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.

The Affordable Care Act is here and the sky has not fallen

Brad Wright, PhD

Health Policy

January 28, 2014

The Affordable Care Act was enacted all the way back in 2010. But, even before then, critics were asserting that this new law would more or less destroy the American economy, insert Uncle Sam squarely between patients and providers, and initiate the end of freedom as it ushered in socialized medicine. That was nearly 4 years — and 40 repeal attempts — ago, and yet, the sky remains intact above …

How the Affordable Care Act will affect emergency department payments

Cedric Dark, MD, MPH

Health Policy

January 25, 2014

A recent article in the Annals of Emergency Medicine analyzed the revenue increases due to emergency physicians for services delivered to currently uninsured individuals when they begin to receive coverage (via either Medicaid or private plans) under the Affordable Care Act.

The authors analyzed payments for outpatient emergency department (ED) visits using the Medical Expenditure Panel Survey from 2005-2010. They looked into characteristics of charges and payments for the following groups: …

Learning about Obamacare from a car accident

Bob Doherty

Health Policy

January 24, 2014

Just a little over a week into 2014, my new year started off with a bang — literally — as I got into an automobile accident that involved my car sideswiping another vehicle and then crashing my car into a tree at 30 MPH. The car was totaled, but fortunately, I (mostly) walked away from the accident with only a fractured sternum and bruising.

Just a little over a week from …

When doctors complain: How to resonate with the public

Margalit Gur-Arie

Health Policy

January 22, 2014

There is a dark cloud of discouragement, dejection, disheartenment, and all other synonyms of despair, hanging over the medical profession. It’s not that all physicians live in constant gloom and doom, although quite a few do, particularly those still in private practice, but the profession itself seems to be losing its luster.

Some doctors seem content to pragmatically adapt to the new and duller definition of their old profession, but in …

The New York Times takes a cheap shot at specialists

Wes Fisher, MD

Health Policy

January 22, 2014

Most of us would agree that health care costs are too high in America. They must be controlled or else we won’t have a sustainable health care system here. And we should acknowledge that, on average, all doctors in America are paid higher than their overseas counterparts. But we should also agree that expenses for doctors to earn a degree, maintain that degree and licensure, and pay their malpractice premiums …

What if the uninsured don’t buy Obamacare?

Robert Laszewski

Health Policy

January 21, 2014

Now that consumers can generally make an efficient health insurance purchase at Healthcare.gov and most of the state-run exchanges, we can finally get to the real question.

Are the healthy uninsured going to buy it?

The big health insurance changes Obamacare made to the individual and small group market were arguably done in order to get everyone, sick and healthy, covered in a more equitable system.

To be clear, no one I know …

Let’s learn from No Child Left Behind: Measuring quality in healthcare

Luis Collar, MD

Health Policy

January 20, 2014

As we address the issue of quality in healthcare, there is much to be learned from other industries. I believe our current approach, though, is a dangerous one, one that won’t yield the desired results. Thus far, we’ve approached quality assurance as if healing were an industrial process, a process similar to those that yield cars, air conditioners, or even cheeseburgers.

But in an age where science, technology, and health policy …

Balancing the physician work force: It takes more than money

Richard Young, MD

Health Policy

January 20, 2014

Here we go again. There is yet another round of evidence of how the physician workforce hole we’ve dug for ourselves keeps getting deeper, but there has been still no substantive payment reform on the government side (Medicare/Medicaid) or the private payer side.

One recent study appeared in Academic Medicine. Clese Erikson and colleagues surveyed a random sample of 4th-year medical students in 2010. Only 13% of the students stated they …

Why the Oregon Medicaid study ultimately won’t matter

Angelo Falcone, MD

Health Policy

January 19, 2014

2014 has dawned, and with it more than 2.1 million people have new health insurance under the Affordable Care Act. This, as they say, is where the rubber meets the road. But a new study out of Oregon is challenging a key argument for extending health insurance to millions: that doing so will reduce costly emergency room visits.

The study in question showed that when health insurance was extended to Oregon residents …

What can we learn from health policy in China?

Ashish Jha, MD, MPH

Health Policy

January 16, 2014

I was just recently in Guiyang, the capital of the Guizhou province in China and had a chance to visit the Huaxi District People’s Hospital (HDPH), one of the largest “secondary” hospitals in the province. Like the rest of China, it has been gripped by the construction boom, recently opening a new surgery center and revamped medical facilities. They had a terrific EHR from a local vendor — probably …

How should we define the success of the Affordable Care Act?

