A guest column by the American College of Physicians, exclusive to KevinMD.com.
In 1998 I started a period of national service to the American College of Physicians leading to my term as President for 2010-2011. During that time I kept an almost full time private practice in Fayetteville, Tennessee. Moving between the worlds of health policy and “the trenches,” I …
ACP: What’s a small group practice to do?
Any ruling by the Supreme Court on the constitutionality of the Affordable Care Act’s controversial individual mandate isn’t likely for at least another several months, but it’s worth thinking about what might happen after the case is decided. The first scenario is easy: If the Court upholds the mandate, the ACA goes forward as planned to the continued objections of many conservative Americans and politicians. The second scenario is less …
What happens if the Supreme Court strikes down the individual mandate?
A quality-driven MD colleague writes with frustration about two problems in his academic medical center. I often hear similar comments from nurses and doctors, and so I present the examples for your consideration.
This hospital has a poor record with regard to hand hygiene (in the 30% range), and my colleague suggested at an infection control meeting suggested that the rates be publicly posted in the hospital to provide an impetus for …
Patient safety requires hospital leaders to take personal responsibility
A guest column by the American Medical Association, exclusive to KevinMD.com.
Anyone making a major purchase wants to maximize value by exploring their options. Shopping for the best option drives market competition and promotes innovation and efficiency. Shopping for competitive health insurance options can be difficult when a market is controlled by one or two large commercial insurers. The lack a competitive …
AMA: Health insurance monopolies hurt patients and physicians
Why do we need to occupy healthcare? Why are we here, on this website, calling for change? We are so often told that America has the best healthcare system in the world. If that were so, then there would be no need to change anything. We could continue running things as we currently are, and all would be well …
Except that we do not have the best healthcare system in …
While we are talking about things that drive health care costs up, this one has bothered me since I was in practice years ago. I am a believer in competition, I think it forces us to be creative and provide better, cheaper, more efficient products and services.
But there is the mindset of leadership at play as well. Are we competing to provide better patient services to improve patient care, or …
Why do non-profit hospitals compete with each other?
There are two crises in America, both of which have a profound effect on the economy. The cost of healthcare is eating away at our ability to finance other needy areas. Poor performance of our educational system is weakening our international competitiveness. Both healthcare and education are at the precipice of complete collapse. They both deliver glaringly inferior results with prohibitive expenditures. The performance of our healthcare system relative to …
How the crises of healthcare and education are related
Recently the Michigan Task Force on Nursing Practice hosted a regional forum in my area. I was fortunate enough to attend and hear from the RN’s there the many issues that they face, which are varied and challenging. The state wanted to hear from this forum of RN’s what changes were needed in the state’s nursing regulations so that certification could be updated to reflect the current nursing environment. It …
Legislating the duties that can be performed by a nurse
The recent budget crisis in many state Medicaid programs has led the directors of these health care programs for the poor to cast about for ways to cut their costs, and many have landed on a ‘solution’ that puts lives at risk and undermine the financial viability of an emergency care safety net that is already severely underfunded and overwhelmed. Some 21 states use a variation of the old definition …
The new definition for a medical emergency
Why can’t the United States have a smarter health care system?
That was the frustrating question that kept poking through my train of thought as I read a study from the most recent issue of Pediatrics, the official journal of the American Academy of Pediatrics (AAP). The study, out of UCLA, examined the association between length of well-child visits and quality of the visits, including things like developmental screening and what …
Why can’t the United States have a smarter health care system?
In March 2010 President Barack Obama and the Democratic-led Congress passed the single largest change in the American health care industry since the introduction of Medicare and Medicaid in 1965. The Patient Protection and Affordable Care Act (PPACA) aims to drastically change the way that health care is delivered and financed. It partially draws upon the idea of personal responsibility and its role in promoting individual health. Some states, notably …
Personal responsibility in promoting individual health
What is an essential health benefit? I suppose that is a health or medical action, product, or process that should be paid for by someone other than the patient, in a society that provides so-called “third party coverage.”
Many very smart people and strong organizations have struggled with this issue for many decades.
Prior answers, such as they are, have come from staff model HMOs like Kaiser Permanente, the Veterans Health Administration, …
Is it possible to implement a list of essential health benefits?
We are finally in the midst of American football season again, after so many dull months. Are you ready for: “We’re Number 1; we’re Number 1”?
School pride; conference pride; regional pride; confirmation of identity; proof of manhood.
Think Summer Olympics in London, 2012. As the Gold Medals add up, the chants will ring out … U.S.A, U.S.A.
Goose bumps; spine tingles; national pride.
Years back, when John McKay coached the USC Trojans, he …
How to control health care costs in the USA
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Few things smell worse to me than the stank of a cigarette while trying to trying to load up on cholesterol via awesome blossom. Perhaps one such thing is the beguiling tale of what perverse fate has befallen the gobs of cash money rewarded to state governments from Big Tobacco.
This seemingly righteous pursuit was fought by brave attorneys general of 46 various states to regain money we dished out to pay …
How state governments are addicted to tobacco revenue
By mid-November, the Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) must respond to the legal complaint filed in a Maryland federal court by six Augusta, Georgia family physicians.
These doctors are not asking for money, but for relief from the negative effects brought about by CMS’ twenty year reliance on the American Medical Association’s Relative Value Scale Update Committee (RUC) …
Why CMS should settle with primary care plaintiffs
The October 19 Health Affairs briefing entitled “Saving Medicare Dollars and Improving Care,” sponsored by the ABIM Foundation and other funders, was a watershed moment in which ideas that would require less spending on health care that would actually improve care for patients were discussed on K Street. This is a great message for patients and, it so happens, for the super committee deliberations a few miles away.
Dr. Nancy Morioka-Douglas, Clinical Professor of Medicine/Family and Community Medicine …
Stop paying for tests that don’t improve health
Six months after Congress passed the health reform law last year, the Institute of Medicine of the National Academy of Sciences issued a landmark report on nursing. Although seemingly separate events at the time, it’s clear now that they are integrally linked: Never has quality care been more dependent on the total engagement of nurses as well as other health professionals.
At its core, the Affordable Care Act is about …
Quality care is dependent on the total engagement of nurses
Just think about it for a second. This means now we actually practice medicine based on bona fide evidence? What the hell have I been doing for the past 25 years? Making it all up? And who wrote those thousands of articles I’ve read? Dr. Seuss?
Evidence based medicine, or EBM, may be just another way to remove a physician’s autonomy. This trend has marched on for years, …
Evidence based medicine removes a physician’s autonomy
An alarming article in Politico.com looks at what could happen if the Supreme Court determines that the Affordable Care Act’s individual mandate provision is unconstitutional—something that the current conservative leaning of the Court seems to indicate is somewhat more likely than not.
Assuming that such a possible decision by the Court follows that of the Eleventh Circuit Court of Appeals in ruling that the mandate is unconstitutional but …
What if the individual mandate was unconstitutional?
Here are my next two principles of affordable healthcare reform.
First, healthcare reform cannot occur without tort reform. Anything less is akin to a drunk leaning up against a lamppost for support but insisting it is for illumination.
It is well known that fear of malpractice suits accounts for defensive medicine; e.g., performing tests and procedures and making unnecessary referrals to assure staying out of the court room. We are all …
Tort reform and integrated systems in health reform
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