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.
by William Bayer
Buying health insurance across state lines and health savings accounts are good – but they do not resolve the core issue.
The core issue is that the employer is making the main choice for the employees, leaving them essentially with a choice between small, medium or large. That may satisfy the most important needs, but it does not encourage competition because the …
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Selecting health insurance requires free choice for individuals
The country seems to have shifted in less than 18 months from a slogan of “Yes We Can!” to “Oh, well…” and a shrug, then back to “Cool! I think. What was that, really?”
Hopes for a true rebirth of health care turned into the Year of Screaming Inanely, then took that long slide from what we might hope for to what we might settle for. Yet suddenly it seems like …
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Making health care better, faster, and cheaper with collective innovations
I live in New York. Last week my daughter in Chicago called to say that a five dollar charge had been refused at a local coffee shop. My credit card company had identified an unusual pattern of purchases, and had put a hold on the card.
No similar process exists for the Medicare system, where cost savings could be realized by systems that identify unusual patterns of charges and outright abuse …
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Medicare needs to be more like a credit card
A revealing article in Bloomberg recently described the latest way in which elderly patients are getting screwed by the system.
Medicare reviews all admissions and if the patients don’t meet indications for admission, the hospital doesn’t get paid by Medicare. Medicare has also recently implemented a mercenary system called Recovery Audit Contractors (or RAC for short) in which third parties audit hospital charts to see whether Medicare “overpaid” for a patient’s …
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How observation admissions affect Medicare patients
Like it or not, “garbage in, garbage out” is the rule rather than the exception for the vast majority of bureaucratically dictated “quality control” programs that we’re ever likely to launch. There are three primary reasons for this.
First and foremost, there’s Goodhart’s Law:
“Originally, an economic theory stating that if a particular definition of the money supply were to be used as the basis for monetary policy, the stability …
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Quality programs have social and medical consequences
Over the past year, states across the country have begun to develop Regional Extension Centers (RECs) to help support the broad electronic health record (EHR) initiative passed as part of the economic stimulus package in 2009.
Why should physicians care? With benefit of a little background information, the answer is pretty clear.
The evidence suggests — and it is generally believed — that adoption of EHRs by physicians and other healthcare providers …
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Why doctors should care about Regional Extension Centers (RECs)
Peter Orszag wants doctors to work weekends.
The former director of the White House Office of Management and Budget wrote as much in this past weekend’s New York Times:
Doctors, like most people, don’t love to work weekends, and they probably don’t enjoy being evaluated against their peers. But their industry can no longer afford to protect them from the inevitable. Imagine a drugstore open only five days a week, or …
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Doctors should work weekends, and how reformers alienate physicians
by Asa Lockhart, MD
Doctors, that age-old business advice still applies: Take your time and read carefully, and evaluate what it might mean to your patients and your practice, before you sign a contract.
Specifically, the Patient Protection and Affordable Care Act (PPACA) paves the way for Medicare shared savings accountable care organizations (ACOs).
Conceptually, this type of ACO is a collaboration of physicians and health care providers …
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6 points every physician should consider about Medicare ACOs
Somewhere in the Obama Administration, there is an elitist central cabal that operates with the support of the highest organs of our central government. It conspires in windowless basement rooms to plot the gun control, mass vaccinations and the nationalization of key U.S. economic sectors like automobile and chardonnay manufacturing.
Healthcare, however, is its maximum target. Much like pieces on a chess board, and with the support of renegade organizations like …
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Can accountable care organizations lower costs and improve quality?
How do you judge how good a doctor is? By personal interaction? By what relatives and friends say? By whether he or she is on time when you go for your visit? By doctor rating websites on the Internet? By patient satisfaction surveys conducted by doctors themselves or rating agencies?
Or do you do it by the numbers? The federal …
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How judging doctors by the numbers may be meaningless
Today we mostly have prepaid medical care insurance with some co-pays and deductibles – both with commercial insurance and with Medicare.
