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.
As the Affordable Care Act continues to impact millions of Americans through its second year of implementation, many things have become clear to both patients and health care providers alike: nothing is as it seems. While the ACA has provided health care to millions of previously uninsured Americans, it has also robbed many patients of their doctors and has forced others into higher premium, lower service plans. Even those with …
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Less time, more patients: The perverse incentives of medicine
SGR has been the bane of my time in policy. And I want it to be yours.
SGR, formally known as the sustainable growth rate, is a formula developed under none other than the Balanced Budget Act (the same one that set the cap for GME-funded residency slots at 100,000) to determine the Centers for Medicare And Medicaid Services (CMS) reimbursement payments to physicians. And because the universe loves a good …
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The unsustainable SGR: It’s time to stop kicking the can
The country is in a state of health care denial. Politicians, pundits, and executives proudly declare America’s medical care is the best in the world. But it isn’t.
The U.S. lags behind other industrialized nations in many important health measures — partly because citizens of certain races, ethnicities and incomes experience poorer versions of U.S. health care than others. The disparities are glaring. The solutions aren’t nearly as obvious — but we’ll explore some …
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Health disparities are glaring, but the solutions aren’t obvious
In late January, government officials announced a timeline for Medicare’s shift to paying clinicians based on quality of care rather than quantity of services. As Medicare goes, so go private insurers; this makes the agency’s move toward quality-based reimbursement nothing less than a sea change. It builds momentum for a view of health and health care that is integrated and holistic, rather than comprising discrete, disjointed episodes of treatment.
This …
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Community-centered health homes: The next iteration of quality-based care
Health care in the U.S. continues its radical transformation with the rollout and rapid adoption of high-deductible insurance plans. More than even value-based purchasing, this has the potential to reshape the health care landscape because it has awakened the health care consumer. In its 2014 Employer Health Benefits Survey, The Kaiser Family Foundation reported that 41 percent of all firms (32 percent of large employers, 61 percent of small …
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Patient experience builds brand equity
Members of Congress and the news media have a bad habit of referring to efforts to stop Medicare from arbitrarily cutting payments to physicians for taking care of their patients as the “doc fix.” Typical is this story from CNN — “Bipartisan Love: Boehner, Pelosi strike deal to kick doc fix” — that reported on the release yesterday of an agreement between the two leaders on a bill to repeal …
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Stop calling SGR repeal the doc fix. It’s about fixing Medicare.
As we begin the journey to value-based health care, the relationships between a hospital and its medical staff are changing. For decades, these relationships were straightforward: doctors admitted patients to the hospital, performed procedures and delivered therapies, and at some point, sent the patients home. This simple formula was the business model for hospitals, and it worked well.
Same with the doctors. The hospital would pretty much let us do what …
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Why you should help your local hospital improve
For many of the millions of low-income families seeking quality health care in the safety net, the quest can be bewildering. They may walk into a drab, disorganized and unwelcoming clinic, with the staff, signage, and endless medical forms all using unfamiliar language, with unexplained, lengthy waiting times, and with providers burying them in information they can’t understand. On a second visit, they may feel even worse when they end …
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The health care safety net: Put patients first
The Centers for Medicare and Medicaid Services (CMS) has put its foot down, this time on the side of patients. Many hospitals charge you more for the same outpatient tests you get in your doctor’s office. Sixty-six different services are being targeted by CMS to leverage the playing field.
Are the tests really all that different?
We are not talking about inpatient tests that happen when you are sick enough to be …
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Hospitals fight to charge you more
The feds are at it again. Medicare is in the cross hairs with an anticipated 0.9 percent cut to Medicare Advantage plan payments in 2016. The final decision is to be made on April 6 of this year.
Medicare Advantage plans are an alternative to traditional Medicare. Traditional Medicare consists of Part A (hospital) and Part B (medical) coverage. Medicare Advantage plans (Part C) can be chosen in place of the …
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Will cuts to Medicare Advantage reduce quality?
I admittedly don’t understand much about the intricacies of economics. But I don’t have to in order to recognize the significance of Walmart’s decision to raise the minimum pay for its lowest paid hourly employees. In the week following the company’s announcement, plenty has been written about the impact that such a move will have on the company’s success and on local economies. It goes beyond that, however. What I see is …
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Raising minimum wage directly impacts health
Whether you like it or not health care financing is transitioning from payment for discrete services to global payment for value. Whether you agree with this trend, or comprehend its meaning, if it has one, is largely irrelevant in the short term. The government of the United States, the Chamber of Commerce, both political parties, all health care stakeholders, and even your own medical associations are fervently supporting, and actively …
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The transition to value-based care: Think Starbucks
We want to make sure that we stop it before it starts. It’s so much easier to prevent bad medicine than it is to stop it after it’s started.
– Arkansas Rep. Julie Mayberry (R-East End) speaking on Arkansas Public Radio about SB-53, a bill that restricts medical abortions by preventing them via telemedicine — an unfortunate development for the 78 percent of Arkansas women who don’t …
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Say no to meddling in medicine
Medicaid expansion “is one of the biggest milestones in health care reform,” according to the Obamacare Facts website. The goal was to provide insurance coverage to low-income Americans, specifically the uninsured. The major problem with Medicaid is low reimbursement. “Due to low payouts, many doctors don’t take Medicaid, and the quality of care tends to be poor,” admits the website. The solution was to raise the amount doctors get paid under …
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How Medicaid’s bait and switch fooled doctors
More and more hospitals are realizing that the 30 to 50 percent of waste occurring within their organizations is not only real, but a tremendous opportunity. This is good news for both our patients and our health care system. The bad news is that many hospital executives believe that this waste is largely limited to processes like materials management, ER wait times and operating room first-starts.
The next step in our …
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Where is the waste in health care?
There are many good reasons for Congress to enact President Obama’s proposal to raise the Federal minimum wage to $9 per hour. Many of these reasons, from economic stimulus to possible reductions in gaping income inequality to much-needed financial relief for working families, have been extensively discussed in the public sphere. However, one important benefit of increasing wages has not received enough attention: improving mental health.
Numerous studies show that poverty …
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Increase the minimum wage for better mental health
Hospital leaders who are successful managers today are successful because they manage change. The great hospitals leaders by now have become masters at it. But there’s a difference between change you can see coming (bundled payments, EHR implementations, declining reimbursements) and change that shows up unannounced on the front door.
That’s often what it feels like when a huge, publicly traded company acquires a smaller physicians group. It can feel like …
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Your ER group was just bought. What next?
Incentive structures in health care have to change. Right now, we pay for services, or have a so-called, fee-for-service system. The idea is that the more patients doctors see, the more expensive tests doctors order and the more patients doctors hospitalize, the more money clinics and hospitals make. This incentive structure has transformed our health care into sick care.
The reality is, in America, we are adept at caring for complicated medical problems that require …
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3 ways to change the way we pay for care
