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.

Innovation in health care: Too much, too little, or just right?

Tara F. Bishop, MD, MPH

Health Policy

September 20, 2015

I was recently discussing all the changes going on in healthcare at a summer cookout with a few doctors in private practice. The topic of accountable care organizations (ACOs) came up, and the group started debating the pros and cons of them. At one point in the conversation, I brought up Medicare’s Innovation Center (the organization leading efforts like ACOs) and asked the group what they thought of it. No …

Less regulation in health care. Please.

Rocky Bilhartz, MD

Health Policy

September 14, 2015

Pharmaceutical drugs cost too much. The new ones are always so expensive.

Hence, we need more regulations. And, the government should impose them. Set price limits. Cap drugmaker profits. This will make it better for all of us. The paternalism of our government should be the strongest when we are ill. Because we may need that medicine.

The government should regulate things more so we can get it cheaper.

Case in point. One new medication …

Read more…

Less regulation in health care. Please.

4 ways to improve the lives of doctors and their patients

Robert Pearl, MD

Health Policy

September 8, 2015

Ask physicians across the country what problems they want solved, and they won’t hesitate to tell you. They worry about the growing health risks they observe in patients based on lifestyle choices, obesity and a variety of social factors that they feel powerless to change. Ask what they would modify if they had a magic wand, and they’ll point to the illogical, problematic and increasingly complex reimbursement schemes still favored …

How can we measure the doctor-patient relationship?

Margalit Gur-Arie

Health Policy

September 6, 2015

Sixty years ago, before he became a controversial figure in the field of psychiatry, Dr. Thomas S. Szasz co-authored an article for the Archives of Internal Medicine (now JAMA Internal Medicine) on “The Basic Models of the Doctor-Patient Relationship,” which is well worth reading today, particularly for those who believe that patient empowerment/engagement is a novel and disruptive innovation of our digital times.

The paper is describing …

Hold nurse practitioners accountable by including them in the conversation

Tracy Cardin, ACNP

Health Policy

August 28, 2015

I read a fascinating article from ProPublica about a nurse practitioner (NP), Heather Alfonso, who pleaded guilty in June to accepting $83,000 in payments from a drug company in exchange for prescribing a high priced drug used to treat cancer pain. However disturbing this is, notably in the data released by the federal government on payments by drug and device companies to doctors and teaching hospitals, …

This doctor is on a mission to take back medicine

Rocky Bilhartz, MD

Health Policy

August 25, 2015

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I’m taking back medicine.

If you didn’t know it left or that someone stole it, I’ll give you a pass. Medicine has been disguised for a long time now. And, when you leave the scene in camouflage, you often go unnoticed.

Medicine is supposed to be the science or practice of diagnosing, treating, and preventing disease. I love medicine. There’s so much to learn. Lots …

What is a 5-star hospital? The answer may surprise you.

Ashish Jha, MD, MPH

Health Policy

August 24, 2015

Now we’re giving star ratings to hospitals? Does anyone think this is a good idea? Actually, I do. Hospital rating schemes have cropped up all over the place, and sorting out what’s important and what isn’t is difficult and time consuming. The Centers for Medicare & Medicaid Services (CMS) runs the best known and most comprehensive hospital rating website, Hospital Compare. But, unlike most “rating” systems, Hospital Compare …

Want satisfied patients? Keep nurses happy.

Jayson Marwaha

Health Policy

August 23, 2015

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Ever since Medicare started using patient satisfaction surveys in 2012 to calculate hospital reimbursements, the healthcare system has been looking to the hospitality industry to learn how to make patients enjoy their hospital stay. Hotels do have the answer, but hospitals are looking in all the wrong places.

What hospitals are doing wrong

The concept behind Medicare’s HCAHPS survey — a short questionnaire asking …

A new model for effective company-sponsored primary care programs

Stephen C. Schimpff, MD

Health Policy

August 23, 2015

Part of a series.

Patients need doctors that take time to listen which means a limited number of patients under care. Employers need programs that reduce costs and ideally improve the health of their staff. These apparently disparate needs can come together in a new model for effective company-sponsored primary care programs.

