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.

ACP: Benefits, harms, and quality in high value, cost conscious care

American College of Physicians

Health Policy

March 28, 2011

A guest column by the American College of Physicians, exclusive to KevinMD.com.

by John Tooker, MD, MBA, MACP

Last month, my KevinMD.com column introduced a concept paper published in the Annals of Internal Medicine by Owens and colleagues titled High-Value, Cost-Conscious Health Care: Concepts for Clinicians to Evaluate the Benefits, Harms, and Costs of Medical Interventions. …

Reduce variations in cancer care that do not improve outcomes

Merrill Goozner

Health Policy

March 26, 2011

Here are a few facts to enliven the next public discussion about death panels.

An analysis of Medicare claims by researchers at Dartmouth University found that nationwide nearly one in three cancer patients died in hospitals or in intensive care, the most expensive form of end-of-life care and contrary to most patients’ wishes. Nearly half are not offered hospice …

Expand health care systems in a way that is professionally satisfying

Michael D. Shapiro, MD, MBA

Health Policy

March 24, 2011

You try to do the right things to sustain your business. You set high standards for delivery of quality care, follow the basic tenets of marketing, align your organization so that everyone in your firm “gets it,” avoid unnecessary expenses but identify important growth opportunities and prudently invest so that you remain competitive and serve your patients well. But can you afford investing in the assets you require to become or …

Accountable care organizations: The lost art of medicine?

Kevin

Health Policy

March 22, 2011

by Sharolyn Rhees Medina, MD

It’s no secret that healthcare’s inevitable move toward accountable care organizations (ACOs) has many physicians feeling a bit …nervous. Admittedly, most physicians are creatures of habit who fiercely defend their individual approach to patient care, focus on cures not cost, and dread the concept of “cookbook medicine.”

And under the ACO model, physicians …

Concierge and primary care medical home hybrid model of care

Mark W. Browne, MD

Health Policy

March 21, 2011

As a consultant, I spend a lot of time on airplanes and subsequently get to meet a new “person in the next seat” almost every week. Once the small talk is over, the conversation is nearly the same every time. “Oh, you work in healthcare! What do you think about all of this reform stuff anyway? Is there an answer?” I’m always very cautious how I frame my answer. As those …

Huge holes exist in the health reform law

Richard Reece, MD

Health Policy

March 19, 2011

Huge holes exist in the health reform law you can drive an 18-Wheeler through. These holes are not “devils in the details.” They are so obvious nobody talks about them. They are the proverbial elephants in the room. I suppose this makes sense. It takes an 18-wheeler to transport …

Slowing health costs requires answering 3 simple questions

Donald H. Taylor, PhD

Health Policy

March 19, 2011

If we ever slow health care cost inflation to a sustainable pace, it will be because we learn how to ask 3 simple questions when thinking about a medical treatment.

Does it improve quality of life for the patient?
Does it extend the patient’s life?
How much does it cost?

Asking the questions are of course much simpler than figuring out the …

A global view on effectiveness research

Christopher Johnson, MD

Health Policy

March 18, 2011

We badly need effectiveness research — which medical treatments work and which ones don’t. After all, some reasonable estimates are that a third or so what we spend on medical treatments is for things that aren’t known to work, or worse, don’t work. Effectiveness research means comparing two competing therapies to see which works better; if both work the same, our preference …

Read more…

A global view on effectiveness research

The next generation of public health won’t involve the medical world

Jay Parkinson, MD

Health Policy

March 17, 2011

I received my Masters in Public Health from Johns Hopkins in 2006. I took a course on transportation safety where we focused on designing roads for safety, making airlines safer, and decreasing the risk of medical helicopter crashes.

In 2007, I worked for Public Citizen, Ralph Nader’s consumer advocacy group. Ralph’s book, Unsafe at Any Speed, forced the automobile industry to focus on converting their cars from …

The differences between comparative and clinical effectiveness

Kevin

Health Policy

March 13, 2011

by Peter J. Pitts

“Newspeak,” the language of Big Brother, was designed “not to extend but to diminish the range of thought.”

Some well-known examples of Newspeak are Bellyfeel (a blind, enthusiastic acceptance of an idea), Duckspeak (meaning literally to quack like a duck or to speak without thinking), Crimethink (the Newspeak word for thought crime) and Goodthink (or “political orthodoxy”).

