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.

Insurance status when arranging follow-up from the ED

Kevin

Health Policy

February 15, 2011

by Katherine Fullerton, MD

As a pediatric emergency physician in Northern Virginia, I have the good fortune to work with an amazing staff in a busy pediatric emergency department (ED) that sees a wide range of patients with both minor and life-threatening illnesses. Of note, we have a wonderful electronic medical record (EMR) that allows us to see past visits, lab tests, and medical problems.

My last shift was an overnight …

Our health is worsening at a time when medicine has never been better

David Gratzer, MD

Health Policy

February 14, 2011

With little notice, UnitedHealth released a major paper recently considering diabetes in America.

First the bad news: a large portion of our population either has the disease or is pre-diabetic.

Now, the really bad news: diabetes and pre-diabetes rates are going to soar in the coming decade, according to the analysis, in part driven by the obesity crisis.

I’ll return back to the study in a moment, but it underscores a …

Onsite clinics within a competitive health care marketplace

Brian Klepper, PhD

Health Policy

February 13, 2011

The recent explosion of interest in onsite clinics – not just by employers, but by health plans, hospital systems, public health programs, and others – is anything but just another health care fad. At once, clinics’ growing popularity signals purchasers’ weariness with an intransigent, self-interested health system, as well as their guarded optimism about a better way.

Today’s best clinics are single-mindedly focused on what works best for the patient and …

What physicians should believe about Accountable Care Organizations

Kevin

Health Policy

February 13, 2011

by Jeffrey L. Cohen

In the 90s, physicians were told “The sky is falling. You have to find a tree to stand under or you will be crushed.” The “trees” were things like IPAs and PHOs. The future outlook was bleak. All patients were going to be part of some system with which the physician would have no input or control. Decisions would be made on purely …

Physicians’ voices heard through AMA advocacy activities in Washington, DC

Kevin

Health Policy

February 10, 2011

A guest column by the American Medical Association, exclusive to KevinMD.com.

by Ardis Dee Hoven, MD

This week, hundreds of physicians and medical students converged in Washington, D.C., for the AMA’s annual National Advocacy Conference. The current and future physicians learned about and discussed key legislative issues, including how new policy will impact physician practices, and heard from officials including CMS Administrator …

Can President Obama and the GOP agree on improving health reform?

Bob Doherty

Health Policy

February 2, 2011

Everything seems to be pointing toward two years of partisan and ideological confrontations over health reform. The leadership of an emboldened Republican party has made it clear that it will use its newfound House majority to seek to “repeal and replace” the Affordable Care Act (ACA), and if that doesn’t work, to “defund” it. Huge GOP gains in statehouses make it likely that more states will resist implementation. Meanwhile, President …

Ethics of the individual mandate

Kevin

Health Policy

February 2, 2011

by Raymond Raad, MD, MPH

There is a remarkable inconsistency between the ethics of medical practice and the discussion about the health care reform law passed this past March, especially the individual mandate.

In medicine, it is considered unethical to force a patient to do something against his will. Patients are allowed to disagree with their doctors and to decide for themselves whether they want to heed their advice. Patients are even …

Read more…

Ethics of the individual mandate

Having insurance does not mean you get health care

Joseph Paduda

Health Policy

January 30, 2011

There’s no question the Accountable Care Act needs work – everyone agrees on that.

So let’s talk about the specifics – what needs fixing, why, and how can we get those fixes passed.

First, let’s understand how bad our current system is. Some who want to repeal and/or replace the ACA continue to publicly state we have “the best health care in the world.”

While that may – or may not – have …

Healthcare costs can be reduced with emerging business models

Joe Flower

Health Policy

January 29, 2011

Here’s a simple key to parsing the future economics of healthcare. We have been trying for over 30 years to control healthcare costs. And there is little evidence that any of these efforts have had much effect. For decades the rise in healthcare costs has been consistently several times higher than the general inflation level.

There have been dozens of schemes used in various parts of the industry — inpatient, ambulatory, …

Government is already involved with the majority of health care

ER Stories, MD

Health Policy

January 26, 2011

US District Judge George Steeh of Michigan ruled last year that the constitution permits the federal government to require individuals to obtain health insurance coverage.

