Antibiotic Resistant Bacteria Trends

Antibiotic medications have made a major contribution to human health.  Many diseases that once killed people can now be treated effectively with antibiotics, but some bacteria have become resistant to commonly used antibiotics.  Antibiotic resistant bacteria are bacteria that are not controlled or killed by antibiotics; they are able to survive and even multiply in the presence of an antibiotic.

Antibiotic resistance refers specifically to the resistance to antibiotics that occurs in common bacteria that cause infections.  Antimicrobial resistance is a broader term, encompassing resistance to drugs to treat infections caused by other microbes as well, such as parasites (e.g. malaria), viruses (e.g. HIV) and fungi.  Most infection-causing bacteria can become resistant to at least some antibiotics. Bacteria that are resistant to many antibiotics are known as multi-resistant organisms.

The World Health Organization (WHO) declares that antibiotic resistance is one of the biggest threats to global health today.  When infections can no longer be treated by first-line antibiotics, more expensive medicines must be used.  A longer duration of illness and treatment, often in hospitals, increases health care costs as well as the economic burdens.  Scientists have found that antibiotic resistant bacteria can spread from person to person in the community or from patient to patient in hospital.

According to WHO, in the European Union alone, drug-resistant bacteria are estimated to cause 25,000 deaths and cost more than US $1.5 billion every year in healthcare expenses and productivity losses.  In the United States, the Centers for Disease Control and Prevention (CDC) as found an ever-increasing number of cases related to drug-resistant bacteria.  Here are some recent facts published by the CDC:

154 million prescriptions for antibiotics are written in U.S. doctor’s offices and emergency departments each year.

2 million illnesses are related to drug-resistant bacteria every year.

23,000 deaths annually are linked to drug-resistant bacteria.

70% of prescriptions are considered necessary although improvements in selection, dose and duration are still needed.

44% of outpatient antibiotic prescriptions are written to treat patients with acute respiratory conditions (e.g. sinus infections, middle ear infections, pharyngitis, viral upper respiratory infections, bronchitis, bronchiolitis, asthma, allergies, influenza, and pneumonia).  The CDC estimates that 50% of these outpatient prescriptions are unnecessary.

30% of antibiotics prescribed are unnecessary.  The CDC estimates that one in three prescriptions (or 47 million annually) are inappropriate.

In the United States, the government has put forth a National Action Plan for Combating Antibiotic Resistant Bacteria which aims to reduce inappropriate outpatient antibiotic use by 50% by 2020.  They note that this would require the elimination of 15% of all antibiotic prescriptions.


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Recipe for U.S. Healthcare Reform

Dead end.  Turn around.  Try again.

Many policymakers have pitched ideas on how to reign in healthcare spending as well as reform the U.S. healthcare industry as a whole.  Healthcare reform is difficult because everyone has a stake in it; consequently, many proposals are going nowhere.  Donald Berwick, a former Administrator of the Centers for Medicare and Medicaid Services (CMS), recently published an article in JAMA where he outlined his views on transforming healthcare in the United States.  In nine principles, he outlined what he refers to as a new “moral era” for healthcare:

  1.  Reduce Mandatory Measurement. “Intemperate measurement is as unwise and irresponsible as is intemperate health care.”  He argues that much of what the government currently mandates providers to measure is useless and wastes valuable time and money for providers.  He would like to see a reduction in all metrics by 50% within 3 years and by 75% within 6 years.
  2. Stop Complex Incentives. He calls for a moratorium on complex incentives that are placed on individual physicians because they are “confusing, unstable, and invite gaming.”  He would like to see CMS “confine value-based payment models for clinicians to large groups.”
  3. Shift Strategies from Revenue to Quality. Aside from the obvious regarding quality-based healthcare, he also jabs at payers, calling on them to stop linking reimbursements to current input metrics which “are not associated with quality and drive volume constantly upward.”
  4. Give Up Professional Prerogatives. He calls for a reform in medical training, stating “physician guilds should reconsider their self-protective rhetoric and policies.”  He argues that physicians and nurses alike should focus more on working as a team rather than exposing their individual competencies.
  5. Use Improvement Science. In short, he advocates for the study and usage of Edward Deming’s PDSA (plan-do-study-act) cycles.
  6. Ensure Complete Transparency. He calls on Congress, insurers, and regulators to ease data sharing and encourages states to adapt all-payer claims databases.
  7. Protect Civility. This one is pretty much self-explanatory.  Although, he does go on to say that “jokes about herding cats . . . or the demanding patient . . . are not funny.”
  8. Listen to the People Served. “Clinicians, and those who train them, should learn how to ask less, ‘What is the matter with you?’ and more, ‘What matters to you?’
  9. Reject Greed. He demands for “a new set of forceful principles for ‘fair profit and fair pricing,’ with severe consequences for violators.”  He continues by stating that medical training institutions and healthcare professional associations must “articulate, model, and fiercely protect moral values intolerant of individual or institutional greed in health care.”

Indeed, if healthcare reform were simple, we would have done it already.  Are we at a dead end?  Should we turn around and try again?


Contact ABISA, a consultancy specializing in solo and small group practice management.  Visit us at

Successful Physician Entrepreneurs

Over the years, I have worked with many physician entrepreneurs around the world (and also with the investors interested in funding healthcare innovation, but that’s a topic for another post).  During this time I have noticed similarities with this very distinct breed of business professionals.  The reality for a lot of physician entrepreneurs is that their startup isn’t their only job.  Many still work full-time with their medical practice or hospital while pursuing their motivating ideas.  Consequently, there seems to be some common threads with these physicians in their early morning routines.  For those of us who are business owners, we know that when running a business, it may seem like there are never enough hours in the day.

