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.

The New York Times changes the Dartmouth Atlas narrative

Health Policy
June 7, 2010

Several have asked me to comment on the New York Times versus Dartmouth Atlas spat.

In summary, the Dartmouth Atlas comprises of studies showing variation in care for Medicare recipients.  Their main, take home message is that high-spending areas of the country sometimes had poorer outcomes than lower-spending ones.

Their work has been influential with the current administration, and among progressive health reformers.  Last week however, the New York Times published a …

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The New York Times changes the Dartmouth Atlas narrative

Should Americans be forced to buy health insurance?

Health Policy
June 6, 2010

by Joyce Frieden

When it comes to the healthcare reform law, no provision is more controversial than the individual mandate – the part that requires every citizen to purchase health insurance or pay a penalty.

More than 20 state attorneys general are suing the federal government over the health reform law, in large part because of this provision. Several states have already passed laws declaring an individual mandate unenforceable in their state, …

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Should Americans be forced to buy health insurance?

Will healthcare reform survive the Supreme Court?

Health Policy
June 5, 2010

by Joyce Frieden

Partisan wrangling aside, the Supreme Court will have to address serious constitutional questions about the healthcare reform law, and it’s far from clear how the justices will decide the issues, legal scholars say.

So far, 21 state attorneys general are suing to overturn the law on constitutional grounds. One of their arguments is that by forcing individuals to either buy health insurance or pay a fine, the law violates …

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Will healthcare reform survive the Supreme Court?

Machine and technology fixation is why health costs are high

Health Policy
June 4, 2010

Obsession with medical technologies and machines characterizes American’s cultural expectations. We tend to think of our bodies as perpetual motion machines, to be preserved in perpetuity.

If the face of our machines sag, we lift it up. If our pipes clog, we roto-rooter or stent them. If impurities gum up our machinery, we filter them out. If our joints give out or lock up, we replace them. If we want to …

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Machine and technology fixation is why health costs are high

Prevention improves health and lowers healthcare costs

Health Policy
June 2, 2010

Prevention is the key to both better health and lower healthcare costs over the long haul. This is where the nation — and each of us as individuals — needs to put energy and resources. In the long run, it is more important than addressing the high cost of new technologies and drugs or their inappropriate overuse.

Today, the U.S. basically has a medical care system rather than a health care …

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Prevention improves health and lowers healthcare costs

Paperwork results in wasted work for doctors, insurers and patients

Health Policy
May 30, 2010

by Marianne Mattera

“I Hate [Insert Health Insurer Here]”

Not long ago I sent an e-mail with those headline words as the subject line — I have withheld the name of the insurer to protect . . . , well, myself.

A combination of circumstances has led to massive hassles costing me what is easily 100 hours of checking, rechecking, e-mailing, and phone calling over the last 3 months. …

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Paperwork results in wasted work for doctors, insurers and patients

HSA-compatible high deductible health plan advantages

Health Policy
May 29, 2010

by Ray Carlson

With so many health insurance consumers familiar with standard “PPO” or Preferred Provider Organization health plans that feature lower annual deductibles, the HSA-compatible health plan might be getting overlooked.

These same consumers who – because of the downturn in the economy and subsequent job loss – are now shopping for, or considering shopping for, a new individual or family health plan might gravitate towards a PPO that features the …

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HSA-compatible high deductible health plan advantages

Healthcare needs to be simpler and more like real economics

Health Policy
May 27, 2010

A middle aged patient whom I have seen in the past for benign palpitations called today because of atypical chest pain. Although I have criticized the overuse of nuclear imaging studies, and probably order the fewest of any cardiologist in the city, there are times when they are appropriate –this was one of those occasions. Symptoms did not rise to the level of an invasive angiogram, but could not be …

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Healthcare needs to be simpler and more like real economics

Standardizing claims can save billions of dollars

Health Policy
May 25, 2010

by Joyce Frieden

A standardized claim form and a single set of submission and payment rules for all health plans could save the U.S. healthcare system $7 billion annually, a study has found.

“Although not all costs of excessive administrative complexity have been captured in our study, both real costs in billing operations and opportunity costs in physicians’ practices are significant,” Bonnie B. Blanchfield, ScD, of Massachusetts General Hospital in Boston, and …

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Standardizing claims can save billions of dollars

When will cost effectiveness ever be acceptable in US healthcare?

Health Policy
May 24, 2010

Cancer. The Big C. No one wants money to stand in the way of curing a patient.

But real life is messier. Many new treatments for cancer are pricey yet provide only marginal gains over existing therapies in life expectancy and/or quality of life. Forty thousand dollars for a cure is not a real dilemma for policymakers — the same spend for an extra six weeks of life is another story.

In …

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When will cost effectiveness ever be acceptable in US healthcare?

