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.

Our dysfunctional system: Both doctors and patients are at fault

James C. Salwitz, MD

Health Policy

September 6, 2013

I do not argue with my patients. Rather, I teach, outline options and explain my point of view, as each person must choose their path. However, the other day, Audrey and I got in a tiff when she was in the office to discuss her breast cancer. We had an enthusiastic discussion not of chemotherapy, x-rays or surgical options. Nope, we disagreed about what is wrong with healthcare.

It seems to …

The dark side of the Physician Payment Sunshine Act

Wes Fisher, MD

Health Policy

September 6, 2013

Another seemingly harmless bureaucratic initiative aimed at physicians sunk its taproot deep in the daily workings of medicine recently. The Physician Payment Sunshine Act promises transparency in all industry dealings with physicians by shedding light on the issue of payments to physicians from pharmaceutical companies and medical device manufacturers. In turn, it will save the system money, since all those freebies bestowed upon physicians when the corporate world came knocking …

The primary care crisis has been legislated

Jordan Grumet, MD

Health Policy

September 5, 2013

It was the same years ago in residency. There was both a categorical and primary care residency track. Each had their own distinctive curriculum and rotation schedule. The outpatient track did more time in the clinic, the categorical more on the hospital wards. We trained side by side. We attended many of the same lectures. And our fellowship choices matched identically. In fact, most of my colleagues from the primary …

What health care in the United States can learn from Nepal

Brad Wright, PhD

Health Policy

September 5, 2013

Beautiful Nepal Photos (10)

In the US, many health care woes are blamed on the federal or state government. Whether there is too little oversight and lack of transparency or too much interference and regulation, it seems that policy and politics often end up getting blamed for health care system troubles. But what happens when one lives in a country with no functioning …

How customer service mechanisms don’t exist in health care

Paul Levy

Health Policy

September 4, 2013

Now that I am a “civilian,” I get to experience the health care system like most of you. I marvel at the degree to which customer service mechanisms used by service providers in other sectors do not exist in health care. Please understand that I am not talking about the quality of care, or empathy, or attentiveness offered by doctors, nurses, radiology techs, lab techs and the like. On that …

To the legislators blocking Medicaid expansion

Chris Lillis, MD

Health Policy

September 1, 2013

As a primary care doctor I typically see 20-25 patients a day in my private practice. My community is gearing up for changes and is planning measures to integrate the many private practices locally. I was asked to serve on a committee evaluating software solutions to connect the disparate electronic medical records in the community, and had several hours of meetings at the hospital at the beginning of the week. …

What good is Medicaid expansion if no doctor sees Medicaid patients?

Peter Ubel, MD

Health Policy

August 29, 2013

With its expansion of Medicaid eligibility, the Affordable Care Act (a.k.a. Obamacare) was supposed to go a long way towards providing healthcare coverage to millions of uninsured Americans. That accomplishment was dealt a large blow by the Supreme Court, when it forbade the federal government from requiring states to expand Medicaid coverage. Nevertheless, many states plan to offer Medicaid to anyone with incomes at or below 138% of the Federal …

Do we need less art in medicine?

Vipul Kella, MD

Health Policy

August 28, 2013

After eating at my favorite restaurant last week, I started to think why I enjoyed it so much. I have been eating at the same place regularly for years, but never stopped to think about what makes it special. After thinking about it for a bit, I came up with one word: consistency. I know that every time I eat there I can expect the same dish prepared the exact …

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Do we need less art in medicine?

Should hospitals subsidize physician salaries?

Janice Boughton, MD

Health Policy

August 28, 2013

I have been doing locum tenens work as a hospitalist for nearly two years. One of my reasons for doing this is that the practice of medicine in the US is very interesting, and by working in very different places I get to see how things work and don’t work, and make up cool theories. I have time to read and listen to people and have become curious about several …

Will delays pose a big problem for Obamacare?

Bob Doherty

Health Policy

August 27, 2013

“What, me worry?” could pretty much characterize how Obamacare supporters are reacting to the news that the administration is delaying or modifying the implementation of some of its requirements. Like Alfred E. Neuman, they are expressing a public confidence that there is no reason to worry, everything is fine, the announced delays aren’t really that important, and Obamacare will be up and running and ready to start enrolling people on October 1. No worries.

“The …

The medical home requires building a better team

Fred N. Pelzman, MD

Health Policy

August 25, 2013

How do we get the many disparate members of our healthcare team together to provide better care in a patient-centered medical home?

