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.
Have you ever been in a negotiation with a health plan for a network participation contract and had the impression that the plan knew all the rates that you had agreed to in confidential negotiations with other health plans? Allow me to reassure you: you are not being paranoid. It is quite likely that the plan you are negotiating with knows exactly what rates and terms you have agreed to …
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Doctors and hospitals are cheated during rate negotiations
With all the debate about how to best implement coordinated care that benefits patients while being feasible for providers and economical for the government, it’s ironic that little attention has been given to a decades-old managed care model that does all this.
But as Medicaid reform progresses in New York and elsewhere, that may be about to change.
The program is called PACE, or the Program of All-inclusive Care for the Elderly, …
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Building on the success of coordinated care
I am often fascinated by the simplified dichotomies and ironies of the health care discussion. Some argue that the individual mandate infringes on individual rights yet one could argue that tying health insurance to a particular employer is in itself a violation of individual liberty. When Patrick Henry stated, “Give me Liberty or Give me Death” in protest of the Stamp Act of 1775, he helped swing the assembly (including …
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Health reform is in the hands of the Supreme Court
Imagine an America with no health insurance companies.
What do health insurance companies do?
They take as much money as possible from people who want health insurance coverage. They pay out as little money as possible — so-called medical loss — to settle claims from creditors for health services and products that have been delivered.
They keep as much money as possible for the incomes of their executives and other employees, and to …
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An America without health insurance companies
Recently, The Doctors Company (TDC), the country’s largest insurer of physician and surgeon medical liability, decided to survey doctors to determine what they are thinking and feeling about health reform. The results are pretty gloomy.
To put this in context, it is important to understand a bit about how TDC conducted the survey. First of all, the universe of doctors they reached out to were doctors insured by The Doctors Company. That means …
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Physicians are gloomy about health reform
Today and for the next few years the weather of this industry will be dominated by pervasive, discontinuous change. Structures, revenue streams, relationships of every level: All are shifting in fundamental ways. Specifically, the weather will be driven by:
i) invention and propagation of new business models;
ii) shifting risk onto both the provider and the patient, accompanied by building of new risk-based relationships, contracts and alliances;
iii) smart primary care coming to …
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10 strategic questions to ask yourself about the future of health care
Your doctor’s exam room is getting overcrowded. Modern US health care means that, like it or not, you and your physician are sharing that once private space with an insurance executive constantly hissing in your doctor’s ears to move it along. You are also sharing it with pharmaceutical marketers, lobbyists from the food industry … special interest groups of every stripe.
Now move over and make room for one more interested …
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How political agendas erode the doctor-patient relationship
Author of the new book “The Future of Health Care Delivery” and the former CEO of the University of Maryland Medical Center, Stephen C. Schimpff, MD, FACP, says effective care coordination, especially for patients with chronic illness, requires technology, more involvement of primary-care physicians and a health-care system – not a medical-care system.
A physician, educator and cancer researcher for more than 40 years, Dr. Schimpff shares his …
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Care coordination is key to fixing health care
There are an awful lot of reasons that led up to my eventual resignation from a career in primary care medicine. I don’t know that any one of them is more important than the other (it really just depends on which day you ask me). One that stands out for me though as a universal problem shared by millions is Managed Health Care, and the imposition it has posed on …
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Why this pediatrician quit medicine
The United States Preventive Services Task Force (USPSTF) is a federal committee composed of private sector experts in prevention and primary care. Its mandate is to make recommendations as to which preventive services are beneficial, which are useless and which are harmful. Disconcertingly, there is a small but vocal opposition to the USPSTF as embodied by an op-ed piece in the Wall Street Journal by Dr. Scott Gottlieb.
Dr. Gottlieb’s main argument against the USPSTF is …
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The USPSTF should stay independent from politics
Last year, Ann Mathews wrote a brilliant piece in the Wall Street Journal about the future of medical care in the United States. It is an extremely informative study and provides the reader with a very fine 50,000-foot view of the current condition of its subject.
What she did not mention, or truly highlight, is the threatening trend that is taking place with ever increasing rapidity, of hospital conglomerates, both …
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Healthcare consolidation may bend the cost curve the wrong way
For centuries, hospitals have served as a cornerstone of the U.S. health care system. During various touch points in life, Americans connect with a hospital during their most intimate and extraordinary circumstances. Most Americans are born in hospitals. Hospitals provide care after serious injuries and during episodes of severe sickness or disease. Hospitals are predominately where our loved ones go to …
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Why one-third of hospitals will close by 2020
Ever been put on hold when calling your insurance carrier? Or had so little time with your physician that you could not discuss everything you thought was important?
Our care is generally good in the United States but not as good as it could be nor as good as it should be. There are multiple problems to consider.
First, ours is a medical care system not a health care system. It is …
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Patients are not the customer
There has never been a more hectic time to be in the business of healthcare. Healthcare reform has brought many players to the table. And the “game” is bound to have winners and losers. This game is analogous to the board game Monopoly — a number of health care companies are buying up property (i.e., hospital and smaller providers) to position themselves as winners in the new shared savings payment …
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The gamble of the ACO monopoly game
Just when American healthcare system seems so dysfunctional that it seems impossible to imagine how it could be screwed up further, a decision is made that restores one’s faith in the creativity of Man. But before you run out of guesses as to which particular decision we’re talking about today, we’ll just blurt it out. We are referring to a recent decision by Washington State Medicaid to deny payment for …
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Denying payment for unnecessary emergency room visits
For some 30 years now, I have been tracking the work of a gifted “futurist” — one Clement Bezold, PhD.
In this context, a futurist is a social scientist who specializes in making systematic predictions of the future of society, either in general or with respect to a particular segment.
Dr. Bezold has done considerable thinking about the future of healthcare, much of which he has captured in his books (“The Future …
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4 possible scenarios for the future of primary care
An excerpt from The Future of Health Care Delivery.
We Americans like to pride ourselves on having the best health care system in the world, but unfortunately that is not the case. We have a medical (that is, sick) care system—a system that waits until we become ill before it kicks into action—instead of a health care system focused on helping us stay healthy. We give lip service to prevention and, depending …
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A sick care system instead of a health care system
As Americans we believe we have the best healthcare system in the world. But think again, it’s really not the truth. We do have superb medical schools, very well trained providers, superb science and technology but the delivery of medical care is just not what it should be. We spend more for healthcare than any other country does on a per capita basis.
And yet when we compare ourselves to other …
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America has a medical care system not a health care system
