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Where Does It Hurt?: An Entrepreneur's Guide to Fixing Health Care Hardcover – May 15, 2014


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Where Does It Hurt?: An Entrepreneur's Guide to Fixing Health Care + Reinventing American Health Care: How the Affordable Care Act will Improve our Terribly Complex, Blatantly Unjust, Outrageously Expensive, Grossly Inefficient, Error Prone System
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Product Details

  • Hardcover: 240 pages
  • Publisher: Portfolio Hardcover; 1 edition (May 15, 2014)
  • Language: English
  • ISBN-10: 1591846773
  • ISBN-13: 978-1591846772
  • Product Dimensions: 6.3 x 0.9 x 9.3 inches
  • Shipping Weight: 10.4 ounces (View shipping rates and policies)
  • Average Customer Review: 4.5 out of 5 stars  See all reviews (35 customer reviews)
  • Amazon Best Sellers Rank: #77,184 in Books (See Top 100 in Books)

Editorial Reviews

Review

“I loved this book. Jonathan Bush is a goggle-eyed radical foaming for revolution in the house of health care—with the crucial, page-turning difference that for years he’s actually been delivering on it. His story alone is worth the price of admission. He’s driven ambulances in New Orleans, remade child delivery in San Diego, and built an Internet company that is transforming the way people practice medicine. And along the way you’ll learn more about the real world of how health care works than should be possible for a book this interesting. Jonathan Bush is a singular new voice in American health care.”
Atul Gawande, surgeon, professor, and author of The Checklist Manifesto

“This is a compelling, entertaining story—an insider’s perspective on American health care by someone who has been closely involved in its reshaping. Few people amass Jonathan Bush’s kind of experience or articulate as clearly what lies ahead.”
Abraham Verghese, physician and author of Cutting for Stone

“Jonathan Bush is not only a brilliant visionary but he walks the talk when it comes to tackling the dysfunctions of our health care system. Reading this book will help you understand why things are as broken as they are and inspire you to be part of the fix.”
Regina Herzlinger, Nancy R. McPherson Professor of Business Administration, Harvard Business School, and author of Who
Killed Health Care? 
America’s $2 Trillion Medical Problem—and the Consumer-Driven Cure

“Health care has successfully resisted organizational innovation to the detriment of our health and our economy. In Where Does It Hurt? Jonathan Bush gives exciting accounts of current innovation, and irreverently imagines an attainable future in which a vibrant medical marketplace is driven by health entrepreneurs, of which he himself is a prime example. Patients, physicians and policy wonks alike would be well served to take the provocative and illuminating tour.”
Jeffrey Flier, MD, dean of Harvard Medical School

Where Does It Hurt? teaches us all that great entrepreneurship does for reform what yeast does for bread. Jonathan Bush has done it, and now he’s sharing the recipe.”
Governor Mike Leavitt, secretary, U.S. Department of Health and Human Services (2005 to 2009)

“Jonathan Bush is one of the most charismatic and outspoken people in health care IT. His passion for driving innovation is changing the industry. The tale of disruption in his book offers lessons for us all.”
John D. Halamka, MD, chief information officer, Beth Israel Deaconess Medical Center

About the Author

JONATHAN BUSH is the CEO and cofounder of athenahealth, one of the fastestgrowing technology companies in the country. The nephew and cousin of two U.S. presidents, he has worked in health care for two decades. He has an MBA from Harvard and lives in Cambridge, Massachusetts.

STEPHEN BAKER is a former senior writer for BusinessWeek and author of The Numerati and Final Jeopardy.

Customer Reviews

An easy read.
Am
Jonathan Bush is an excellent summary of what ails America, a healthcare system that is fundamentally broken and bloated with any lack of relevant business model.
Alan M Pitt
I highly recommend business owners, entrepreneurs, and frankly all of us that are healthcare consumers to read this book.
jm87

Most Helpful Customer Reviews

13 of 14 people found the following review helpful By S. Farber on May 19, 2014
Format: Hardcover Verified Purchase
I pre-ordered the book, and read it in one weekend. The book is an easy read, and whether you agree or disagree with Bush (I agree with most of his points), he does make you think. Healthcare is broken, and he highlights some very basic flaws in the current model. Both from the perspectives of an early stage business, as well as addressing some of the innate conflicts which exist within healthcare, this is a great read. Sit back, relax, and enjoy. You'll chuckle at the storytelling and almost forget that it's making you think as well.
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15 of 17 people found the following review helpful By Sinohey TOP 1000 REVIEWER on May 22, 2014
Format: Hardcover
Unarguably, America's medical care is technologically the best in the world; however as a health care system it falls short, lying somewhere at the bottom ranks of "first world", and even some "second world" countries.
The system, like another behemoth (the IRS), mismanaged by government's confusing and often contradictory regulations, should be scuttled and restructured to fit a twenty first century culture and economy.

