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the
Acute Care
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It's Time for a Broader View of Healthcare Value

By Brian Anderson, MD

One of the toughest challenges facing any military is how a trained soldier will act when bullets start flying.

Some hunker down, claiming it’s common sense to avoid injury. Of course, this type of rationalizing can also be a way (subconscious or otherwise) to disguise fear. Nor does it accomplish the unit's goals, because inaction and self-preservation aren’t exactly keys to success in battle.

Other soldiers face fear head on. In a 2011 blog post for the Wall Street Journal, reporter Bing West shared his experiences while embedded with a highly effective platoon of Marines in Afghanistan. One of the officers told West about a radio conversation they’d recently interrupted between Taliban leaders and the local militia. The Taliban was chastising the guerillas for running from fights. The locals protested that victory was impossible because the Marines actually ran toward their bullets.

Reform Realtime Video: How Have You Prepared for Reform?

The Affordable Care Act brought about a lot of changes for providers, administrators, and patients. Although three years passed between passage and implementation of the key elements, everyone has been trying to prepare to meet the new regulations and requirements. In this video, hear from providers across the country on what they've done to prepare for healthcare reform.

What has your organization done to prepare? Share your thoughts in the comments section.



The Role of Urgent Care in Population Health Management

By Bonnie Carl, RN, MBA

20140107__08HWOAT~2_500.jpgMy pediatrician made house calls. I always knew when I heard the pan of water being placed on the stove that a needle was being sterilized and an injection was coming. He knew that I was a gymnast and that my brother was on the swim team, and frequently asked how we were doing in competition.

What I just described was commonplace in the 1950s and 1960s. To me, those were the "good old days" when the doctor actually knew me. And he was my doctor in the hospital, outside the hospital and even in the emergency room! He called the surgeon, orthopedist or urologist and facilitated the specialized care I needed.

Times Have Changed

Fast forward to today … we have too many patients in the emergency department (ED), too few inpatient hospital beds, too few primary care providers and too many people who are uninsured or underinsured. For primary care physicians, the income is in the office, not the hospital. And given their workload, very few have the time to make house calls.

This struggle is playing out across our country, with more consolidation of services, creation of medical homes and efforts to expand coverage (though the depth of these new insurance products is questionable). It all boils down to diminished capacity to provide care.

Could Healthcare Reform Actually Raise the Cost of Care? (Part 1)

By John Fredericks, MD, FACEP

16x9.jpgWhile courts continue to hammer out the details, it's probably safe to say that the Affordable Care Act (ACA) is here to stay. Most significantly, the Supreme Court has opined that the individual insurance mandate is a de facto tax — and not an unconstitutional imposition of mandatory insurance.

This isn't necessarily bad news. While the ACA may be flawed, something needed to be done to contain rising costs and improve access to care in our country. However, as I've watched implementation play out, I've been concerned that the policy will have unintended consequences that could lead to even greater cost inflation.

Essentialism Is an Important Practice of Mindfulness (Part 2)

tumblr_inline_mn9bpe0ZBW1qz4rgp.pngDo Less, but Do It Better.

By Anne Bruce

Welcome to Part 2 of my article on essentialism and mindfulness. In Part 1, I explain that when we are mindful, we choose to live by design. When we marry mindfulness with essentialism, we expand our capacity to be all that we can be. We reclaim the power of making better choices by focusing on what really matters, or what is absolutely essential. We cut out a lot of the so-called "white noise" that can distract us or suck the energy out of us — distractions that are prevalent in acute care settings.

In Part 1, we talked about the differences between essentialist and non-essentialist thinking. Now let's take a look at how these habits of mind can make us more effective healthcare providers and leaders.

Putting Pressure on Ourselves

Do you feel it? The relentless pressure to try to do it all for your leadership, your patients and your team? Are you trying to sample all the good things in life at once by saying yes to every high-profile project? Or are you participating in too many things that you thought would showcase all of your talents at once?

How Providers Can Prepare for Population Management

By Jeff Bass, MD

adaptability.jpgOn my first day of medical school, during introductory lectures, the dean said something that seemed a little radical:

"At least 50 percent of everything we teach you in the next four years is going to be proven wrong at some point in the future. The only problem is, we don't know which 50 percent that is."

Those words are particularly salient today as our system begins its shaky transition away from fee-for-service toward population health management. Today's physicians must adapt and evolve not only clinically, but in the realm of care delivery as well.

The Path of Least Resistance: Engaging Healthcare Professionals in Change

By Tiffany Hackett, MD, MBA, FACEP

Four years into healthcare reform, change fatigue is pretty common among healthcare providers. We're overwhelmed with metrics and mandates. We're held responsible for patient outcomes we sometimes feel helpless to control.

On top of it all, we're expected to provide excellent customer service. The patient experience piece often draws resistance from change-weary providers. After all, they're providing excellent clinical care. Isn't that enough?

As a practicing emergency physician, I definitely have empathy for this viewpoint. But recently, a colleague told me a story that really drives home the link between patient experience and outcomes.

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