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Medical Staff – Hospital Alignment
The growing misalignment between hospital medical staffs and administration is examined, with a hybrid solution proposed involving employed physicians and service line co-management agreements to improve engagement and quality metrics.
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Baby Steps to Healthcare Reform
Three concise healthcare reform proposals are offered — eliminating pre-existing condition exclusions, allowing insurers to sell across all US markets, and adopting a loser-pays malpractice standard — with particular emphasis on how loser-pays would curb frivolous suits and the hidden costs of defending dropped claims.
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Nationalized Healthcare and the Free Market
A scenario is laid out in which nationalized healthcare arrives not through legislation but through a government-sponsored insurance option so much cheaper than private plans that employers adopt it by default, eventually leaving physicians and hospitals with a de facto single payer.
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Appendiceal Duplication
An unusual operative case is described in which a patient with classic appendicitis signs was found intraoperatively to have an appendiceal duplication — a rare anomaly confirmed on pathology — with the perforated duplicate forming a phlegmon and a relatively normal true appendix discovered just before closure.
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General Surgery in NY
Observations from the American Society of General Surgeons meeting in New York City, where academic presenters championed controversial minimally invasive approaches — such as laparoscopic closure of diverticular perforation without resection — that struck the author as treatments that would fail an oral board exam.
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Saving Medicare?
The post argues that physicians brought the Medicare reimbursement crisis on themselves by accepting low contracted rates, and endorses letting the 10.6% cuts stand in hopes the financial pain will finally compel doctors and hospitals to cancel their Medicare contracts and force real systemic change.
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Ambulance Chaser
A lawyer showed up uninvited outside the ICU to solicit a trauma family, claiming a vehicle defect — even though the driver was intoxicated and traveling over 100 mph — confirming that ambulance chasing is very much real.
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Never Events
CMS expanded its list of so-called never events — hospital-acquired conditions it will no longer reimburse — and a surgeon argues the policy is a cost-cutting measure disguised as patient safety, since many of these conditions cannot be prevented 100% of the time.
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Immediate Breast Reconstruction and CMS
A frustrating CMS billing dispute is recounted after performing immediate breast reconstruction following another surgeon's mastectomies, with Medicare refusing payment because the add-on code requires both procedures to be done by the same physician.
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Ivory Towers
A regional Level 1 trauma center refused a difficult transfer for specialized endovascular care, sparking reflection on how academic medical centers have drifted from their traditional mission of supporting community surgeons without question.
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Closing the Office
An announcement that the author is closing his elective surgical practice to join a local trauma group, a move driven by the rising costs of running a private office.