The New England journal of medicine
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Pay-for-performance programs are being adopted internationally despite little evidence that they improve patient outcomes. In 2008, a program called Advancing Quality, based on the Hospital Quality Incentive Demonstration in the United States, was introduced in all National Health Service (NHS) hospitals in the northwest region of England (population, 6.8 million). ⋯ The introduction of pay for performance in all NHS hospitals in one region of England was associated with a clinically significant reduction in mortality. As compared with a similar U.S. program, the U.K. program had larger bonuses and a greater investment by hospitals in quality-improvement activities. Further research is needed on how implementation of pay-for-performance programs influences their effects. (Funded by the NHS National Institute for Health Research.).
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A 42-year-old man presented with impaired nasal breathing and a slowly growing mass on the tip of the nose. Examination revealed a multilobulated sebaceous nodule protruding from the nasal tip.
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After receiving a ventricular assist device, a patient experiences months of advances and setbacks in the ICU. She's one of a new subcategory of ICU patients: the chronically critically ill. Their stories reveal shortcomings of common perspectives on medical decision making.
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Medicare legislation mandates that the program not pay for items and services that are not "reasonable and necessary" - terms that are open to interpretation and easily politicized. In today's fiscal environment, "reasonable and necessary" warrants a closer look.