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.

Look to technology to reduce health costs

Stephen C. Schimpff, MD

Health Policy

May 7, 2012

Technology to lower costs rather than accelerate them. Smart phones to increase physician and other providers’ productivity. Fewer primary care physicians but more involvement by nurse practioneers and others. And increasing appreciation of the value of integrative medicine. These are but a few of the disruptive changes in care delivery that are coming.

I have posted concepts on how the health care delivery system will change in coming years – quite …

How to save a trillion dollars in health care

George Lundberg, MD

Health Policy

May 5, 2012

It is both conventional wisdom and factual truth that, unimpeded, American healthcare cost inflation will bankrupt the United States economically, educationally, socially, and politically in the not too distant future.

The inexorable upward trend line is unsustainable.

In 2009, I described six ways to save nearly $1,000,000,000,000 per year without serious harm, and with positive benefit to the public health.

They were:

Use intensive medical therapy instead of coronary artery bypass grafts and invasive …
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How to save a trillion dollars in health care

How the Affordable Care Act combats preventable hospital infections

Christian John Lillis

Health Policy

May 4, 2012

As the Supreme Court deliberates the Affordable Care Act, Americans should take a closer look at the commonsense reforms embedded in the law, including those that strengthen public health. Fixation on the law’s individual mandate has overlooked the law’s very important benefits for public health.

Lost amid the rhetoric about individual liberty is the public interest and common good of protecting all Americans from the costly and deadly menace of preventable …

Being insured does not equate to being covered

Richard Just, MD

Health Policy

May 3, 2012

A few weeks ago, my wife and I attended “A Conversation With David ‘Sonny’ Lacks” at the California Center for the Arts, Escondido. The event was a sellout with 900 attendees. As it turns out, most of the colleges and universities in San Diego County designated “The Immortal Life of Henrietta Lacks” as the book discussed by students and …

What do patients want from the health care delivery team?

Stephen C. Schimpff, MD

Health Policy

May 2, 2012

Ours is a provider-oriented system. Doctors like me and (former) hospital executives like me hate to admit it but it is true. Consumerism will slowly but surely drive it toward being a patient-oriented service model. What do patients and their families want from the health care delivery team? First and foremost is respect followed by service given in a high quality, very safe manner. Patients expect that the information gap …

ACP: If I were health care king

Fred Ralston Jr., MD

Health Policy

May 2, 2012

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

In preparation for a panel discussion at Internal Medicine 2012, the annual scientific meeting of the American College of Physicians, I was asked some questions about changes I would make in health care if I were king. That stimulated some serious thinking. For those of us in practice it is more usual to think about what new regulation …

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ACP: If I were health care king

Health care needs the Lollipop man

Vineet Arora, MD

Health Policy

April 29, 2012

I recently watched Dr. Atul Gawande on video describe how what American healthcare needs is pit crews and not cowboys. This sentiment is also memorialized in his thought-provoking writings for the New Yorker.

Interestingly, Dr. Gawande is not the first person I have heard to suggest such a thing. A colleague named Dr. Ken Catchpole actually studied Formula 1 pit crews and used the information to guide improvements in …

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Health care needs the Lollipop man

Where do our wasted health dollars go to?

Roy Benaroch, MD

Health Policy

April 29, 2012

The biggest problem with health care delivery in the US is cost, which seems to have taken a back seat to other issues meant to be addressed by health care reform. We spend about $2.5 trillion dollars a year on health care—that’s over eight thousand dollars a year for every man, woman, and child. What’s that getting you?

According to the government, about 30% goes to hospitals; 20% goes …

3 common misconceptions about doctors

Bradley Evans, MD

Health Policy

April 28, 2012

In the current climate of health care reform, it is important to understand doctors and the work they do. I have found 3 common misconceptions, held even by doctors themselves, concerning the job of being a doctor.

The first is the idea that doctors are conservative, resistant to change. Facts show that doctors deal with change all the time. They are familiar with the concept of change for change’s sake and …

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3 common misconceptions about doctors

While doctors disagree, every physician wants to fix health care

Kohar Jones, MD

Health Policy

April 27, 2012

Three out of four dentists recommend this tooth brightening toothpaste — make your smile sparkle like never before! Six out of seven plumbers recommend this drain opening de-clogger — make your bathtub drain like never before! Nine out of ten doctors recommend improving the medical system in the United States — make your health care system heal like never before!

But how do we do that?

