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 Jeoffry B. Gordon, MD, MPH
I have always considered it to be my professional responsibility and ethical imperative to fight for my patients with the insurance companies to get approval for every test and medication that I think is medically necessary.
My batting average is close to 100% Lately, the insurance companies have been trying to draw the noose tighter and make the task of getting …
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Insurance companies affect patients with paperwork for tests
The recess appointment of Dr. Donald Berwick as head of CMS has incited a furor among politicians outraged at what they claim are his advocacy for rationing and fondness for Britain’s National Health Service.
To support their claims, these politicians are using Berwick’s own words, in a way eerily reminiscent of the recent Shirley Sherrod debacle.
It started with Glenn Beck, master of the one-word quote, and then slipped over into more …
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Don Berwick is a patient centric, consumer oriented radical
The rapidly ramifying crisis in health care may (we can pray) end all delusions. It may at least begin to weaken them by exposing them to the light, to the sobering effects of reality.
The reform act has not brought us to the Promised Land. By bringing us access without capacity, fierce restrictions coupled with vague language and loopholes, mandates coupled with fines low enough to become the cheap way out, …
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Health care reform provides a chance that we can do the right thing
On my way onto the plane for my recent flight home from France I picked up a copy of Le Figaro thinking I might enjoy the article about actress Sophie Marceau, who was on the cover of everything while we were in France in celebration of her turning 40.
I did enjoy catching up on Marceau – I still remembering watching La Boum in my high school French class – but …
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Health care reform controversy in both Europe and the United States
I have lived on the Gulf Coast for all but 5 of my 50 years. I grew up in Baton Rouge, Louisiana and now live in Mobile Alabama.
I was educated in the public schools during the height of the desegregation battles and my experiences were colored by those battles in a number of ways. I ran track in high school and was in the racial minority on that team (as …
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Southern states may block the government from delivering health care
According to the Washington Post, it is highly unlikely that Congress will undo the planned “sustainable growth rate formula” (SGR) mandated Medicare fee schedule cuts. While there’s an outside chance of a fix, the American Medical Association, as well as other organized physician groups, can’t be happy about the constant threat of the 20% payment reductions.
Recall that the SGR was signed into law back in 1998. It was designed to …
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Why the sustainable growth rate formula (SGR) is here to stay
What follows are ten thoughts on checks and balances in health reform.
I am writing from Oak Ridge, Tennessee, where I am attending a high school class reunion. My son Spencer, a nationally known poet and a candidate for the Episcopal priesthood, is with me. He is checking on my past, and I am trying to provide balance so he can understand his father’s legacy.
There …
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Checks and balances in health reform
by James Gaulte, MD
Apart from some apparently radically contradictory expressed views on patient “centeredness” and patients being in control, the newly appointed head of CMS, Dr. Donald Berwick, has made it clear what sort of medical system he would have for the United States.
What he wants is well explained in this commentary from National Review Online as is the authors’ reasoning of why …
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The medical system Donald Berwick prefers in the United States
Whether we have commercial insurance through our employer or Medicare, the incentives are poorly aligned to lower costs and improve quality.
In fact, they actually encourage greater and greater expenditures. In most instances, our insurance covers everything from prevention to basic routine care to complex care of serious illness. Coverage may not be all that good for some things like preventive care and our primary care …
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Insurance does not have incentives to lower costs or improve quality
Health reform will do a lot of things that most Americans don’t realize it will do, and it will not do a lot of things that many Americans mistakenly believe it will do.
One of the most recognizable components of health reform that didn’t actually become law is the public option. The public option was the lighting rod in the health reform debate. After all, it had a concise name, and …
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The public option dissonance in health reform
Hard choices and healthcare reform are here. Donald Berwick, M.D., has been installed as the administrator for the Centers for Medicare and Medicaid services as a “recess appointment” by President Obama.
Dr. Berwick is an academician, a pediatrician who has spent the bulk of his professional existence as the CEO of the Institute for Healthcare Improvement of Cambridge, MA. He is an outspoken advocate for the single-payer system, admires Britain’s National …
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Healthcare reform ethical questions
Everyone understands the need for a robust primary care workforce in making healthcare more affordable and accessible while keeping those in our care healthy. With the aging of America and healthcare reform, even more Americans will need primary care doctors at precisely the same time doctors are leaving the specialty in droves and medical students shun the career choice. So as a practicing primary care doctor, I’ve watched with …
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Americans will need doctors but physicians are leaving primary care
Recently, the 21 percent cut in Medicare physician reimbursements was replaced with a 2.2 percent pay hike.
Later this year, Congress will have to consider the matter once again, just as it has ever year since 2003. This is the third time this year that Congress has averted Draconian cuts to physician’s payments. What, you might wonder, is going on?
Here is the back-story. In 1997, Congress enacted a so-called “sustainable growth …
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Congress is actually increasing physician Medicare pay
As might be expected of reform legislation, the Patient Protection and Affordable Care Act (PPACA) places a lot of emphasis on innovation.
Reasonably enough, most of the potential changes—at least in Medicare—are to be preceded by pilot or demonstration projects designed to test their feasibility. In fact, according to one health care blogger with time on his hands, PPACA includes no less than 312 mentions of demonstrations and 80 mentions of …
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Will pilot programs really lead to innovation and save money?
Recently, I was lucky to be invited to a New England Healthcare Institute discussion entitled “From Evidence to Practice: Making CER Findings Work for Providers and Patients” in Washington, DC.
How to disseminate and implement Comparative Effectiveness Research (CER) so that patient care is really improved was the first topic tackled by the expert panel and the moderator, Clifford Goodman of The Lewin Group.
The target audiences for CER findings include: patients, …
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Comparative effectiveness research (CER) in patient care
One of the big complaints about the recently enacted health care reform law is that it does little to control costs. There is some truth to that because the major focus is on increasing access to insurance. And yet there is reason for optimism on a couple of fronts:
- First, with many of the access issues settled, stakeholders can focus directly on cost matters rather than cost-shifting and finger pointing
- Second, health …
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Medicare needs to take the lead for health care cost control
by Charles W. Patterson, MD
Is it possible that some do not understand that to promote Healthcare Savings Accounts is the most effective thing we could do to preserve traditional medical practice? In a true doctor-patient relationship only doctors and patients discuss the options agree to the treatments and handle the money. No third party touches any of these.
If everyone had a HSA it would be just like the good old …
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Can HSAs restore the doctor patient relationship?
The Wall Street Journal reported that overall medical use fell as patients had fewer doctor office visits, lab testing, and maintenance medications possibly due to the recession or as a result of consumer driven healthcare in the way of higher deductibles and copays.
This is very worrisome. Certainly patients should have some financial responsibility for their care, but skimping on care will only result in Americans not becoming healthier, but sicker. …
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Patients will skip care with higher deductibles and copays
