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.

Are we successfully moderating health care spending?

Janice Boughton, MD

Health Policy

January 6, 2014

David Blumenthal and others recently published a paper in the New England Journal of Medicine entitled “Health Care Spending — A Giant Slain or Sleeping?”

In it they look at the ongoing, and rarely discussed, phenomenon of slowing of health care spending, which has persisted over several years. Health care spending grew remarkably after the establishment of Medicare and Medicaid in the 1960’s, resulting in the fact that health care …

We must rise up against the hospital-industrial complex

Gene Uzawa Dorio, MD

Health Policy

January 5, 2014

In his farewell address to the nation on January 17, 1961, President Dwight D. Eisenhower warned the American people about the looming “military-industrial complex” which would sway public mindset and enhance money flow from government to the defense industry. This concept persists today with the practice re-adapted and launched against the health and welfare of the American people through the “hospital-industrial complex.”

Health care organizations like the California and American Hospital …

Real market reforms for health care

Duncan Cross

Health Policy

January 4, 2014

Whatever the problems with the roll out of Healthcare.gov, the fact is that the government take-over of health care has been happening for more than a century. If we want a truly free market for health care, we have to think in broader and bolder terms than simply rolling back the ACA. With that in mind, here is a short list of patient-focused ways to get the government out of …

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Real market reforms for health care

Medicine should welcome the fact that it’s a business

Richard Bottner, PA-C

Health Policy

January 4, 2014

At the end of each day during my primary care rotation, my preceptor and I sat together and reviewed patient charts. Simon Craig, MD*, built his internal medicine practice from the ground up and is a pillar of the Connecticut community he has served for more than two decades. He is a physician, a clinician and a scientist. While he manages the day-to-day operations of his practice, he avidly denies …

When health care adopts best practices from other industries

Peter Pronovost, MD, PhD

Health Policy

January 4, 2014

Last fall, the Armstrong Institute, along with our partners at the World Health Organization, had the privilege of hosting more than 200 clinicians, patient advocates, health care leaders and policy makers for our inaugural Forum on Emerging Topics in Patient Safety in Baltimore.

The event featured presentations by international experts in a dozen different industries, including aviation safety expert Captain Chesley “Sully” Sullenberger, a former space shuttle commander and the …

The impact of Obamacare on small business

Stephen C. Schimpff, MD

Health Policy

January 3, 2014

The Affordable Care Act is not so affordable if you own or if you are an employee of a small business. Here is why.

Consider the owner of a small service business with one or multiple outlets (e.g., a large restaurant or a small chain of sit down restaurants, a chain of barber shops, a taxi company.) The owner has more than 50 employees but the business is still “small” with …

Is Obamacare finally on track and moving toward success?

Robert Laszewski

Health Policy

January 1, 2014

After the disastrous launch of Obamacare the enrollment of 1.1 million people in the 36 state exchanges run by the feds is a major accomplishment. It is likely that the enrollment in the 14 state-run exchanges will take total Obamacare’s private insurance enrollment to near 2 million for the year.

Does this mean that Obamacare is finally on track and moving toward success?

At least the front-end of Healthcare.gov is now clearly …

4 health stories that deserve more attention

Robert Pearl, MD

Health Policy

December 30, 2013

The Affordable Care Act (ACA), sometimes called “Obamacare,” dominated health care media coverage this year. And rightly so. It is the most significant change in American medicine in more than half a century. But the legislation is just one aspect of a complex and highly fragmented system. It is also just the beginning (not the end) of the process to fix U.S. health …

Reduce health expenditures by putting the N back in SNAP

Neal Barnard, MD

Health Policy

December 28, 2013

With the nation’s attention still riveted on Obamacare, if we collectively remain focused on the health insurance component of health care, we could miss a crucial opportunity to improve the primary driver of our collective health: food.

Health care is important, yes, but it is not the only determinant of our well-being. The rest lies in what keeps us healthy, prevents chronic disease, and what the government subsidizes. As a physician, …

Why a physician shortage is inevitable

Kevin R. Campbell, MD

Health Policy

December 27, 2013

This week in the New York Times, Drs. Scott Gottlieb and Ezekiel Emanuel make the case that there will not be a physician shortage as a result of the Affordable Care Act (ACA). Both have extensive experience in policy and have held respected positions in government.

