Advance Praise for “Modern Healthcare Delivery…”

“Dr. Zema has authored a most comprehensive tome on our U.S. healthcare delivery system. His
observations and citations are cogent and wise, well serving all who wish to gain a greater
understanding and appreciation of our current challenges and reasonable/responsible solutions going
forward. This is a must read for all interested in a complete awareness of our current healthcare
dilemma.”

– Thomas E. Price MD
23rd Cabinet Secretary of H ealth and H uman Services (H H S)

“American medicine is desperately in need of change. This brilliant, coherent, and most readable book
is a must read for those seeking solutions, both members of the medical profession and the interested
lay public.”

– Sidney Alexander MD, FACC

Chairman Emeritus, Division of Cardiology
Lahey Hospital and Medical Center

“From the well-chosen book and chapter titles to the researched and documented details, this work is
insightful, engaging, balanced, and thought-provoking — an excellent point of departure for those
seeking a better understanding of the workings of healthcare and those with interest and influence in
healthcare reform.”

– H olly Gadd, PhD, RN, APRN, FNP-BC

Dean & Professor, School of Nursing
Southern Adventist University

“No other book encompasses such a comprehensive assessment of our healthcare delivery system,
providing history, criticism and potential solutions to this, our greatest domestic endeavor — a
valuable read for the lay audience, students and advanced clinical professionals alike. Bravo!"

– William H. Frishman MD, MACP, FACC

Professor of Medicine and Pharmacology
Emeritus Chairman of Medicine
New York Medical College

“Dr. Zema’s book highlights many of the changes that have occurred in healthcare that not only have
not met their goals, but also have had unintended consequences for patients and clinicians. It is a call
to action for everyone to actively engage and work together to create a healthcare system that is high
quality, equitable, and sustainable.”

– Susan Thompson Hingle MD, MACP, FRCP, FAMWA

Prof. of Medicine & Assoc. Dean for Human and Organizational Potential
Department of Medicine, SIU School of Medicine

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 Contents

AUTHOR’S NOTE.......................................................................9

Chapter 1 The Electronic Health Record—the Good,

the Bad, and the Ugly................................................13
Chapter 2 Have You Ever Wondered How Your Doctor
Gets Paid?—A Health Insurance Industry
Primer.......................................................................51
Chapter 3 What the Heck Ever Happened to “Marcus
Welby MD”?...........................................................104
Chapter 4 You’ve Waited Weeks for This Appointment
with Your Doctor…................................................141
Chapter 5 Ill and Hospitalized—Where’s My Doctor?.............187
Chapter 6 The New World Order: Convenience Care.............214
Chapter 7 Better Healthcare for Less v1.0................................245
Chapter 8 What Exactly Are “Quality” and “Value” in
Healthcare?..............................................................286
Chapter 9 Better Healthcare for Less v2.0 ...............................320
She’s congested, sore throat is just not
getting better, and then there’s that sinus
headache and nasty earache. With no
appointments available to see Dr. Be Well until
late the next day, Ms. Runouta Patience decides
it's off to QuickFix retail medical clinic to get
herself feeling well again. Somewhat better, a
week later she arrives at Dr. Be Well's office for
a follow-up visit where the receptionist hands
her a clipboard with pages upon pages of forms
to complete before seeing the doctor. She is
also asked if she wishes to join Dr. Be Well's
new Accountable Care Organization - an ACO
- what? Wasn't she already his patient! Finally
after almost getting writer's cramp, she is taken
to an exam room where in walks Dr. Guess
Who ANP-C, ACNS-BP, DNP. At first,
Runouta Patience is disturbed that Dr. Be Well
himself is unavailable. But Doctor Guess Who
is kind, professional in her demeanor,
extremely thorough and even takes a few
minutes to test her understanding of the
asthma recommendations that she makes.
Leaving the office, Runaouta Patience writes
out a check for her office visit copayment and
upon arriving home downloads an app onto
her smartphone that will allow her to send peak
airflow rates to her doctor to help manage her
asthma. Some weeks later, despite everyone's
best efforts, her condition worsens and she is
off to the local emergency room where she
receives a breathing treatment and is admitted
to hospital. Expecting to see Dr. Be Well, she
is again surprised as in comes young Dr. Hyam
Here, the hospitalist on duty that day, who will
care for her for at least the next forty-eight
hours while she is hospitalized.

(continued on back flap)

 (continued from front flap)
Through simulated patient scenarios such
as these, the reader is introduced to many of
the relevant milestones that have occurred in
healthcare delivery during the past fifty years.
Problems currently faced are discussed and
potential solutions provided. While everyone
ostensibly someday will be a patient, for many,
that exposure is intermittent, often skewed and
largely gleaned from the outside looking in. For
those who dare, Dr. Zema provides a glimpse
of healthcare delivery seen from the inside, looking
out, thereby affording readers additional
insights whereby they may navigate outside
their comfort zone while achieving a broader
perspective of the overall healthcare delivery
system.

MICHAEL J. ZEMA MD, FACP, FACC, CPE,

CSSG has enjoyed a tenure of forty plus years in the
healthcare arena on the “inside” as physician trainee;
private practitioner; member of a Hospital Medical
Board; Vice President of a Physician Independent
Practice Association; Board Member of a Physician
Holding Company; Pharmaceutical Industry and
Malpractice Legal Consultant; Chief of Cardiology at
both community hospital and academic medical centers;
Professor of Medicine at two State University Colleges
of Medicine; and Physician Clinical Reviewer for a large
national Radiology Benefits Manager. Having operated
in all of the above "silos," at one time or another, unlike
so many of today's so-called "pundits," Dr. Zema has
indeed walked the walk and not merely talked the talk
and as such is uniquely qualified to debate healthcare
delivery providing a glimpse from the inside out.