ACP: Can medical societies interact ethically with commercial entities?

Health Policy
May 18, 2010

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

by Steven Weinberger, MD, FACP

acp-logoThe Council of Medical Specialty Societies (CMSS) recently developed its “Code for Interactions with Companies,” which outlined the principles that should guide relationships between medical societies and commercial entities, including pharmaceutical companies and medical device manufacturers. Although a subsequent editorial in the New …

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ACP: Can medical societies interact ethically with commercial entities?

Doctors may be forced to accept Medicare rates to stay licensed

Health Policy
May 17, 2010

Massachusetts has a problem.

In April 2007, they became the first state to require residents to have health insurance. Reportedly this has resulted in 300,000 newly insured patients and lowered the uninsured population to 5%. But of course, given the relatively poor reimbursement rates for primary care providers, especially when it comes to government insurance, the state is facing a growing shortage of primary care providers.

Without an adequate supply of primary …

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Doctors may be forced to accept Medicare rates to stay licensed

Physician assistant not associate: Reasons against a name change

Health Policy
May 17, 2010

In reference to the seemingly “simple” name change being proposed for Physician Assistants to Physician Associates, I take great exception to the commentary offered by Dr. Zilberberg in her recent article entitled, Physician assistant name change rubs doctors the wrong way.

She states: “Physicians have been only too successful at becoming the final word in health, at the exclusion of all others.”

Physicians are the highest and most extensively trained group …

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Physician assistant not associate: Reasons against a name change

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How doctors can reduce unnecessary tests and treatments

Health Policy
May 14, 2010

Several years ago, when my wife directed the third-year Family Medicine clinical clerkship at a highly ranked medical school, she developed a popular workshop on the cost of health care that presented students with scenarios of patients who were either uninsured or underinsured and challenged them to provide cost-conscious health care by selecting medications and tests that were clinically appropriate and financially affordable.

Many students remarked that it was the only …

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How doctors can reduce unnecessary tests and treatments

Doctors are focusing on lifestyle when practicing medicine

Health Policy
May 14, 2010

An interview with Elizabeth Chase, MD, obstetrician-gynecologist in Dover, New Hampshire

Elizabeth Chase, better known as Betsy, is a close and enduring college friend of my son, Spencer. She is a solid, pragmatic, hard working obstetrician-gynecologist, with two sons, and an architect husband, who spends his time caring for their children and their house in Dover, New Hampshire. She represents many of changes that occur when women become full-time physicians. The …

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Doctors are focusing on lifestyle when practicing medicine

AMA legal battle a victory for fair pay from insurers

Health Policy
May 13, 2010

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

Physicians filing claims in $350M UnitedHealth Settlement can get help from new AMA guide

by J. James Rohack, MD

In mid-April, the first of 18 million people around the country began receiving legal notices containing details of a record-breaking settlement reached last January in a historic court challenge …

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AMA legal battle a victory for fair pay from insurers

Physician assistant name change rubs doctors the wrong way

Health Policy
May 11, 2010

Much like many other news items, I came upon the one about the proposed name change for Physician Assistants quite by accident: it came to me as an e-mail notification of a new topic being discussed on one of the physician only discussion boards that I am a part of. Apparently, after 40+ years of the profession’s existence, there is a grassroots effort afoot to upgrade the name, and presumably …

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Physician assistant name change rubs doctors the wrong way

Health insurance will be reformed by a little known department

Health Policy
May 11, 2010

by Joyce Frieden

In one of those “important but little noticed” announcements that government officials are prone to put out, the Department of Health and Human Services recently let the world know – via the Federal Register — that it has created an Office of Consumer Information and Insurance Oversight to assist with implementation of the newly passed health insurance reform law.

This new office has four divisions. Here are a …

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Health insurance will be reformed by a little known department

Transparent medical pricing lowers health costs

Health Policy
May 10, 2010

My friend, the Buckeye Surgeon, has resisted reforms in medical residency training programs, that have eased some of the inhumane exhaustion on young interns and residents.

I have a different view on the subject. This issue generates spirited debate in the blogosphere and in teaching hospitals across the country.

Not all medical education reforms, however, provoke controversy. I learned recently from an Ohio medical student that they are now being taught …

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Transparent medical pricing lowers health costs

Calorie counts in health reform is significant for patients

Health Policy
May 6, 2010

Counting calories as part of health care reform—who knew? But apparently it’s there on page 455 of the health-care reform act, according to Marion Nestle, Professor of Nutrition at NYU, writing in the New England Journal of Medicine. There will now be a national effort at posting calorie counts in chain restaurants.

There are many ways to improve the overall health of Americans, but tackling obesity is surely one of the …

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Calorie counts in health reform is significant for patients

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