In firefighting, pump physics is one of the most critical things an engine company officer must understand. How do we “get the wet stuff on the red stuff” in sufficient quantity without sacrificing penetrating power? The inverse ratio between volume and pressure (as the water pressure increases, volume decreases) has befuddled many a rookie lieutenant.
The same, I think, is now true …
Taking a page from firefighting to fix health care
In the forty years since I started medical school, I have worked in socialized medicine, student health, a cash-only practice and a traditional fee for service small group practice. The bulk of my experience has been in a government-sponsored rural health clinic, working for an underserved, underinsured rural population.
Today, I will make a couple of concrete suggestions, borrowing from all the places I have worked and from the latest trends …
A country doctor’s proposal for health insurance reform
I’ve listened over the years to well-meaning people say that the general public doesn’t care about physician payments, because they think all doctors are rich and any physician who complains is just whining. This is a huge mistake on the part of people who want to have a long-term relationship with comprehensive family physicians as their primary care givers, and those who want better health care at a lower cost.
Let’s …
The payment bigotry against primary care doctors
Labor unions have been reliable supporters of President Obama and his policies. Their support for Obamacare was critical to its passage in 2010. Yet they are continuing to learn that their members will be paying more for their health care, not less.
One of the selling points of Obamacare was the lowering of health insurance costs. Nancy Pelosi promised, “Everybody will have lower rates.” President Obama was more specific, telling us that his signature …
I recently described the loathsome “relative value unit” (RVU) and its role in the decline in prestige and pay in primary care. The RVU is maintained and updated by a small panel of 31 physicians called the Specialty Society Relative Value Scale Update Committee (RUC). Twenty-seven of the 31 physicians are specialists, which is not at all representative of the physician workforce, given that primary care doctors comprise over one third …
A new buzz around primary care
At the end of my interview with Chip Heath, co-author of the New York Times bestsellers “Made to Stick” and “Decisive,” I asked him what topic he’d like me to cover in the future.
“I’m impressed by the culture you’ve created at Kaiser Permanente in Northern California,” he said. “You’ve generated quarter-to-quarter change that I think would have taken three years elsewhere. I don’t think most organizations know how to do that. …
Innovation in health care: 3 lessons from Kaiser Permanente
If you read my articles, then you likely know about the scam known as pay-for-performance (P4P). This program not only fails to deliver on its stated mission to improve medical quality, but it actually diminishes it.
In short, P4P pays physicians (or hospitals) more if certain benchmarks are met. More accurately, those who do not achieve these benchmarks are penalized financially. I do not object to this concept. Folks who perform …
Pay-for-performance is all about cost control
A physician I have known for many years recently told me about his decision to enter the world of concierge medicine. His reasoning was telling, saying that it came down to a very simple decision on staying independent or becoming a hospital employee. He liked being an independent solo practitioner, and that was his primary motivation: to maintain independence in a time of consolidation.
Richard Gunderman, writing for the Atlantic, tackled …
Should physicians work for hospitals?
“It is immoral that the wealthiest nation on the planet does not provide affordable, high-quality health care to all of its citizens. Despite being the only global ‘superpower’ still standing, we trail much of the industrialized world in life expectancy, infant mortality, and countless other indicators of health. Until we fix our broken, prohibitively expensive delivery system, things will only get worse.”
I’m not sure if anyone has used those …
Stop trying to copy health care systems from other countries
I’m not sure if you’ve heard the parable of the tall man and the cat.
Maybe not, since I had to make it up in light of health care’s unending cost increase.
In this allegorical village, there was a group of citizens who were very upset with a man who lived there. This man was very, very tall, and he made all the villagers feel uneasy (they were insecure about the crowns of their heads, …
Today’s high deductibles are tomorrow’s bad debt
I saw the caller ID and immediately picked up the phone; it was an old friend from college.
“I want to sue a doctor, and I want to sue the hospital,” said Karen.
Sadly, I hear those words all too often. I’m a newly-minted lawyer — after a 35-year career as a publisher — working at one of New York’s top medical malpractice plaintiff’s firms. What made this particular call so unusual …
Malpractice lawsuits aren’t just about money
We all know about the increase in Medicaid patients resulting from Obamacare, and how this is exacerbating the shortage of providers who accept Medicaid. I see Medicaid patients in Denver, where there is a reason for the shortage that is often overlooked: managed care Medicaid.
The managed care concept peaked decades ago, a failed attempt to reduce health care spending by forcing patients to go to only one doctor or …
Medicaid cost shifting: The case of Denver Health
Overwhelmingly, doctors’ reimbursement has been the target of government programs and insurance companies. The idea underlying this movement has been, pay doctors less and curtail their incentive to see patients and the cost of medical care will decrease. As a result of this faulty reasoning, we have ushered in the era of unhappy doctors, those retiring early, and those asking for extra payments to justify the hours needed to give …
To cut health care costs, pay doctors more
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As our nation struggles with the mind-boggling algebraic-like task of reigning in on health care expenditures while increasing provider access and high-quality medical care, provider payment structures are in flux between traditional payment methods and relatively new financial structures.
While I am no means an expert of health policy nor medical business and financing, I think it’s important for medical trainees and enthusiasts alike to understand the very general basics of …
So you think there is a war on doctors, don’t you? It certainly looks that way from your particular vantage point. The government is deftly intruding into your professional life with a computerized fifth column that is extracting information on your every move, and to add insult to injury, it forces you to actually collect the data which is to be used against you in the court of public opinion. …
There really is no war on doctors: There’s a war on patients.
People have criticized the Affordable Care Act for amounting to a large transfer of wealth, from wealthy Americans to those not as well-off. But the real transfer of wealth has been from United States to other developed nations, whose health care costs we have subsidized for many years by paying so generously for many of our health care services. No better example of this comes to mind than the price …
It is wrong to subsidize rich, European nations
This is often proposed, but I have trouble understanding it. Real outcomes are not blood pressure or blood sugar numbers; they are deaths, strokes, heart attacks, amputations, hospital-acquired infections and the like. In today’s medicine-as-manufacturing paradigm, such events are seen as preventable and punishable.
Ironically, the U.S. insurance industry has no trouble recognizing “Acts of God” or “force majeure” as events beyond human control in spheres other than health care.
There is …
Should doctors be paid for outcomes?
I recently read the New York Times article on the ridiculous amount that insurance company executives and hospital administrators make. So the reason that American health care is so expensive is not because doctors earn too much, or drug companies charge too much or device manufacturers are making ever more expensive devices with ever expanded indications. Except that it is all of that and more.
Hospital administrators and insurance company executives do …
The outrage over how much hospital administrators make
The continued implementation of the Affordable Care Act (ACA) in 2014 will be as controversial as in previous years.
Here are five main areas of concern:
1. The individual mandate. By what right does the federal government “force” its citizens to buy a product they may not want? The Supreme Court upheld the mandate in 2012, but that does not end the matter. Partly — perhaps largely — because the ACA sets …
5 controversies surrounding the Affordable Care Act
“Get the suits out of medicine.”
This refrain has become commonplace among physicians, who worry that patient care, the essence of medicine, is increasingly taking a backseat to bureaucratic demands on safety metrics and electronics health records as well as corporate measures of efficiency. Without physicians, after all, there is no health care system for administrators to administrate, they say. Not only do top-down regulations make patient care more cumbersome, they …
Is medicine for the suits or the white coats?
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