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.

Question why your relative needs to be at a rehab facility

Trudy Lieberman

Health Policy

September 28, 2014

American health care has become a gigantic game board with players of all sorts strategizing to win. Winning, of course, means getting more money from payers: government or private. It turns out this medical marketplace game is not all that new. It’s just become wilier, as I have shared in a couple of posts over the summer.

An obituary last week for Dr. Rashi Fein, an influential economist with a …

Workplace wellness programs: Are they really failures?

Naomi Freundlich

Health Policy

September 27, 2014

There’s been a lot of controversy recently about workplace wellness programs: Do they save money for employers on health care costs? Can they produce measurable benefits for employee health? Do they unfairly punish people who are unable to participate? Are these programs just a ploy to shift medical costs to unhealthy employees?

Recently Austin Frakt and Aaron Carroll revisited these questions in a piece for the New York Times’ Upshot column, “Read more…

Workplace wellness programs: Are they really failures?

Physician assistants: 5 predictions in the era of health reform

Jennifer Coombs, PhD, PA-C

Health Policy

September 26, 2014

1. Physician assistant (PA) growth will remain unprecedented. Demand is driving growth and PA program expansion. The educational programs are charging students higher tuition costs for these coveted PA positions. PA students now acquire unparalleled debt, according to a recent Robert Graham Center report; one in four PA students owed more than $100,000. Although high student debt may impact PA graduates ability to go into fields like primary care, it …

The uninsured rate has fallen, but it may soon rise

Brad Wright, PhD

Health Policy

September 24, 2014

While there are plenty of valid reasons to be skeptical about the Affordable Care Act, regardless of where you fall on the political spectrum, it’s hard to argue that imposing an individual mandate to purchase insurance won’t result in more people obtaining coverage. According to the results of a recent survey conducted by the Centers for Disease Control and Prevention (CDC), that’s precisely what’s happened.

Based on results of the National …

Employer-sponsored primary care: An explanation

Stephen C. Schimpff, MD

Health Policy

September 23, 2014

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 …

Our value judgments are often psychologically frail

Peter Ubel, MD

Health Policy

September 23, 2014

In health policy circles (yes, those exist!), experts often refer to three aims for a modern health care system: to offer 1) universal access to 2) high quality medical care at 3) an affordable cost. Access, quality, and cost: a possibly unachievable set of goals, certainly in the U.S., where the quality of our care is decent (but uneven), while access to care and the high cost of our care compare dismally to …

Urgent care won’t replace primary care. Here’s why.

Marc-David Munk, MD

Health Policy

September 19, 2014

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About seven years ago, the California Healthcare Roundtable and Health Affairs sat down to prepare a white paper on the emerging phenomenon of urgent care centers, and what it might mean for primary care. At the time the group couldn’t agree that urgent care (UC) was a disruptive innovation, but it seemed clear to all participants that it represented a threat to primary care: The …

This is what population health looks like

Janice Boughton, MD

Health Policy

September 18, 2014

shutterstock_58244269

It is a beautiful day here in my little college town. The sun is shining and at 11 a.m. it is about 78 degrees with a barely perceptible breeze. People are out walking on Main Street and riding their bikes. The mountain nearby calls: I can go for a hike today with my dog and still be within 20 minutes or so …

5 health care megatrends to watch for

Robert Pearl, MD

Health Policy

September 18, 2014

Recently, Cisco chairman and CEO John Chambers told me that U.S. health care is at a tipping point. A positive one, he hopes, but the truth is no one knows for sure which direction the system will tip.

At the close of our interview, I asked Chambers what health care topic he’d like me to cover in the future. He asked me to …

Read more…

5 health care megatrends to watch for

How to choose a nursing home: Why 5-star ratings may be wrong

Trudy Lieberman

Health Policy

September 17, 2014

Just a few years ago it seemed that advocates for health care transparency had scored a big victory. The Centers for Medicare & Medicaid Services (CMS) announced that they would rate nursing homes by awarding five stars to the best and fewer stars to lower-quality facilities. Families searching for care for loved ones would have access to a familiar rating system to help them make choices. After all, star ratings for …

Reducing health care costs through company wellness plans

Stephen C. Schimpff, MD

Health Policy

September 14, 2014

Part of a series.

