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.

What does the NYC Marathon have to do with health reform?

Health Policy
November 16, 2010

Legend tells of an Athenian named Pheidippides who, in 490 B.C., ran from the battlefield at Marathon to Athens, telling of the victory over the Persians. Proclaiming the news that Athens would be spared pillage and fire, the Athenian dropped dead. The story is a myth.

But the marathon, like most things worth doing, does offer both risks and rewards. Because it gives a chance to go beyond usual boundaries, with …

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What does the NYC Marathon have to do with health reform?

Design solutions by truly understanding how humans use tools

Health Policy
November 16, 2010

The Futurama exhibit from the 1939 World’s Fair, although pretty in exhibition form, looks like a terrible place to live. It’s a world of machines, concrete, and efficiency. How boring! Futurists have always imagined the “what can we do?” scenarios. They’ve never really asked the questions:

  • What should we do?
  • What do people want that would make them feel more alive and more happily human?

Jane Jacobs, in her excellent book The Death …

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Design solutions by truly understanding how humans use tools

Preventive care as a cost saving measure is a fallacy

Health Policy
November 12, 2010

I like reading Maggie Mahar’s Health Beat.

She usually gets it, from the function of insurance to the complexities of assorted payment systems, I get the sense that she is generally rational when it comes to paying for health care. This doesn’t mean there aren’t times when she gets it wrong. Her embrace of primary care provided by nurse practitioners shows a truly spectacular …

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Preventive care as a cost saving measure is a fallacy

Why patients in Grand Junction, Colorado have better health outcomes

Health Policy
November 12, 2010

The New England Journal of Medicine analyzed Medicare statistics from the beloved Dartmouth Atlas of Health Care study revealing a wide disparity in the number of coronary bypass procedures in Golden Colorado compared to other areas.

The report reveals a 60% reduction in the number of procedures as compared to Miami, Florida.  The Dartmouth Atlas Study has been used to justify changes in payment systems by Medicare. The study has …

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Why patients in Grand Junction, Colorado have better health outcomes

AMA: Patients and physicians call on Congress to stop Medicare cut

Health Policy
November 11, 2010

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

Medicare physician payment cuts are once again looming in the immediate future, with a cut of 25 percent now threatening to hurt access to care for seniors and military families. As many doctors know all too well, the looming cut is forcing physicians to make difficult decisions about the continuing role Medicare can play in their practices.

The AMA is working on …

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AMA: Patients and physicians call on Congress to stop Medicare cut

Why moral hazard fails in health care

Health Policy
November 11, 2010

I’m going to take the time to review a topic that is one my pet peeves, one you hear bandied about all the time in discussions of more consumer directed health care.  It’s a topic I came back to repeatedly on my old blog – the moral hazard.

Basically, the moral hazard is the idea that people insulated from risk behave differently than people exposed to risk.  For instance, …

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Why moral hazard fails in health care

Will the new Congress allow the physician Medicare cuts to pass?

Health Policy
November 10, 2010

Well it’s that time of year again.

No, not Thanksgiving or Christmas, or even the venerable Interim Meeting of the AMA. It’s the time that physicians nationwide anticipate another mandatory cut in Medicare reimbursement rates.

This time the recurrent temporary fix will result in a cut of 23.6 percent on December 1st. Assuming political gridlock the rate will fall another fraction of 6.5 percent on …

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Will the new Congress allow the physician Medicare cuts to pass?

Uninsured Americans cannot afford many medications

Health Policy
November 9, 2010

I went to the doctor recently and got a new prescription.

The doctor was kind enough to give me some free samples, and a voucher that I could redeem to fill the prescription once at no cost. In the future, it will cost me $50 if I decide to refill it. If I didn’t have pharmaceutical benefits through my insurance coverage, the medication would set me back about $500 for a …

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Uninsured Americans cannot afford many medications

An ACO may or may not reduce health insurance premiums

Health Policy
November 8, 2010

Is the move towards accountable care organizations (ACOs) and capitated (aka, global) payments likely to reduce health care costs and insurance premiums, or will it do the opposite?

Being an economist, my answer will be, “On the one hand … On the other hand …”

On the one hand, ACOs offer the potential for a better integration of care across the spectrum of primary care, hospitalization, skilled nursing, rehabilitation, and hospice. If …

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An ACO may or may not reduce health insurance premiums

Why public support for health care reform is falling

Health Policy
November 4, 2010

The latest Kaiser Family Foundation poll, conducted in August, shows public support for health care reform falling. After two monthly polls in which reform was viewed increasingly favorably, the new poll shows a sharp decline in public backing for the new law.

Kaiser polls in the first couple of months after enactment of Patient Protection and Affordable Care Act (PPACA) showed more confusion than clear support or opposition, but by June favorable …

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Why public support for health care reform is falling

If health care reform is killed, what happens?