Those of you who have followed this series know that I am an advocate for PCPs finding ways to …

The crumbling walls of health care is a good thing

James C. Salwitz, MD

Health Policy

August 18, 2015

There was a doctor. The doctor had an office. In the office, he had a practice. The doctor worked hard, was honest, smart and compassionate. He took care of many patients, everyday, and helped many people. The people paid with cents, checks, and chickens. He was solo, alone, by himself. It was good.

There was a hospital, near the doctor. It was an important hospital. It took care of many patients, …

The tension between traditional medical values and expanding commercialism is real

Steven Reidbord, MD

Health Policy

August 17, 2015

The history of American medicine is the story of the rise and fall of a professional guild. In the 19th and early 20th centuries, physicians distinguished themselves from other healers by banding together to form professional associations dedicated to science-based practice. Even more important, medical ethics put the patient first, above considerations of personal gain or even collective social goods. The medical guild may have been insular, self-protectively territorial and …

What happens when moral physicians stand up to power

Richard Gunderman, MD, PhD

Health Policy

August 14, 2015

Dr. Melos is a gastroenterologist in solo practice in a medium-sized Midwestern city. One day she hears a knock on her door. When she answers, she finds two representatives of Athenian Health System, who request a few minutes of her time. She invites them to take a seat in her office.

After exchanging pleasantries, the visitors get down to business. They extend Dr. Melos an …

The Hunger Games of health care is here. Who will be our Katniss?

Regina Druz, MD

Health Policy

August 13, 2015

“Doctor, the patient is complaining,” said my secretary in a hush-hush voice. “She has been waiting for 30 minutes.”

“She” had an appointment for later in the afternoon but phoned our office about 2 hours before the scheduled time, and requested to come earlier. No emergency. No acute complaints. We always try to accommodate, and pushed to “squeeze” her in. The earlier time, …

Health care could use someone like Donald Trump. Wait, what?

Suneel Dhand, MD

Health Policy

August 13, 2015

He’s loud, brash and audacious. He’s been a celebrity for decades, a well-known businessman and reality TV star. And anyone who is even remotely following the news at the moment knows he’s also dominating headlines with his presidential run. I’m going to pause here to say that I’m not going to get into the politics of anything he has said — no …

How Medicare benefits doctors: A complicated history

Bob Doherty

Health Policy

August 11, 2015

Fifty years ago, President Lyndon Baines Johnson signed Medicare (and Medicaid) into law. Medicare’s relationship with physicians since then can best be described as a complicated one.

First, recall that Medicare became law notwithstanding the American Medical Association’s fierce opposition to it. Three years prior to its enactment, AMA President Ed Annis warned that, “We doctors fear that the American …

Is solving the primary care crisis easier than we think?

Stephen C. Schimpff, MD

Health Policy

August 10, 2015

Part of a series.

There is a crisis in the provision of primary care in the United States. If you are a patient, a primary care doctor, an insurer, an employer or a policy maker, this crisis is exceptionally important to you. The crisis means that Americans do not get the level or quality of health care that they deserve and need. This crisis is the major reason that …

There’s a difference between happy and satisfied patients

Rick Evans

Health Policy

August 6, 2015

Recently I have been reading articles regarding the patient experience that I find both stimulating as well as challenging. As the chief experience officer at Massachusetts General Hospital (MGH), you might imagine just how many times these articles are forwarded to my inbox when they are published.

In “The Problem with Satisfied Patients” by Alexandra Robbins in April’s edition of The …

In defense of single-payer: How it would reduce administrative waste

Adam Gaffney, MD

Health Policy

August 4, 2015

Would a single-payer national health program, at the end of the day, truly be sleeker and slimmer than our bloated and fragmented semi-private system? Not according to Dr. Michel Accad, who takes on this important single-payer talking point in his post: “Will single-payer really reduce administrative waste?”

Given that savings from reduced expenditures on billing and overhead are a core argument that single-payer advocates (myself among them) employ to advance …

It’s inevitable that physicians will evolve into virtualists

Margalit Gur-Arie

Health Policy

July 28, 2015

If someone was sitting on a veranda somewhere in the Alpha Centauri system, reading about health care in America of planet Earth, one would most likely conclude that the family of viruses known as the common cold are destroying a health system already crippled by a glut of poorly educated physicians practicing their miserable craft on a slow-moving …