Which brings us from the nightmare fantasy of “1984” to the health …

Withholding liver transplants for Medicaid recipients in Arizona

Gary Levin, MD

Health Policy

March 12, 2011

Governor Brewer’s decision to withhold liver transplants for Medicaid recipients in Arizona should serve as a loud warning to the electorate regarding governmental intrusions into health care financing and health care operations.

The decision was ill advised on the basis of multiple factors. The survival rates differ from one facility to another.

What is the liver transplant survival rate and what information needs to be considered when looking at such numbers?

For example, …

Challenge the constitutionality of EMTALA

Lucy Hornstein, MD

Health Policy

March 11, 2011

Here is a letter to the editor in a recent Philadelphia Inquirer:

… In 1986, Congress passed and President Ronald Reagan signed the Emergency Medical Treatment and Active Labor law, which requires hospitals to admit all who arrive at the emergency room and treat them without regard for their ability to pay.

In essence, we had federally mandated national health care – signed …

Read more…

Challenge the constitutionality of EMTALA

Is Medicare the biggest challenge to seeing the doctor of your choice?

Dan McCoy, MD

Health Policy

March 8, 2011

Medicare was touted as the social entitlement program that would forever change health care access for our seniors.

But is it becoming the biggest challenge to seeing the doctor of your choice?

For the first time in the almost 50 years of the program more and more Medicare recipients are facing the challenge of finding a doctor who will take their government sponsored insurance.

Sure, there have recently been …

Repeal of reform won’t fix our health system

Brad Wright, PhD

Health Policy

March 4, 2011

The system we had before health reform became law was simply not working. I think we can all agree on that. A significant number of people oppose “Obamacare.” I can understand that. But repeal doesn’t really solve the problem. Sure, if you think that health reform has or will actually make our system worse than it was before, it seems prudent to undo the legislation, but that brings us back …

Requests for OTC prescriptions for a FSA burdens primary care

Matthew Mintz, MD

Health Policy

February 27, 2011

As reported by MSNBC, the federal government will no longer allow flexible spending accounts (FSAs) to be used for over the counter medications, without a prescription. FSAs, which are offered by many employers, allow you to use tax free dollars for medical expenses that aren’t covered by your insurance. FSAs are a great idea and can be used for things like eye glasses, dentistry, or even …

How medical loss ratios impact mini-med policies

Roger Collier

Health Policy

February 23, 2011

It’s amazing how much trouble a couple of hundred inexpensive health insurance policies can cause.

Up until recently, few people were aware of the existence of so-called mini-med policies. Marketed primarily by for-profit insurers Aetna and Cigna, they are designed to provide bare-bones coverage to employees of low-wage low-margin service companies. Unlike other approaches to affordable insurance that emphasize catastrophic coverage, mini-meds typically keep premiums affordable (some as low as $15 …

Why more primary care may not improve health care quality

Maggie Mahar

Health Policy

February 22, 2011

The emphasis on primary care as the “key” to lifting the quality of U.S. healthcare may be exaggerated according to a report by Dartmouth’s Institute for Health Policy & Clinical Practice.

“Primary care forms the bedrock of a well-functioning, effective health care system,” the researchers observe. But– and this is an important caveat- “simply increasing access to primary care, either by boosting the number of primary care physicians in an area …

Change of culture in a rapidly evolving health care environment

Kent Bottles, MD

Health Policy

February 19, 2011

When a health system asked me to facilitate a Board discussion on physician alignment and integration on November 12, 2010, I was already committed to giving a keynote on the future of health care for the American Institute of CPAs in Las Vegas on November 11. Although I usually fly Delta or USAir where I have priority frequent flyer status, the only way I could get to the Board meeting …

Requiring an ultrasound and counselling before an abortion

Robert Luedecke, MD

Health Policy

February 17, 2011

A bill given emergency status by Texas Governor Rick Perry is the largest invasion of the patient-physician relationship that I am aware of. Proposed by Senator Dan Patrick (R-Houston) and supported by Lt. Gov. David Dewhurst, the bill as originally written would require physicians to perform a ultrasound and explain the physical characteristics of the fetus to anyone contemplating an abortion.

Physicians would be required to inform women about alternatives to …

Clinical guidelines in healthcare reform

Richard N. Fogoros, MD

Health Policy

February 17, 2011

While DrRich is a conservative American, and has made plain the difficulties he has with the Progressive program in general and with Progressive healthcare reform in particular, at times he is forced to admit that, on occasion, the Progressive way of looking at the world has certain merits. And as DrRich contemplates a question that has been bothering him lately, a question that no doubt plagues many American physicians who …

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