A new model of online health care delivery science education for mid-career health care professionals.

Health care delivery science focuses on ways to improve health and health care services provided to individuals and populations. Health care professionals must be trained in health care delivery science in order to diagnose and treat the sources of health care system dysfunction and achieve better outcomes while controlling costs. The ideal model for health care delivery science training has not been fully defined, but doing so is critical especially for frontline mid-career health care professionals whose original clinical training omitted these concepts. To better prepare leaders to address the complex challenges of health care, we created a novel hybrid residential/online 18-month master's degree in health care delivery science. Key strengths of the program are the curriculum, pedagogy, teaching team and close-knit cohort. Here, we discuss the program design rationale and six years of evaluation data of a novel master of health care delivery science program. Novel online education in health care delivery science can empower inter-professional leaders in multiple leadership positions throughout health care to improve the United States health care system.

The unintended consequences of bundled payments.

Consensus is building that episode-based bundled payments can produce substantial Medicare savings, and the Center for Medicare & Medicaid Innovation's Bundled Payment Initiative endorses this concept. The program generates potential cost savings by reducing the historic cost of time-defined episodes of care, provided through a discount. Although bundled payments can reduce waste primarily in the postacute care setting, concerns arise that, in an effort to maintain income levels that are necessary to cover fixed costs, providers may change their behaviors to increase the volume of episodes. Such actions would mitigate the savings that Medicare might have accrued and may perpetuate the fee-for-service payment mechanism, with episodes of care becoming the new service. Although bundled payments have some advantages over the current reimbursement system, true cost-savings to Medicare will be realized only when the federal government addresses the use issue that underlies much of the waste inherent in the system and provides ample incentives to eliminate capacity and move toward capitation.

Economic impact of a primary care career: a harsh reality for medical students and the nation.

PURPOSE: The ranks of U.S. medical students choosing careers in primary care (PC) are declining even as the demand for new PC physicians is increasing. Although the decision to choose a career in PC is multifactorial, financial security in the setting of rising medical student debt is often cited as a reason to pursue other medical specialties. The authors sought to quantify the financial factors associated with a career in PC. METHOD: The authors used economic modeling, which employs a variety of factors, to develop a net income and expense model. They attempted to account for the variability of factors by looking at best, worst, and average expense scenarios. They used published retrospective data from the Bureau of Labor Statistics, the 2007 Physician Compensation Survey, the National Association of Realtors, the College Board, and U.S. News and World Report regarding medical student debt, physician reimbursement, retirement planning, college savings, and cost-of-living expenses to develop their models. RESULTS: PC salaries, in contrast to other subspecialties, result in an initial budgetary deficit and decreased discretionary spending. This gap closes as PC physician income rises in the first few years of practice. Only under scenarios of optimal low cost assumptions or no debt do a PC physician's initial earnings exceed predicted expenses. CONCLUSIONS: PC physicians, in the first three to five years following residency, will have expenses that exceed earnings. This reality greatly increases the financial disincentive for pursuing a career in PC compared with other fields of medicine.

The fixed-cost dilemma: what counts when counting cost-reduction efforts?

The high fixed-cost structure of hospitals and the predominance of "joint costs" mean few truly variable costs can be captured by small or incremental cost reduction strategies. Many of the proxy metrics used to measure cost savings, such as length of stay and readmissions, typically does not reflect true cost savings, but should be seen as measures of additional capacity with the potential for added revenue. To achieve true savings, hospitals should consider reducing capacity when possible and making better use of the remaining capacity, increasing throughput, and reducing costs per discharge.