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Implications of Medicare’s Value-Based Payment Initiative for Specialty Health Systems

Despite the current uncertainty about the direction of health care reform in the United States, the Centers for Medicare and Medicaid Services (CMS) appears poised to transition from standard fee-for-service reimbursement to value-based payments in the coming years. These new models, which were codified in the Medicare Access and CHIP [Children's Health Insurance Program] Reauthorization […]

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Joseph S. Alpert, MD

Are You Planning to Sign Up for a Trip to Mars? Extreme Environmental Health Consequences of Space Travel

In this issue of The American Journal of Medicine, Lipman et al report on therapy for a serious environmental medical condition.1 My commentary below describes an even more serious environmental condition with multiple dangerous and even life-threatening consequences. Recently, one of my colleagues and I at the University of Arizona heard a lecture by one of the retired […]

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The 2017 Match and the Future US Workforce

For 25 years from 1980 to 2005, the number of US MD medical schools and the number of MD students did not increase because of predictions of an oversupply of US physicians by the Council on Graduate Medical Education (COGME).1 Then, in 2005, the COGME reversed its opinion and predicted a shortage of physicians. The […]

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The Seven Ages of the Physician

All the world’s a stage, And all the men and women merely players; They have their exits and their entrances, And one man in his time plays many parts, His acts being seven ages. At first, the infant, Mewling and puking in the nurse’s arms. Then the whining schoolboy, with his satchel And shining morning […]

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Dr. Joseph S. Alpert

Challenging Patients: An International Perspective

Recently, I related the sad stories of 2 challenging patients that I had helped to care for during one of my rotations as attending physician on our internal medicine service.1 The first patient was a frail elderly lady with a number of serious and potentially life-threatening illnesses who insisted on going home to her apartment where […]

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