Based on a projected need of nearly 90,000 more physicians by 2020, I have difficulty seeing how a shortage will not occur. The …

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Why a physician shortage is inevitable

10 reasons to like the bills that repeal the SGR

Bob Doherty

Health Policy

December 26, 2013

At a time when Republicans and Democrats, House and Senate, can’t seem to agree on anything, Medicare physician payment reform is the exception to the rule. Recently, the House Ways and Means and Senate Finance committees reported out nearly identical bills to repeal the Medicare SGR formula and begin to move Medicare more rapidly toward paying physicians based on quality improvement activities — the closest Congress has ever gotten to …

3 questions doctors should ask themselves in 2014

Natasha Deonarain, MD, MBA

Health Policy

December 25, 2013

Next year will be a landmark year for America. Since our Great Recession and its far-reaching effects on the economy, housing markets, jobs, relationships, personal savings, spreading wealth, increasing poverty, divided politics and collapsing health care system, America seems to be purging a lot of karma.

Doctors play a huge role, allowing themselves to become puppets pulled by the purse strings of politicians, conglomerates and a divided country gone wild.

As we …

Merry Christmas, American health care!

Margalit Gur-Arie

Health Policy

December 25, 2013

It’s that time of year when the OECD publishes its “Health at a Glance” comparative health indicators, and The Commonwealth Fund follows with an international survey of health care related activities. A cursory review of these documents always ends up with the customary assessment of American health care: much more expensive than all others, wasteful and inefficient.

But this is the month of December, and health care workers are people too, …

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Merry Christmas, American health care!

The sense of abandonment from my society

Robert Fogerty, MD

Health Policy

December 23, 2013

“You look nice today. People don’t come to chemo in suits very often.” The friendly and familiar receptionist mentioned as I was checking out, the always full jar of lemon flavored hard candy on the shelf between us. As I pocketed a few of the candies, I managed to swallow the nausea and metallic taste just enough to say, “Thanks. I have a job interview today.”

During my senior year in …

Stop the Medicare cuts to senior citizens and the disabled in pain

Scott Mayhew, MD

Health Policy

December 22, 2013

As a pain physician, I would like to personally explain to President Barack Obama, Kathleen Sebelius, senior citizens and any disabled American suffering in pain, the devastating effects that will result from the drastic Medicare cuts in chronic pain care that are scheduled to take effect January 1, 2014. These cuts will severely, drastically and unfairly cut access to chronic pain care for senior citizens and other Medicare beneficiaries and …

The cheapest form of health care is to let sick people die

John F. Hunt, MD

Health Policy

December 21, 2013

If you learn nothing else today, I would ask you to learn that moral hazard is the cause of medical price hyperinflation.

Moral hazard is not just two words that don’t seem to go together. Moral hazard is when the person who bears the economic burden of a decision is not the decision maker. In the health care setting, moral hazard is when the third party payer (insurance/government) bears the …

The Affordable Care Act perpetuates a myth of health insurance

Luis Collar, MD

Health Policy

December 21, 2013

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 we never seem to question this premise enough before getting more patients fitted with shiny, new policies. This was precisely the case with the Affordable Care Act. But where is the evidence insurance plays any role in …

Is it racist to oppose Obamacare?

Peter Ubel, MD

Health Policy

December 17, 2013

It is pretty easy to be against Obamacare these days.

The federal government can’t come up with a working website to help people buy health insurance. The president misled people about whether they could hold onto their old insurance plans. And come next tax day, the least popular provision of the Affordable Care Act — the individual mandate — will be implemented for the first time.

Lost amidst all this controversy is …

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Is it racist to oppose Obamacare?

Dear lawmakers: Why aren’t doctors involved in health care reform?

Matthew Moeller, MD

Health Policy

December 16, 2013

As I was watching CNN news recently, I noted in the headlines different ways Obamacare is failing. Current problems discussed were the customers’ sticker shock of high deductible plans (up to $12,700 for families), the president blaming the insurance companies for having substandard plans, and the people blaming the president for losing their current insurance.

One patient even complained, “My new health care plan tripled in price, and now, it is …

Will fee for service ever go away?

Brian Klepper, PhD

Health Policy

December 14, 2013

The catchy title of a recent Harvard Business Review Blog post, The Big Barrier To High Value Health Care: Destructive Self-Interest, suggested that the Institute for Healthcare Improvement (IHI) is forging arrangements that can overcome fee-for-service reimbursement’s propensity to drive excess. As the honest broker, IHI could advocate for arrangements of mutual self-interest based on the right care, better outcomes and less money. Employers and unions would get lower costs, with …

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Will fee for service ever go away?

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