Policy

CPT coding changes: 5 proven methods of how to do more with less

Policy
December 31, 2021

It’s well known that coding changes drive provider behavior, and billing behavior drives provider decisions.

For the last 30 years, little has changed in health insurance billing, which is why the standard of care within the payer system has remained, well, standard.

Then the pandemic hit, and suddenly everything was turned on its head. Patient demands increased sharply, office visits became impossible or prohibited across most of the country, and with telemedicine, …

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Health care guest workers could make “home, sweet home” a reality for America’s seniors

Policy
December 31, 2021

“If you want to be happy in a million ways, for the holidays, you can’t beat home, sweet home.” The late Perry Como’s observations reflect a bittersweet truth about an unattainable goal — not just during the holiday season, but each day of the year — for the 1.4 million Americans age 65 and over who reside in long-term care facilities. Older Americans who might prefer to age in place …

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The U.S. doesn’t have enough faculty to train the next generation of nurses

Policy
December 29, 2021

Despite a national nursing shortage in the United States, over 80,000 qualified applications were not accepted at U.S. nursing schools in 2020, according to the American Association of Colleges of Nursing.

This was due primarily to a shortage of nursing professors and a limited number of clinical placements where nursing students get practical job training. Additional constraints include a …

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Why health care delivery is an exceptionally different industry: Why does it matter?

Policy
December 27, 2021

Third in a series. Please read part 1 and part 2.

We expect that most readers have noticed the differences in health care delivery compared to other industries that we discussed in part 1 and part 2. Those differences relate to board governance, health care leadership, infrastructure, and operations. Readers probably also noticed that these differences …

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High deductible health insurance is bankrupting Americans

Policy
December 24, 2021

Two decades ago, high deductible health plans barely existed. Today, more than half of the U.S. workforce is on one, which are plans with deductibles greater than $1300 per individual or $2,600 for a family.

It’s a growing, undiscussed problem for public health. Most doctors have had patients refuse treatment due to out-of-pocket costs caused by their high deductible health plan. All the while medical debt continues to …

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The goal of health care is in peril

Policy
December 23, 2021

Introduction and background

As an emergency department medical director and physician, a busy emergency department can be a thing of beauty to me. We work hard to set up systems that will provide the care our patients need. Despite our best efforts, almost daily, variables occur that throw the system into chaos and lead to inefficiency. The COVID-19 pandemic unveiled and exacerbated many challenges that affect our ability to provide the …

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Why health care delivery is an exceptionally different industry: health system infrastructure and health system operations and execution

Policy
December 22, 2021

Second in a series. Please read part 1.

The business of health care delivery differs markedly from other consumer and service industries in many ways. First and foremost, the economics differ. Specifically, the payers of medical care are often different from the customers, the government and third-party insurers are the primary payers, demand is inelastic, quality metrics are typically unavailable, and the industry consists largely …

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Key change are needed to make the No Surprises Act work as Congress intended

Policy
December 19, 2021

Physicians prioritize patient needs above all other considerations. To advance that mission, the AMA works tirelessly to improve access to quality, affordable health coverage for everyone, which includes protecting patients from the financial harm posed by unanticipated medical bills that can be generated through out-of-network care.

That is why the AMA has joined the American Hospital Association in asking the courts to …

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Why health care delivery is an exceptionally different industry: board of directors and CEOs

Policy
December 17, 2021

First in a series.

The business of health care delivery differs markedly from other consumer and service industries in many ways. First and foremost, the economics differ. Specifically, the payers of medical care are often different from the customers, the government and third-party insurers are the primary payers, demand is inelastic, quality metrics are typically unavailable, and the industry consists largely of nonprofits that avoid taxes. And that’s just the start …

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The bipartisan infrastructure deal is now law, but here’s what it forgets

Policy
December 16, 2021

In June 2021, the Biden administration announced bipartisan support for federal legislation to rebuild our nation’s crumbling infrastructure. The Infrastructure Investment and Jobs Act seeks to revive highway, transit, rail, and public work systems, as well as improve broadband internet access, mitigate the supply chain crisis and combat climate change.