The core of medicine is the relation between patient and physician, which can be even more intimate than family; it has been disrupted by layers of administrative record keeping, obfuscated payment/reimbursement policies, threat of multi-varied and unpredictable litigation as well as undertones of disruptive audits and arbitrary disciplinary actions for perceived or real accounting/billing errors.
To most physicians, medicine is a vocation and life ambition, worthy of the significant sacrifices made learning the science and practicing the craft. Their families learn, early on, to cope with the absentee husband and father because always "the patient comes first".

But in today's environment, the physician is expected to be a businessman, a manager, an expert on health care law, an accountant, and an insurance coding & reimbursement specialist. By the end of the day the provision of medical care becomes secondary and the most important component of the system (THE PATIENT) is reduced to an entity for generating codes (ICD-10 & CPT) for billing. Patient care is upended by medical chart documentation.
No wonder the media reports that 42% of physicians are unhappy with their profession and 59% would not recommended it to others. The real numbers are much higher; also since the year 2000 more 50+year old physicians have retired than ever before.
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10 of 11 people found the following review helpful By C. Martel on May 18, 2014
Format: Kindle Edition Verified Purchase
Downloaded this on Friday and, with few interruptions over the weekend for family commitments, has been a non-stop consuming adventure. Jonathan sounds all the notes in self-effacing harmony, covering every sector of the healthcare space in revealing detail. Felt like a broadcast symphony of "the emperor's new clothes" where the author confronts the unsustainable insanity, but not with the press-worn rehash, but with vivid calls for new pathways. Outstanding book!
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3 of 3 people found the following review helpful By David D. Schram on June 23, 2014
Format: Kindle Edition Verified Purchase
I'm a physician with nearly 20 years in medical practice. I have worked both in private practice and for a hospital system. No matter your political stripes, this book does a great job of explaining the absurdity of our healthcare system in a humorous and non-fatalistic way. The author also gives ideas to implement change that are within the reach of the average physician and patient. Empowering.
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2 of 2 people found the following review helpful By Chris on June 29, 2014
Format: Hardcover Verified Purchase
This is a useful book to understanding how to improve the healthcare system. Clayton Christensen who wrote the Forward labeled it a ‘bottom up’ view as opposed to the ‘top down’ view from the “The Innovator’s Prescription”. This feels accurate.

The book is an easy read, a narrative in 4 parts written in colloquial language with personal anecdotes. Below are the principal ideas. Apologies for license in choice of words, omissions, or misinterpretations.

I Observations from the front
- general waste from underutilized high capital equipment (e.g. hospitals) vs specialist businesses that can employ continuous use for diagnosis or treatment (e.g. MRI in hospital vs MRI shop)
- high capital based treatment options vs low capital options (not obvious high capital solutions necessarily produce better end results)
- lack of market competition for procedures with patients sharing in any savings
- no/limited treatment and insurance availability across state lines (e.g. analysis by expert radiologists or dermatologists via Internet … must travel to another state for expert services)
- care organizations ownership can dictate type of treatment (e.g. home vs care facility for dialysis in doctor owned businesses)
- system preserves profits for incumbents as opposed to allowing for alternatives (e.g.
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6 of 8 people found the following review helpful By Michael E. Martin on May 30, 2014
Format: Hardcover Verified Purchase
This is an easy read, but inspirational. The ideas presented for improving US health care are easy to understand and even if you're not an industry professional, you may be motivated to go out and start a disrupting business. While so many industries have been dramatically altered and improved by out of the box thinking and application of technology, health care is not one of them. The opportunities to improve health care are boundless, and it isn't brain surgery.

As the book title indicates, this is the entrepreneur's guide to fixing health care. While Mr. Bush does briefly discuss the ACA, I'm not sure that he has adequately addressed the roadblocks that it presents. Furthermore, US health care consumers have been the 3rd party to health care for so long that no matter what is done by entrepreneurs, it may take years for the majority of consumers to rethink their responsibilities as it relates to their own care. Again, I didn't see this addressed.

At over 10 cents per page, this is an expensive book and because it focuses on the most recent developments in health care, it will be out of date in 6-12 months (unless a new edition is released.) So, buy it now and read it and then pass it along to a friend. Even if you don't start your own health care business, but simply write a letter to Congress or rethink what you can personally do improve management of your own health care, this book will be perhaps one of the best health care purchases you ever make. 
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