Health Policy
November 2, 2010

If conservatives manage to kill health care reform legislation, what will happen next?

I really don’t want to go there.

First, I’m convinced that conservatives won’t be able to repeal the Affordable Care Act (ACA).  Democrats will hold onto the Senate, and President Obama still has a veto. If necessary, he will use it to protect the bill. Meanwhile, the majority of the public either favors the legislation or want to “wait …

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If health care reform is killed, what happens?

Covering the uninsured and the costs to society

Health Policy
November 2, 2010

by Lucas Restrepo, MD

Recently, the fire department of a small town in Tennessee called South Fulton ignored the call of a man who needed help quelling a fire near his house.

The firefighters declined lending a hand because the caller neglected to pay a $75 bill, the prerequisite for deserving assistance. The caller tried to put down the fire with a garden hose, but …

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Covering the uninsured and the costs to society

Providing Medicare to everybody increases continuity of coverage

Health Policy
October 31, 2010

At a recent staff meeting, a colleague mentioned her client was at an “awkward age”.

I thought she was referring to a teenager, but she quickly clarified herself. She was referring to the age before someone is old enough for Medicare at sixty five, an awkward time indeed.  Many people between the ages of fifty to sixty four find that relatively minor health problems make health insurance unaffordable. For those with …

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Providing Medicare to everybody increases continuity of coverage

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Deceptive marketing is widespread in health care

Health Policy
October 29, 2010

Recently, reports about deceptive marketing and other questionable practices used by the growing for-profit higher education industry in the US appeared in the news.  For example, per Bloomberg:

Recruiters at U.S. for-profit colleges lied to entice students and encouraged them to commit fraud to qualify for aid, a report by the Government Accountability Office found.

Recruiters at all 15 colleges studied by the GAO, Congress’s investigational arm, misled potential students about the …

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Deceptive marketing is widespread in health care

Unintended consequences from healthcare reform

Health Policy
October 27, 2010

In early October, the New York Times published two articles that addressed a pervasive problem from slightly different perspectives. Boiled down to its essence, the problem is the unintended consequences of some provisions of the new healthcare reform legislation.

In his well crafted article, entitled “Health Care’s Uneven Road to a New Era,” David Leonhardt explored the impact caused by the introduction of new regulations into a “status quo” system.

So-called “mini-med” …

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Unintended consequences from healthcare reform

Will the accountable care organization (ACO) be a durable part of reform?

Health Policy
October 25, 2010

Magic bullets come and go in the world of health policy, but the accountable care organization (ACO) is likely to be a durable reform. Except for group practices like Geisinger, Harvard Vanguard, Kaiser Permanente, systems like the VA, and local communities in which independent practitioners have established cooperative collaborations, health care has been grotesquely uncoordinated in the U.S. ACOs speak to that structural lesion.

Title III of the Patient Protection and …

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Will the accountable care organization (ACO) be a durable part of reform?

Why the Florida Medical Association (FMA) is angry with the AMA

Health Policy
October 24, 2010

At an Orlando meeting recently, Florida Medical Association (FMA) members fumed that their parent, the AMA, isn’t adequately representing Florida’s private practice doctors. After talk of secession and forming a new group, they settled for writing a stern letter urging the AMA to straighten up.

The FMA dustup began with a resolution written by Douglas Stevens MD, a Fort Myers cosmetic surgeon – you can’t make this stuff up – complaining …

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Why the Florida Medical Association (FMA) is angry with the AMA

How the Affordable Care Act helps Medicare

Health Policy
October 19, 2010

One of the more effective criticisms of the health reform law (Affordable Care Act, or ACA) is that it hurts Medicare. It also is wrong.

Effective, in that it has been widely reported that seniors are more likely to express negative views of the ACA than other age groups. (Although the Kaiser Family Foundation’s Drew Altman, citing the group’s most recent tracking polls, writes that seniors’ opposition to …

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How the Affordable Care Act helps Medicare

Is healthcare is a right? A balanced opinion

Health Policy
October 15, 2010

Chris Mathews had Ron Paul on his show, Hardball, earlier this year to discuss Social Security and the new health care bill.

Mr. Mathews pointed out that people get old and no longer have an adequate income source to take care of their basic needs, and pointed to this as a reason to force working Americans to save for our retirement through a government program as a sort of …

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Is healthcare is a right? A balanced opinion

Tips for questioning costs in today’s health care system

Health Policy
October 14, 2010

by Joanna Fief

About two years ago in the wee hours of the morning, I found myself in a local emergency room with severe stomach pain, incessant vomiting and dehydration.  It wasn’t pretty, and I was desperate for something – anything – to ease my pain and stop my vomiting.

Gratefully, within minutes of receiving an IV with medications for pain and nausea, my symptoms subsided.  After a couple of blood tests …

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Tips for questioning costs in today’s health care system

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