Pay for Performance vs Intrinsic Motivation

Among the many stories about health care heroes during Hurricane Sandy, this was my favorite: Allison Chisholm, 46, who works for the Visiting Nurse Service, lives with a frail mother in Park Slope, Brooklyn. When the lights started flickering during the storm on Monday, she had images of her mother falling in the dark. But she also had patients who needed her, including one receiving hospice care in a 12th floor apartment in Chinatown, and one needing an intravenous round of antibiotics in the West Village. “It was treacherous driving during the hurricane,” said Ms. Chisholm, fitting an intravenous line into the arm of Jill Gerson, 71, who teaches social work at Lehman College in the Bronx. “But it’s just something you have to do as a nurse. That continuity of care helps the healing. I don’t see this as being heroic. I have a conscience. I need to get…

Was the Massachusetts Board of Registration Too Harsh on this case of Doctor-Patient Sex?

The Boston Globe recently reported that the Massachusetts Board of Registration in Medicine revoked the license of Dr. Gary Brockington, a 54 year old primary care physician and cardiologist, for having had a sexual relationship with a patient. I’ve not been able to get a copy of the report from the Division of Administrative Law Appeals, so I’m entirely dependent on the Boston Globe story, which has extensive quotes from Brockington’s lawyer. The story, if accurate and complete, leads me to speculate that revocation of licensure may be too severe a penalty in this specific situation. According to the Globe, Brockington experienced a Job-like series of events in 2006. He was newly divorced, bankrupt, and depressed. During the same stretch of time his sister (his only sibling) broke her neck and was left by her husband. Brockington became legal guardian for her two young children. One of his patients, a…

More about the Massachusetts Board of Registration in Medicine and Doctor-Patient Sex

There were two letters to the editor in today’s Boston Globe about the Massachusetts Board of Registration in Medicine’s decision to take away Dr. Gary Brockington’s license. (See here for my original post.) Nurse Mary Hourihan gives a perspective on Dr. Brockington’s overall practice like what we’ve heard from patients of other physicians who have been disciplined for sexual relationships with patients: As a nurse who has worked at the Faulkner Hospital for more than 30 years, I was shocked and saddened to read your article concerning the state Board of Registration in Medicine’s revocation of Dr. Gary Brockington’s medical license (“Board revokes Faulkner cardiologist’s license after affair,” Metro, Nov. 24). The doctor has cared for his many patients with the utmost professionalism and expertise. Although I do not work directly with him, nearly every day I hear from our mutual patients the reverence in which he is held. The…

Politics vs Rational Medicare Reform

I’m a staunch New England liberal/yellow dog Democrat. And I support Howard Dean’s organization – Democracy for America. But I shuddered when I received this message in a fund-raising email: Republicans lost big in the election, but John Boehner is trying to force his right-wing agenda on the American people anyway. Republicans in Congress are taking advantage of the fiscal showdown and trying to jam through massive cuts to Medicare that would be devastating to America’s seniors. (emphasis in the original) Republicans, occasionally joined by renegade Democrats, have plenty of bad ideas about Medicare, like raising the age of eligibility (see here) and turning Medicare into a voucher program (see here). But experts agree that at least 30% of what we spend on health care is waste. I’ve talked with lots of practicing physicians about this. No one has ever estimated waste at less than 25%, and many have estimated…

Accountable Care Sprints Ahead

A recent report from the Oliver Wyman consulting firm – “The ACO Surprise” – argues that ACOs are on the verge of triggering a major transformation of the US health system. I hope their prediction comes true! For all the complexity of federal ACO regulations, I see ACOs as making four core basic commitments: Take responsibility for helping a population be as healthy as possible Connect specialties, disciplines, and sites (hospitals, rehabilitation, nursing homes) in a coordinated manner Engage patients as active partners – ideally leaders – in promoting their own health and guiding their treatment Accept payment for producing valuable results for the population, not for the individual units of service rendered Here’s the Oliver Wyman view of the near term ACO landscape: 2.4 million current Medicare ACO patients 15 million non-Medicare patients of the Medicare ACOs. The report predicts that the Medicare ACOs will move towards caring for all…