Health Policy

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.

We shouldn’t focus exclusively on patient satisfaction

Richard Young, MD

Health Policy

April 28, 2014

“Patient-centered.”

It sounds so right, doesn’t it? Right up there with mothers and apple pie. If only family medicine were so simple.

A report by ABC News told the story of a doctor at a VA hospital in Kansas City who claims she was forced to leave her job because she tried to limit prescriptions for opioid pain medications to reasonable amounts. Patients complained, so she was canned.

She claimed that some patients …

The Maryland approach to controlling health costs

Pascal Crosley, DO

Health Policy

April 28, 2014

We needed to move away from a fee-for-service-driven health care system, where the incentive was to do more to be paid more, and instead move to a system where the incentives are aligned to what we all feel needs to be done.
– Carmela Coyle, CEO, Maryland Hospital Association

Since 1977, Maryland’s unique all-payer system has succeeded in keeping health care costs relatively low. Now the state is embarking on a …

Considering the latest threat to the Affordable Care Act

Anonymous

Health Policy

April 26, 2014

As an income-less medical student, I would be one of the now 7.1 million people who have signed up for Obamacare for this year. Except I live in Texas, one of nearly half of all states that elected to not expand Medicaid. At the same time, I don’t have enough of an income to qualify for federal subsidies, making insurance from the Marketplace unaffordable.

As such, the individual mandate — the …

Transparency is here, and it’s hunting season on doctors

Margalit Gur-Arie

Health Policy

April 25, 2014

It’s here. For the first time in 35 years (or 33, depending on which click bait headline you clicked on), the much anticipated release of data on Medicare payments to physicians, has been released to the public, on the historic date of April 9th, 2014.

“Data trove shows U.S. doctors reap millions from Medicare,” according to the distinguished Reuters news service. The Washington Post will tell you “everything you need …

How generations of doctors will handle health care change

Robert Pearl, MD

Health Policy

April 25, 2014

With American health care in the midst of rapid transformation, both doctors and patients will be forced to adapt to changes stemming from the Affordable Care Act, also known as “Obamacare.”

Of course, everyone responds to change differently. But is it possible to predict how doctors will adapt to health care reform based on the year they were born? The answer may surprise some patients and even force them to think differently …

The Medicare spending we should be concerned about

Leslie Kernisan, MD, MPH

Health Policy

April 24, 2014

“Do patients care about how much money their doctors make?”

This is the headline of a recently published post by Trudy Lieberman, and was written in response to the recent New Your Times’ coverage of Medicare disclosing payments to individual providers.

Now, I found the Times story fascinating on many levels, but I’ll admit it hadn’t occurred to me that the main value of this data release is that patients can …

The Affordable Care Act has made restaurants more partisan

Peter Ubel, MD

Health Policy

April 24, 2014

Politics in the US is discouragingly partisan. National politics has become increasingly partisan since at least the late ’60s, when the passage of civil rights legislation influenced many conservative southern Democrats to join the Republican Party. Even state politics has become more partisan, where even famously nice people in Wisconsin have found themselves battling their neighbors across political divisions. Fortunately, most of life does not force us to confront our political differences, meaning …

How a hospice model can save American health care

James C. Salwitz, MD

Health Policy

April 22, 2014

America is one of the sickest places on earth. We have the best diabetic care, but the most diabetes. First-rate cardiac care, but we are obese, hypertensive, inactive, and have high rates of heart disease. We are the world’s standard for cancer technology, innovation and access, but we have high cancer rates even while we waste most of the money from cigarette taxes on road repairs. At every socioeconomic level, …

There are no quick fixes to hospital-acquired infections

Peter Pronovost, MD, PhD

Health Policy

April 22, 2014

Recently, the U.S. Centers for Disease Control and Prevention issued two reports that are simultaneously scary and encouraging.

First, the scary news: A national survey conducted in 2011 found that one in every 25 U.S. hospital patients experienced a healthcare-associated infection. That’s 648,000 patients with a combined 722,000 infections. About 75,000 of those patients died during their hospitalizations, although it’s unknown how many of those deaths resulted from the …

The ICD-10 emperor has no clothes

Betsy Nicoletti, MS

Health Policy

April 21, 2014

The howling about the delay of ICD-10 was loud and fierce. It seems the quality of health care in the United States depends on our ability to use 68,000 diagnosis codes. The rest of the world has switched to ICD-10, and we alone insist on using an outdated coding system. Here’s a secret. The World Health Organization’s version of ICD-10 has about 16,000 codes, equivalent to ICD-9-CM. The rest of …

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The ICD-10 emperor has no clothes

ICD-10 will accelerate the demise of private practice

Brian C. Joondeph, MD

Health Policy

April 19, 2014

You won’t read about the International Classification of Disease (ICD) on TMZ or hear it discussed on The View, but it has the potential to be an unpleasant October surprise in the healthcare world. It is a list of codes that physicians and hospitals use when billing insurance companies. These codes cover all manner of medical diagnoses for diseases, conditions, and injuries.

