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 key to medical home success: Bringing the stakeholders together

Fred N. Pelzman, MD

Health Policy

August 18, 2013

One of the greatest challenges when it comes time to affect major change in any system is figuring out who the stakeholders are, who has a vested interest in seeing a project rise or fall.

Without knowing who all the players are from the word go, there is almost no way to move things forward. But recognizing that we can’t keep everyone happy is also a big part of this process.

So …

Direct pay is the solution to real world cost transparency

Kim Byars, ARNP

Health Policy

August 18, 2013

In an environment of increasing regulation, government mandated red tape, and shrinking reimbursement, health care practitioners find themselves caught between a rock and a hard place. They are being forced to see more patients to make ends meet and both parties are poorer for the process. Not necessarily in just a monetary way. Patients are beginning to feel frustrated and disengaged from their mutually frustrated and disengaged providers. Both parties …

Why the Accuracy In Medicare Physician Payment Act should pass

Brian Klepper, PhD and Paul Fischer, MD

Health Policy

August 18, 2013

With the recent release of two mainstream exposes, one in the Washington Post and another in the Washington Monthly, the American Medical Association’s (AMA) medical procedure valuation franchise, the Relative Value Scale Update Committee (RUC), has been exposed to the light of public scrutiny. “Special Deal,” Haley Sweetland Edwards’ piece in the Monthly, provides by far the more detailed and lucid explanation of the mechanics of the RUC’s arrangement with …

The blueprint for decreasing the cost of health care

Manoj Jain, MD, MPH

Health Policy

August 13, 2013

We have done it. We have decreased the increase in the cost of health care. Let us explain. For three decades (1980-2009), the cost of health care has been increasing each year at an average rate of 7.4 percent — double the rate of inflation. However, over the past three years, the increase in health care expenditure has remained at a low 3.1 percent.

Is this decline …

Thousands of dollars are put at risk with a single click of a button

Wes Fisher, MD

Health Policy

August 12, 2013

There is so much entropy in health care right now. So much finagling, so much shifting, so much arguing, so much uncertainty, so much shock. Shock at prices, shock at waiting times, shock that doctors don’t know how to increase referrals, shock that doctors aren’t doing more to help. What gives?

In triage, you don’t spend time with the expectant.

Doctors are keeping their heads down. They are still seeing patients. They …

Observation status: How Medicare’s solution could make things worse

Robert Wachter, MD

Health Policy

August 11, 2013

There are tens of thousands of policies in Medicare’s policy manual, which makes for stiff competition for the “Most Maddening” award. But my vote goes to the policy around “observation status,” which is crazy-making for patients, administrators, and physicians.

“Obs status” began life as Medicare’s way of characterizing those patients who needed a little more time after their ED stay to sort out whether they truly needed admission. In many hospitals, …

My health care wish list if I were king

Bob Doherty

Health Policy

August 9, 2013

I think we all have fantasies from time-to-time what we might do it we were made King for a day (only benevolent kings, of course—no despots need apply!) What decrees might we issue to make the world a better place? What changes would we order to make our politics better? What improvements would we institute to make health care better? Well, here’s my (health care) list:

1. I would decree that every …

Read more…

My health care wish list if I were king

For patients, reforming the RUC matters

David Margolius, MD

Health Policy

August 6, 2013

“Doc, if I have cancer, I don’t want to know. Stop bugging me about this colonoscopy.”

Mr. H said to me, his primary care physician, during our appointment. He folded his arms and nodded his head, indicating that his decision was final.

“Mr. H, as uncomfortable as colonoscopies seem, they can actually find lumps that might grow into cancer, and cut them out before they ever become cancer. That’s why I’m bugging you so much about this.”

I …

Read more…

For patients, reforming the RUC matters

Limiting your choice of doctors: Is Obamacare to blame?

Trudy Lieberman

Health Policy

August 6, 2013

The specter of loss of choice and freedom to select the doctor you want haunts again. This time it’s being raised on the airwaves with an ad from Americans for Prosperity, a group that advocates limited government and free markets. The ad, an attack on Obamacare, plants doubt in viewers’ minds about whether they can choose their own doctor, a theme that continues to resonate with both the public and …

Our patients pay for dumbed down American medicine

Jordan Grumet, MD

Health Policy

August 4, 2013

I guess what is so utterly frustrating is that the guys up there don’t see what is going on down here. The march of health care reform continues with little realization of what it feels like to be one of the tiny peon foot soldiers on the ground. We are not deaf. We hear the politicians and policy wonks. We read as non-clinician “doctors,” ivory towered administrators, and the business …

Are we unfair to the RUC? A view from the inside

Yul Ejnes, MD

Health Policy

August 3, 2013

A guest column by the American College of Physicians, exclusive to KevinMD.com.

