At UC Berkeley in the 70s, the secretary in the Department of Psychology pasted a bumper sticker on her desk positing the question: “… yes, but are we asking the right questions?”
For some reason, this subtle invitation remains with me today, echoing amidst the ACO fervor of “… better care at lower costs.”
… the good news is we’re making great time, the bad news is we don’t know where …
Are ACOs putting form ahead of function?
A guest column by the American Medical Association, exclusive to KevinMD.com.
Billions of dollars in administrative waste would be eliminated each year if health insurers sent a timely, accurate and specific response to each physician claim, and while this year’s AMA National Health Insurer Report Card shows promising improvements in denial rates, more work needs to be done.
The AMA’s fourth annual check-up …
AMA: Health insurers’ denial rates are down, but error rates are up
We all know, broadly speaking, the mission of comparative effectiveness research (CER), now sometimes called patient-centered outcomes research. Such studies should inform clinical and health policy decisions made by physicians, payers, and regulators to help determine treatment guidelines, coverage policies, and the therapeutic value of new therapies relative to standard-of-care in real-world settings.
But dive deeper, and it’s clear there remains an uncomfortable level of confusion as to what CER …
The confusion surrounding comparative effectiveness research (CER)
In the Chicago Tribune recently, Bruce Japsen has an excellent article addressing Accountable Care Organizations, quality of care issues, and the change in how physicians will be paid in the future.
Clearly, the government and insurers have decided that physicians will not be paid for services rendered. Physicians will be paid based on patient outcomes and will share in any losses insurers sustain due to poor patient outcomes. There are …
There have been scores of recent articles about Congresswoman-elect Kathy Hochul’s upset win in New York’s 26th Congressional District special election. They all seem to share a thread of incredulity, followed either by chortling or spin depending on the source. These stories also share the sense that her victory was truly an underdog performance destined to become legend.
According to The New York Times, “Two months ago, the Democrat … was …
Our growing ability to prolong life and our shrinking ability to pay for it
Does it really matter how many ribs Michelle Obama ate on her vacation? For too many conservatives, the answer seems to be yes, with pundits poking fun at the anti-obesity guru’s dinner choice. But conservatives need to give it a rest: many seem to prefer scoring easy points against the First Lady to arguing about the best way to attack the obesity epidemic — and some even claim that …
Why obesity should concern conservatives
What if I were to tell you that Washington is trying to balance the budget by making cuts to a program that covers 70% of the nation’s nursing home costs and 43% of all births in California? Well they are.
The rancorous debate over how to balance the federal budget includes drastic cuts to Medicaid. And while this program may seem distant to people in power and the general public, …
Medicaid represents our nation’s moral commitment to help the poor
by J.E.B. Johnson, MD
Let me preface this comment by stating I am not an actuarial. I hated statistics and am no fan of insurance companies. That said I would like to know why patients and the US government think that health insurance companies should accept unlimited risk? My car insurance has limits, my homeowners insurance has limits, my malpractice insurance has limits. Why …
A private sector solution for wider, more affordable health coverage
Many of you are familiar with the famous “invisible gorilla” experiment, wherein an audience, being instructed to watch closely for the number of passes made with a basketball, fails to see a rather large and deliberate gorilla march slowly across the screen, stop in mid picture and thump its chest.
In fact over 1/2 of those tested failed to notice this obvious action. The predominant response is one of suspicion and …
We need a radical change in the way health care is delivered
Comparative effectiveness outcome studies have shown that while percutaneous coronary intervention (PCI) may be more effective than optimal medical therapy (OMT) for treatment of acute coronary syndrome, it is not more effective for treatment of stable ischemic heart disease.
Results of the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial, published in 2007 and 2008 in the NEJM, demonstrated that PCI did not improve survival or prevent myocardial …
Do physicians have the courage to implement comparative effectiveness?
Perhaps you are just beginning a quality improvement program or project. Perhaps you have several project improvement projects successfully completed at your healthcare site.
No matter what your level of experience, you have encountered staff who are roadblocks to your efforts. What are you to do? Ignoring them or doing nothing will imperil your quality efforts eventually. Let me share some ideas on what to do based upon my own …
Staff who resist quality improvement efforts
by Sam Wainwright
There’s a fascinating blog post over at the New York Times math blog that has the health policy program here at New America scratching our heads, sharpening our No. 2 pencils, and dusting off our calculators.
Turns out, German mathematicians have been studying how and why the human brain seems to struggle with comprehending risk. We find it difficult to translate the …
Why the human brain seems to struggle with comprehending risk
The creation of consumer-driven health plans (CDHPs), health insurance policies with high deductibles linked to a savings option and with more financial responsibility shouldered by patients and employees and less by employers, was completely inevitable.
The American public likes to have everything, whether consumer electronics or other services, as cheap as possible. With escalating health care expenses rising far more rapidly than wages or inflation, it’s not surprising employers …
Consumer driven health care will only shift costs if implemented poorly
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It strikes me that in developing payment reform related, compensation driven cost-containment strategies aimed at constraining the cost of emergency care, policy makers, emergency physicians, and health insurers should adhere to certain principles.
The American College of Emergency Physicians should be at the forefront when it comes to establishing these principles, which I hope will be focused on protecting our patients first, and our specialty second.
The concept and practice of …
Cost containment strategies for emergency care
Much is being written about the ever increasing cost of health care in the US, especially compared to the rest of the developed world.
As a nation, we spend nearly 16% of our GDP on health care. All estimates predict that this amount will continue increasing unless costs can be controlled now. Hence the passage of the Affordable Care Act. Not only was it designed to extend coverage to more …
Cost of care is related to the advancements in medicine
by Benjamin P. Geisler, MD, MPH
A recent New York Times article on how to value a life drew almost two-hundred heavy-handed comments. It discussed how different governmental agencies such as the Food and Drug Administration (FDA), the Environmental Protection Agency (EPA) or the Department of Transportation (DoT) place a monetary value on each life saved.
In many public policy areas, cost-benefit Analysis (CBA) is being used to assess whether an investment …
A monetary value on each life saved
by John Kaegi
We all complain about the cost of health care and health insurance. Ours is by far the most expensive health care system in the world. And for the money, our health isn’t so hot either. On the world stage, the U.S. ranks 37th in health care efficiency (a measure of health outcomes such as infant mortality, incidence of chronic disease, etc.) as reported by the World Health Organization. America …
Reverse our attitudes and values to control health costs
by Grayson Wheatley, MD
It was supposed to be a routine office visit for my patient.
Unexpectedly, it turned into a real-world health economics lesson for me, the treating physician. The old adage “listen to your patients; they will always give you the answer” became exceedingly true in this case, even when it dealt with an issue beyond a medical diagnosis, such as lack of transparency …
The challenge of pre-authorization for an elective procedure
The New York Times reports on Washington state’s efforts to “to determine which medical devices and procedures Washington will cover for state employees, Medicaid patients and injured workers, about 750,000 people in all.”
An expert panel, appointed by the state, is getting national attention, writes the Times, “in part because its process is public and open. . . [and] provides a living laboratory of the complexities of applying evidence-based …
A transparent process to allocate resources based on evidence
With the roll out of the Affordable Care Act and perhaps more significantly the approach of the 2012 elections, public discussions of healthcare reform has been drowning in an alphabet soup of ACOs (not to be confused with the above ACA), CMS, SCHIP, and RUVs, just to name a few.
The challenge is twofold. Most of these plans/systems/agencies deal with how to better pay for a seriously flawed system. …
How doctors can shape the health reform narrative
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