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.

MACRA is a disaster. Here’s what we should do instead.

Caroline Poplin, MD, JD

Health Policy

November 4, 2016

MACRA — the Medicare Access and Chip Reauthorization Act of 2015 — is a disaster.

It will take the joy out of practicing medicine without significantly improving patient outcomes (except in a circular way) or reducing cost, by moving medical decisions from the bedside to the C-suite. It benefits primarily the health policy community — consultants, academics, executives — who designed it. Ironically, MACRA was one of the few major pieces …

Direct primary care: An evidence-based dialogue is needed

Bob Doherty

Health Policy

November 3, 2016

One thing I’ve learned is that physicians who have gone into direct primary care (DPC) practices are passionate about their decision: they not only believe that DPC is better for their patients and their own professional and career satisfaction, many assert it is the answer to just about everything ailing primary care. There is an evangelical fervor among some DPC advocates to spread the word and convert …

The costly Medicare boondoggle that’s wasting tax dollars and infuriating doctors

Andrew Lam, MD

Health Policy

November 2, 2016

In the last decade, the federal government has undertaken considerable steps to control the way doctors care for their patients. Its goal is to improve healthcare quality and lower costs, but the very regulation tasked with achieving this has created a paperwork nightmare that actually does the opposite: it impedes care and increases costs.

I’m referring to the Physician Quality Reporting System, or PQRS, which originated with the Tax Relief and …

The government tried to fix primary care and failed. Here’s why.

Peter Ubel, MD

Health Policy

October 25, 2016

Americans spend more per capita on medical care than just about any other country and, yet they often have little to show for it. Americans have worse access to care than people in other countries, and are often less likely to receive primary care services, like preventive therapies and screening tests. Determined to address these problems, Medicare leaders have been testing out new models of primary care, hoping to find …

Did Obama break the law to save the Affordable Care Act?

Kevin R. Campbell, MD

Health Policy

October 20, 2016

Recently, a federal audit found that the Obama administration has illegally redirected funds related to collections from the Affordable Care Act that, by law, should have been deposited in the U.S. Treasury. President Obama, under the guise of executive order, used these tax dollars to bail out insurance companies that have experienced hundreds of millions of dollars in losses due to their participation the Affordable Care Act (ACA) exchanges.

In their …

This election is focusing on the wrong health issues

Miranda Yaver, PhD

Health Policy

October 19, 2016

For all the media’s (and candidates’) attention to candidate health over the course of this presidential campaign, we seem to be spending precious little time in the presidential debates discussing the candidates’ actual health plans.

Those on the left have “diagnosed” Mr. Trump as unhinged and mentally unstable, calling attention to a narcissistic personality consistent with a DSM diagnosis, though in violation of the “Goldwater Rule.” They have further raised the Read more…

This election is focusing on the wrong health issues

Health care: The big issue Trump and Clinton choose to ignore

Manoj Jain, MD, MPH

Health Policy

October 17, 2016

For me, the saddest part of the 2016 presidential election is not that we have two of the most disliked presidential candidates in history but that so little attention is being paid to health care.

You may have noticed that health care rarely comes up in campaign speeches or in debates, and when it does it’s often scripted empty promises. Donald Trump has a plan entitled “Healthcare Reform to Make America …

Why do so many Americans hate their health care system?

Peter Ubel, MD

Health Policy

October 13, 2016

There is lots to love about American health care. We have some of the best clinicians in the world, as evidenced by the huge number of people who come to the U.S. from other countries when they are sick. Yet the American people are less satisfied with their health care system than are citizens of the majority of other developed countries.

Why do people in the land of the Mayo Clinic …

Money and virtue: An odd tension in health care

Dr. Saurabh Jha

Health Policy

October 8, 2016

Publishing in the BMJ, Vinay Prasad, an oncologist and health care’s leading evidence-based iconoclast, found that over half of medical reviewers who leave the FDA work for device and pharmaceutical industries. Prasad’s findings created disquiet amongst purists of various stripes. The media was shocked and tried shocking people by showing how shocked it was. The …

We are all responsible for behavior change

John Corsino, DPT

Health Policy

October 4, 2016

Helping our patients make better health decisions can be a challenge. Whether we aim to get them out of bed in the hospital or off of the couch at home, factors contributing to follow-through may be complicated, and the best strategies to facilitate the right choices are seldom clear.

