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.

AMA health insurer report card finds need for more accuracy

Kevin

Health Policy

July 12, 2010

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

There has been some notable progress in just two years since the American Medical Association’s first National Health Insurer Report Card evaluated the claims processing performance of the nation’s largest insurers. Health plans have made improvements in the efficiency and transparency of their claims processes, but there is still a lot of room for improvement – and the AMA …

Practical barriers for comparative effectiveness studies

David Williams

Health Policy

July 10, 2010

Writing in the New England Journal of Medicine three authors share their experience in running a head-to-head trial of Avastin (bevacizumab) versus Lucentis (ranibizumab) for wet age-related macular degeneration (AMD).

They describe the barriers they faced and suggest that the barriers will need to be removed for comparative effectiveness research to succeed. They make good points and may well be correct in their policy recommendations.

However the case of Avastin and Lucentis …

Emergency room waits grow as more people become insured

Kevin Pho, MD

Health Policy

July 8, 2010

Remember when I wrote, way back when, that expanding health coverage without a concurrent increase in primary care access will only worsen emergency room waits?

For instance, consider this, from CNN.com:

What good is having health insurance if you can’t find a doctor to see you? …

… The Massachusetts Medical Society reported that the average wait time for a new patient looking for a primary care doctor ranged from 36 to …

Read more…

Emergency room waits grow as more people become insured

Does prevention improve health care outcomes and lower costs?

Kevin

Health Policy

July 5, 2010

by Joseph W. Stubbs, MD, FACP

The eighth paragraph of the modern Hippocratic Oath reads: “I will prevent disease whenever I can, for prevention is preferable to cure.”

Support and encouragement of prevention are deeply rooted among physicians. Intuitively, to prevent a deadly or disabling disease from occurring or stop it at an early stage seems like a bread-and-butter concept with obvious health benefits.

But it should also accrue cost savings by avoiding …

Why the medical home may not save primary care money

Jaan Sidorov, MD

Health Policy

June 29, 2010

When the Disease Management Care Blog saw the flurry of news reports about the Patient Centered Medical Home (PCMH) “saving money,” it couldn’t wait for the full print version of Health Affairs to arrive at the DMCB World Headquarters.

The DMCB had previously reviewed Group Health’s negative “no statistically significant…. cost differences” one year study and was looking forward to seeing researchers Robert Reid et al’s reportedly positive two …

Why Obamacare scares this cardiologist

Richard Reece, MD

Health Policy

June 27, 2010

I recently visited my cardiologist. It was a routine follow up after a heart attack a year ago. I enjoy our relationship. As a token of my regard, I came bearing a gift. It was a copy of my book Obama, Doctors, and Health Reform.

I knew he had qualms about Obamacare. He expressed doubts about the health reform bill’s merits. The bill will roll out over the next ten years. …

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Why Obamacare scares this cardiologist

Healthcare reform’s focus on outcome and how that affects doctors

David B. Nash, MD, MBA

Health Policy

June 25, 2010

With the signing of national healthcare reform into law, the U.S. healthcare system faces almost immediate — and substantial — transformation. I spent a recent Sunday reading all that I could find in order to get my arms around this massive piece of legislation and to understand its health policy implications.

Here is my view from 50,000 feet.

I needn’t list all of the aspects relating to expanded coverage and insurance reform …

7 disruptive changes that will affect medicine

Stephen C. Schimpff, MD

Health Policy

June 24, 2010

Generally we prefer calm seas but often they don’t get us anywhere.

We need disruptions, transformations to make the changes necessary for real progress in medicine. Sometimes it is a new technology; sometimes a cultural change. But then a refinement may occur. The refinement may not seem like a “disruption” but indeed it can be because the refinement may create a demand for change.

Here a few more disruptive changes or refinements …

Shop for benefits, not premiums, when looking for health insurance

Kevin

Health Policy

June 23, 2010

by Ray Carlson

When discussing health insurance plan strategies with clients, there can sometimes be an awkward pause in the conversation after asking the client if they checked to see if their own doctor is in the network of the health insurance company whose plan they are applying for.

It’s possible that many first time shoppers for individual health coverage are applying for health plans without first verifying if a family physician …

How healthcare reform will affect Medicaid

MedPage Today

Health Policy

June 22, 2010

by Cole Petrochko

Medicaid expansion under new healthcare reform laws could add millions of participants to the program over the next nine years and greatly decrease the number of uninsured Americans — with the federal government picking up most of the tab, according to a Kaiser Family Foundation report.