I will begin this month’s column with a confession on something that most people don’t know about me. I hope it doesn’t lose me any friends. I am a member of the AMA/Specialty Society Relative Value Scale Update Committee, better known as the RUC. Actually, I’m an alternate, but …

What Detroit’s bankruptcy means for patients

Birju Rao

Health Policy

August 3, 2013

Detroit

On July 18th 2013, the city of Detroit filed for bankruptcy. Early estimates size up Detroit’s as the biggest in history with composite debt figures approaching the ballpark of $20 billion. Through the eyes of a clinician why should we care and what does this mean for our practices.

Detroit is dying.

While filing for Chapter 9 bankruptcy may give the city an extra lifeline, …

Are doctors ethically obligated to sign patients up for Obamacare?

Bob Doherty

Health Policy

August 2, 2013

One of the most disheartening developments in the unrelenting political fight over the health reform law is the organized effort by its opponents to dissuade the public from signing up for coverage. Having failed in efforts to block Obamacare in the Supreme Court, or to elect a president or Senate that would work for its repeal, they are now working to kill the law by persuading people to not sign …

How to revolutionize health prevention efforts around the world

Abraar Karan, MD

Health Policy

July 30, 2013

Imagine your 7-year-old son’s face, abdomen, and legs begin to mysteriously swell one morning. Your initial reaction as a parent would likely be to worry first. However, your second instinct is probably to rush to your computer and search the Internet for what might be going on. This is easy enough for the roughly 72% of people in America who have a computer with Internet access in their homes.

Now, imagine …

Break the cycle of event centered care

Fred N. Pelzman, MD

Health Policy

July 28, 2013

Creating a patient-centered medical home within our existing system seems, at times, like a Herculean task. Getting all the pieces in place so that we can make the needed changes sometimes seems too vast to get it all right.

We find ourselves asking: Why bother? Is our healthcare system that broken? Is the way we take care of patients now failing, satisfactory, or outstanding? If we just continue on the path …

Read more…

Break the cycle of event centered care

Turning health care into a giant used car lot

Naomi Freundlich

Health Policy

July 28, 2013

I’m not a big fan of bargaining and my half-hearted attempts to get a better price for a used car, garage sale find or contractor’s service have been mostly unsuccessful. There’s always that nagging feeling that the seller is laughing with delight once I’m gone, thinking, “I really pulled one over on that rube!”

And so it has come as somewhat of a shock to me that medical care has become …

How to aggressively pursue population health

David B. Nash, MD, MBA

Health Policy

July 27, 2013

A good recipe is one that combines high-quality ingredients in appropriate quantities to produce a savory main course or a decadent dessert.

It strikes me that, in order to answer the Affordable Care Act’s call for us to aggressively pursue population health, we must first understand what the recipe calls for.

Dichotomous as it may seem, the primary ingredient for population health is accurate, comprehensive data on the individuals who comprise the …

Reform creates new incentives in health care

Kohar Jones, MD

Health Policy

July 24, 2013

I advocated for the Affordable Care Act, and celebrated when it was passed.

It’s good to have everyone covered, I thought.

Insurance for everyone is the first step to health care for all.

Alas, access to health insurance isn’t the same as access to health care.

First there is the niggling detail of providers. We already have a primary care provider shortage. Internists, pediatricians, family physicians are already working at full capacity in caring for …

Are Cadillac plans responsible for rising health costs?

Chris Rangel, MD

Health Policy

July 23, 2013

If there’s anything that liberals hate it’s inequality – unless it’s the Federal tax code – and health care is a prime offender. The liberal mantra is that everyone should have the same access to basic health care. But this doesn’t just involve improving health care access and affordability for millions of uninsured Americans. It also involves limiting or impairing (through taxes) those health care plans liberals have decided are …

Navigating the shopping troubles with insurance exchanges

Trudy Lieberman

Health Policy

July 23, 2013

One could easily make a case that health care is today’s biggest consumer problem—not unlike those that sparked the consumer movement of the 1960s and 70s. Back then, consumer issues centered on problems with using credit, buying cars and home improvement services, and obtaining the best price for food, appliances, and just about every other new-fangled and expensive product that sprang from the post-war economy.

Like many old consumer problems, health …

Health Policy

Most Popular

Past Week

Past 6 Months

Recent Posts

Subscribe to KevinMD and never miss a story!

Most Popular

Past Week

Past 6 Months

Recent Posts