elegation’s posterous

el·e·ga·tion: being highly effective, yet simple  
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Medicine

 

CMS Proposed 2010 Payment for Procedures

 

Again, from the federal registrar, table 40, page 720:

While the previous table tries to demonstrate stability in fees, this table shows that charges for the same procedure and care delivery net a 10-30% decrease in charges for 2010.

Does this mean that physicians will receive a 20-30% pay decrease?

Likely not, as the Wall Street Journal reports.

The issue goes back to a law passed in the 1990s that was supposed to ensure that the amount Medicare paid doctors for each beneficiary grew no faster than the overall economy. That didn’t happen. (The law created something known as the “sustainable growth rate,” or SGR, in Washington jargon).

So now there are two different worlds. There’s the official world, in which doctors are scheduled to get a 21.5% pay cut from Medicare next year under SGR. And then there’s the real world, where Congress will intervene at the last minute to block the pay cut, as it’s done time and again in recent years.

There have been calls for Congress to fix the situation, but doing so would wreak budgetary havoc: It would require admitting that payments to physicians are way higher than the government officially expected.

Filed under  //   cms   decrease   medicare   Medicine   payment   procedures  

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2010 Proposed Medicare Changes

Very Interesting.

Culled from the latest 1100+ page document on (pages 716 & 717).

As you can see, the CY 2010 Changes pay less for Cardiology (-11%), Interventional Radiology (-10%), Nuclear Medicine (-13%), Radiation Oncology (-19%), Radiology (-11%).

Specialties with the highest increase in funding include Ophthalmology (11%), Family Practice (8%), Geriatrics (8%), Physical Medicine (7%), Internal Medicine (6%), Anesthesiology (6%), Interventional Pain Management (6%).

Personally I'm a bit confused as to why ophthalmology got such a huge bump, as did anesthesia, interventional pain management, and even orthopedic surgery all enjoy an increase in reimbursement.  Meanwhile cardiology, radiology, and related radiologic service get pretty deep cuts.  

Meanwhile GI, dermatology, emergency medicine, hold steady.

Looking at the graph, its easy to tell that it truly is a zero sum game.  The combined impact nets 0-1% overall changes in funding, meaning that cuts in one area of medicine could be linked to increases in others.

Filed under  //   2010   charges   funding   healthcare   medicaid   medicare   Medicine   politics  

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Madison, Medicine, and Efficiency: One Blog on Multiple Topics, or Multiple Blogs on Single Topics?

I was inspired to make some updates on the blog after watching Michael Hyatt's presentation about blogging.


 

He is the CEO of one of the major publishing companies , and has effectively been blogging since the late 90s.

What I did - updated some of the old posts , including embedding videos directly , clarifying the titles & adding tags to the older posts .  Posterous did not allow tags early on.  I also added google analytics , we'll see if that helps any of the blog's googlejuice (as explained in the book What Would Google Do?) .

I have been thinking about splitting off into 3 separate blogs, for the 3 main topics that I blog about: Madison , Medicine , and Efficiency .  Michael Hyatt & Jay Parkinson keep all of their posts together, even if there is not exactly one common theme, but many themes.  Other successful bloggers such as Joshua Schwimmer (from KidneyNotes , EfficientMD , TechMedicine ) successfully run multiple blogs.

The advantage of having a single blog is the ease in continuing to post, and the simplicity in posting.  The advantage of multiple blogs would be more focused posts, with a unified theme and more relevance to the individual reader.  Google could find my posts easier, and deem me relevant if I ran multiple focused blogs.

Thoughts?

Filed under  //   blog   efficiency   google   gtd   jay parkinson   Joshua Schwimmer   Madison   Medicine   Michael Hyatt   wwgd  

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Choosing a Medical Specialty: Paradox of Choice


Those are the most intimate question you can ask a medical trainee.  It is an intensely personal question and gets to the core of their individuality and self worth.

To try and wedge yourself into this narrative, to offer opinions about the specialty in which they are going to go is to tinker with their fragile narrative in which they have built.  


Intensely anxious times in training include the application process of medical school, residency, and fellowship.  I actually broke out in shingles after my residency match day as I was so run down, my immune system took a hit.

Right now I am reaching one of those points.  While, I need to jump through some hoops including step III USMLE, I also have to start applying to fellowships.  Internal medicine is a wonderful specialty in that it allows a graduate to go into a number of different sub-specialties.  It also allows for one to practice general internal medicine , or hospitalist medicine.


The "choice paradox" makes it extremely painful for me to choose a specialty.  While there are a number of specialties that I could see myself in, and would be happy in, this makes it even more difficult to choose.  When I choose one specialty I am in effect saying "I will not be going in to, x".  The loss of that possibility hurts:

Paradox of Choice via Lifehacker 

"the paradox of choice. In a media-saturated world where you see and hear about so many people doing so much interesting stuff day in and day out, it's even more difficult to settle down on one pursuit than it was 10 to 20 years ago, when people simply didn't have as many options. With so many things out there you could do, so much greener grass over the fence taunting you, it feels almost impossible to commit. Choosing one thing really means you're not choosing a million others"

Filed under  //   Choice   Medicine   Paradox   Specialty  

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ePocrates for iPhone (medical app) critique

Overall I have been impressed with ePocrates for the iPhone.  It is an application I have been waiting for for some time.

However three annoyances have popped up:

1.  It takes a few taps to get to the app in the first place (as it does for any application on the iPhone).
      - A shortcut, or hotkey to go right to ePocrates would be great 

2.  The program takes 5 to 10 seconds to load before I can tap on the blank query spot to type in my drug name.
     -  The default load when loading ePocrates should already be with the keypad pulled up, waiting for you to enter the drug name.
     -  My colleagues using the old PDA are able to load drug info much faster than me.

3.  I do not get reception for my cell phone in the place where I see many of my new patients:  The emergency department.
     - The hospital should give free, fast, and unlimited wifi access to its employees.

Filed under  //   design   efficiency   ePocrates   iphone   medical   Medicine  

Comments [1]

Ebling.

Where I gather my thoughts and think big.



Sent from my iPhone

Filed under  //   architecture   design   inspiration   iphone photo   Library   Madison   Medicine   study space  

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I'm rooting for hello health

Hello Health, hope it works.  Can't wait to see it in action.

Filed under  //   jay parkinson   Medicine   web 2.0  

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My new pocket handbook -concise cardiology





Sent from my iPhone

Filed under  //   book   cardiology   iphone photo   Medicine   recommended  

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JTF Wiki

I just discovered this website.  It appears to be a wiki for helping interns in one of the VAs around the country.  Very relevant even to my program.

Includes helpful cross-cover tips, art-line tips, etc.

Filed under  //   inspiration   Medicine   recommended  

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Doctor's room on friendfeed:

Created by Dr. Joshua Schwimmer, the doctor's room on friendfeed is much easier to read than the RSS link of all the twitter posts of the same format.

Kudos.

Filed under  //   friendfeed   Joshua Schwimmer   Medicine   recommended   twitter   web 2.0  

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