw gains in insurance coverage.  For individuals under the age of 65, the drop in the uninsured rate was at least 5.7% from the fourth quarter of 2013.  And all income brackets saw higher rates of coverage, with those earning less then $36,000 in annual household income seeing the rate drop by nearly 10%

uninsured rate

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Age at first marriage

This has absolutely nothing to do with health policy, but it was interesting so on the blog it goes.

If you’ve ever looked at your Facebook timeline and wondered why all the pictures are of people you know getting married – well, there’s a reason for that.  Everyone has an opinion about when the right age is to get married – and it turns out that age at marriage is a vital statistic that is tracked by each state.  So… you can see the average age of first marriage and how you stack up against others in your state.  Personally, I’ve always aimed for being above average.


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(hardly) working late?

During residency, there were definitely times when all the work was done, and we would sit around fully ready to go home and yet found it difficult to get up.  We called this “the inertia”.  This is another form of inertia.


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