Do doctors think the Affordable Care Act is the soothing balm …

Lack of health care coordination benefits physicians

John Toussaint, MD

Health Policy

April 25, 2012

An excerpt from Potent Medicine The Collaborative Cure for Healthcare.

It was mid-summer 2010 when the full scope of everything that Nancy D’Agostino did not know hit home. Still raw from surgery and missing parts of her body, she thought that all the hard choices were behind her. Then here was a new face, a radiation oncologist, outlining side effects of treatment and asking her to choose. And then a medical …

The coming changes in health care delivery

Stephen C. Schimpff, MD

Health Policy

April 24, 2012

There will be some very disruptive and some transformational changes in the way health care is delivered, not as a result of reform, but as a result of the drivers of change described in a previous post on KevinMD.com. They included an aging population, an obese society, shortages of doctors, and emerging consumerism, among others.

I interviewed in depth about 150 medical leaders from across the United States to collect …

5 key trends to look for in the emergency department

Wesley Curry, MD

Health Policy

April 24, 2012

Patients have been arriving at the doors of emergency departments in increasing numbers over the past decade, and this trend will only grow in the future. I believe there are five key factors that suggest every ED should brace itself for a never-ending rush hour.

As the CEO of a physician group that provides medical care to over 4 million patients per year, I have the opportunity to study in great …

Healthcare reimbursement will change dramatically in the future

Donald Tex Bryant

Health Policy

April 22, 2012

Based upon the past and the current state of affairs in healthcare, healthcare reimbursement will change dramatically in the future. I believe that reimbursement based upon fee-for-service will gradually disappear and be replaced by models based upon the ability to better manage patient diseases and conditions. That is, reimbursement will be based upon the quality of service delivered by the provider. For insurers, whether private or governmental, I believe that …

What exactly is this thing we call healthcare?

Robert Sewell, MD

Health Policy

April 21, 2012

Amid all the political rancor and media hoopla currently surrounding the American healthcare system and the clamor for reform from all sides, one question has gone unasked; what exactly is this thing we call healthcare? Is it the local hospital with its giant façade and ambulances coming and going all hours of the day and night? Is it the clinic where you sit and wait to have your blood pressure …

The problem of mixing productivity with patient safety

Michael Appel, MD

Health Policy

April 20, 2012

The fundamental challenge in any high-risk industry is balancing “productivity” versus “safety.” The term “protection” is frequently used within the scientific literature to express the role of safety departments within an organization. Described this way, it might sound as if the safety experts are framing the debate to suggest “the evil factory bosses are continually speeding up the assembly line, while the righteous safety-folks are yelling ‘slow down!’” This essential …

A simple innovation to improve hospital quality and safety

John Self

Health Policy

April 19, 2012

When I moved from the news business, writing about crime and investigating corrupt politicians and police officers, to the healthcare industry in the mid-1970s, we measured only the basic hospital performance indicators — including census, staffing, inventory, days in accounts receivable and average length of stay. The data was not in real time by any stretch of the imagination. By the time the information was produced and distributed to managers, …

Why we need physician champions to reform health

Kenneth H. Cohn, MD, MBA

Health Policy

April 19, 2012

One advantage of being a surgeon and an MBA is the opportunity to observe different ways of approaching and responding to challenges. My surgical training and 25 years of practice in academic and community hospitals have helped me become more comfortable with making major decisions despite the lack of perfect information. Although I find that it takes longer to bounce back from nights on call, I relish the excitement of …

Is our high cost of cancer care worth it?

Naomi Freundlich

Health Policy

April 19, 2012

The U.S. spends far more on cancer care than 10 European countries, but according to a new study, it may be “worth it” as “the value of the survival gains greatly outweighed the costs.”

The study, published this week in Health Affairs, found that U.S. spending on cancer care, in 2010 dollars, increased by 49% from 1983 through 1999, from $47,000 per cancer case to $70,000 per case. Meanwhile, in …

Why doctors should drive health reform

Kohar Jones, MD

Health Policy

April 17, 2012

Who better knows how to fix a leak than a plumber?
Who better knows how to repair a cracked doorway than a carpenter?
Who better knows how to solve the conundrum of our leaking cracked health care system than a doctor?

Doctors are an important part of public discussions about health care reform. Our prescriptions drive healthcare costs. We are the crucial middlemen between the biomedical industry and patient health. Sharing our first hand experiences in health care …

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Why doctors should drive health reform