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.

Would I vote for the Senate healthcare bill? Here’s where I stand on reform

Kevin

Health Policy

December 21, 2009

Now that the Senate health care bill is nearing its home stretch, some are wondering if I continue to support reform.

As a reminder, I wrote back in July that doctors should support Congress’ health care reform efforts, because, “some reform is better than none, and doctors advocating for a free market-based system shouldn’t hold out, hoping for the perfect package.”

There were deuling columns in last Friday’s New York Times, …

The medical home in health reform’s attempt to fix primary care

Kevin

Health Policy

December 19, 2009

Originally published in MedPage Today

by Kristina Fiore, MedPage Today Staff Writer

Encouraging “medical homes” to deliver care outside the emergency room should be a key aspect of healthcare reform, according to researchers, policymakers, and business leaders.

“It’s not rocket science to put a nurse practitioner near a public housing project,” said Jeffrey Brenner, MD, a physician in private practice in Camden, …

The limits of using Medicare patient data for quality outcomes

Kevin

Health Policy

December 16, 2009

Originally published in MedPage Today

by Todd Neale, MedPage Today Staff Writer

Most primary care physicians don’t see enough Medicare patients to determine statistically significant differences in cost and performance between practices, researchers found.

In fact, nearly two-thirds (65.7%) of primary care doctors worked in practices that saw too few Medicare patients to provide reliable comparisons with national benchmarks for cost and …

AMA weighs in on the Senate health reform bill

Kevin

Health Policy

December 15, 2009

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

by J. James Rohack, M.D.

As the year winds down, health system reform continues to move forward. The Senate bill currently under debate includes a number of provisions that are consistent with the AMA’s reform priorities, some provisions we oppose and others that need to be improved to better benefit patients and physicians. As part …

Why doctors and hospitals oppose expanding Medicare

Kevin

Health Policy

December 15, 2009

Originally published in MedPage Today

by Emily P. Walker, MedPage Today Washington Correspondent

The notion of a public health insurance plan appears to be evaporating from the Senate’s healthcare reform bill, replaced in part with an expansion of Medicare — an idea that’s meeting resistance from doctor and hospital associations.

A proposal to scrap the public plan to allow people as young …

Should medicine be efficient in the business sense?

Marya Zilberberg, MD, MPH

Health Policy

December 6, 2009

When we talk about efficiency in the business world, we are basically talking about getting as much profit as possible. This profit is wrung out of the system by reducing production costs to the maximum extent possible and by charging the top price that the market allows.

Some of the ways in which the US companies have increased their efficiencies over the last 30 years are, 1) by moving manufacturing to …

Specialists should staff the patient centered medical homes, not primary care doctors

Kevin

Health Policy

December 3, 2009

Originally published in HCPLive.com

by Alan Berkenwald, MD

The approaching fire storm over the “patient-centered medical home” model reminds me of the destructive powers seen before in HMOs. Once seemingly destined to revolutionize organized medicine, the HMO model nearly destroyed it.

We can learn from past failures. We need to promote best-practice models and make physicians accountable for their actions, both physiologically and …

Senate health reform plan analysis

Kevin

Health Policy

November 19, 2009

Originally published in MedPage Today

by Emily P. Walker, MedPage Today Washington Correspondent

After weeks of closed-door meetings, the Senate leaders released their $849 billion healthcare reform bill on Wednesday evening, paving the way for a procedural floor vote soon.

The bill, combining versions approved by the Finance Committee and the Senate Health, Education, Labor and Pensions (HELP) Committee, would create a …

Read more…

Senate health reform plan analysis

AMA’s democracy in action at this defining moment in the history of medicine

Kevin

Health Policy

November 13, 2009

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

by J. James Rohack, M.D.

Delegates Vote to Continue AMA’s Commitment to Reform, Medicare Vote Pending in U.S. House of Representatives

Twice a year, physicians come together for an exhibit of democracy at its best through the AMA House …

Will the abortion restriction survive the Senate health reform bill?

Kevin

Health Policy

November 11, 2009

Originally published in MedPage Today

by Emily P. Walker, MedPage Today Washington Correspondent

After a controversial amendment to restrict abortion was approved as part of the House healthcare bill over the weekend, senators are grappling with the abortion language in their legislation.

Senate Majority Leader Harry Reid (D-Nev.), who personally opposes abortion, said the issue was being negotiated.

