Rick Peters, commenting on John Halamka’s post, the "Broken Window Effect" …

"Speaking of downtime – have you ever determined why your organization,
mine, and virtually everyone in health care does routine scheduled
system downtimes on Saturday nights? I understand the theory that it
gives you Sunday to recover, but there isn’t an ER in the country that
isn’t busiest Friday night, Saturday night, Sunday late
afternoon/evening, and Monday night (Tuesday if it’s a three day
weekend). More admissions to our institutions occur at those busy ER
times than at any other time. I would think that physicians in IT
organizations could change this – do routine downtime on Wednesday
night, and in reality do it Thursday morning between 3AM and 5AM –
that’s when things are quiet."

Maggie Mahar has this to say in the thread on Matthew’s "Critical of Critical"" post …

"As for group practice vs. solo practice–solo practice is becoming economically unaffordable. More and more younger doctors recognize this, and would prefer to work in a very large group, on salary. The Dartmouth reserach also confirms that the most efficient outcomes (high quality at a lower price) come in multi-specialty centers where docs are on salary."

Harvard Pilgrim CEO Charlie Baker comments on the thread on his recent "Is Massachusetts a model for national reform?"  …

"if there’s a better way to do this, I’m all ears, but don’t
underestimate three factoids when you consider applying other industry
smarts to these particular problems. Factoid #1 – Through Medicare, the
federal government is the biggest payor – by far. This is an incredibly
constraining market reality. Factoid #2 – Employers and state and
federal governments are the ultimate payors, the consumer is the user,
and the provider/supplier makes most of the resource use and allocation
decisions. This is not a traditional buyer-seller market. Factoid #3 –
When asked, most people think health care services should be "free."
This really complicates reform efforts, whatever direction they go in".

More Commentology coming soon …