A Defense of Physicians’ Gatekeeping Role: Balancing Patients’ Needs with Society’s Interests

Although scholars and policymakers increasingly accept the need to ration health care, physicians doing so at the bedside remains controversial. Underling this debate is how to characterize the duty of care physicians owe their individual patients. Ethically, physicians are under strict fiduciary obligations that require them to give primacy to individual patients\u27 best interests. However, new health care delivery models that hold providers financially accountable for health care costs assign to physicians a gatekeeping role, with physicians obliged to balance individual patients\u27 needs with the competing societal goal of controlling costs. This Article explains that the choice between the traditional patient-centered duty of care and a dual duty of care that balances patient and societal concerns turns on which paradigm best promotes the public interest. It then argues that the public interest would be better served by a dual duty of care because bedside rationing is essential if the U.S. is to successfully control health care costs. In addition, a dual duty of care furthers the policy goals underlying recent federal and state health policy initiatives. This Article concludes by identifying several tenets of health law and ethics biased toward a patient-centered duty of care--physicians\u27 duty of advocacy, the medical malpractice system, and informed patient consent--and contends that each should be reformed to accommodate physicians\u27 dual duty of care

Investigating the potential for a user-driven electricity monitoring application to provide useful electricity consumption patterns

Conventional electricity usage monitoring involves complex data collection via costly and intrusive hardware installation. There is a perceived need for a simple and affordable tool that provides users with feedback about their electricity consumption without the hardware installation. This study involves the design and development of a user driven mobile and desktop application that provides users with information on electricity usage patterns and historical trends. The application was designed using Ionic Framework, a tool ideal for the design of hybrid applications that are compatible with both desktop Windows devices and mobile Android devices. The goal of the research will be that the user will track their appliance usage on the application whilst taking electricity meter readings at regular intervals to calculate appliance-specific consumption. The data is added to the mobile or desktop application, which then provides users with a comprehensive display of the electricity usage patterns and trends. The objective is to provide users with the information required so that they can start understanding their electricity consumption better and it is a first step towards empowering the user to make smart decisions at home that will reduce their electricity consumption. The USE (Usefulness, Satisfaction, Ease of Use and Ease of Learning) questionnaire was used to gather user experience feedback from participants about user experience. The USE questionnaire tests the perceived Usefulness, Satisfaction, Ease of Use and Ease of Learnability The 31 individuals who initially volunteered to take part in the study are all residents of the City of Cape Town Municipality, aged between 20 and 80 years old. Not all participants are home owners; some are tenants in their premises. The sample group was selected on a convenience basis, and social media group posts were also used to reach individuals with a potential interest in the study. The two motivating factors that were considered to identify individuals who could potentially have an interest in the study were cost saving and environmental impact. 21 volunteers completed the study and returned the USE questionnaire. The study findings showed that all participants believe that using the application helped them to better understand their electricity consumption

Developing a Health Care Workforce That Supports Team-Based Care Models That Integrate Health and Social Services

Across the country, health care professionals are joining forces to improve the health care of populations with complex social, financial, and behavioral health needs. One promising approach relies on community-based integrated health teams (CIHTs), or interprofessional teams that integrate a broad range of medical, behavioral health, and social services, offer intensive case management, and link patients to available community resources. Yet whether CIHTs fulfill their potential depends in part on policymakers enacting policies that support CIHTs delivering comprehensive, high-value care to their patients. Drawing on the insights of CIHT professionals shared with the authors, this Article highlights several factors that contribute to CIHTs’ success, namely utilizing community health workers (CHWs) to provide patients with high-touch care, including behavioral health experts on the care team, and increasing coordination between CIHTs and patients’ primary care providers. The Article then calls for federal and state policies that would promote expansion of the CHW and behavioral health workforce, provide more flexible and sustainable financing to CIHTs, and support primary care providers acquiring the financial resources, data capabilities, and personnel needed to either embedding CIHTs within their practices or coordinate with outside CIHTs

Spending Medicare’s Dollars Wisely: Taking Aim at Hospitals’ Cultures of Overtreatment

With Medicare’s rising costs threatening the country’s fiscal health, policymakers have focused their attention on a primary cause of Medicare’s high price tag—the overtreatment of patients. Guided by professional norms that demand they do “everything possible” for their patients, physicians frequently order additional diagnostic tests, perform more procedures, utilize costly technologies, and provide more inpatient care. Much of this care, however, does not improve Medicare patients’ health, but only increases Medicare spending. Reducing the overtreatment of patients requires aligning physicians’ interests with the government’s goal of spending Medicare’s dollars wisely. Toward that end, recent Medicare payment reforms establish a range of financial incentives that encourage more efficient practices among physicians. Physicians, however, do not practice medicine in a vaccum. Rather, they are profoundly influenced by the organizational cultures of hospitals. Far too often hospitals’ cultures lead physicians to provide Medicare patients care of questionable value. If Medicare is to successfully contain costs, it must prod hospitals to move from cultures of overtreatment to cultures of efficiency. Current Medicare reform proposals, however, do too little to address hospitals’ cultures of overtreatment. That is unfortunate, as regulators will have limited success in constraining Medicare’s growth if hospitals’ cultures continue to foster the overtreatment of Medicare patients. This Article therefore sets forth a more robust proposal for reforming Medicare payment policy, one that would facilitate hospitals fully embracing a culture of efficiency. Specifically, federal regulators should reform the Medicare Hospital Value-Based Purchasing Program so that a hospital’s Medicare payment rates are tied to the hospital’s success in lowering the cost of treating patients both inside and outside the hospital setting. Regulators could accomplish this goal by incorporating into the program efficiency measures based on broadly defined episodes of care