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.
If you have been paying attention to US healthcare policy debates lately, you know that hospitals have a price problem. Walk across the street from one hospital to a competitor hospital, and you could easily find yourself facing a $30,000 increase in your medical bills. At one extreme for instance recent information shows that replacing your hip with a surgical implant might cost anywhere from $5000 to …
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How Obamacare will largely eliminate price variations
One reason is to apply an extra “facility fee” to patients’ bills.
Another reason is that primary care docs generate a ton of money for the hospital. A new survey was sent to hospital chief financial officers across the nation and based on data submitted by 102 facilities, it found that PCPs generate more annual revenue than specialists do.
PCPs (defined in the survey as family physicians, general internists, and pediatricians) generated a …
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Why do hospitals buy primary care practices?
I always believed that, if we could harness the entrepreneurial spirit of the American physician, we could be capable of great things. Physician decisions drive much of what is good and bad about our health care system. Their pens are the biggest driver of cost and their vigilance is the most significant driver of quality. It is a shame that physician-owned hospitals are accelerating the creation of a two-tier system …
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How physician-owned hospitals are making teaching hospitals pay
Several physicians have reached out recently to discuss attractive employment offers from health systems. They are invariably conflicted. They understand the trade-offs, that they’ll give up the autonomy they’ve become accustomed to in exchange for more money and fewer practice management headaches. On the down side, they’ll be accountable for generating significant revenues, sometimes independent of care appropriateness.
Most also are aware that the same care services they provide now will …
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A brave new world as more physicians become employed
I attended a medical staff meeting recently. These are required meetings and attendance is taken, as was done when we were in kindergarten. While some folks are interested in these meetings’ content, many are not and simply sign the attendance sheet and then slither out in a stealth fashion. Sly doctors grab their pagers and then leave hurriedly pretending that they were summoned to an urgent medical situation, when they …
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How the medical profession is being forced to game the system
The Baylor PCP chapter co-hosted a screening of Escape Fire at Rice University. I had heard about the film some time ago when it first came out and had always wanted to see it myself, but now I am convinced that it should be screened at every medical school orientation.
The film provided a poignant portrayal of several all-too-familiar stories: the overworked, underpaid primary care doctor who cannot afford to spend …
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Why isn’t primary care idolized?
Amid massive change in our healthcare delivery systems and seismic shifts in many regional markets, physicians are increasingly being faced with a simple choice: be acquired or become employed as part of a large healthcare system, or stay independent while offering a compelling service that hospitals and health systems value.
The changes occurring in our care delivery systems have generated great interest, innovation, and yes, fear among many in healthcare, doctors …
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As health care consolidates, physicians face a choice
Arkansas is now the first state to use Medicaid expansion dollars to buy private coverage for many of its 250,000 newly eligible residents rather than enroll them in the existing Medicaid program. The Arkansas House of Representatives approved the plan, followed by the Senate, to confirm that the state will be implementing this “market-based approach” to expanding Medicaid.
The idea of buying private insurance for Medicaid recipients is emerging as a “conservative …
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Buying private insurance for Medicaid recipients
Right now hospitals around the country are being asked to reckon with some stark realities regarding readmissions. $17 billion a year is spent on readmissions for Medicare patients alone, and 75% of those readmissions are considered to be preventable. Of all Medicare patients who are admitted to a hospital, 18 percent will be readmitted in 30 days and of those, 50 percent will not have seen a primary care physician …
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Transitional care programs are ripe for innovation
This past November, the New England Journal of Medicine published results from the “Advancing Quality” program in the United Kingdom: hospitals in the northwest of England were paid up to 4% more based on quality scores for treating several common medical conditions. Patient outcomes were compared to other National Health Service hospitals not eligible for the bonuses, and several other conditions that were not explicitly measured in the same …
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Why pay for performance saves lives in the UK but not in the US
Like it or not, measuring physician performance is now a key part of the conventional wisdom on improving our health care system. Borrowing from management guru Peter Drucker’s mantra “You can’t manage what you can’t measure” health care policy makers have embraced performance measurement as being central to managing our heretofore unmanageable health care system. But there is a small but seemingly growing group of Don Quixote-like dissenters who are …
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Is it possible to improve clinical performance without measuring it?
Much has already been written about the Oregon Medicaid study that came out in the New England Journal of Medicine. Unfortunately, the vast majority is reflex, rather than reflection. The study seems to serve as a Rorschach test of sorts, confirming people’s biases about whether Medicaid is “good” or “bad”. The proponents of Medicaid point to all the ways in which Medicaid seems to help those who were …
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Why the Oregon Medicaid study is misunderstood
I recently took part in a “civil discourse,” an unusual occurrence in this era of media pundit-orchestrated shouting matches.
Unlike a debate with winners and losers, a civil discourse begins with the premise that, when there are different points of view on a topic, it is better to understand those with whom we disagree than to turn off the sound.
By listening and asking probing questions, we come to understand how such …
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Health reform needs a healthy respect for civil discourse
It was bound to happen.
By “it,” I mean that the small group of specialty hospitals (usually orthopedic or cardiology-focused) across that country that are owned by doctors were going to have their “See! We Told ‘ya so!” moment.
Doctor-owned hospitals. How many are there? Two hundred and thirty-eight of them in the whole country (out of more than five thousand)–somewhere between four and five percent of the total in the U.S. (numbers courtesy …
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Doctor owned hospitals: Are the rich getting richer?
I know what I want in healthcare. I want it to be efficient, effective, thoughtful and inexpensive. I want it to create healthy people who don’t need very much health care. I want it to involve elegant solutions to problems that take less time, money and effort. I want it to be so much easier and less expensive that taking care of all of our people uses even less resources …
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What does American healthcare want?
What is the path forward for physicians who want to remain in private practice, outside the constraints of health system employment? How will the environment change and what new demands will that place on practices and physicians? What follows are the observations of one industry-watcher who has worked on all sides of health care, but who now spends most his time focused on the interests of those who pay for …
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The path for physicians who want to remain in private practice
Over the past decade, patient-centered care has become a mantra for high-quality health care. Policymakers, researchers, physician-leaders, and patients have all cited the need for care to be tailored to patients’ unique needs and preferences. And there is solid evidence that patient-centered care can help improve care quality and reduce costs. However, in the rush to become more patient-centered, the health care system has misplaced its focus.
Current approaches to …
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Patient-centered care requires learning from the service industries
Ask a nurse about Nurses’ Week, and you’ll likely get a snarky answer. The sweets designed to obesify already unhealthy nurses are intended to kill them off so they can bring in a whole new crop, as they’ll be cheaper than the old experienced ones.
We need a national initiative to start giving out coupons during Nurses’ Week for plastic surgery to have smiles permanently stuck on our faces.
Nurses like to …
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We need a new way to value the work of nurses
