Letter from the Editor-in-Chief

Posted On February 1, 2018 By In Letter from the Editor-in-Chief

Expectations Disease

There are a few things from residency training that resonated so profoundly for me that they permeate everything I have done since. I will never forget my first delivery, not because I thought I would ever deliver babies in my practice, but because of the emotional and enduring collision of medicine and nature it represented for me. And who can forget the 36-hour shifts (now extinct) that I am quick to recount for young clinicians with the perfunctory “back in my day….” There were, of course, specific patients whose storiesRead More
In the year 2000, Google famously adopted the corporate code of conduct motto, Don’t Be Evil to represent its approach to both business and workplace behavior. At the time, the approach seemed sensible, but today it feels strikingly out of touch. It’s a low bar that misses the mark on one of the most pressing issues of our time: respect and freedom from harassment, at work, at home, and at play. Don’t be evil is simply not good enough anymore. The ugliness of workplace culture—and, in particular, discrimination and harassmentRead More
It pains me to write this column. The opioid epidemic is arguably the most catastrophic and enduring public health crisis since the flu epidemic of 1918—yes, even worse than the HIV/AIDS epidemic of the ‘80s. Since 2000, over 200,000 people have died from overdoses of prescription opioids alone, another 300,000 from heroin and synthetic opioids. Now synthetic fentanyl has infiltrated the market with the most toxic opioid ever known. The overdose death curve is steepening. There is no fix in sight and our response is already too little, too late.Read More
Connecticut Democrats Seek Regulations for Urgent Care Centers. When this alert hit my inbox, I must say it was a bit alarming. Whenever I see “urgent care” and “regulations” in the news it’s unsettling to say the least. I am probably not alone. The regulatory rumblings have come and gone before, but this one has me more concerned. Here’s a little background: Connecticut legislators and the state Department of Public Health (CDPH) have been interested in looking for ways to reduce the healthcare expenditures related to emergency department utilization forRead More
In my last column, I tried to explain the complicated math involved in calculating the potential financial impact of MACRA/MIPS on urgent care centers. I made the case for a significant return on investment for a typical urgent care with a typical mix of Medicare patients. Of course, all of the potential return depends on implementation of practical and efficient quality improvement programs that meet the measurement and reporting expectations outlined by the Centers for Medicare and Medicaid Services. So, in this column, we will explore the core categories inRead More

Posted On August 28, 2017 By In Letter from the Editor-in-Chief

Do the MACRA’ena?

Corny titles aside, MACRA/MIPS is creating a great deal of uncertainty and anxiety among physician practices, and urgent care centers are no exception. I have seen a lot of urgent care news sources, including this journal, referencing the latest updates from CMS (or recent articles published by other organizations), but urgent care-specific analysis is in short supply. I frequently hear colleagues say, “Medicare is such a small percent of my business, it’s just not worth the hassle.” Or is it? As with most government programs, complying with the rules indeedRead More
“Grant me the serenity to accept the things I cannot change; courage to change the things I can; and wisdom to know the difference.” I’m not usually one to quote religious text, but this excerpt from the Serenity Prayer resonates. Perhaps the most pointed and overwhelming challenge facing physicians today is the loss of control over our profession. The last three decades have seen dramatic erosion of the status, ownership, and independence of physicians. The root cause is multifactorial to be sure, with influence from powerful special interests across multipleRead More
CQI – Continuous Quality Improvement: The process by which an organization identifies a problem, plans action to address the problem, implements the plan, and reviews the results for effectiveness.       In healthcare, we commit to CQI in order to affect outcomes; we focus on systems and process and how inefficiencies and lack of integration lead to undesirable outcomes. We scrutinize and identify a problem and propose a plan to change the process to improve outcomes. Here’s a very simple example: A universally accepted clinical quality goal is to reduce theRead More