As providers, we would hope that a long and healthy life would serve as the most powerful incentive for behavior change, but …

The interference in health care is mesmerizing

Rocky Bilhartz, MD

Health Policy

October 3, 2016

“Beep,” went the machine.

I left a message and hung up.

My patient, Mr. G, had just been denied a medicine by his health insurer. It’s the same medication for the same condition that he had been taking last year.

I was leaving a message on his behalf.

You can be assured that if you hand an insurance card to the front desk employee at your doctor’s office, your doctor deals with health insurers …

The Affordable Care Act presents challenges for college students

Aldebra Schroll, MD

Health Policy

October 1, 2016

The school year is back in session, and our student health center is busy. As a college health doctor, I have been able to watch the rollout of the Affordable Care Act (ACA) among this population. Since its passage, more of our students are now insured, but many unique challenges still persist for this population.

Young adults have historically demonstrated high rates of un-insurance. An estimated 30 percent of those 19 …

What’s wrong with socialized medicine, and what we can learn from the NHS

Janice Boughton, MD

Health Policy

September 26, 2016

The British National Health Service (NHS) was born in 1948, based on legislation passed that year mandating free high-quality health care for all paid by taxes. In contrast, the U.S. started Medicare in 1966 to provide health care to the elderly and the State Children’s Insurance Program (SCHIP) in 1993 to fund health care for children whose parents were unable to afford it. Health care in the UK is still …

Fee-for-service isn’t always a bad thing

Suneel Dhand, MD

Health Policy

September 18, 2016

One of the biggest shifts in American health care over the last several years (and we’ve only just seen the tip of the iceberg so far) is the shift of the system away from the traditional fee-for-service model, and towards a system based more on quality, outcomes, and yes, a degree of rationing.

By all measures, we know that the pure fee-for-service model — at least mostly funded by Medicare — …

Does the government know what it’s doing to physicians?

Don R. Read, MD

Health Policy

September 15, 2016

Physicians spend almost twice as much time each day typing on computers and filling out paperwork as they do seeing patients. That astonishing conclusion comes from research published this week in the Annals of Internal Medicine.

Just think about that. How would you feel if you spent two hours documenting every hour of work that you do? How would your boss feel about it? You’d be depressed and frustrated; your boss …

Accountable care organizations: Who are the winners and losers?

Ashish Jha, MD, MPH

Health Policy

September 6, 2016

Recently, CMS sent out press releases touting over $1 billion in savings from Accountable Care Organizations. Here’s the tweet from Andy Slavitt, the acting Administrator of CMS:

NEW ACO RESULTS: physicians are changing care, w better results for patients & are saving money. Over $1B. https://t.co/FEfe3QErb5

— Andy Slavitt 🇺🇦 (@ASlavitt) August 25, 2016

The link in the tweet is to a press release. The link in the press release citing more details is to another press release. There’s little in the way of analysis or data about how …

Keep hierarchical condition categories in mind when you code

Yul Ejnes, MD

Health Policy

September 1, 2016

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

This will not be another article focused on the Medicare Access and CHIP Reauthorization Act (MACRA) and its Merit-Based Incentive Payment System (MIPS). Everyone else is writing about that. (But I can’t promise that I won’t mention MIPS at all.)

Hopefully, by now, most of you …

Why are ERs so busy? It’s really no surprise.

Manuel Momjian, MD

Health Policy

August 29, 2016

If the emergency room is the most expensive place to receive health care, then why are more patients visiting the ER than ever before? There are no local doctors’ offices that can charge $1,000 to put a Band-Aid on your finger or $8,000 to tell you that your abdominal pain is due to drinking too much coffee. But, I don’t think you would mind paying this premium if you were having …

Invest in primary care and you get what you pay for

Niran S. Al-Agba, MD

Health Policy

August 26, 2016

In 1978, the Institute of Medicine published A Manpower Policy for Primary Health Care: Report of a Study where they defined primary care as “integrated, accessible services by clinicians accountable for addressing a majority of heath care needs, developing a sustained partnership with patients, and practicing in the context of family and community.”

The four main features of “good” primary care based on this definition are: 1. First-contact access for new medical …

Government-run health care isn’t going away

Bob Doherty

Health Policy

August 25, 2016

We all want this sometimes, don’t we? We want the things in our daily lives that bug us the most, like long lines at the DMV, to just go away. But how often does that really happen?

As the senior staff person for ACP’s governmental affairs team in Washington, DC, I often hear from exasperated physicians who want ACP to just make things they don’t like go away, whether it’s MACRA …

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