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.

An ACO must make the patient experience meaningful

Patricia Salber, MD

Health Policy

April 26, 2011

Accountable Care Organizations (ACOs) are supposed to be provider-led (physician groups +/- hospitals) and, they are supposed to inject a new accountability, at the provider level, for the value of services delivered.

You know the old equation. Value=Quality/Cost. Those of us inside the health policy “beltway” know this mantra well. We have been talking about it for years (decades, really).

I spent almost …

The future of primary care in Accountable Care Organizations

Davis Liu, MD

Health Policy

April 23, 2011

A recent blog post in Health Affairs proclaimed The End of Internal Medicine As We Know It. What the article is really asking is the future of primary care in the world of health care reform and the creation of Accountable Care Organizations (ACOs).

While doctors should be naturally concerned about change, I don’t completely agree with this …

Can the Relative Value Scale Update Committee (RUC) be defended?

Brian Klepper, PhD

Health Policy

April 19, 2011

Recently, 47 American medical specialty societies sent Rep. Jim McDermott (D-WA) a letter, with copies to all members of Congress, containing a detailed defense of the American Medical Association’s (AMA’s) Relative Value Scale Update Committee (RUC).

For 20 years, the RUC has exclusively advised the Centers for Medicare and Medicaid Services (CMS) on physician procedure valuation …

To sell your practice or not: The decision facing most physicians today

Philippa Kennealy, MD, MPH

Health Policy

April 17, 2011

I took my eye off the ball for just a little while, and guess what happened? When I looked again, I discovered that familiar solo practitioner or small group physician medical practices are on the verge of disappearing. Going the way of the dinosaur.

At least, that’s what the pundits are saying.

In a recently published nifty newsletter, STAT Monthly, I read:

Primary care physicians and other specialists will continue to be the …

Read more…

To sell your practice or not: The decision facing most physicians today

How an ACO will affect physicians and Medicare patients

Benjamin Geisler, MD, MPH

Health Policy

April 14, 2011

by Benjamin P. Geisler, MD, MPH

Everybody is talking about Accountable Care Organizations or ACOs these days.

The reason being that the Centers for Medicare and Medicaid Services or CMS has released the rules for shared savings between ACOs and CMS.

The complete proposed rule is 429 pages long and they’re seeking comments on it now until early June.

What is an ACO?

ACOs will take care of …

How the ACO regulations set the stage for Accountable Care Organizations

David Harlow

Health Policy

April 13, 2011

ACO regulations and related federal issuances hit the street, after several months of waiting — from CMS, OIG, FTC, DOJ and IRS.

They cover the waterfront, ranging from the central regulation defining the structure and workings of the ACO, to limited Stark self-referral ban and anti-kickback statute waivers in the fraud and abuse arena, to new frameworks for antitrust analysis, to rules governing joint ventures involving taxable …

Physicians referring patients to a diagnostic facility they own

Bob Doherty

Health Policy

April 10, 2011

Federal law generally prohibits physicians from referring their own patients to a diagnostic facility in which they have an ownership issue – a practice called “self-referral” – unless the facility is located in their own practice.

This exemption exists to allow patients with access to a laboratory test, x-ray, or other imaging test at the same time and place as when patients are seeing their physician for an office visit. Less …

Overhauling America’s Healthcare Machine, an excerpt

Douglas Perednia, MD

Health Policy

April 8, 2011

An excerpt from Overhauling America’s Healthcare Machine: Stop the Bleeding and Save Trillions, published by Financial Times Press (2011). Reprinted with permission of FT Press, and imprint of Pearson.

In recent years, more and more of the revenue collected by U.S. healthcare facilities ends up paying for costs that have nothing to do with providing actual healthcare goods and services: things such as administration, billing, documentation, and the cost …

What you need as a leader of your accountable care organization

Donald Tex Bryant

Health Policy

April 7, 2011

The Michigan Medical Group Managers Association had a conference recently in Mt. Pleasant, MI. The theme of the conference was “Medical Management: Coaching Your Team to a Winning Season.”

Two speakers—Lloyd Carr, former head football coach of the University of Michigan Wolverines, and Lou Rabaut, partner of law firm Warner Norcross & Judd—both delivered excellent lessons on leadership. Several of the …

Controlling health care costs requires shared sacrifice

Joseph Paduda

Health Policy

April 6, 2011

To understand how hard it is going to be to control health care costs, one merely has to consider the outrage surrounding TSA’s recent roll-out of “enhanced security” measures – measures which include ‘enhanced pat downs’ and full body scans.

