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.

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.

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.

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.