Ironically, some of the newer value based initiatives, such as BPCI, along with changes to the post acute skilled nursing reimbursement, is actually decreasing the amount of time and care some of these elderly could benefit from post operatively to enhance their recovery.
If we allowed our elderly Medicare patients to go into a rehab unit for the amount of days they need, without requiring a 3 night hospital stay first, I wonder the impact this would have on morbidity and mortality, especially after minor operations.
Great idea. I've read about Scanwell before.
Does the accuracy of the results vary at all with the quality of the camera (newer vs older iPhones)?
Also, if a patient is someone who is colonized with bacteria, and doesn't necessarily have an acute infection, would the app be able to inform them as such?
True, but that’s pretty much what I took from this article. People with vascular heart disease who have not had an acute coronary event still compromise a significant chunk of the patient population. Many of them still currently receive stents or cabg.
"Doctors know that the price of the most effective treatments may not sustain their profession."
This is not really a fair assessment. The most cost effective treatments can be self administered. But if you are coming in to see me because of persistent knee pain, more often that not you have already tried tylenol and over the counter nsaids (ibuprofen, etc.), and your pain has been persistent. The next set of treatment options, aside from maybe some physical therapy, are more expensive, because they involve using drugs that are more expensive or treatment measures that are more expensive.
With re: PRP, it is not covered by insurance, since the benefits of it over a placebo are still not entirely clear. Many doctors offer it however, and to insure accuracy of needle placement, they usually perform it under ultrasound guidance- not something most people would be able to do on their own, at least not yet. As more and more physicians offer it, and if it remains uncovered, market forces will drive the prices down (like Lasik), although I'm doubtful PRP is considered an effective treatment option in the future.
I don't disagree with the notion that healthcare remains quite expensive in general. I see telemedicine, for certain conditions, reducing costs and maybe Direct Primary Care - bundling care into one package instead of serving it piecemeal could be a good way to go forward.
that was what the RUGs were supposed to do, but it was easily gamed and I don’t see why this wouldn’t be either.
The only advantage it offers, IMO, is that it allows patients with a greater variety of needs (like more nursing skill and less or no therapy) to receive care. For example, the end stage cancer patient who can’t withstand much therapy but isn’t ready to accept hospice.
This is stunning in its scope and made me wonder in what other developed country is it even possible for a citizen to defraud its government of over 1 billion dollars?
The skilled nursing system in this country is broken, with no meaningful oversight other than an annual inspection which everyone knows is coming. Lengths of stay are unnecessarily long and the quality of care is unbelievably sub par. Despite all of this, fraud at this level is pretty astounding, and should serve as a wake up call for the government to more aggressively monitor all facilities, or outsource monitoring from the States to private agencies.
There’s some evidence that suggests adipose tissue can be an inflammatory mediator - which potential could lead to arthritic changes in joints. This is used to explain why we get arthritis not only in weight bearing joints such as the knees and hips, but also in the digits of the hands, which don’t bear as much weight.
Presumably as a regular runner, you are not overweight (less adipose tissue than a more sedentary person)
The flaws with eCWs system aside, the larger problem with EHRs, and the fact that to date they have not improved outcomes in any significant way, lies with the fact that they are primarily designed to “optimize” revenue cycle management. Everything has to be documented correctly - or else it can’t be billed for or may get rejected on audit.
Hospital staff, including physicians, are responsible for the accuracy of this documentation, but that’s a big responsibility to bear.
The only way this may change is if we change how we pay for our care. This is not on the horizon at this time. Even the value based programs that CMS has implemented are really fee for service with a look back and adjustments to payments made based on savings that were encountered.
I don't disagree with this, but the children have the right to know - for example, are there inheritable medical conditions which they may be at risk for? or if not medical, what about inheriting other traits? I think this paragraph summed up this concern well:
"Ballard struggled with what it meant, existentially, to have inherited the DNA of a man who would lie to his patients and abuse his position as a doctor. Whatever made him do it, was that inside her, too? She knew the thought wasn’t entirely rational, but she couldn’t shake the feeling that a dark impulse might be lurking deep within her."
Why would Versace, Chanel, Burberry etc which are considered luxury brands, all of the sudden sell discounted frames? They have extensive markups on all of their clothing, handbags etc.
They are targeting a different, and I would imagine dwindling, market.
There are plenty of options online and offline for cheaper frames.
I realize that, and I don’t have the valuation numbers for either company, presumably CB Insights does.
But using the example you gave, if there were a list of companies entering the 3 billion valuation, business fundamentals aside, I’d be hard pressed to pick between Aurora and Nuro.
They should describe how they came up with this list.
For example, Alto pharmacy, which appears to primarily operate in California, is on the list. They raised $50 million last December. Capsule pharmacy, which essentially does the same thing, primarily operates out of NYC. They also raised $50 million a few months earlier, in August 2018, but are not on this list.
