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.
For several weeks, the bumpy rollout of the federal health insurance marketplaces has overshadowed almost all other health care topics. But after reviewing the timely Health Affairs issue dedicated to the health care work force, it is clear we must maintain our focus on building a primary care system of the highest quality and value. Within that increasingly complex system, primary care physicians are the first, most critical line of …
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AAFP: The right care by the right provider is more important than ever
I was reading a blog about health policy and the failings of the ACA rollout posted on CNN. The author spends time talking about how much we want to change our health care system. And how, since change is hard, no one should be surprised by the pains accompanying this change, particularly in terms of individuals loosing their current insurance policies due to the rollout of the ACA …
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We really need 3 health care systems
As we mark significant milestones in our changing healthcare landscape, much of the dialogue continues to focus on the goals of payers and providers. Yet the goals of a third group are just as important. In order to truly transform care delivery in coming years, our efforts must include patients — their needs, interests, and engagement — at every step.
For the first time, the Affordable Care Act (ACA) will give …
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Bringing low income patients into the health care conversation
If you had to pick a single metric to a measure a hospital, which would you choose?
Of course, you can’t boil everything about a hospital down to one, single data point. Defining quality, throughput, and other factors used to evaluate a hospital is difficult business. The Centers of Medicare & Medicaid Services (CMS) tracks dozens of core metrics related to both quality and process, both inpatients and outpatients. As a practicing …
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What is the best metric to measure a hospital?
The sustainable growth rate (SGR) formula was enacted into law in 1997 to tie Medicare payment for services to physicians to the overall status of the economy. Basically, if the U.S. gross domestic product (GDP) does well, doctors get more money, and if it does poorly, doctors get less money for the same service. A decade of tinkering with legislation for circumventing the application of the SGR formula, preferably a few days …
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How will repealing the SGR affect your practice?
In an earlier post, I presented some data on which kind of physicians in the United States are most and least likely to see new patients who receive Medicaid, the state/federal program to pay healthcare costs for low income people. Now a recent study lays out some reasons why many physicians are so reluctant to see such patients.
Not surprisingly, it starts with low reimbursement rates. Medicaid pays about 61% …
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Why physicians are hesitant to take Medicaid patients
The president, by his own admission, did “fumble the ball” on the rollout of the major elements of health reform implementation. Not only is Healthcare.gov not functioning as it should, but people in the individual market are having their health insurance coverage cancelled–despite repeated assurances that if they liked their current coverage, they could keep it.
While that is absolutely a problem, it needs to be put into perspective. For …
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You can now keep your plan: What does this mean for you?
In my previous blog, I made the argument that whatever strategy we use to improve care in hospitals will not be implemented and executed well without proper focus by hospital leadership. So, it is in this context, that we recently published some pretty disappointing findings that are worth reflecting on.
We examined the pay of CEOs across U.S. hospitals and found that some CEOs got paid a lot more than others. This …
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Why quality doesn’t affect hospital CEO pay
By now, the Obamacare insurance exchange debacle is old news. Our attention spans are so short, we’re on to the next disaster. So we sit before our TVs and enjoy the Humana ads with a smiling senior pointing to a whiteboards with their insurance plan name, or watch the news sponsored by UnitedHealthcare or Walmart’s pharmacy department. Everyone’s got a cheaper plan these days with more benefits than the other …
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What Healthcare.gov can learn from the Challenger shuttle disaster
Dr. Bob Centor, author of the always provocative and thoughtful DB’s Medical Rants, suggests that the deep divide over the Affordable Care Act is based on “a major philosophic disagreement” over the respective roles of government and of individuals in choosing what is best for them:
The administration and their supporters believe that government’s job is to protect citizens from their bad choices. They want to decide what the people need and …
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Is Obamacare paternalistic?
Covered California, the state-run Obamacare health insurance exchange, announced recently that 59,000 people have so far signed up for health insurance.
Given that California amounts to about 10% of the nation’s population, this would suggest a smooth running federal exchange might well have enabled the Obama administration to have met its national first month goal of 500,000 sign-ups.
But the California enrollment also points to the real challenge Obamacare faces.
In the first …
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California offers clues to the future of the Obamacare exchanges
From the point of view of the rational humble classical liberal, Obamacare sucks.
We rebel against the further intrusion of a narcissistic national government into our lives, as any sane person would who recognizes the value of liberty and the repeatedly proven harm of collectivism.
Given that the national government constantly takes away liberty, and given that even the Constitution has been unable to defend our liberty against the onslaught of the …
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The unintended beneficial consequences of Obamacare
A little known rule published by CMS to implement the Affordable Care Act (ACA) could pose a significant financial risk for doctors, hospitals and other healthcare providers. The rule requires health plans participating in the exchanges to provide individuals purchasing insurance through the exchanges a grace period before terminating the coverage for non payment of the premiums. Doctors and other healthcare providers will continue to provide care during the grace …
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A little known rule in the ACA could pose financial risk to doctors
The roll out of Healthcare.gov has given plenty of ammunition to opponents of health care reform, who style themselves as crusaders against incompetence. While many who oppose the program do so in good faith, some critics carry an ugly prejudice against sick and disabled people.
That prejudice is “just deserts” — the idea that people get what they deserve. Rich people deserve their luxury. Poor people deserve their poverty. Sick and …
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Do you believe sick and disabled people deserve care?
Over the last couple of years, we have been witnessing the start of a seismic shift in healthcare philosophy. For far too long, the system has been totally focused on rewarding quantity: The more patients seen, tests performed, procedures completed — the higher the incentives.
Now, instead of rewarding healthcare providers for quantity in the “fee-for-service” model, we are moving towards a system that rightly focuses on the quality of care …
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How can we judge the ideal health system of the future?
I was hired in 2011 by the Veterans Health Administration (VHA) to direct the Office of Patient Centered Care and Cultural Transformation and charged with ensuring that the VA transforms from physician-centered care to personalized, patient-centered care that is based on relationships, built on trust, and committed to positive results over the veteran’s lifetime.
This undertaking represents one of the most massive changes in the philosophy and process for healthcare delivery …
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Our veterans drive the transformation of healthcare
Congress is closer than ever to repealing Medicare’s sustainable growth rate (SGR) formula. Competing plans, with traction, are on the table. The leaders of American medicine are convening this weekend in our nation’s capital.
The Coalition of State Medical Societies — representing nearly 160,000 members in nine states — calls on Congress to act decisively, but not rashly.
Congress must act now to repeal the flawed SGR formula used to pay physicians …
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Repeal the SGR and enact a permanent solution that supports physicians
Recently, the New England Journal of Medicine published a perspective by Lawrence Casalino, MD titled, “Professionalism and Caring for Medicaid Patients – The 5% Commitment.”
In the piece, Casalino argues that physicians should commit a portion of their practice to the Medicaid population as a matter of professional obligation. Yet this got me thinking: if physicians don’t respond to the professionalism argument and, instead, insist on being completely market-driven actors, then how can …
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Accepting Medicaid patients may be smart business
If you are a staunch conservative who believes that free markets should solve health care, or that poor people should work harder and have more skin in the game, or that governments should stick to building armies, you don’t need to read this post, unless of course you enjoy being aggravated by liberals.
If you are one of the talking heads posing as a progressive, while repeating the slogans of Obamacare …
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3 reasons to be against Obamacare