Doctors (attendings and residents), nurse practitioners, nurses, medical assistants, phlebotomists, registrars, medical secretaries, social workers, community care organizers, pharmacists … the list goes on and on.

As it is right now, everyone is so busy trying to do their own job, to keep up with all of their paperwork, to …

Medicare places hospitals in a discharge conundrum

David Mokotoff, MD

Health Policy

August 25, 2013

A long time ago, in a bygone era, hospital discharges were simple. As a physician, you decided when to admit and discharge a patient from the hospital. Unfortunately, this process was often inefficient, costly, and subject to the whims of doctor and patient. Medicare, and other third-party payers, ultimately realized that this format made little sense and motivated keeping patients in the hospital too long. Many unethical doctors gamed the …

Aviation doesn’t hold all the answers to patient safety in health care

Suneel Dhand, MD

Health Policy

August 24, 2013

Slowly but surely, patient safety is taking its’ rightful place at the forefront of American medicine. Ever since the landmark report from the Institute of Medicine in 1999, To Err is Human: Building a Safer Health System, the issue has been gaining increased traction year on year. Dismal patient safety statistics in some hospitals are correctly being highlighted by the media, with pressure growing on senior leadership and administrators to vigorously …

How will primary care handle the influx of patients in 2014?

Edward Pullen, MD

Health Policy

August 23, 2013

As a family physician I look forward to the next few years in practice with a sense of uncertainty. One of biggest of these uncertainties is how to help meet the anticipated demand for primary care I expect. A number of changes are coming that will alter the supply and demand equation for patients and primary care providers. These include significant projected population demographics, and others that are due to …

We have the potential to have the best health care system in the world

Aaron E. Carroll, MD

Health Policy

August 22, 2013

Every once in a while, I’m forced to engage the health care system in a more personal way. Yesterday was one of those days. First, one of my children (who shall remain nameless), decided to take a stroll in the mulch on Monday without any shoes. He managed to lodge an enormous splinter in his foot which I couldn’t get out. By the time I saw it that night, it …

The physicians to solve the doctor shortage are already here

Karan Chhabra

Health Policy

August 21, 2013

Catherine Rampell recently wrote up an often-overlooked aspect to the doctor shortage debate:

Thousands of foreign-trained immigrant physicians are living in the United States with lifesaving skills that are going unused because they stumbled over one of the many hurdles in the path toward becoming a licensed doctor here.

The United States already faces a shortage of physicians in many parts of the country, especially in specialties where foreign-trained physicians are most …

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The physicians to solve the doctor shortage are already here

Why does Ezekiel Emanuel have such a low opinion of physicians?

Jordan Grumet, MD

Health Policy

August 20, 2013

A study in JAMA suggested that physicians feel that other players (lawyers, insurance companies, hospitals, etc.) are more responsible than doctors for reducing healthcare costs. Furthermore, they are hesitant to promote reforms that eliminate the current fee for service payment system.

Although I would bet the no one would be surprised by these findings, a scathing editorial by Ezekiel Emanuel and Andrew Steinmetz caught my eye. Before I get …

Primary care versus specialists: Sophie’s Choice in health care

Wes Fisher, MD

Health Policy

August 19, 2013

Sophie’s Choice is a novel by American author William Styron, whose plot ultimately centers around a tragic decision Sophie was forced to make upon entering the Nazi concentration camp: on the night that she arrived at Auschwitz, a sadistic doctor made her choose which of her two children would die immediately by gassing and which would continue to live, albeit in the camp.

While not of the same gravity, I have seen the discussion by policy wonks about physician payment reform …

Many hospitals approach safety improvement the wrong way

Paul Levy

Health Policy

August 19, 2013

The time has come to drive a stake through the heart of an oft-repeated assertion.

How often have you heard something like the following when those of us in healthcare who want to stimulate quality and safety improvements draw analogies to the airline industry?

“Well, in an airplane, the pilot has an extra incentive to be safe, because he will go down with the ship. In contrast, when a doctor hurts a …

5 questions ACOs need to ask themselves

David B. Nash, MD, MBA

Health Policy

August 18, 2013

ACO — for accountable care organization — is by now a familiar acronym within the healthcare industry and among all Americans who have followed the steady implementation of the Affordable Care Act.

Easily described but very challenging to operationalize, ACOs rely on effective partnering among healthcare providers of all shapes and sizes — health systems, hospitals, clinics, physician practices, urgent care centers — to collectively share responsibility for the health of …

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5 questions ACOs need to ask themselves