Brad Wright, PhD

Health Policy

January 15, 2014

In recent months, news reports focused on the number of new enrollees as a key test of the law. Although the troubled performance of the Healthcare.gov website during October and November delayed enrollment for hundreds of thousands of potential subscribers, Obama administration officials and congressional Democrats hailed a surge in enrollment at the end of the year as proof that the law would fulfill its promise of providing affordable coverage to …

4 scenarios that would dramatically improve health care

Robert Pearl, MD

Health Policy

January 14, 2014

Radical change often happens suddenly, the result of a single decision or event.

The fall of the Berlin Wall and the dissolution of the USSR stand out as two dramatic political examples. In a social context, Supreme Court decisions in Brown v. Board of Education or Roe v. Wade both radically changed our society.

Then there’s the U.S. health care system. We know it can take 17 years for a new, proven treatment to …

Why Obamacare isn’t at risk for a death spiral anytime soon

Robert Laszewski

Health Policy

January 14, 2014

If the Obamacare health insurance exchanges are not able to get a good spread of risk — many more healthy people than sick — the long-term viability of the program will be placed in great jeopardy.

Given the early signs — far fewer people signing up than expected, enormous negative publicity about website problems, rate shock, big average deductibles, narrow provider networks, and a general growing dissatisfaction over the new health …

Why does Medicaid increase emergency department use?

Dr. Saurabh Jha

Health Policy

January 11, 2014

The interpretation of results of a policy study lies in the political inclination of the beholder.

If one likes the results they are “ground breaking.” If they are not in line with our world view there are “nuances” of hypothesis testing that detractors have overlooked, it’s too “premature” to draw conclusions and “further research” is needed. Statisticians, like lawyers, can be recruited to argue any point of view to meaningless insignificance.

This …

3 health care predictions for the New Year patients should know

Wes Fisher, MD

Health Policy

January 10, 2014

As we enter the New Year, I like to reflect on where we’ve been and where we’re heading in medicine. By far and away, this is the most tumultuous time I have ever experienced in health care.

It’s strange really.

I thought I’d try to make some realistic predictions of what patients should expect in the year ahead now that the “Patient Protection and Affordable Care Act” (PPACA) begins to sink it’s …

Price transparency alone won’t solve our health system’s ills

Renee Y. Hsia, MD

Health Policy

January 8, 2014

His right testicle had jumped into his abdomen after he lost control of his motorcycle on the highway. My 43-year-old patient, whom I’ll call Richard, in otherwise healthy condition, was brought to the ER with severe pain. Fortunately, his testicle was still intact and only needed to be put in the proper place.

I am an attending physician in the emergency department and trauma center at San Francisco General Hospital. I …

Bridging the gap between planning and reality

Paul Levy

Health Policy

January 8, 2014

A colleague once said, “Every plan is excellent, until it’s tested. It’s execution that’s the problem.” And so it is.

Clay Shirky wrote an excellent article about the gulf between planning and reality. Although the focus was on the misadventures of Healthcare.gov, the US government’s insurance exchange website, the broader lessons that he presents are worthy of consideration in many other settings.

Shirky notes: “The management question, when trying anything new, is ‘When does reality …

What can physicians expect from Obamacare in 2014?

Bob Doherty

Health Policy

January 7, 2014

Tthe ACA will now begin to transform how millions of Americans get health insurance coverage. Most of us will find that the plans offered by our employers are mostly unchanged because they measure up to federal standards. To the extent that some employers are imposing “negative changes, which include higher premiums, co-pays and deductibles, they’ve all been happening for more than a decade” because of employers wanting to …

Solving the high rates of hospital readmissions

Suneel Dhand, MD

Health Policy

January 6, 2014

Statistics show that about 1 in 5, or 20 percent of all Medicare patients are readmitted to hospital within 30 days of discharge. That’s a staggering number, not to mention all those patients that are readmitted frequently during the course of a year, but not necessarily within 30 days.

The problem of frequent hospital readmissions is actually one that exists all over the world and not just in the United States. …

On the heels of the Obamacare rollout comes ICD-10

Kevin R. Campbell, MD

Health Policy

January 6, 2014

Due to the ineptness of the Obamacare team and the debacle that has ensued, the botched rollout of the Affordable Care Act has dominated the political and medical headlines since October.

However, other health care changes are on the horizon (and have gone virtually unnoticed by the public) that have the potential to further disrupt our ability to treat patients. In fact, the technical and time consuming aspects of …

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