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.
Part of a series.
Helping employees improve their health is right for the company’s bottom line and is doing right by our employees. Healthier employees are happier, demonstrate less absenteeism and presenteesism, and are more productive. This is a win for everyone involved.
– John Torinus, Jr., a retired CEO and current board chair of Serigraph, Inc., a mid-sized Wisconsin company with about 500 employees
In my earlier posts in this series …
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A business approach to controlling health care costs
A recent report from the Commonwealth Fund, which placed U.S. last amongst developing nations in health care, analyzed Britain’s high score on the management of chronic conditions. The authors attributed care coordination to the widespread adoption of health information technology in the National Health Service (NHS).
That’s like someone saying Chinese food is tasty because chopsticks are widely used.
Like quants so fastidious about decimal points they’ve missed the overall point.
Where do …
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To those who admire the NHS: Empower primary care physicians
According to a new Commonwealth Fund sponsored study published in Health Affairs, “Small Primary Care Physician Practices Have Low Rates Of Preventable Hospital Admissions.” The study of over one thousand practices of various sizes and ownerships, conducted by some of the most respected names in health care, found that the smallest independent primary care practices, that are physician owned, provide better care …
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The study you never heard of: Small practices aren’t dead yet
Doctors, hospitals and judges have over the years attempted to control the decisions of pregnant women. In a recent Florida case, it’s not clear whether the controllers sought to protect the fetus, the woman or both. They may have wanted to protect the hospital from potential liability.
The case involved a 39-week-pregnant woman.
According to a press release issued by the National Advocates for …
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Hospitals should not control the decisions of pregnant women
One of my main interests in primary care is providing care to all people, regardless of their income or ability to pay. In my limited experience with health care, I have found it most rewarding to work with the underserved and underprivileged, those who do not have their own money available to allocate to health care. These patients are on Medicaid or are at the mercy of free clinics. This is why I …
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Can direct primary care solve the physician shortage?
That the government overpays sellers of Medicare Advantage plans is well known in Beltway circles even if much of the public remains unaware. Recently, two Department of Health and Human Services (HHS) researchers posted new findings on the Medicare and Medicaid Research Review, a peer-reviewed online journal supported by the Centers for Medicare and Medicaid Services (CMS), documenting how some insurance companies are overbilling the government and have been …
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Upcoding in Medicare Advantage: Transparency can clean the mess
The recent disagreement between Uwe Reinhardt and Sally Pipes in Forbes is a teachable moment. There’s a dearth of confrontational debates in health policy, and education is worse off for it.
Crux of the issue is the more efficient system: employer-sponsored insurance (ESI) or Medicaid. Sally Pipes, president of the market-leaning Pacific Research Institute, believes it is ESI. Employers spend 60% less than the government, per person: $3,430 versus $9,130, …
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Employer-sponsored insurance or Medicaid? An ideological debate.
“We lost our regular doctor with Obamacare, so now we have to see you.”
I routinely ask my new patients how they heard about our pediatric office, and this is the answer I dread most. My pediatric practice is a very nice and modern private office, and in my opinion, full of excellent physicians. I entrust my own children’s care to my partners. But none of that matters when you’re the rebound doctor, the …
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Confessions of a rebound doctor: The impact of narrow networks
The Medicare trust fund has been extended to 2030, 4 years longer than projections made just one year ago. This sounds like wonderful news until you take a closer look. The fine print reveals that this is little more than campaign rhetoric. Four years in the grand scheme means little when you look at the real numbers.
More baby boomers approach eligibility age every day. In 2012, there were 50.8 million …
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Medicare’s trust fund has been extended. Big deal.
In an ironic analogy to the recent Occupy Wall Street movement publicizing the wealth gap between America’s elite and the general public, the health care world also has its own infamous 1%. According to the Agency for Healthcare Research and Quality’s 2012 report, the top 1% of health care seekers incurs nearly a third of the nation’s $1.26 trillion yearly health care expenses (and up to half of this expenditure …
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The uphill climb of complex care management
In a previous post, I described how the American health care system is morphing into a system designed to service impoverished populations, and concluded that the transition “will take time, thoughtful planning, lots of innovation and a carefully cultivated disdain for human life.”
However, a new blog post from Dr. Peter Ubel makes me think that it may not take that much time after all. It seems that Dr. Ubel …
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Go ahead, let’s just make poverty a disease
The unrelenting opposition by American conservatives to Obamacare may have the unintended consequence of leading the United States to a single-payer system like Canada’s.
How’s that, you say? Isn’t the whole point of conservative opposition to Obamacare to drive home the point that the government is incapable of managing people’s health care? Yes. And aren’t conservatives effective in driving home that point? Yes, polls show that confidence in government is at …
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Will the attacks on Obamacare lead to a single-payer system?
“Then you should say what you mean,” the March Hare went on.
“I do,” Alice hastily replied; “at least–at least I mean what I say–that’s the same thing, you know.”
“Not the same thing a bit!” said the Hatter. “You might just as well say that “I see what I eat” is the same thing as “I eat what I see!”
The brilliant Lewis Carroll had a field day with logical fallacies in …
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The Affordable Care Act will face many more Halbigs
I am a long-time proponent of measuring provider performance and aligning it with payment as an effective means for improving the quality of care and with it, patient outcomes.
Because of this, I welcomed the value-based purchasing concepts and quality improvement initiatives that are fundamental to the Affordable Care Act (ACA).
But, as in so many things, the devil is in the details and, despite their best efforts, measure designers can’t always …
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Quality measures benefit from quality improvement
This is a simple plan that would empower patients, improve the lot of primary care physicians and likely hold down medical costs while improving quality in the health care system. I would first like to present the plan, then elaborate on how it could accomplish the above objectives.
The first part of the plan would set aside a portion of each person’s health care dollars (i.e., insurance premiums) and place it …
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The 7% plan to fix primary care
We hear a lot about the death of the independent physician practice. But perhaps the more important discussion is about the death of practicing medicine independently. That is, the days when individual physician groups could operate their businesses and treat patients independently and without regard to the surrounding network of other physicians, nursing facilities, health networks, social workers, case managers, and other support is over.
It doesn’t matter whether the physician …
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Interdependent physician practice is here to stay
For years, critics of Obamacare (Affordable Care Act), have predicted that it would turn out to be a “train wreck” — or something worse. But now we know that by every objective measure, the ACA is working out pretty darn well. Let’s run through the “train wreck” predictions, and what we now know to actually be the case:
Train wreck prediction #1: “Obamacare will lead to skyrocketing health care cost increases and …
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Obamacare isn’t a train wreck. Here’s why.
As Americans, we love to associate with groups. More than that — we love to plant ourselves in a group, stand firmly in our decision, and then adamantly refuse to budge or to see the other party’s perspective.
Pro-life. Pro-choice. Democrat. Republican. Pro-Obamacare. Anti-Obamacare.
I suppose for all of us, myself included, it is easy to identify with our group of choice when we are sitting at home watching or reading our …
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It is time for physicians to stop making the easy decisions
