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.

Government-controlled health insurance may politicize health

Paul Hsieh, MD

Health Policy

March 25, 2010

During President Obama’s final push for “universal health care” legislation, his biggest obstacle was not Republicans but rather anti-abortion Democrats let by Congressman Bart Stupak (D-Michigan).

Stupak eventually reached a last-minute deal with the White House on federal funding of abortion services. But no one should be surprised that under government-controlled health insurance, medical coverage decisions will be based on political considerations. Rather, the recent wrangling over abortion will be …

Health reform should make conservatives very happy

Kevin

Health Policy

March 24, 2010

Let’s get one thing out of the way.

The health care reform bill that passed the House this past Sunday, and will be fixed via reconciliation in the Senate, is a moderate, relatively incremental approach to fixing our health care system.

Conservatives are up in arms, as they have been during the entire process, and are lining up lawsuits and trying to gather momentum to repeal the bill.

And I’m asking myself, …

Tax credits and new patient care models in health reform

Kevin

Health Policy

March 23, 2010

by Robin Tang

Sunday, March 22, 2010, marked the passage of the Health Care and Education Affordability Reconciliation Act (H.R. 4872) by the House by a narrow 219-212 margin, with no Republicans voting in favor. Whether you think the bill is good, bad, sustainable, or even constitutional, we can agree this was a historic day.

Putting politics aside, I want to highlight two parts of the bill that aren’t getting enough …

Healthcare reform will be challenged in states

Kevin

Health Policy

March 23, 2010

Originally published in MedPage Today

by Joyce Frieden, MedPage Today News Editor

With the House and Senate now in basic agreement on healthcare reform and President Barack Obama about to sign the underlying bill into law, opponents are gearing up to challenge the legislation on a variety of fronts.

This effort was beginning even before Sunday’s House vote sent the Senate …

Health care reform passes the House in a historic vote

Kevin

Health Policy

March 22, 2010

Originally published in MedPage Today

After a year-long struggle and often-raucous partisan debate, the House of Representatives passed an historic health care reform package late Sunday night.

The vote on the last of the two bills in the package was 220-211. All 178 Republicans, along with 33 Democrats, voted against the measure. The margin was similar on the other measure; both …

Healthcare reform is an achievement but isn’t perfect

Robert Wachter, MD

Health Policy

March 21, 2010

Heading into the final weekend of Mr. Toad’s Wild Ride, who could have guessed that in a year that brought us Death Panels, Pickup Trucks, “You Lie”, The Cornhusker Compromise, Bart Stupak (boy, that must have been a tough name to grow up with), and the Senate Parliamentarian-as-Rock-Star, we would be on the cusp of passing a perfectly …

Flood insurance by the government, but no public option

Kevin

Health Policy

March 20, 2010

Originally published in MedPage Today

by John Gever

This meditation was evoked by the prospect that my basement could be filled with E. coli-laden mud next week.

I live within a few yards of Wheeling Creek, a tributary of the Ohio River that drains about 250 square miles of northern West Virginia and southwestern Pennsylvania. This week has brought temperatures near 70 degrees, …

Medicare rates and capping payments to hospitals

Paul Levy

Health Policy

March 19, 2010

If there is anything about economics that has been proven over and over, it is that price controls do not work. The unintended consequences are usually worse than the problem that led to the solution in the first place.

Massachusetts legislators, feeling the frustration of higher insurance premiums, are now considering a bill to limit doctor and hospital reimbursement payments to 110% of Medicare rates, or perhaps some other percentage …

Business model woes traps doctors and impedes health care

Susan Giurleo, PhD

Health Policy

March 18, 2010

If you are a physician, therapist or any other helping professional whose business model relies on third party manged care reimbursement you are engaged in the world’s worst business model.

Let me start with a story to set the stage.

Imagine you are a bright, idealistic college student. You’re good at academics, want to make a difference in the world and have hundreds of career options in front of you.

After lots of …

Medicare and how a grandmother worries about its costs

Kevin

Health Policy

March 18, 2010

Originally published in MedPage Today

by Liz O’Brien

My grandmother and her hospital roommate — aged, tiny, frail, and sporting matching bright pink hairnets.

They looked like twins — two thin shrubs in winter that had each sprouted an improbable, big pink rose.

