Tuesday, August 28, 2007


Fellow bloggers:

When I first began “blogging” about three years ago I intended it to be a newsletter for a RHIO that I was heading up in my area of the country. About a year ago I chose to rename it “Healthtrain Express”. The term recently coined by others came to my mind in 1989 (that definitely dates me) It was in the pre-DRG, pre RVU, pre managed care (ie, the “golden days”) that my residents often wistfully mention..
I often tell them that no “age in medicine” is trouble free. It’s the nature of the “beast”.

Healthtrain express conjures up the rapid changes that constantly occur in medicine. For those of you who have read “Future Shock “ by Alvin Tofler , this has always applied to medicine. I highly recommend this reading.

It also denotes a vehicle with a tremendous amount of inertia, barreling down a “track” . If you are on the track you had better be moving fast enough to stay ahead of the train. If you are stationery, then you must either move aside or be “smashed”.

Returning to more specifics of our “age in medicine” we see the predictions and evolution of pay for performance and reporting, health information technology, the methodology of reimbursement change, including CMS intention to not reimburse for “poor outcomes” or those due to “poor care”. Medicine will continue to be increasingly directed by third parties, consumers, and political and social planners. Most of whom have never treated a patient. This one issue frustrates most physicians, although it has become a fait acompli, I know it continues to “gall” most doctors.

Physician-hospital relations continue to be in a state of flux. Gone forever in most areas is the leadership of the medical staff as it pertains to the board of directors, or trustees of the hospitals. In some rural areas this may remain intact, unless the hospital is part of a larger financial “holding company”. Creative financing has allowed many hospitals to continue operations with “leaseback arrangements” for management, and other issues.

Looming on the horizon is radical change in hospital accreditation organizations.
The JCAH authority is about to be undermined by pending legislation and some hospitals chose to use alternative accreditation sources This may or may not be a good thing, given that operating requirements have radically changed for hospitals.

For those of my readers you may notice on the sidebar the expansion of medically related blogs. Over the next month this list will be expanded. This is going to involve a significant amount of my time selecting and moderating my personal favorites.

I am also extending a personal invitation for co-authors to contribute to “healthtrain express”. Please email me if you wish to do so. email gmlevinmd@gmail.com

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