National Health Expenditures continue to accelerate in 2015

In 2009 a youthful Barack Obama addressed a joint session of congress on health care on a cold fall evening.  The country was still recovering from the great financial crisis, and the new President was now attempting to turn the nation’s eye to health care. As he had done many times before, Obama spoke powerfully of…

Why Trump won? A brief tutorial for Harvard medical students

Mike Milligan, a Harvard medical student, recently writes in THCB about the shock felt throughout his medical school upon the election of Donald Trump.  Seeking to understand how it may be that ‘equality, service and compassion’ were defeated, Mike settles on the narrative that appears to have taken hold of the elites on the left…

Trade-off’s in heart failure

On the day Donald Trump was elected, I wrote about the inverse relationship that may exist between heart failure readmissions and heart failure mortality – a topic I had been itching to write about for some time.  It all started in 2012 when The Center for Medicare and Medicaid Services (CMS) instituted the Heart Failure…

Death and Readmissions

Eugene’s wife is on the phone.  She has been taking care of Eugene for 41 years.  I supposedly take care of his heart, weakened by two prior heart attacks.  I say supposedly because his wife does all the heavy lifting.  She makes sure he takes his medications when he should.  She watches his weight every…

Medicare Advantage – the cup that spilleth over

I was asked to see an unfortunate elderly man – Harry – one afternoon.  He had multiple coronary stents placed for coronary disease over the course of the last ten years, and after presenting with difficulty speaking, was found to have a brain tumor.  The neurosurgeon was hoping I could provide some reassurance about how…

Making Accountable Care Organizations great again

Test your Accountable Care Organization knowledge: Select all of the options that are True If you belong to an ACO you qualify for the alternative payment model track in MACRA Most ACO’s are enrolled in to a two sided risk model – (They share profits and losses with Medicare) In 2015, ACO’s saved Medicare more than a…

A hole in the heart – Part 2

Click here for part 1 Analysis of the Randomized Control Trials The 3 randomized trials performed tested two closure devices – CLOSURE I tested the STARFLEX device (NMT Medical, Boston, MA). The PC and RESPECT trial tested the AMPLATZER device (St. Jude Medical, St. Paul, MN).  Let’s look at each study closely. CLOSURE I (Starflex…

A hole in the heart – Part I

Strokes are the third leading cause of death in the United States.  800,000 people suffer a stroke every year, and the consequences are frequently devastating.  Lives are not just lost, but changed forever – speech permanently silenced, arms and legs turned into useless appendages.  The brain is very expensive real estate and it is little surprise that…

Tweet thread from @EHSANI 22

Long post. Ignore if you’re not interested in Syria. My lesson from health policy is that the main stream media narrative usually has no basis in reality – the journalists simply report what’s intentionally leaked to them by one paid off think tank or the other. Below is an interesting version of events from Damascus…

A story of holes

Strokes are the third leading cause of death in the United States.  800,000 people suffer a stroke every year, and the consequences are frequently devastating.  Lives are not just lost, but changed forever – speech permanently silenced, arms and legs turned into useless appendages.  The brain is very expensive real estate and it is little surprise that…