The first version of ICD appeared in 1946 with …

Ask if new technology will make a difference in patient outcomes

Elaine Khoong, MD

Health Policy

April 16, 2014

Earlier this year, I completed a medical rotation in Africa. It was an amazing, eye-opening experience. While I expected it might be difficult to acquire newer, more expensive medications and procedures, I had anticipated that, given limited resources, there would be some rationale in deciding which medications and procedures would be available. I was deeply mistaken in this assumption.

During my time abroad, I watched several patients with heart attacks pass …

A tough time to be a doctor, but a tougher time to be a patient

Roy Benaroch, MD

Health Policy

April 16, 2014

Doctor: “Phil, you have pneumonia.”

Phil: “Oh noes. What shall I do?”

Doctor: “Just take these red pills, here.”

Phil: “Great! I feel better already! When can I go back to work?”

Doctor: “I think in about 2 weeks. Or maybe 2 months. And actually, don’t take those red pills — these blue ones are better. It could take a few years for you to get better, and I’ll be retired by then. Here, …

The fatal error in health care

Rob Lamberts, MD

Health Policy

April 15, 2014

The janitor approached my office manager with a very worried expression. “Uh, Brenda …” he said, hesitantly.

“Yes?” she replied, wondering what janitorial emergency was looming in her near future.

“Uh …well … I was cleaning Dr. Lamberts’ office yesterday and I noticed on his computer …” He cleared his throat nervously, “Uh … his computer had something on it.”

“Something on his computer? You mean on top of the computer, or on …

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The fatal error in health care

Why more health insurance isn’t necessarily better

Luis Collar, MD

Health Policy

April 14, 2014

Whenever a discussion of health care policy is initiated, the importance of health insurance, of extending coverage, takes center stage. The need for insurance quickly becomes an undeniable truth, a universal imperative. And no one ever seems to question this subtle premise before getting more patients fitted with shiny, new policies. This was precisely the case with the Affordable Care Act.

My question, however, is simple. Where is the evidence that …

Can narrow networks increase health care quality?

Margaret E. O’Kane

Health Policy

April 12, 2014

American consumers value the freedom to comparison shop. We like to survey a variety of options and select “the one” that what we really want. If we want triple-ply, select-a-size paper towels with a blue shepherdess imprinted on them, then we expect to be able to find them in aisle 9. Deny us options and we’ll take our business elsewhere.

When it comes to health care, though, endless options may not …

How to solve the SGR gridlock

Myles Riner, MD

Health Policy

April 12, 2014

For 11 years, Congress has failed to reform the Medicare physician payment system, and appears prepared yet again (for the 17th time) to fall back on another one-year patch for the unpopular sustainable growth-rate (SGR) formula to avoid a 24% cut in payments to doctors. As House minority leader Nancy Pelosi said recently, “Instead of reforming the Medicare physician payment system, Congress seems intent on imposing yet another round of arbitrary …

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How to solve the SGR gridlock

How much Medicare pays doctors requires context

Cedric Dark, MD, MPH

Health Policy

April 11, 2014

medicare-112k

The Centers for Medicare and Medicaid Services released a massive amount of information regarding how much money it paid out to individual doctors. For the policy nerds out there, here is the original data. For everyone else, here is a simple way to look up how much your own doctor made. I decided to search for myself in the database …

Do patients care about how much money their doctors make?

Trudy Lieberman

Health Policy

April 9, 2014

I am all for transparency when it comes to health care. So when Medicare announced that it would tell the public how much doctors are paid to treat Medicare patients, my first thought was “hooray.” Another victory for consumer information.

Then I began to think about this in more depth. The Centers for Medicare and Medicaid Services (CMS), in response to a ruling in a federal case …

Do rural provider bonus payments do more good than harm?

Peter Ubel, MD

Health Policy

April 9, 2014

If you live in the rural U.S., you probably face relatively limited access to the wonders of American health care. There won’t be as many physicians per capita offering you their services. This paucity of health care professionals will be especially stark for subspecialty care. There are not many ENT specialists opening up shops in rural Texas when they can find jobs in Houston or San Antonio.

This undersupply of physicians …

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