Videos of boys getting patted down personified the problem. But the upset and outrage and anger visible today will be nothing if …

Rationing and limitations are inevitable in any health system

Colin Son, MD

Health Policy

April 6, 2011

Healthcare is a limited commodity. It’s limitations are defined by the numbers of professionals supplying it and their physical limitations on the number of patients they’re able to treat, on availability of biomedical equipment and technology, on availability of physical space to safely provide medical care and, underlying all of these, on the funding for such.

And so, not …

Direct primary care and medical loss ratio will impact health insurers

Dave Chase

Health Policy

April 5, 2011

With my extensive health care background, many people have asked for my opinion during the health reform debate. My response has been that the only way to really “reform” the system is to blow it up and start over, which isn’t politically feasible.

After delving deeper into the current legislation, I believe that we are going to see something …

Overuse of heart stents and the response of Abbott Labs

Joe Flower

Health Policy

April 5, 2011

“Someone needs to take this writer out and kick his ass.”

The quote leaped out at me from a New York Times article.

Now, maybe I’m a little sensitive about using physical threats to try to silence writers, since I am a writer. Maybe I am especially sensitive about threatening to kick someone’s ass for writing about healthcare. To my eyes, the quote stood out as emblematic of the tumor …

The Relative Value Scale Update Committee (or RUC) impact on health care

Brian Klepper, PhD

Health Policy

April 5, 2011

On Kaiser Health News, Barbara Levy MD, the Chair of the AMA’s Relative Value Scale Update Committee (or RUC), published a glowing defense of the RUC’s activities.

Her article extols the work of the 29 physician volunteers who, “at no cost to taxpayers … generously volunteer their time, supported by advisers and staff from more than 100 national medical specialty societies and health care professional organizations.”

She fails to mention that the …

After the ACO regulations: Accountable care organization answers

Kevin

Health Policy

April 4, 2011

by Jeffrey L. Cohen

Patient centeredness, fragmentation and value based purchasing are just a few of the terms that are peppered throughout the newly proposed regulations for accountable care organizations (ACOs).

The healthcare reform law established the Medicare Shared Savings Program for Read more…

After the ACO regulations: Accountable care organization answers

Can ACOs curb health costs and improve quality of care?

Robert Rowley, MD

Health Policy

April 2, 2011

Accountable Care Organizations (ACOs) have received considerable attention recently, and are the new “hot topic” in healthcare delivery policy circles. They are the latest response to the need to do something to stem the runaway inflation of healthcare costs, while maintaining or improving measurable health care quality.

According to a …

Debt prevents health insurance from providing more health care access

WhiteCoat, MD

Health Policy

April 1, 2011

I read an article in the New York Times that underscores my argument that health care insurance does not and never will equal health care access.

Our federal and state governments are being crushed by debt. There are many reasons for that debt, and addressing the reasons for the debt are a necessary aspect of decreasing the debt. For example, if a family household had overdrawn its checking account by …

How primary care will play a central role with health care reform

Kevin

Health Policy

March 31, 2011

by Jeffrey L. Cohen

Healthcare reform used to imply just regulatory change. As time marches on, it also implies market change. Most pundits agree that, whatever happens to the healthcare reform law, whether or not it is found to be unconstitutional, the healthcare business community is unleashed. Change is afoot!

If you follow my naysaying on the …

Why medical students should be passionate about health reform

Kevin

Health Policy

March 30, 2011

by Chris Chen

Recently, I stood in the back of a boisterous, packed auditorium as each of our school’s fourth-years received their match letters and proudly announced in front of friends, family, and classmates where they would be headed for residency.

As peers enthusiastically cheered each other, significant …

Accountable Care Organizations and the need to innovate

Kunmi Sobowale, MD

Health Policy

March 30, 2011

There is a lot of buzz over the creation of Accountable Care Organizations (ACOs) under the Patient Protection and Affordable Care Act (PPACA).

An ACO is a network of health care providers and hospitals that collaboratively manage patient care and prospective budgets. Perhaps the biggest draw of ACOs is the potential to create innovative ways to improve quality and decrease costs. To …

Health Policy

Most Popular

Past Week

Past 6 Months

Recent Posts

Subscribe to KevinMD and never miss a story!

Most Popular

Past Week

Past 6 Months

Recent Posts