Tapping into the power of mornings, a time of day when there are less demands, is a key physician entrepreneurs use to increasing their productivity.  They know that they are less likely to get distracted in the morning and that their day fills up fast.  Waiting until the afternoon or evening to do something meaningful for oneself such as exercising or reading, will likely mean it is pushed off the to-do list altogether.  Physician entrepreneurs recognize that mornings give them an opportunity to set a positive tone for the day.

Dedicated physician entrepreneurs carve out time in the morning to exercise, before their workday begins.  It has been shown that exercising, even for as little as 30 minutes each morning, can make a world of difference throughout your workday.  This is due to the triggering of metabolism which remains elevated for hours, thus helping you feel energized throughout the day.  They also ensure to eat a healthy breakfast and when strapped for time, some even prepare food the night before.

Like many strategic thinkers, physician entrepreneurs take a moment in the morning to visualize their day.  Successful people tend to be notorious for making lists and planning things out.  It was supposedly Benjamin Franklin who said, “If you fail to plan, you are planning to fail.”  Great leaders understand that complacency is the enemy.  The truth is, if you can’t picture yourself achieving a goal, chances are you won’t.

Above all else, what I have learned from my dealings with these clients it to be habitual and consistent.  That is, create a morning routine and stick to it because habits help the mind and body reset in preparation for the tasks ahead.  The physician entrepreneurs I work with around the world tend to wake up at the same time every day . . . even on the weekends.

Physician entrepreneurs are indeed change makers.  They have to be extremely self-motivated with immense drive and energy.  They are survivors, and survivors are creative and innovative.  I believe that having a successful and constant morning routine is at the basis of a successful physician entrepreneur (and anyone else who wants to get ahead in their life).


Contact ABISA, a consultancy specializing in solo and small group practice management.  Visit us at


Patients See Little Benefit with EHRs

Millions of Americans are starting to become more engaged with how they manage their health and wellness, from a host of smartphone apps to a variety of connected health devices.  However, electronic health records (EHRs) are definitely not high on the patient’s preference list of digital health tools.  Proof of this last fact is evidenced in a recent survey by HealthMine which looked at consumers who use mobile apps and/or connected health devices, and were enrolled in a 2016 health insurance plan.  Here are a few highlights:

60% of those surveyed state they have an EHR

55% responded that they see an EHR simply as a means to “stay informed”

44% complained about not being able to see everything their physician sees in the EHR

29% of those with an EHR claim not to get much benefit from it

22% of those surveyed stated they use their EHR to make medical decisions

15% of consumers admitted it is hard to understand the information in the EHR (based on my experience with healthcare providers, I believe this number is actually much higher)

14% responded that they do not access their EHR

Approximately 18 months ago, a survey from the National Partnership for Women & Families claimed to see a growing number of consumers were embracing and utilizing EHRs, citing that patients see “significant” value in EHRs.

Of course, we cannot ignore the vulnerabilities to patient data breaches.  In that same vein, last summer the Office of the National Coordinator for Health IT issued a new Data Brief demonstrating the heightened concerns of consumers over the privacy and security of their medical records.


Contact ABISA, a consultancy specializing in solo and small group practice management.  Visit us at

Three Dimensions of Medical Practice Cohesion

Cohesion is the intense bonding of employees, strengthened over time, that results in absolute trust. It is characterized by the subordination of self and an intuitive understanding of the collective actions of your medical practice and of the importance of teamwork, resulting in increased productivity. Cohesion is achieved by fostering positive peer pressure and reinforcing your practice’s core values. Cohesion provides practice staff with supportive relationships that buffer stress and increases their ability to accomplish the mission or task. Strong staff cohesion results in increased productivity and the achievement of greater successes.

There are three dimensions of cohesion: individual morale, confidence in the medical practice’s capability, and confidence in practice leaders. In combination, these dimensions dramatically affect the effectiveness of your practice.

1.  Individual morale

As a leader, you must know your staff and look out for their welfare. Leaders who understand that morale, only morale, will bring success are more likely to keep morale high among employees. A high state of morale, in turn, enhances practice cohesion and productivity.

2.  Confidence in the practice’s capability

Medical staff members’ confidence in their practice’s effectiveness is gained through training. The longer employees work and train together in a practice, the more effective they become and the more confident they are in their practice’s capabilities. They know what their practice can do because they have worked together before. Keeping staff members together through practice cohesion is a workforce multiplier. Success in healthcare can be directly attributed to a practice’s overall confidence in its level of performance. Of course, the opposite holds true; lack of cohesion, lack of confidence, and poor performance preordain a practice’s failure.

3.  Confidence in unit leaders

Confidence in practice leaders’ abilities is earned as staff members spend time in the company of their supervisors and learn to trust them. Practice leaders must earn the respect of their staff, and doing so takes time. As staff members develop confidence, based on their prior achievements, in their practice’s ability to accomplish tasks, they also develop confidence in their leaders as they work and train together.

Ardant du Picq, a French Army officer and military theorist of the mid-nineteenth century, perhaps summed up the need for cohesion best.

“Pride exists only among people who know each other well, who have esprit de corps, and company spirit. There is a necessity for an organization that renders unity possible by creating the real individuality of the company.”


Contact ABISA, a consultancy specializing in solo and small group practice management.  Visit us at