One set of projections in the report, prepared by the Urban Institute for the Kaiser Commission on Medicaid and the Uninsured, estimates that …

ACP: Increasing the attractiveness of general internal medicine

American College of Physicians

Health Policy

June 21, 2010

A guest column by the American College of Physicians, exclusive to KevinMD.com.

by Steven Weinberger, MD, FACP

In this era of health care reform, much has been written and discussed about the shortage of primary care physicians in the United States, which is projected to get substantially worse over the coming years.

A number of different types of physicians have been …

Return control of our health system back to doctors and patients

Kevin

Health Policy

June 19, 2010

by William Lawson, MD

Representative David Price recently wrote the Chapel Hill News to “set the record straight” regarding Washington’s newly‐passed health care legislation.

Rep. Price argues that the government’s central planning will make health insurance more affordable for small businesses and individuals. Touting tax credits covering 35% of premiums for small businesses with less than 25 employees and less than $50,000 in average annual wages, Rep. Price asserts that the new …

Do large hospital systems increase healthcare costs?

Roy Poses, MD

Health Policy

June 16, 2010

In Rhode Island, hospitals that are part of hospital systems were paid more for the same services than independent hospitals.

The price differences could not be explained by quality of care or severity of illness. The results suggested that market power determines the price of hospital services, and that increasing concentration of power in hospital networks is likely to further increase costs, without improving quality of care.

Recently, a similar report out of the neighboring state …

Who really benefits from President Obama’s health reform plan?

Erin Marcus, MD

Health Policy

June 15, 2010

I don’t know about you, but as I watched coverage of President Obama signing the health care bill three months ago, it was hard not to notice the constant ads for power wheelchairs. Emblazoned across the ads was a flashing notice reminding viewers: Medicare may cover this!

Don’t get me wrong. As a primary care doctor who takes care of low-income patients, I was glad to see something being done to …

Doctors make far less money than most people think

Kevin

Health Policy

June 15, 2010

A video excerpt from The Vanishing Oath, a film directed by Ryan Flesher, MD.

The average physician salary in the United States is $146,000 — which is undeniably a lot of money at face value.

But it’s a lot less when you factor in the overhead costs that doctors incur. And that’s not including the medical school debt which, on average, exceeds $150,000.

This clip shows how the take home pay of …

Medical loss ratios is not all about health insurance profits

David Williams

Health Policy

June 14, 2010

The new health insurance reform law will generally require health plans to pay out at least 80 or 85 percent of premiums in medical expenses, depending on whether they are selling to individuals/small groups or to large groups. Intuitively it makes sense that purchasers would want the medical loss ratio to be as close to 100 percent as possible –- since the purchaser doesn’t derive utility a plan’s administrative expenses …

Government and marathon runner motivation

Jeffrey Hall Dobken, MD, MPH

Health Policy

June 13, 2010

Giving advice is usually a thankless business. I have always been mindful of the unconsciously profound summation given by a six-year-old when she was asked to identify Socrates. “Socrates,” she stated, “was a really old Greek guy who went around giving people good advice. They poisoned him.”

But here goes: We do not need government intervention to improve our health, and, by extension, the quality of our lots in life.

This essay …

AMA: Senate fails to stop a Medicare meltdown

Kevin

Health Policy

June 11, 2010

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

by J. James Rohack, MD

Unbelievable as it is, for the third time this year the Senate failed to act on time to stop this year’s 21 percent Medicare physician payment cut. Senators cut and ran on America’s seniors and their physicians, heading home for the Memorial …

Whistleblowers endure stress and personal hardship

Charles Bankhead

Health Policy

June 7, 2010

by Charles Bankhead

Whistle-blowers in the healthcare industry endure substantial hardship and often pay a high personal price for cooperating with Justice Department investigations, according to a report based on detailed interviews with more than two dozen informants.

Loss of employment, financial ruin, divorce, and a host of mental and physical health problems were common consequences of individuals’ decisions to report corporate fraud.

Cases can drag on for years before reaching a resolution, …

Tort reform for doctors in exchange for less salary

Jeffrey Parks, MD

Health Policy

June 7, 2010

Matt Steinglass at The Economist has interesting take on tort reform, specifically that limiting physician liability for adverse patient outcomes must come with an equable cost to doctors.

In Europe, the costs accrued due to medical errors are covered by the wide-ranging social safety net; the lottery system of massive medical malmalpractice judgments is virtually absent.