Word: physicians
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...cities." And it was a remarkable success for "consilient" thinking, a philosophy formulated in the 1840s in which a cohesive theory from one discipline is used to inform ideas from another. Snow's work on administering ether as an anesthetic convinced him cholera was ingested, not inhaled. As a physician he understood how disease spread through a body. As a resident of Soho, he had the local knowledge to realize that the contagion radiated from a single source. "When you look at cholera at any one of those levels, it's hard to see how it works," says Johnson...
...says. He and other candidates at this stage are given $50 for this trouble, “a trifling sum” according to James. Once this paperwork is completed, the real fun begins: a meeting with a genetic counselor, a physical examination with the company’s physician, and two samples, according the sperm bank’s web site. Unfortunately for James, things went sour—after this stage, he was rejected. “They don’t tell you why you’re rejected,” James explains, unless the reasons...
Hospitals are fighting back in none-too-subtle ways. Some won't let an ASC physician-investor admit patients in their wards. And powerful health systems often use their leverage to lock physician-owned competitors out of preferred networks of insurers. Via Christi owns Kansas' largest managed-care plan; Wesley has an exclusive contract in Wichita with the state's leading insurer, Blue Cross and Blue Shield. "It's brutal competition," says David Laird, CEO of the Heart Hospital of Austin, which competes with the Texas nonprofit Seton Medical Center. "They act like they have a halo over their heads...
Nowhere is this more apparent than in diagnostic imaging. Last year Americans spent more than $100 billion on outpatient scans. Medicare's imaging costs have been growing 16% a year, much faster than the 9.6% rise for all physician services. The most lucrative--MRI and CT--climbed 25% last year. A third of the testing, says Donahue of National Imaging, is inappropriate; doctors order unnecessary scans, or two when one would suffice. "This is one of the most unsavory and concerning areas of how imaging is delivered," he says. "It's when imaging studies are not based upon clinical needs...
Though these changes are probably a step in the right direction, they do not directly address the problem of physician self-referral--or the distorted economics that underpin the rise of specialty facilities. Next year Medicare will pay physicians more for the time they spend on their patients' well-being, but, HSC researcher Dr. Hoangmai Pham notes, it still rewards them far more generously for procedures than for cognitive services like diagnosis and management of disease. So Wichita, which 15 years ago had seven psychiatric inpatient facilities, now has one, run by Via Christi. It has six that do heart...