Wonder why?
I’ve seen them around NYC, downloaded the app and waited for them to expand their routes but they never did.
I’m not sure why. Seems like a good idea - but I suppose it may have been a challenge to compete with the wide variety of services, including public transportation, that are available in the city.
It’s true that Epic and Cerner are the dominant players when it comes to hospital EMRs, but they have less of an influence in outpatient settings outside of academic medical centers.
For larger outpatient practices that are participating in value based programs (ACOs, care bundles, etc.), such as the type apple amazon or google may choose to work with or, less likely, build, there’s less of a need to rely existing EHR vendors and a greater likelihood to rely on a variety of tools that are able to interact with each other.
The trend is for more and more care to move outpatient. There’s opportunity for innovation there.
Yes, in the car via CarPlay. It makes for safer driving. I just plug my phone in and put it away so I can’t reach it to text and drive. I then ask it to text, look up directions or play whatever song I want.
Having post-operative pain is a legitimate reason to use them. Just use them judiciously. Your goal should not be a pain level of zero, it should be a pain level that is manageable. You will likely have the option of using Tylenol instead if you prefer, and possibly NSAIDs, so you can try either of those before you resort to narcotics.
Everyone reacts different. In the past week I've had someone who underwent a hip replacement who can't get around without heavier doses of narcotic pain meds. And I've had a guy who had his leg amputated, who just takes Tylenol.
I picked up a Surface Laptop 2 a week ago, as a replacement for my older MacBook Air, and so far I’ve been pleased with it. The hardware may not have the fit and finish of a MacBook, but it’s still slim, lightweight and attractive in its own way. The screen is great.
And that keyboard...just works.
The article doesn’t mention the Surface product line, it doesn’t contribute much to Microsoft’s revenue, but it allows the company to present itself as a new Microsoft and demonstrate what’s possible with Windows.
If a company has built a product that’s filled with problems, why buy another version of the same product from them.
My original MacBook 12” was plagued with issues. It was underpowered and the keyboard was horrendous. I vowed to not get another MacBook, since most of my work is browser based or using office. I don’t rely on iTunes or iphoto on the laptop. Getting iMessages is nice but not something I’ll miss. For work there are other messaging services.
I love my iPhone, my AirPods and my iPad, but the MacBook product line is disappointing.
But do you really think Michael Bloomberg doesn’t get this?
There’s money spent on research projects and there’s money spent on retaining high quality faculty who could probably do well in a corporate environment if they chose to.
It’s not clear to me how any of this is new.
What id like to hear is how researchers reconcile this concept with what is seen certain other countries, mostly Asian, where rice is a staple of their diet, and where you don’t see the levels of obesity we have in the US.
Sometimes patients don’t have an option but to go to such a facility, at least on a short term basis.
Hospitals try to discharge patients as quickly as possible, which often results in patients leaving when they may be medically stable, but are functionally compromised or are in need of services, such as iv antibiotics or wound care, that may be difficult to provide at home. If they live alone, it’s even more challenging. So the nursing facility becomes the only option.
Facilities traditionally have had an easy access to a constant supply of patients, along with high reimbursement. They’ve have had little incentive to improve.
Fortunately care bundles (BPCI) are starting to change this, giving hospitals a vested interest in where their patients go and what the outcome is. Facilities are going to have to improve the level of care and service they provide - or risk shutting down.
This was essentially announced at the end of last year, and is now being closed.
You can now search for songs on Apple Music by typing in the lyrics to the song.
Whereas I'm sure they are useful in the outer boroughs, I feel ride hailing apps are becoming less useful in Manhattan itself.
It's not uncommon for me to request Lyft or Uber, be told to expect a car in 5 minutes or so during which time the driver gets stuck in traffic or is unable to make a turn somewhere because of construction, etc - and that 5 minutes turns into 10 minutes or longer.
In the interim, several yellow cabs will have gone by and I'm left wondering why I didn't just take a taxi.
I find the apps to be incredibly useful outside of Manhattan, and especially when I'm traveling to other cities, but in Manhattan I've nearly stopped using them.
How about improving on some of the food items?
Starbucks had purchased BayBread/La Boulange for 100 million several years ago. Yet when I walk into a Starbucks and look at the selection of pastries behind the glass casing, they look dehydrated and unappealing. My local cafe has stuff that actually looks like it was freshly baked that morning. They usually don't make them in house, they work with local bakers. Starbucks should consider doing something similar.
His proposal, which hasn't been fully released as of this writing at least, seems to have other modifications as well. The article mentions at least bathrooms and elevators.
He also plans to complete this overhaul in 5 years - previous estimates had suggested it could take 50 years. That sounds ambitious, and i'm guessing there must be significant cost associated with completing it relatively quickly.
Charge me per article I want to read. 25 or 50 cents? Make it seamless so I can hit Apple Pay and then read the article.
I would do it, and I bet so would many others.