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 …

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  1. Its an excellent point by Maggie, one that needs greater emphasis in policy reform discussions. It also highlights one of the downsides of Obama’s possible funding approach for health IT ($50K per provider). A key benefit of the emerging P4P bonuses based on implementation of health IT was that it favored large practices– they have a scale advantage to buy EHR systems first (particularly with relatively modest incentives), which then makes these practices more attractive to patients while they are simultaneously more lucrative to physicians. Health IT-based P4P is potentially an excellent policy tool to accelerate the consolidation of physician practices into these larger, higher performing groups. With such a generous subsidy from an Obama plan, allowing small and large physicians practices to bring health IT on board, the effect will be to slow down our evolution away from 1 and 2 physician practices.