This lawsuit was filed by a Christian legal organization called the Thomas More Law Center, as well as others. Other lawsuits are in the works in numerous other states. These suits are filed primarily by Libertarian-types who don’t want to be forced to buy health insurance …

How repeal and replace will affect patients

Rishi Manchanda, MD, MPH

Health Policy

January 25, 2011

by Rishi Manchanda, MD

As a primary care doctor for working families, I am interested in anything that can tangibly address my patients’ health problems. But how do I prescribe repeal?

The House effort to repeal and replace last year’s health care law is not just an untested placebo with major potential side effects, like increasing the number of Americans without health coverage. For those of us on …

Guns and why doctors should partner with the National Rifle Association

George Lundberg, MD

Health Policy

January 24, 2011

Is there anything that we physicians can and should be doing to help with the huge problem of gun violence in America?

We all know it is nuts to sell guns and ammo to nuts, yet as a country we do it every day.

We all know that, in contrast to rifles and shotguns, the only moving targets for hand guns are people; that the Congress and president in this century legislated …

Payment systems must take into account the art of medicine

Marya Zilberberg, MD, MPH

Health Policy

January 22, 2011

You know that joke about the farmer whose cows are not producing enough milk? A university panel gathers under the leadership of a theoretical physicist. They analyze each aspect of the problem thoroughly and carefully, and after much deliberation produce a report, the first line of which is “First, assume a spherical cow in a vacuum.”

This joke has become short-hand for some of the reductionist thinking in theoretical physics, but …

How effective will the physician payment national database be?

Merrill Goozner

Health Policy

January 21, 2011

ProPublica.org did some interesting frontrunning on the physician payment national database that will become operable sometime around 2013 as part of health care reform.

In the first of a series of stories that has been picked up by several mainstream media outlets, the New York-based investigative journalism non-profit culled all the physician payments that have been publicly posted by seven drug companies to date. It aggregated the dollars …

Personal responsibility and societal structure changes that reduce obesity

Allen Perkins, MD

Health Policy

January 20, 2011

I visited my parents this past week. The are both in their 80s and in relatively good health although my mother received a diagnosis of diabetes while having a medical exam for an unrelated problem. I spent some time educating her about Type 2 Diabetes, the causes (genetics and weight gain) and the options (medication and/or weight loss and exercise). I stayed with my brother-in-law and sister and the conversation …

What health reform compromise could look like

Donald H. Taylor, PhD

Health Policy

January 15, 2011

While the rhetoric around health reform has been incendiary from day one, in policy terms, a compromise between Democrats and Republicans using the outline of the Affordable Care Act (ACA) has always been available. The two primary problems with the health care system are costs and lack of coverage. The ACA does pretty well on the second, and is a start on the first, but much more is needed. It …

Legal tobacco and illegal marijuana are historical accidents costing billions

Kohar Jones, MD

Health Policy

January 13, 2011

“What do you think of medical marijuana?” my mother, who has never smoked a thing in her life, of the tobacco or cannabis variety, asked me one day as we drove through beautiful upstate New York woods. We had just passed a sign saying “We will destroy your crops,” with a marijuana leaf beneath. “It has its place,” I said. “No reason to be against it.” “But isn’t marijuana a …

Optimization of the new PCMH neighborhood

Kevin

Health Policy

January 13, 2011

by Matt Adamson

There are a number of care models now being explored to improve the manner in which healthcare can be delivered. Let’s take a quick look at a few of the well known options:

Accountable Care Organization (ACO): The ACO model has the ability to provide, and manage with patients, the continuum of care across different institutional settings, including at least ambulatory (outpatient) and inpatient …

5 reasons doctors should love the Healthy, Hunger-Free Kids Act

dr_som, MD

Health Policy

January 11, 2011

The Healthy, Hunger-Free Kids Act provides increased funding beyond inflation for school meals for the first time in 30 years and addresses both food insecurity and obesity in children. Here are the details:

1. Growing bodies and brains need good nutrition, the best medicine for our patients. Children at or below 185% of the poverty level qualify for free or reduced cost meals. Although children compose only 25% of …

A culture of fear worsens the nursing shortage and medical errors

Jeffrey I. Kreisberg, PhD

Health Policy

January 10, 2011

There has been a lot talk about changing how we reimburse providers for healthcare from one that pays for services performed, to another that reimburses providers depending on what happens to the patient.

I think we must take a couple of steps back and first tackle the public health crises we are facing that is putting our healthcare in danger, namely, medical errors and the growing nursing shortage. Despite identifying work …

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