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During my residency in emergency medicine, an attending physician watching me place a central venous catheter spoke up. "Don’t let go of the wire!" he warned. "Right," I agreed. But secretly, I thought, "Why not? It’s not going anywhere." I’ve placed easily more than 100 central venous catheters…
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The reform of health care payment systems has centered on moving providers away from fee-for-service payment. The most clinically comprehensive of the alternative payment models — population-based global payment — gives providers a spending target or budget for the entire continuum of care within a…
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Evidence of the value of primary care to the U.S. health care system continues to grow. Supporting primary care is a major goal of the Centers for Medicare and Medicaid Services (CMS), which has added new billing codes to pay for previously uncompensated care (e.g. long-term care and transitional…
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Congress passed the Orphan Drug Act in 1983 to spur development of drugs to treat rare diseases. Among the law’s incentives were exclusive marketing rights for 7 years for the rare-disease indication ("orphan drug exclusivity"), a 50% tax credit for costs associated with the clinical testing of…
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Each year, nearly 40,000 Americans die often painful, protracted deaths from diseases caused by asbestos. These deaths occur in firefighters, police officers, construction workers, miners, military veterans, shipyard workers, and maintenance workers whose exposures to asbestos are primarily…
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Groups of physicians, hospitals, and other health care providers participate in Accountable Care Organizations (ACOs) in the Medicare Shared Savings Program (MSSP) with the goal of delivering high-quality care while spending below a benchmark based on their historical spending. MSSP ACOs can…
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The U.S. Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 authorized an estimated $20 billion to $40 billion in incentives for health care providers to both adopt and "meaningfully use" certified electronic health record (EHR) systems. One of the stated main goals…
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Half my patients died. They died from one disease, but so many different deaths. After a decade of honing my ability to quickly determine "sick or not sick" and allocating time and resources accordingly, I learned that when managing a ward of patients with Ebola, clinical appearance did not always…
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Treating major depressive disorder remains an important challenge worldwide. The disorder impairs productivity, social functioning, and overall health, reducing life expectancy and burdening health care systems. Although many treatments exist, at least a third of patients do not have a response…
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Transcatheter aortic-valve replacement (TAVR) was approved in 2011 in the United States. As a condition of reimbursement, the Centers for Medicare and Medicaid Services (CMS) requires TAVR programs to perform a minimum of 20 TAVR procedures per year or 40 over a period of 2 years. Although other…

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