A guest column by the American College of Physicians, exclusive to KevinMD.com.
by John Tooker, MD, MBA, MACP
Recently, I commented on cost saving, quality, and care coordination requirements in the proposed rule that physician practices will likely need to meet to be eligible for additional Medicare payments.
The public comment period on the proposed rule for …
ACP: ACOs – On to the final rule
If we’re serious about cutting Federal health care expenditures over the long term, here are two changes that will do just that.
1. Requiring HHS to negotiate with pharma for Part D drug costs would reduce annual expenditures by over $20 billion.
As I’ve noted repeatedly(but unfortunately few in the mass media have), Part D’s perhaps the biggest deficit problem we have – the ultimate unfunded liability is now over $20 trillion. …
2 changes to cut Federal health care expenditures
Recently, the Board of the American Academy of Family Physicians (AAFP) announced that, for now, it would continue participating in the Relative Value Scale Update Committee (RUC), the secretive American Medical Association committee that, through a longstanding relationship with the Centers for Medicare and Medicaid Services (CMS), has heavily influenced physician reimbursement.
At nearly the same time, Medicare announced that it will go broke in 2024, a decade sooner …
A new organization for primary care
It’s getting scary.
We are facing, before the end of this decade, a bifurcated future. The way things are going now—with the economy wheezing, doctors bailing, chronic disease rising fast, boomers sliding out of the Viagra years into the Depends years, reimbursements getting squeezed ever tighter, Medicaid sputtering on fumes, and 30 million or more new people soon swarming our doors with insurance cards—if we don’t pull a rabbit out …
5 strategic tools to solve our healthcare woes
by Rishi Manchanda, MD, MPH
Mr. M walked into the community clinic where I work with a portable oxygen tank in tow. At 62, he’s gaunt and winded, battling a disease that is progressively scarring his lungs. Every breath is a fight. Instead of the clear flow of air, I hear the sound of velcro ripping when I place my stethoscope on his chest. In medicine, his …
How Medicaid is under political attack
The Patient Protection and Affordable Care Act is in the process of being rolled out, however many questions remain.
Will it guarantee universal coverage? Will it stand up to the many court challenges? The private insurance industry will receive an estimated 400 billion in taxpayer money to subsidize the purchase of these plans. Is this the best way to spend our money?
Many of us in the health field remain skeptical …
Considering a single payer model for health reform
by Terry O’Keefe
The State of Vermont just passed the nation’s first single-payer universal healthcare system. While there are still some bureaucratic hurdles to cross, Vermont will soon install the kind of system that healthcare progressives have been drooling about for decades.
And whether you think that puts Vermont on the high road to healthcare nirvana, or the low road to socialized medicine, I think we …
Letting the states decide healthcare reform
A guest column by the American Medical Association, exclusive to KevinMD.com.
There is said to be an old Chinese curse: May you live in interesting times. As I wrap up my year traveling the country as President of the AMA, I can without a doubt say physicians are living – and practicing medicine – in interesting times. This can be a challenge, but does not need to be a curse.
There are …
AMA: Revisions, clarity needed before physicians form Medicare ACOs
Whether specialists make too much money depends on whom you ask.
Policy experts
If you ask policy experts, most of whom are progressives, they will say “yes, of course, specialists make too much money.” Too many specialists making too much money spoil the national health care broth.
Just look at any other country, especially countries with government-run systems.
Specialists there make one-half of what our specialists bring home. Look at their total …
Do American medical specialists really make too much money?
The number of patients with acute care problems visiting the emergency rooms is steadily climbing.
According to the article Hospitals Work to Reduce ER Wait Times posted on the ASQ website the rate is increasing at a 3% annual rate. This leads to several problems, including longer waiting time. An analysis of the growth reveals several trends in the demographics …
Helping acute care patients find the right care in the correct setting
Surgery is expensive, there are no doubts about that. However, there are a few things a patient without insurance who desires surgery can do to minimize the costs as much as possible. Before going into cost-cutting measures, you first need to understand where the costs come from.
In rank order, the costs of surgery come from (highest to lowest):
How to minimize the costs of surgery
by J. Walden Retan MD
Begin with what everyone knows. Healthcare costs and health insurance costs are climbing more than twice as fast as the cost of living, and have been for years. There is no need for numbers to prove the point. Just ask anyone who buys health insurance on their own, any employer trying to take care of his employees, any employee whose wages …
Vermont’s version of the Independent Payment Advisory Board (IPAB)
With the expected cutbacks in healthcare funding and the increasingly dismal outlook for “new” money in the healthcare pot, “value” has quickly become a key watchword.
In the past decade, we’ve seen many public and private payers implement value-based, pay-for-performance (P4P) programs as a means of spurring healthcare providers to improve the quality of services they provide and, tangentially, reduce the …
Will paying for outcomes improve healthcare quality and efficiency?
ADVERTISEMENT
Have you noticed the recent trend against specialty physicians? Policy experts have determined that primary care needs incentives to attract medical students away from those “highly lucrative” specialties such as plastic surgery, orthopedic surgery, interventional cardiology, and neurosurgery.
Our federal government believes in equal opportunity — if you wish to become a family doctor. There are incentives sponsored …
Health reform’s prejudice against specialist physicians
8,000 patients will no longer be able to receive care from UNC Hospitals and their affiliated physician practices because of a dispute between UNC and the insurance company Aetna.
The bottom line is that Aetna does not want to pay as much for care provided by UNC as UNC wants to be paid for providing this care. No surprise there, as the interests of the two parties (health care provider and …
How a dispute with an insurance company can affect patients
My first exposure to KevinMD.com is reading Healthcare costs can be reduced with emerging business models by Joe Flower.
While I am not informed about the medical business models to which he refers, I am experienced in business. I hail from a family of doctors and hospital owners. While I did lose touch with the industry for several years, I have noted several changes which do not make sense. …
The evolution of hospitals and the present state of health policy
The cost curve of American medicine continues to bend up. That is unsustainable. It must begin to bend downward.
Two recent headlines focus the problem:
New York Times, May 14, 2011: Health Insurers Making Record Profits as Many Postpone Care
And, CNN Money, May 11, 2011 reports “Your family’s healthcare costs $19,393.” That is for a family of four, which has a median income of $75,700 — before taxes.
Opportunity …
Can ACOs reinvent the American health care system?
Doctors who do not successfully e-prescribe 10 times for Medicare patients in the first six months of 2011 using claims-based reporting may be hit with a 1% penalty on their Medicare Part B payments for covered professional services in 2012.
The penalty will increase to 1.5% in 2013 for those who don’t e-prescribe for 25 Medicare patients during 2011.
Not yet e-prescribing?
Maybe your Read more…
E-prescribe now, or risk a Medicare penalty
A guest column by the American College of Physicians, exclusive to KevinMD.com.
by John Tooker, MD, MBA, MACP
On March 31, 2011, CMS issued a proposed rule to implement a section of the Patient Protection and Affordable Care Act (ACA) that requires the HHS Secretary to establish a Medicare Shared Savings Program. Under the proposed rule, eligible providers and …
ACP: How accountable care is a team sport
The insurance middleman has taken a toll on the family doctor. New practice models plan to change that. Physicians in Seattle, Silicon Valley and Boston are proving what the rest of the world already knows. When you have a high function primary care system, there’s less money spent and better health outcomes.
Before House, M.D., …
Direct primary care and the Marcus Welby vision of primary care
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