Category Archive: NEJM

Physician Payment Reform — Progress to Date

The sustainable growth rate (SGR), a formula used by the Centers for Medicare and Medicaid Services (CMS), frequently specified large cuts in Medicare rates of payment for physician services, which led Congress to step in to defer the cuts. Now that th…

Managing Uncertainty — Harnessing the Power of Scenario Planning

“The greatest danger in times of turbulence is not the turbulence, it is to act with yesterday’s logic.” — Peter Drucker When he got behind the wheel that evening, Father Andrew had no way of knowing how the drive would end. At age 87, he still drove to the grocery store, remained active in church,…

Certain about Dying with Uncertainty

Mrs. C. a woman with whom we’d had a long-standing patient–physician relationship, one of us for over 25 years, died recently in the 87th year of her life. A woman who had always maintained her cheerful spirit even in the midst of quite trying medical setbacks, she was one of our favorite patients.…

Active Surveillance for Low-Risk Cancers — A Viable Solution to Overtreatment?

There is wide variation in the intensity of treatment for low-risk cancers, and many patients are at risk for overtreatment. Despite 5-year survival rates that approach 100% among patients with low-risk differentiated thyroid cancer, prostate cancer, a…

From Last to First — Could the U.S. Health Care System Become the Best in the World?

Many Americans believe that the United States has the best health care system in the world, but surprisingly little evidence supports that belief. On the contrary, since 2004, reports from the Commonwealth Fund have consistently ranked the performance …

The Economics of Indication-Based Drug Pricing

Pharmaceutical treatments and medical devices often have varying effectiveness depending on the indication for which they’re used: in oncology, for instance, response to a treatment varies with the type of tumor and stage of disease. The advent and proliferation of precision medicine in which…

The Chair Grant

For the year between graduating from college and beginning a doctoral program in clinical psychology, I worked as a researcher in a cardiac surgery department in my hometown of Halifax, Nova Scotia. But on Mondays, Wednesdays, and Fridays, I would leav…

Threats to Information Security — Public Health Implications

In health care, information security has classically been regarded as an administrative nuisance, a regulatory hurdle, or a simple privacy matter. But the recent “WannaCry” and “Petya” ransomware attacks have wreaked havoc by disabling organizations worldwide, including parts of England’s National…

Home-to-Home Time — Measuring What Matters to Patients and Payers

Ever since Medicare’s inpatient prospective payment system was implemented in 1983, U.S. hospitals have been trying to find ways to reduce the average length of stay. This payment model flipped the status quo: instead of being paid for each day that a patient spent in the hospital, hospitals were…

Patient-Reported Outcomes — Are They Living Up to Their Potential?

As part of a nationwide movement toward giving patients more of a voice in their health care, an increasing number of organizations are collecting and assessing patient-reported outcomes (PROs). There is a growing chorus of support from clinicians, res…

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