Employers have seen their health care costs rise dramatically over the years. To compensate, they have expected employees to pay an increasing portion of the health care insurance premium, expected employees to pay significant co-pays with each physician visit and have purchased policies that restrict individuals to a narrow network of doctors and hospitals. Largely these have not worked. They have offset some of the expenditures but …

5 things people get wrong about Canada’s health system

Kathleen O’Grady and Noralou Roos, PhD

Health Policy

September 14, 2014

The Canadian health care system is often held up as an example to model or to avoid at all costs in the debates on health care in America, and elsewhere. Yet there are a startling number of misconceptions — on both sides of the partisan divide — about how the Canadian health system actually works, often from experts who should know better. Here are the facts.

1. Doctors are self-employed, not …

Buying physician practices does not equate to clinical integration

Alexandra S. Brown, MD

Health Policy

September 14, 2014

I read an article recently that implied the practice of hospitals acquiring physician groups encouraged “clinical integration and multidisciplinary team-based health care.”

I guess that would depend on your definition of clinical integration.

The American Hospital Association has a particularly cogent one, which is: “[A practice] needed to facilitate the coordination of patient care across conditions, providers, settings, and time in order to achieve care that is safe, timely, effective, efficient, equitable, …

All is quiet on the Obamacare front. That’s about to end.

Robert Laszewski

Health Policy

September 14, 2014

It’s been pretty quiet lately on the Obamcare front.

So quiet, that there has been a flurry of articles recently over how Obamacare has dropped to a second or even third tier issue and will hardly matter come election-time.

Wishful thinking.

Obamacare has largely been out of the news cycle for a couple of months but that is about to change.

A few thoughts.

The 2015 rate increases have been largely modest. Does that prove Obamacare …

High health care costs lead to unhappy workers

Richard Young, MD

Health Policy

September 13, 2014

A recent report from Rutgers University entitled “Unhappy, Worried, and Pessimistic: Americans in the aftermath of the Great Recession” found that 70% of respondents described the typical American worker as not secure in their jobs and 68% of workers are highly stressed. A quote from the study is, “The typical American worker lives in a precarious and doleful existence — unhappy, poorly paid and fearful of losing his or her …

Hard truths: Dispelling 10 health care myths

Luis Collar, MD

Health Policy

September 12, 2014

1. Most physicians are intellectually gifted and therefore rarely make mistakes. Perhaps Hollywood is to blame for this misconception, or maybe we simply find comfort in believing that exceptionally brilliant diagnosticians abound. Either way, I wish it weren’t a myth. But the truth is that the vast majority of physicians are average in virtually every way. Despite all claims to the contrary, …

Value-based care: Bad for doctors, bad for patients?

Margalit Gur-Arie

Health Policy

September 11, 2014

Value-based health care is antithetic to patient-centered care. Value-based health care is also diametrically opposed to excellence, transparency and competitive markets. And value-based health care is a shrewdly selected and disingenuously applied misnomer. Value-based pricing is not a health-care innovation. Value-based pricing is why a plastic cup filled with tepid beer costs $8 at the ballpark, why a pack of gum …

Docs versus Glocks: Why doesn’t the public trust physicians?

Abigail Schildcrout, MD

Health Policy

September 11, 2014

Doctors talk with their patients about many things that might make some people uncomfortable — sexual issues, abuse (physical or emotional), anxiety, depression, sleep habits, bowel habits, and fears about health-related topics — things that many people might not talk about in casual conversation at the coffee shop or at work. Doctors talk with their patients about smoking, weight, eating habits, exercise, seat belt use, helmet use, and a myriad …

CVS removes tobacco products: Did they go far enough?

Brad Wright, PhD

Health Policy

September 11, 2014

As of September 2, CVS — the ubiquitous pharmacy/convenience store — has stopped selling tobacco products, including both cigarettes and smokeless tobacco. This is a bold move from the retailer, which is also planning to rebrand itself as “CVS Health” to emphasize its place in the health care delivery chain. I personally applaud the decision, because there are simply no benefits to tobacco use in any form.

And it’s also …

Bottom up: How grassroots input shapes ACP policies

Yul Ejnes, MD

Health Policy

September 11, 2014

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

This month, the American College of Physicians’ Board of Governors (BOG) will meet in Chicago. One of the items on the agenda is the discussion of resolutions that will help to shape ACP policy. The resolutions process, which looks at proposed policy changes and directives to …

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