Although sick and scared, my grandmother had admired the pink hairnet on the lady in the next bed, so my mother …

Medicare doc fix questions and answers

Vineet Arora, MD

Health Policy

March 17, 2010

A 21% cut for Medicare physician fees is set to go into place soon. This year, fixing physician payment has been overshadowed by all the talk about health insurance reform.

In fact, I remember being invited to talk about healthcare reform on a panel for medical students this past fall. As part of my remarks, I mentioned the 21% pending cut in physician payment and recall the questions and …

Read more…

Medicare doc fix questions and answers

Children with special healthcare needs are underinsured

Kevin

Health Policy

March 12, 2010

Originally published in MedPage Today

by Chris Emery, MedPage Today Contributing Writer

Nearly a third of children with special healthcare needs are underinsured, and where a child lives strongly influences whether he or she will have adequate healthcare coverage, a new study found.

The unadjusted proportion of underinsured special-needs children varied strongly by state, ranging from 24% in Hawaii (standard error=1.75) to 38% …

AMA: Health insurance consolidation can undermine physicians

Kevin

Health Policy

March 11, 2010

The following is part of a series of original guest columns by the American Medical Association.

by J. James Rohack, MD

Physicians in nearly every area of the country face a David and Goliath scenario when negotiating with entrenched health insurance companies. This is clearly illustrated by a new AMA study showing that competition in the health …

Health care reform needs to pass now, and here’s why

Matthew Mintz, MD

Health Policy

March 11, 2010

There are certain actions we take even though we know that ultimately we will not be successful. Sometimes we do this out of hope for a better tomorrow (like playing the lottery) or because we are taking a moral stand (like supporting a candidate that has no chance of winning).

Supporting health care reform is probably a little of both.

Even if any of the currently proposed health care reform plans pass, …

Health reform needs to end fee for service medicine

Pearl Korn

Health Policy

March 3, 2010

As the health reform debate rages on, the central issue of how to improve care while reducing costs remains unaddressed.

Fee-for-service has reduced doctors to assembly line pieceworkers, paid by the office visit and procedure rather than by effectiveness of treatment. The result is an inefficient, costly and dangerous system. It is not unusual for a five minute office visit, which excludes clinical examination or note taking. Many patients/consumers can be …

The Danny Williams surgery shouldn’t be controversial

Kevin

Health Policy

March 2, 2010

Originally published in MedPage Today

by Michael Smith

OK, don’t take this the wrong way, but ….

Chill. Relax. Give the other guy the benefit of the doubt. Don’t jump to conclusions. And most of all, think before you speak, blog, natter, comment, or otherwise pontificate on issues of the day.

And when I say ‘think,’ I don’t mean trying to find the …

Medicare slashes pay to doctors, and what that really means

Wes Fisher, MD

Health Policy

March 1, 2010

What we’re learning from the 21% Medicare pay cut to physicians that occurred today:

* There really must be a cost-control crisis with Medicare and the only politically-acceptable way to implement those cost controls are by cutting working physicians’ payments.

* There’s was widespread political support for blocking the scheduled pay cuts to doctors, but central government control moves very slowly. That’s because doing so is expensive. For now, doctors have been …

Medicare cuts will strengthen doctors’ negotiating position

Richard Reece, MD

Health Policy

March 1, 2010

Doctors will soon be wagging the reform dog.

Look at it this way. Expansion of insurance coverage to the 31 million more Americans, as envisioned in the current reform bill, will require more doctors to care for them. The starting entry of 78 million baby boomers in the Medicare pool, starting in 2011, will also take more doctors.

As everybody knows, coverage does not equal access. This is most vividly illustrated in …

Never events in hospitals depend on patient risk

Kevin

Health Policy

February 25, 2010

Originally published in MedPage Today

by John Gever, MedPage Today Senior Editor

Occurrence of some so-called “never events” in hospitals may depend partly on unmodifiable risk factors such as patient characteristics, undermining the rationale for denying Medicare payment for their treatment, researchers said.

Analysis of some 890,000 surgeries performed in 1,368 hospitals showed that patient age and pre-existing conditions such as weight …

Does your cardiologist deserve his salary?

John Mandrola, MD

Health Policy

February 20, 2010

Conflicted am I on reading of the strategy of a group of South Miami cardiologists who have written their patients complaining of the cuts to reimbursement, primarily cuts in imaging procedures. A tension emerges from within upon reading the following quote from a “healthcare expert.”

“I’m not at all sympathetic with the cardiologists,” said Robert Berenson, a doctor who was once in charge of Medicare payment policy and now is a …