Like most Americans, I am grateful that we are …

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Fund this: Policies can fill medical funding gaps for all

Policy
December 11, 2021

Ellen DeGeneres is ending her popular TV talk show next year after 19 seasons. The need for the type of celebrity and crowdsourcing donations she is known for to assuage an individual’s health care needs to end as well.

This accepted norm is gaslighting at its finest.

As a fan of The Ellen Show, I don’t feel warm and fuzzy after seeing a patient facing cancer with a large medical bill moved to tears …

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We have an obligation to keep firearms out of the hands of children

Policy
December 8, 2021

We are saddened by another school shooting in America. Four lives were cut short, and one young man who was obviously crying out for help clearly did not get it.

There are so many pieces to this puzzle to examine. So many areas where we can improve. As a child psychiatrist, I am fully aware that our mental health system is broken. So many families seeking care run into barriers and …

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Grow, share, eat: We have the opportunity to subvert the dominant supply chain

Policy
December 2, 2021

You might not be able to afford the usual Christmas roast this year.

According to the USDA, beef prices in the U.S. are up nearly 10 percent this year over last. And it’s not just in the U.S.  Distribution and other supply chain problems have led to severe price inflation for produce in Beijing, where a pound of lettuce now costs as much as a pound of pork. China’s agriculture ministry …

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Why the Build Back Better Act is an investment, not a cost

Policy
November 28, 2021

The original Build Back Better Act proposed various provisions to improve Americans’ lives, including two years of free community college, child care assistance, and investments in clean energy. The steep price tag has led many to question whether or not we can afford to spend so much.

But as a pulmonary and critical care physician at a major metropolitan hospital, I have a different question: can we afford not to?

Every day in …

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“Take it or leave it” is not negotiation but coercion

Policy
November 23, 2021

“Take it or leave it” is not negotiation but coercion.

Physicians have been subject to this tactic for much too long. As an ophthalmologist in clinical practice for nearly four decades, I experienced too often what a recent author on KevinMD described as a one-sided arrangement with a health insurance company. “Here is the fee schedule. Here is the document to sign.” End of story.

If you object to the terms of …

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How to address the mental health fallout of climate change

Policy
November 22, 2021

An existential crisis

On August 9, the 2021 Intergovernmental Panel on Climate Change (IPCC) Sixth Assessment Report made public what many had feared. Global temperature warming to 1.5 C is all but inevitable by 2040 — even by the most optimistic scenarios — unless radically drastic steps are taken to end the use of fossil fuels.

Severe weather events such as California wildfires and Atlantic hurricanes of the past …

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Open enrollment: It’s time to leave your insurance plan behind

Policy
November 20, 2021

Research shows inadequate health insurance accounts for nearly 67 percent of all bankruptcies. This statistic is staggering, and illustrates a difficult reality for the many American families navigating today’s insurance market.

Not only can medical debt become a heavy burden – it can impact every facet of an individual’s life; compromising financial stability and potentially even exacerbating underlying medical conditions, creating complications due to the stress it causes. …

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Direct primary care is an answer to volume-based insurance reimbursement models

Policy
November 10, 2021

An excerpt from Medical Answers Now!: How Direct Primary Care Guarantees Fast Access to Your Doctor.

Health care costs are out of control and volume-based insurance reimbursement models are felt to be contributing to the problem. Medicare and most major private medical insurance carriers have begun testing and transitioning to reimbursement models that pay for health care services based on the …

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Why private equity is a dangerous employer

Policy
October 25, 2021

About 4 months after emergency medicine physician Jessica (a pseudonym used out of fear of retaliation from her employer) joined a Michigan hospital in 2014, the department’s staffing group was bought out by TeamHealth, a staffing firm backed by the private-equity behemoth Blackstone.

Ever since Emergency Medicine Specialists (EMS) — which touts itself as one of the oldest emergency physician groups in Michigan — was acquired by TeamHealth, “it’s been …

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The success of Australian firearms regulation: What it could mean for children

Policy
October 24, 2021

An article in the New England Journal of Medicine in 2018 noted the sad milestone that firearms were causing 15% of all deaths in children and adolescents. Somewhat encouraging, a later study showed states with stricter firearm laws correlated with lower numbers of firearm deaths in children. The relationship was quite linear, as you can see below. The authors had specific criteria for weak vs. strong gun laws: if …

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