Robert P Kocher

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HOSPITAL READMISSIONS HAVE BEEN THE SUBJECT OF ever-increasing scrutiny. Indeed, they are an important focus of the US Patient Protection and Affordable Care Act (ACA). Identified by the Medicare Payment Advisory Commission as a major action item for some time, hospital readmissions remain prevalent, costly, and largely preventable. The recently updated(More)
n engl j med 364;19 nejm.org may 12, 2011 1790 ulus to use a less-effective regimen and would lead to unnecessary strokes and disability. The Cardiovascular and Renal Drugs Advisory Committee considered these issues at length5 and slightly favored approval of only the higher strength. A closely related issue in comparing a new anticoagulant with warfarin is(More)
O f the $2.6 trillion spent in 2010 on health care in the United States, 56% consisted of wages for health care workers. Labor is by far the largest category of expense: health care, as it is designed and delivered today , is very labor-intensive. The 16.4 million U.S. health care employees represented 11.8% of the total employed labor force in 2010. Yet(More)
The Affordable Care Act is a once-in-a-generation change to the U.S. health system. It guarantees access to health care for all Americans, creates new incentives to change clinical practice to foster better coordination and quality, gives physicians more information to make them better clinicians and patients more information to make them more(More)
became public. For example, responding to the Senate report, Vice President Dick Cheney said rectal feeding was not approved but that he believed “it was done for medical reasons.” It seems more accurate to describe rectal feeding as a technique of sexual assault. Seen in the context of the constant state of nudity of most black-site prisoners, it seems(More)
2579 person who has been awake for more than 22 of the previous 24 hours is impaired by sleep depri­ vation (www.sleepresearchsociety .org/Government Affairs.aspx). Chronic sleep deprivation de­ grades one’s ability to recognize the impairments induced by sleep loss.5 Sleep­deprived clinicians are therefore not likely to assess ac­ curately the risks posed(More)
IMPORTANCE Recent governmental and private initiatives have sought to reduce health care costs by making health care prices more transparent. OBJECTIVE To determine whether the use of an employer-sponsored private price transparency platform was associated with lower claims payments for 3 common medical services. DESIGN Payments for clinical services(More)
n engl j med 370;16 nejm.org april 17, 2014 1473 approved by the FDA since 2009 are for orphan diseases and cancers.1 This disproportion is not solely the result of scientific breakthroughs; the economics of drug development and the business of health care delivery also play large roles. Although these drugs may end up being critically important to patients(More)
We conducted interviews with senior executives at 10 leading health systems to better understand how organizations use performance-based compensation. Of the organizations interviewed, five pay physicians using productivity-independent salaries, and five use productivity-adjusted salaries. Performance-based pay is more prevalent in primary care than in(More)