In other words, our insurance covers essentially everything from basic and routine care to the catastrophic. And the insurance pays out based on units of care – a visit, a test, a procedure, a hospitalization, a prescription. This creates a system in which providers (physicians, …
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A system based on units of activity encourages more units of care
I remember this one moment back in the midst of health care reform when I was sitting in a radio studio, feeling pretty glum about the whole ordeal, and I mused aloud, “I wonder if anyone is enjoying this at all.”
For some of us, improving the health care system is more than a passing fancy. I’m a health services researcher. It’s my job. Those people on the TV pay attention …
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Wanting better health care shouldn’t be conservative or liberal
In making the case for health care reform, inappropriate utilization of emergency rooms is frequently cited as an example of our inefficient system and an important factor behind the staggering cost of U.S. health care.
At first, the logic makes sense: emergency rooms have to treat people, so the uninsured often turn there for care, including primary care, which is very expensive to provide in an emergency room, and would be …
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Should reduced ER use be a measure of health reform?
This has to be a very difficult time for insurance companies in Massachusetts. Notwithstanding that they are non-profits, they are under a lot of scrutiny with regard to reserve margins and profitability. Much of this is unfair, but I think that is just a sign of the times. Hospitals face a similar issue, too. Doctors are certainly next in line.
But the Massachusetts insurers have an additional problem. They have been …
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A difficult time for health insurance companies in Massachusetts
As part of the new health care legislation, the government has instituted Medicare’s Physician Quality Reporting Initiative (PQRI) in an attempt to motivate health professionals to do the right thing.
According to the legislation, PQRI asks physicians to report how the care they furnish aligns with evidence-based clinical guidelines for a variety of medical conditions, such as diabetes or heart disease. In 2010, physicians who successfully report these measures will receive …
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What motivates health care workers is needed to explain health care costs
The individual mandate is the single most controversial feature of the Patient Protection and Affordable Care Act. Everyone who can afford coverage—unless an undocumented immigrant or exempted on religious grounds—is required to have it or pay a penalty of $695 or 2.5 percent of income.
The rationale is straightforward: without a mandate, many people would wait until they needed care before buying insurance, driving up premiums for those with ongoing coverage, …
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Patient Protection and Affordable Care Act individual mandate controversy
by James P. Davison, DO
Emergency department utilization and its impact on health care reform legislation has been a hot topic of conversation in healthcare journals and the blogosphere. It is a tenet of the currant legislation that ER visits and cost growth will go down, contributing to a decreased health cost growth curve.
Opponents state the newly insured will flock to the nation’s emergency rooms. Proponents …
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Emergency department utilization and its impact on health care reform
Health Affairs reports on a study that finds Evidence That Consumers Are Skeptical About Evidence-Based Health Care.
According to the abstract,
We found many of these consumers’ beliefs, values, and knowledge to be at odds with what policy makers prescribe as evidence-based health care. Few consumers understood terms such as “medical evidence” or “quality guidelines.” Most believed that more care meant higher-quality, better care. The gaps in …
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Patients don’t believe the evidence, blame our healthcare system
Howard Brody, a family physician, recently wrote an article in the Annals of Family Medicine discussing, “Professional Medical Organizations and Commercial Conflicts of Interest: Ethical Issues.”
The article focused on how AAFP has “recently been criticized for accepting a large corporate donation from Coca-Cola to fund patient education and materials on obesity prevention,” and how this money has been called a “conflict of interest.” To that effect, Dr. Brody defines such …
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Working with industry requires building a culture of trust
Is the pen mightier than the PC?
When it comes to prescribing, it appears so. A new report from the Center for Studying Health System Change finds that most physicians write their RX scripts by hand, despite financial incentives for physicians to adopt electronic prescribing. Even those who have e-RX systems do not always use them, and when they do, they may not to use the features that were …
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Why are most physicians writing their prescriptions by hand?
