Word: doctoral
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Dates: during 2000-2009
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...Geisinger uses a little of all three strategies. Founded in 1915 as a 70-bed hospital in a small, underserved rural community, the operation now spans a 43-county region, with a total of 67 sites - stretching from one-doctor offices and in-store clinics to a sprawling main campus in Danville, Pa. Like Kaiser, the 13,000-employee Geisinger is both a care provider and an insurer. About 30% of its 783,000 patients have the in-house coverage; the remaining 70% are covered by other private insurers or Medicare...
...doctor's pay is not fixed in advance. Salaries are pegged so that they stay within 80% of the national average, but up to 20% of income is based on teams' achieving performance goals. If the cardiac group keeps its complication and readmission rates below a certain level, paychecks get fatter because costs decrease. Ditto for the pediatric orthopedic team, which must successfully treat kids for, say, spinal curvature without being too quick with the knife for those who don't need surgery or too slow for those who do. "We keep cash compensation flexible and incentivized," Steele says. "That...
...primary care is: separate charges for the hospital, the anesthesiologist, the lead surgeon, the post-op checkups, and on and on. Care itself can be similarly fragmented, with patients finding themselves in the hands of whoever happens to be on duty at any point in the day and a doctor on the night shift knowing little about a patient whose surgeon worked the day shift. Dr. Alfred Casale, Geisinger's chief of cardiothoracic surgery, tells stories of surgeons who don't even conform to the same rules for color-coding wires in a heart device, making it awfully hard...
...need a computer to tell you that an 80-lb. 4-year-old needs to lose weight, it helps when the same system also warns about a food or drug allergy or a missed measles vaccination. When a child Grauso-Eby treats goes to see a specialist, that doctor will see the same chart, and an alert will flash if the two doctors are prescribing drugs that adversely interact. The chart will track the kid throughout life - for the orthopedist or cardiologist or obstetrician he or she sees in later years. (Watch TIME's video "Uninsured Again...
...make medicine less lucrative for some practitioners. But it would give others a new opportunity to practice medicine in an almost forgotten way: getting to know their patients and keeping them healthy so they can avoid a surgeon or a hospital. "It's a chance for a primary-care doctor to be a hero again," says Dr. Thomas Graf, chairman of Geisinger's community-practice team. That's not the stuff of AA bond ratings or billion-dollar revenue streams, but it just might be worth more than both...