Michelle Obama recently wrote an opinion piece in the New York Times discussing her pet project of childhood obesity. Discussing the Special Supplemental Nutrition Program for Women, Infants, and Children, known as WIC, she criticized the House of Representatives for considering a bill that would allow white potatoes to be included in the list of foods that could be purchased with WIC funds.
One …
Obamacare and WIC: When others pay the bills
The administration issued a report recently that says individuals who selected plans in the federal health insurance exchanges have a post-credit premium that is on average 76% less than the full premium for the plans they selected. And, 69% are paying less than $100 after the subsidies — 46% are paying $50 or less.
The administration also pointed out that 65% of individuals selecting the silver plan in the federal exchange chose …
Obamacare plans aren’t attractive to the middle class
“Everyone I know agrees that President Obama’s problem is that he isn’t liberal enough. Everyone I know believes that the problem with Obamacare is that it gives insurance companies too much power, when what we really need is a single payer system where the government runs everything, like Canada. Everyone I know believes that the answer to gun violence is to ban guns, and if the Supreme Court won’t allow that, to at least license, …
Obamacare: Not everyone thinks the same way you do
I have made several observations as to why developmentally challenged people are losing out in our health care systems. Given that there are 11 million children in the United States with an emotional, developmental or behavioral condition, we really can’t afford to neglect this important issue.
My first observation is that primary care remains a chronically undervalued component of health care delivery in the U.S. Despite the 60 million Americans …
Our health system doesn’t serve the developmentally challenged
If you put ten physicians in a room, you will get nine different opinions. It doesn’t matter if you are discussing policy, diagnostics, or politics. Indeed, medical training develops deep independent thinking. We often feel alone in the care of our patients, we picture ourselves the sole barrier between illness and well being. We battle our fellow physicians, administrators, and insurers. You can argue the pros and cons of …
Medicine is a house divided: It is time to unite on common goals
I am responding to the article, “Frustrations of the primary care physician should be a wakeup call.” Having practiced medicine for 25 years as a primary care physician, and accountable primary care physician for the past 10, I understand the demands on PCPs’ time and the pressure to please patients, satisfy documentation/coding requirements, manage care teams, run a practice, and earn a living. However, there are some best …
How to achieve the Triple Aim plus physician satisfaction
The VA scandal over excessive waits for doctors’ appointments is an early warning of things to come. Over the last three years, the demand for primary care appointments at the VA increased by 50% while the number of providers rose by only 9%. With four hundred vacancies for primary care providers, the VA is facing a severe gap in its ability to care for its patients.
It isn’t surprising that the …
How doctors can change the way they work and care for patients
I have been writing a bit lately on the need for health care providers to talk with their patients about health care costs, if for no other reason than to enable patients to determine whether they can afford to pay for the healthcare that their doctors are recommending them to receive. I have been criticized for this position, on the grounds that I am rationing care from people with …
Doctors must discuss the cost of care with their patients
I have a confession to make. The purpose of a recent blog post was to set up this one. What I questioned, at that time, is whether the future of primary care will come from outside change (business, politics, or even specialist physicians and administrators) or internally, hence creative destruction versus internal combustion.
When I entered my first primary care practice in 2002, I had great doubts that the traditional …
The only way primary care can survive
All of the focus that CMS is putting on hospital readmissions via the Readmissions Reduction Program, and the financial penalties that readmissions can generate, is causing hospital administrators to look to the emergency department and emergency physicians to intervene and resolve the issues that interrupt recovery for post-hospitalization patients.
In today’s world of budget-constrained financing of government health care programs and narrow hospital margins, the question of how best …
Reducing hospital readmissions from the emergency department
A stark reality of the past year has been the ever-looming ICD-10 transition, which ultimately got punted on by the federal government to October 2015.
With the deadline to make the transition to ICD-10 now more than a year away instead of six months (and who knows if that will even be the case next summer), I’d still wager that many health systems are working to keep their transitions on track …
How to prepare yourself for the ICD-10 era
Health behavior change is hard; if it were easy, everyone would be doing it. But running a marathon is also hard, and lately it seems that just about everyone is doing it. The health care industry could learn a lot from the increasing popularity of the marathon about how to design programs that help people make positive health behavior changes.
At its core, running 26.2 miles has much in common with the process of health …
5 things health care can learn from running a marathon
As the VA scandal unfolds, with continued revelations of secret waitlists and delayed or denied medical care, calls have been building Veterans Affairs Secretary Eric Shinseki to resign. He did just that, resigning because, “He had become a distraction as the department struggles.”
President Obama, eager to show America that he was being proactive about the scandal, regretfully accepted the General’s resignation. But other than allowing the president to show that he is doing something about …
Shinseki’s resignation: Rearranging Titanic deck chairs at the VA
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Mental health patients and their families already pay a hefty price with the stigma of mental illness and the emotional roller coaster they often face dealing with symptoms. But insufficient mental health resources across the United States also means that they must pay a financial price as well in the form of lost productivity, out-of-pocket costs for treatment and sometimes periods of unemployment. A recent USA Today special report estimates …
The troubling deficiencies in our mental health system
There are over 16,000,000 American children (21.8%) who live in official poverty and double that number who are just poor. This is not happening in an obscure country, in a continent far away. It is happening right here, across the street from you. For those enjoying a good episode of Duck Dynasty, these are not children of illegal immigrants, and the vast majority is white kids.
Over 44,000,000 American children (more than 1 …
Health care for the poor: A race to the bottom
I get paid by Medicaid to see patients. How much?
Exactly $52.28 if it is an easy patient issue, like a cold, and $78.54 for a harder one, like a kidney stone. Who decides when the issue is easy and when it is hard? I do. But I have to follow some complex rules when deciding whether to bill a 99213 …
Conflicting state versus federal incentives confuse doctors
Opening my mail today, there are multiple letters from multiple insurance companies, reportedly communicating valuable information to me about my panel of patients that they cover.
One of the envelopes holds two single sheets of paper, one of which contains a listing of my panel of patients and the providers they have been referred to over the past quarter.
The second sheet, mysteriously, contains only a single line: This page intentionally left …
Blank pages are emblematic of health care waste
A guest column by the American College of Physicians, exclusive to KevinMD.com.
Physicians in California are mobilizing to oppose an initiative on the November ballot that will raise the cap on non-economic damages in medical malpractice cases. The current cap of $250,000 is part of California’s Medical Injury Compensation Reform Act, or MICRA. Adopted in …
The California ballot initiative: Protecting patients or letting in a Trojan horse?
The U.S. spends nearly $3 trillion a year on health care, significantly more than any other nation.
In fact, America’s annual health care spending is greater than the total gross domestic product (GDP) of every other country except China, Germany and Japan.
Yet our measurable health outcomes — from infant mortality to life expectancy — aren’t any better than nations spending much less.
I’ve written about this paradox before, pointing to a few …
Why do we think more care is better for us?
We all want the advantage. We put our kids in special preschools so they have the advantage. We work 100 hours a week so our kids can do 8 activities and get the advantage. Tall people have an advantage, we’re told. Poor people are “disadvantaged.” Well folks, there are a whole bunch of senior citizens in Massachusetts who are about to get disadvantaged starting September 1.
UnitedHealthcare (UHC) will be Read more…
The effect of dropping doctors from Medicare Advantage plans
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