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.
Clearly, one issue dominated the election this past fall: the economy, and more specifically the lack of jobs.
So I would like to pose a few questions and ideas on just how government actually performs in creating economic growth and in kick starting job growth. I don’t necessarily have the answers, but I’m real good at asking questions.
Did government assisted mortgages help the economy? …
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Will health care melt down, like the mortgage industry?
In early 2011 Department of Health and Human Services will be issuing guidelines for the formation of Accountable Care Organizations (ACO’s) for CMS (Medicaid and Medicare).
I know of several organizations looking into this type of organization as they anticipate the new guidelines. There seems to be great anticipation of the guidelines in various health care publications that I have recently read. On December 18, 2010 on the Health Affairs website …
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An ACO primer and get started on forming an Accountable Care Organization
I wish I knew how to express myself. I wish I knew how to put this into words. How the direction of things has just become depressing. How each day makes me wonder how we got to where we are today. And I think back. Back to the beginning.
I think back to my childhood. And how I looked up to my father … the physician. How he died when I …
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Government and health insurance intrusion penalizes efficient doctors
The talk around the country among health insurance companies is that their insurance business is dying.
What is happening? First, the consolidations in other industries, resulting in large, multistate corporations, already mean that many companies self insure their employees. Even many local firms have large enough work forces that they can be self-contained risk pools. (One source I found says that in 2008, 89 percent of workers employed in …
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What will become of health insurance companies after reform?
How do you think American physicians should be paid?
I think many of the current methods are insane. Case in point:
In the 1980s, during a meeting of the board of trustees of the American Medical Association, I experienced sudden unexpected unilateral loss of hearing. You might say that was lucky. But I was scared and went right to my ENT’s office.
He looked in my ear and extracted a large wad of …
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How American physicians should be paid
The Affordable Care Act is the most important piece of federal health care legislation since the Social Security Act of 1965 established the Medicare program. It assures that 32 million Americans will have access to health insurance for the first time. But who will care for these people?
Our health care system was plagued by a severe and worsening physician shortage even before the new law took effect. In fact, a …
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A surge in demand for physicians from newly insured patients
Massachusetts’ Connector, operational since 2006, is the prototype for PPACA’s insurance exchanges. Connector boosters have claimed it is a vital and successful part of Massachusetts’ health care reform; its critics have noted its failure to influence either benefit or administrative costs or to attract significant enrollment. However, whether success or failure, the Connector offers lessons for other states.
Low enrollment means failure
As Massachusetts discovered, it’s impossible for the exchange to influence …
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Maximizing enrollment in insurance exchanges is essential
Medicine used to be different. Doctors couldn’t do too much for you. They didn’t get paid very much and they were focused more on helping than on managing a business.
Hospitals were community-based not-for-profit or public entities. Drugs and devices were not as sophisticated or expensive, and they weren’t marketed directly to consumers. Well Toto, we’re not in Kansas anymore.
After witnessing our “healthcare reform” process you must have seen that almost …
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Everything about medicine is now big business
Comparative effectiveness research (CER) is suddenly a hot topic at all the health care conferences.
How come? Everybody agrees that we have to decrease per-capita cost and increase quality. Why? Government programs like Medicare and Medicaid foot more than 50% of our nation’s health bill, and if everything stays the same these programs will go belly up (bankrupt) in 8 years. Big problem.
Health and Human Services (HHS) has defined comparative effectiveness …
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Comparative effectiveness research (CER) needs honest discussion
by Kevin Fickenscher, MD
In the great healthcare alphabet soup, it’s easy to lose sight of the differences between proposed solutions for making healthcare more efficient and effective.
Rather than tackling payment reform in isolation of care delivery, Accountable Care Organizations (ACOs) and Medical Homes offer a consolidated approach to both issues. While the models are still developing, various pilot programs are being implemented around the …
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Accountable care organization (ACO) and medical home differences
Imagine that an innovative health plan – aware that half or more of health care cost is waste and that physician costs to obtain the identical outcome can vary by as much as eight fold – hopes to sweep market share by producing better quality health care for a dramatically lower cost.
So it begins to evaluate its vast data stores. It’s goal is to identify the specialists, outpatient services and …
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Physicians need to compare themselves with their peers
From its inception, Medicare has been agnostic about the effectiveness of different treatments when it sets payment rates. Once a treatment is found to be “reasonable and necessary,” Medicare establishes a payment rate that takes into account complexity and other “inputs” that go into delivering the service. But it is prohibited by law from varying payments based on how well an intervention works.
This would change under a “dynamic pricing” approach …
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Medicare rates will be influenced by comparative effectiveness
by Ray Carlson
As we all know, this past March Congress passed and the President signed The Affordable Care Act. One component of the new legislation was the creation of a program called the Pre-Existing Condition Insurance Plan (PCIP). This is a federally funded high risk pool for state residents who – having been denied individual insurance coverage within the past 12 months for a pre-existing condition – would now, theoretically, …
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Why the Pre-Existing Condition Insurance Plan (PCIP) fails
We’re learning a lot from Massachusetts’ experiment in universal coverage – and some of the lessons are rather enlightening.
According to Bestwire, Lora Pellegrini, president of the Massachusetts Association of Health Plans, said something along the lines of “That’s the problem with the new U.S. health care reform law … it offers millions of uninsured Americans access to health insurance but doesn’t address underlying medical costs, which are contributing to costly …
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Learning from the Massachusetts experiment in universal coverage
They are coming in fast under the radar, out of peripheral vision, in the magician’s other hand—and they will change everything. New ideas, surprising networks, stealth business models that may change health care profoundly, are bubbling up in pilot programs, experiments and full-on corporate transformations. There is something here that does not yet have a name, that no one is yet calling a movement, that no one is yet seeing …
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Integration and virtual accountable care organizations in health reform
So there was a neurosurgeon who called a plumber for a house visit.
The plumber arrived and after spending an hour bestowed the neurosurgeon a bill of $500. The surgeon was stunned; he said, “Even I don’t charge this much after a surgery.” The plumber stood up, gave him a sly look and said, “well that is why I am a plumber now; I used to be a neurosurgeon.”
I mention this …
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How a plumber charges more than a neurosurgeon
When I was in training as a resident and a fellow, I remember taking only a couple of sick days over the entire 6-year period.
And I had to stay home because I could not stop praying to the porcelain Goddess during a bout of a particularly nasty flu, despite a vaccination. I actually took pride in my health record, and attributed it directly to being rather sickly as a child. …
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Why comparing healthcare access to food is a false analogy
The Disease Management Care Blog received this posting from an experienced nurse with a background in clinical and administrative medicine.
We’ve all seen them. Those vacuous workplace posters exhorting teamwork, creativity and other forms of inspiration and accomplishment. A version has begun to creep into our nation’s health care facilities. reminding everyone of the need for privacy, how infections can be spread and the importance of patient service. And if my …
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Do posters in the hospital really help patients?
Among the many provisions in the Patient Protection and Affordable Care Act are elements intended to assure that every American has access to healthcare that is patient-centered, affordable, and of the highest clinical quality.
In my mind, one of the act’s most essential goals is to establish a National Health Care Quality Strategy — one that integrates disparate federal and private sector initiatives, building on and expanding current quality assessment and …
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A National Quality Strategy can create improve patient safety
