Although members of the Obama team are now celebrating their election victory, the next four years will not be smooth sailing. Ignoring the campaign rhetoric, there is still much more work to be done in order to reshape our health care system; the effect on academic medical centers and teaching hospitals will be significant.
The political conscience is still being driven by …
Predicting the next 4 years of health reform
American Medical News featured an article with the disturbing title, “Massive health job losses expected if Medicare sequester prevails.”
I wasn’t entirely sure what a “sequester” was, since I thought it was a verb. Sequestration, I thought, was the noun. (I hear a loud knock. It must be the grammar police.) The story, as I understand it, is that when our government decided to pull together and raise the debt ceiling, …
Why across the board Medicare cuts are a bad idea
What will health insurance cost in 2014?
Will the new health insurance exchanges be ready on time or will the law have to be delayed?
There will be sticker shock
First, get ready for some startling rate increases in the individual and small group health insurance marketplace due to the changes the law dictates.
In a November 2009 report, the CBO estimated that premiums in the individual market would increase 10% to 13% …
The cost of health insurance in 2014: Get ready for sticker shock
I’ve been getting emails about the New York Times piece and my quotation that the penalties for readmissions are “crazy.” It’s worth thinking about why the ACA gets hospital penalties on readmissions wrong, what we might do to fix it—and where our priorities should be.
A year ago, on a Saturday morning, I saw Mr. “Johnson,” who was in the hospital with a pneumonia. He was still breathing …
Reducing medical errors should take priority over readmissions
Costs and revenue: This is the oxygen of any business, any organization. What are your revenue streams? How much does it cost you to produce them? Life is not just about breathing, but, if you don’t get that in-out equation right, there is nothing else life can be about.
Right now this enormous sector is turning itself inside out. It has turned the “transmogrification” setting to “warp.” Why? It’s all about …
Why cost and revenue will kill independent hospitals
With notably few exceptions, the American health care system has been financed on the basis of volume rather than value. That means that we’ve been paying providers for everything that they do, rather than paying them for the outcomes they produce. This is not common in other fields.
For example, if you are in an accident and have to take your car to a body shop, you (or your insurance company) …
The loopholes around penalizing hospitals for readmissions
Recently, “60 Minutes” (in my view the last bastion of great traditional network news investigative reporting) described a for-profit hospital system that apparently uses percent targets (allegedly 20%) to encourage high admission rates by their ER doctors.
In setting up this report, the reporter commented that as much as 10% of healthcare expenditures in this country were “unnecessary.”
Actually, most health experts I have read and consulted would put that number much …
Medical homes need ready access to good data
A lot of us get health benefits through our workplace, and employers are increasingly turning to wellness programs as a means of reducing costs and improving productivity.
In the coming year, as aspects of the Affordable Care Act take effect, many employers will provide even greater incentives for participation in programs that require the employee to achieve certain wellness goals, such as smoking cessation or weight loss.
What this means for the …
Motivating employees to meet their wellness goals
A guest column by the American Medical Association, exclusive to KevinMD.com.
When health plans have merged, they’ve said that a bigger insurance company would drive down premiums. The casual acceptance of this economic fallacy led to more than a decade of unchecked megamergers that helped health plans cement dominant market positions across the country.
It’s now clear that when health insurers talk …
AMA: Patients are vulnerable to health plan monopoly power
When you walked into the voting booth on Tuesday, November 6, did you do so with a feeling of calm certainty that the man who would get your vote for President was unquestionably the best choice, or even the only possible choice? Did you feel confident that your candidate’s political party fully supports your political views as well as your personal values?
For many physicians, I suspect that the answer to …
Neither political party truly represents doctors or their patients
A guest column by the American College of Physicians, exclusive to KevinMD.com.
Recently, I was invited to speak at an ACP chapter meeting on the topic of shared vision. In the talk, I used as examples Dr. Martin Luther King Jr., John F. Kennedy, and Steve Jobs, leaders whose visions inspired people and helped them to achieve great things. As I wrote the talk, it occurred to me that …
ACP: Practice transformation is more than checking off boxes
Those who resist health care reform point to America’s great cancer care – instead, we should protect “the best health care system in the world.” After all, if we’re the best, other countries should change, not us.
Do we really have the world’s best cancer care?
A good indication is the American survival rate for breast cancer, the world’s longest. But …
Do we really have the world’s best cancer care?
I recently said I would describe the essential elements of “true reform.” I realize others might add or subtract from my list, but here it is – at least for today:
Payment reform. I put this first because no matter what form or structure healthcare takes, without payment reform it will be doomed to failure. And by “payment reform” I mean switching from the “fee for service” model I discussed in …
4 essential elements of true health reform
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The growing concern about reducing the cost of healthcare delivery is the major focus in revamping the U.S. healthcare system.
There have been numerous attempts to better understand the key drivers contributing to rising healthcare costs, yet the ability to successfully control the rising trend has been met with consistent challenges.
A key motivating factor of the Affordable Care Act was to drive …
Price transparency is no longer a luxury, but a necessity
Of all the complex, costly, and downright intimidating issues in U.S. healthcare today, Super Storm Sandy tops my list as the scariest.
Even though hospitals from the Carolinas to Maine deployed their emergency plans and had extra providers on site to deal with the expected influx of patients, those in the hardest hit areas couldn’t withstand such a powerful storm surge.
Like many …
Hurricane Sandy’s profound impact on population health
The 2012 Presidential election is over. Obamacare is the law of the land and is certain to remain so. There was tremendous uncertainty not knowing whether the law would be repealed, revised or remain. Many of us opposed the bill, and there certainly are negatives. Like it or not, it is time to “get over it,” and not a second later than now. …
How Obamacare will create a new normal for medicine
I was chatting with someone who asked what I did for a living, and I told him I am a doctor. “The kind that helps people?” he joked.
I knew what he meant. The MD is the practical fixer, the PhD the omphalocentric academic. Many believe in this dichotomy, as false as it is. And such a philosophy underlies the opposition to some elements of the PPACA, aka Obamacare.
There’s a board of …
Does the Independent Payment Advisory Board need physicians?
The American Academy of Family Physicians (AAFP) took a bold stance in a report regarding the future of primary care in the US by reinforcing its endorsement of the Patient Centered Medical Home (PCMH), specifically led by physicians. The report was supported by other large national physician organizations including the American Academy of Pediatrics, the American Medical Association, and the American Osteopathic Association.
The report took a close look at independent nurse …
Who should lead the patient centered medical home?
If you get sick, health insurance should cover all the “stuff” necessary to make you better, right?
While that sounds good in principle, Uncle Sam has made it a lot more complicated than that. As we continue to struggle with health reform, this New England Journal article on “Medicare’s Enduring Struggle to Define Reasonable and Necessary Care” is very timely.
According to Drs. Neumann and Chambers, Medicare has always covered medical services that …
Reasonable and necessary: 2 words Medicare has trouble with
Now that President Obama has won a second term, discussions about healthcare have seemingly disappeared from the public’s radar.
Big mistake – although I do understand the public’s shifting interest in the General’s sex life and, much more serious, the heartbreaking tragedy of the renewed hostilities between Israel and Gaza.
I do expect that healthcare costs will be back on the radar fairly soon as discussions about the fiscal cliff intensify – …
We will soon be heading for a medical cost fiscal cliff
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