“I expect the bill that …

How should doctors discuss healthcare reform with patients?

Kevin

Health Policy

November 10, 2009

Originally published in HCPLive.com

Physicians are increasingly bringing their views on healthcare reform into the examination room. Others are distributing flyers or taping up signs in the office. Given that healthcare reform has become such a contentious subject in the United States, it is not surprising that conflicts have arisen between physicians and patients who hold different views.

The St. Petersburg Times …

Doctors and patients need to learn to live with health insurance companies

Kevin

Health Policy

November 10, 2009

by Marie Cooper

Consider two patients with the same managed care plan.

One has multiple sclerosis and receives an infusion of Tysabri every month. It needs pre-certification. The requirements are black and white. The patient qualifies if they have relapsing/remitting MS and have failed other therapies. The drug costs $2,000, the infusion center is another $1,000. The infusion center is a contracted provider that has …

What’s next for health reform after the House passed their bill, H.R. 3962?

Kevin

Health Policy

November 8, 2009

Originally published in MedPage Today

by Emily P. Walker, MedPage Today Washington Correspondent

The House of Representatives voted 220 to 215 to pass historic healthcare reform legislation late Saturday night, after 11 hours of debate before a packed gallery of spectators.

H.R. 3962 passed by a narrow margin: Democrats needed 218 votes to pass the bill and wound up with just two …

How the health care system is corrupting doctors

Kevin

Health Policy

November 7, 2009

Originally published in HCPLive.com

by Jeff Brown, MD

I had the same reaction . . . shock at seeing an almost obscene claim about our profession in a national newspaper. But it got me thinking, which no doubt was its intended purpose. While we are thinking and feeling our way through this wide-ranging debate on health care, we might as well examine …

Support for the patient centered medical home in the House health reform bill

Kevin

Health Policy

November 6, 2009

by Thomas C. Bent, MD

As the House of Representatives prepares to vote on its historic health care reform bill on Saturday, family physicians are heartened to see the support it gives to the emerging new model of care, the patient centered medical home.

The House bill is good news on many fronts. It would provide health insurance coverage for some 96 percent of Americans and would reduce the federal deficit by …

Saving what’s good about the United States’ health care system

Kevin

Health Policy

November 4, 2009

by Bruce Goldman

The U.S. health care system, although it’s the costliest in the world, doesn’t even deliver the goods when it comes to delivering health. That’s the conventional wisdom. But is it true?

At least a few well-researched studies by credentialed and respected experts suggest we might want to pause to consider whether, in the mad dash now underway to fix our ailing health care system, we could inadvertently end up …

Is the impending physician shortage worse than we thought?

Kevin

Health Policy

October 31, 2009

Originally published in MedPage Today

by Charles Bankhead, MedPage Today Staff Writer

The physician workforce in the U.S. is growing smaller and younger, according to data from the Census Bureau, but conflicting estimates make it difficult to determine just how many doctors are out there — and how many the nation will need.

The census survey showed 67,000 fewer physicians than estimates based …

Health reform ignores primary care doctors at its own peril

Richard Reece, MD

Health Policy

October 30, 2009

I would like to introduce you a remarkable article by Edward J. Volpintesta, MD, a 65-year old solo primary care doctor in Bethel, Connecticut. Dr. Volpintesta is a veritable writing machine and has been published in The Wall Street Journal, the New York Times, medical journals, and other publications. His articles cry for a deeper understanding of primary care dilemmas.

In the October issue of Connecticut Medicine, Dr. Volpintesta hits the …

Discussing end-of-life care in the ICU and saving Medicare money

Marya Zilberberg, MD, MPH

Health Policy

October 25, 2009

I think by now there is not a person in the US who cannot quote at least approximately how much we spend annually on healthcare. Fewer people appreciate that nearly 1/3 of this $2.2 trillion bill is eaten by hospitalizations, amounting to about $680 billion. Although the data in the diagram below represent a single year, the overall distribution of expenses is remarkably constant over time.

When compassion meets progress in American health care

Edwin Leap, MD

Health Policy

October 24, 2009

Does anyone realize that the chaos of modern American health-care is not a tragedy, but a triumph? We’re so busy trying to fix what isn’t broken and ignoring what is, so busy casting stones and casting doubts that we are blind to what we have.

I have practiced medicine in this labyrinth for 16 years. I am an emergency physician. I practice in what may be considered the ‘epicenter’ of modern …

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