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NEJM—Health Policy and Reform

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https://www.readbyqxmd.com/read/28723331/certain-about-dying-with-uncertainty
#1
Jeffrey M Drazen, Maria A Yialamas
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...
July 20, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28723330/active-surveillance-for-low-risk-cancers-a-viable-solution-to-overtreatment
#2
Megan R Haymart, David C Miller, Sarah T Hawley
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, and ductal carcinoma in situ (DCIS) of the..
July 20, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28723329/managing-uncertainty-harnessing-the-power-of-scenario-planning
#3
Margaret L Schwarze, Lauren J Taylor
"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,..
July 20, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28723320/physician-payment-reform-progress-to-date
#4
Paul B Ginsburg, Kavita K Patel
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 Now that the SGR has been repealed, the dominant policy..
July 20, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28708020/from-last-to-first-could-the-u-s-health-care-system-become-the-best-in-the-world
#5
Eric C Schneider, David Squires
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 of the U.S. health care system last among..
July 14, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28700848/the-economics-of-indication-based-drug-pricing
#6
Amitabh Chandra, Craig Garthwaite
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..
July 13, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28700838/the-chair-grant
#7
Jennie G David
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 leave work in the early afternoon, head down to the..
July 13, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28700269/threats-to-information-security-public-health-implications
#8
William J Gordon, Adam Fairhall, Adam Landman
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..
July 12, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28679102/patient-reported-outcomes-are-they-living-up-to-their-potential
#9
Judith F Baumhauer
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, researchers, and payers for embracing PRO..
July 6, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28679095/home-to-home-time-measuring-what-matters-to-patients-and-payers
#10
Michael L Barnett, David C Grabowski, Ateev Mehrotra
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..
July 6, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28657878/air-pollution-and-mortality-in-the-medicare-population
#11
Qian Di, Yan Wang, Antonella Zanobetti, Yun Wang, Petros Koutrakis, Christine Choirat, Francesca Dominici, Joel D Schwartz
BACKGROUND: Studies have shown that long-term exposure to air pollution increases mortality. However, evidence is limited for air-pollution levels below the most recent National Ambient Air Quality Standards. Previous studies involved predominantly urban populations and did not have the statistical power to estimate the health effects in underrepresented groups. METHODS: We constructed an open cohort of all Medicare beneficiaries (60,925,443 persons) in the continental United States from the years 2000 through 2012, with 460,310,521 person-years of follow-up...
June 29, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28657876/air-pollution-still-kills
#12
EDITORIAL
Rebecca E Berger, Ramya Ramaswami, Caren G Solomon, Jeffrey M Drazen
In late October 1948, a dense smog descended over the town of Donora, Pennsylvania. The town was home to a zinc plant and a steel mill, both run by the United States Steel Corporation. Susan Gnora, a 62-year-old resident of Donora, started to gasp and cough as the smog descended. She died the next..
June 29, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28657869/decision-aids-and-elective-joint-replacement-how-knowledge-affects-utilization
#13
Said A Ibrahim
The health care market is undergoing rapid transformation, spurred in part by the Affordable Care Act (ACA) and recent payment reforms introduced by the Centers for Medicare and Medicaid Services (CMS). The industry is shifting from a business-to-business model involving insurers, health care..
June 29, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28657867/machine-learning-and-prediction-in-medicine-beyond-the-peak-of-inflated-expectations
#14
Jonathan H Chen, Steven M Asch
Big data, we have all heard, promise to transform health care with the widespread capture of electronic health records and high-volume data streams from sources ranging from insurance claims and registries to personal genomics and biosensors. Artificial-intelligence and machine-learning predictive..
June 29, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28658587/recognizing-sepsis-as-a-global-health-priority-a-who-resolution
#15
Konrad Reinhart, Ron Daniels, Niranjan Kissoon, Flavia R Machado, Raymond D Schachter, Simon Finfer
"Some very important clinical issues, some of them affecting life and death, stay largely in a backwater which is inhabited by academics and professionals and enthusiasts, dealt with very well at the clinical and scientific level but not visible to the public, political leaders, leaders of..
June 28, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28654356/health-wealth-and-the-u-s-senate
#16
Debra Malina, Stephen Morrissey, Mary Beth Hamel, Caren G Solomon, Arnold M Epstein, Edward W Campion, Jeffrey M Drazen
The Better Care Reconciliation Act (BCRA), as the U.S. Senate calls the health care bill released by a small working group of Republican senators last week, is not designed to lead to better care for Americans. Like the House bill that was passed in early May, the American Health Care Act (AHCA),..
June 27, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28636856/on-incarceration-and-health-reframing-the-discussion
#17
Rahul Vanjani
What remained of Mr. P.’s hair had come undone from the tight braid he’d fastened before his last chemotherapy treatment. His facial bones now protruded, as if a sculptor had gotten carried away. There was no mirror in his cell at the maximum-security prison where Mr. P. had spent more than half..
June 22, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28636834/implementation-of-medical-homes-in-federally-qualified-health-centers
#18
Justin W Timbie, Claude M Setodji, Amii Kress, Tara A Lavelle, Mark W Friedberg, Peter J Mendel, Emily K Chen, Beverly A Weidmer, Christine Buttorff, Rosalie Malsberger, Mallika Kommareddi, Afshin Rastegar, Aaron Kofner, Lisa Hiatt, Ammarah Mahmud, Katherine Giuriceo, Katherine L Kahn
Background From 2011 through 2014, the Federally Qualified Health Center Advanced Primary Care Practice Demonstration provided care management fees and technical assistance to a nationwide sample of 503 federally qualified health centers to help them achieve the highest (level 3) medical-home recognition by the National Committee for Quality Assurance, a designation that requires the implementation of processes to improve access, continuity, and coordination. Methods We examined the achievement of medical-home recognition and used Medicare claims and beneficiary surveys to measure utilization of services, quality of care, patients' experiences, and Medicare expenditures in demonstration sites versus comparison sites...
July 20, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28636831/health-insurance-coverage-and-health-what-the-recent-evidence-tells-us
#19
Benjamin D Sommers, Atul A Gawande, Katherine Baicker
The national debate over the Affordable Care Act (ACA) has involved substantial discussion about what effects — if any — insurance coverage has on health and mortality. The prospect that the law’s replacement might lead to millions of Americans losing coverage has brought this empirical question..
June 21, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28636481/turmoil-in-the-individual-insurance-market-where-it-came-from-and-how-to-fix-it
#20
Henry J Aaron, Matthew Fiedler, Paul B Ginsburg, Loren Adler, Alice M Rivlin
In recent weeks, some health insurers have announced that they will not offer individual market coverage in 2018, while others have requested sizable premium increases. In response to this news, President Donald Trump has pronounced the individual market structure created by the Affordable Care Act..
June 21, 2017: New England Journal of Medicine
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