Physicians writing on KevinMD about the rules they practice under: prior authorization and the algorithms now deciding it, gold card laws, scope of practice and who may practice without supervision, Medicare and Medicaid, the Affordable Care Act, drug pricing, rationing that is done and not named, and the policies that decide which patients get care. Four maintained records draw on this archive: Prior authorization: what physicians say, in their own words, Scope of practice: what physicians, nurse practitioners, and PAs say, in their own words, Race and medicine: what physicians say, in their own words, and Medical ethics: what physicians say, in their own words.
The Affordable Care Act expanded Medicaid eligibility this year in those states which decided to follow its provisions. That means lots of people are now newly eligible for Medicaid. However, the number of people signing up for Medicaid in the states has been underwhelming. Which raises a question: How much can we expect enrollment numbers to increase over the next few years?
To begin to answer that question, a group of …
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Predicting Medicaid enrollment numbers under the Affordable Care Act
Currently, the United States spends approximately 3 trillion dollars on health care, which is roughly 18% of our gross domestic product (GDP). Not only is this more than every other country in the world, but it’s also more than the next 10 largest spenders combined. Looking backwards, health care spending rose steadily from about 9% of our GDP in 1980 to about 16% in 2008. Looking ahead, by 2020, health …
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The United States takes the spoiled rich kid approach to health care
One of the many aspects of Obamacare adding overall costs for both patients and insurance companies is the feature called essential benefits. This means that Congress and the administration, in their infinite wisdom, have decreed that anyone purchasing health insurance must have a policy that includes emergency, maternity and preventative care, whether or not such coverage is needed or desired. For example, a middle-age man, such as myself, must have, and through the …
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What does cable television and Obamacare have in common?
As the Wall Street Journal reported, there’s a growing shortage of qualified pilots in the US, driven by both economic reality and federal policy.
Pilots typically start their professional careers at small, regional airlines — airlines that pay, approximately, fast-food wages. Less than that, really — for the hours they work, many pilots make less than minimum wage. After a few years, these pilots have enough flight time and experience to try to …
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What we can learn from the looming airline pilot shortage
Round and round and round we go yet again. The system is broken. Do something. Health care reform!
“Pay for performance” morphs into “measure (and pay) for quality.” The big problem is that no one has bothered to actually define the term, maybe because everyone assumes they know what it means — and that everyone else agrees with them. Wrong.
Quality is very much in the eye of the beholder, and …
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Health care quality can be surprisingly subjective
Despite the political angst, the doomsday predictions and a very rocky launch, the Affordable Care Act has enabled more than 8 million Americans to acquire insurance coverage through the public exchanges.
Health insurance increases the probability that patients will access the medical care they need. And my colleagues at Kaiser Permanente are already seeing some positive stories emerging as a result.
They’ve shared dozens of stories with me about patients with undiagnosed …
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Learn from the success of Medicare Advantage
Did you ever read a seemingly inconsequential sentence somewhere and it then just refused to leave your mind for days on end, triggering avalanches of thoughts way beyond the original intent, if there even was one? It just happened to me a few days ago when I read one more industry article about the recent Medicare data dump.
The following remark was attributed to a primary care doctor: “The U.S. is …
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Translucency by design and turbidity by negligence
California, along with the rest of the nation, is facing a serious primary care physician shortage that grows worse every year. As health care reform takes full effect and millions more Americans gain coverage and therefore can afford to seek the care they need, many will have trouble finding a family physician or other primary care doctor to care for them, as many patients already do. We must make certain …
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How California is addressing the primary care shortage
As a future doctor, I believe that digital dialogue affords medicine a powerful responsibility to educate and engage. I believe physicians have a responsibility, as daily witnesses to the gaps and failures of public policy, to advocate for social justice and policy reform. I believe that medicine should extend beyond the proximate effects of illness and injury to address their root social etiologies.
I’ve always held these beliefs with firm conviction. …
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The risks of being a physician advocate
I’ve long been a skeptic when it comes to disclosing information about how doctors practice medicine, how hospitals treat patients and what both doctors and hospitals charge for their services. While I am all for transparency, it’s still an open question how patients or consumers of medical care can actually use that stuff to find “the one that’s right for you” or “the best” as marketers like to say.
I’m dropping …
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Disclosing calories in food: An unsung legacy of Obamacare
I do not provide health care. What we physicians do is practice medicine, and what we do for patients is called medical care.
No one says, “I want some health care.” What they think is, “I don’t feel well. I want to see a doctor.”
People get sick and they get hurt. It’s true that many these conditions occur as a result of things they do (smoke, eat junk food, drink too much alcohol, …
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We do not have a health care system
During ACP’s annual meeting in Orlando recently, the American College of Physicians released a new position paper on reducing injuries and deaths from firearms — the first comprehensive update of College policy since the late 1990s. (I am a co-author of the paper.)
Published as an online-first article in the Annals of Internal Medicine, the paper is the result of an extraordinarily comprehensive review of the evidence of the causes and …
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Evidence-based policies to promote gun safety
As the Center for Medicare & Medicaid Services prepares to enhance its Physician Compare website to include quality of care information, practices across the country are getting ready to share data on the care of their Medicare patients or face penalties come 2015.
Publicly reporting performance measurement data is something we have been doing for the past seven years with 16 communities across the country as part of the Robert Wood …
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From denial to acceptance: Getting doctors behind performance data
What a shame: Reimbursement rates are going up for private Medicare Advantage plans.
Contrary to its April 7 announcement that private Medicare reimbursement rates would be reduced, the Centers for Medicare & Medicaid Services has just reversed course and announced that it will increase overall Medicare Advantage rates. The change in policy came after pressure from the political parties and insurance companies. As Medicare spending per beneficiary grows at a …
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Demand parity among Medicare programs
Next in a series.
There has been a lot of interest in the Daily Beast article written by Dr. Daniela Drake, about very frustrated primary care physicians (PCPs). She quoted both Dr. Kevin Pho and myself from posts here at KevinMD.com. Dr. Drake noted that nine of 10 doctors would not recommend medicine to their children as a career and that 300 physicians commit suicide each year: “Simply put, being a …
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Let’s reframe the question of physician frustration
Medicare released the most comprehensive ever look at how Medicare dollars are paid out to physicians across the United States. In the name of transparency, this data drop will “provide consumers with an ability to compare doctors and treatments in a way they have never had until now.”
Will it really? Let’s look a bit closer at the data release.
According to the Centers for Medicare and Medicaid Services, the payment data release aims to “make our …
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How the Medicare data release subtly rations health care
According to a study by Jackson Healthcare, the percentage rate of U.S. physician compensation is among the lowest of western nations. In 2011, physicians’ salaries compromised 8.6 percent of the nation’s total health care costs. This is in comparison to 15 percent in Germany, 11 percent in France, and 11.6 percent in Australia. Detractors point to the fact that although the percentages speak for themselves, if you look at …
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The Medicare data dump: How the government gave physicians the finger
A long time ago, when I worked in Sweden’s socialized health care system, there were no incentives to see more patients. In the hospital and in the outpatient offices there were scheduled coffee breaks at 10 and at 3 o’clock, lunch was an hour, and everyone left on the dot at five. On call work was reimbursed as time off. Any extra income would have been taxed at the prevailing …
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A toxic environment for delivering health care
