Bob Doherty

Bob Doherty is senior vice-president, governmental affairs and public policy, American College of Physicians and blogs at the ACP Advocate Blog.

Both sides are spewing nonsense when they talk Medicare

Bob Doherty

Policy

September 19, 2012

Medicare has suddenly become a centerpiece issue in the 2012 election—but not in a good way. Instead of an informed debate about Medicare’s present and future place in our health care system, the politicians have subjected us to a daily assault of nonsense over substance:

Let’s start with the nonsense accusation by Governor Romney that “There’s only one president that I know of in history that robbed Medicare, $716 billion to …

An evidence based assessment of universal coverage

Bob Doherty

Policy

August 30, 2012

A staple of conservative critiques of universal coverage is that having health insurance doesn’t equal access. The corollary is that the uninsured already have access to care—from doctors and hospitals willing to take care of them on a charitable basis and from “safety-net” institutions.

This argument isn’t new, having been made years before the Affordable Care Act became law. In 2007, the Council for Affordable Health Insurance opined that universal coverage …

What the Romney-Ryan and Obama Medicare plans have in common

Bob Doherty

Policy

August 23, 2012

Which of the candidates for President proposes to give people a defined amount of federal money (call it a voucher) to buy coverage from competing qualified private insurers (under federal benefit mandates) offered through a health insurance marketplace run by government?

The answer: Mr. Romney, and his new running mate, Paul Ryan. And President Obama.

How is that, you say? Isn’t the Romney/Ryan vision of how to reform health care diametrically opposed …

The truth about Medicare physician spending

Bob Doherty

Policy

August 3, 2012

Most doctors will tell you that Medicare payments to doctors haven’t increased in a decade, and that doctors are turning away Medicare patients in droves. But they would be mistaken on both counts.

An authoritative compilation of current data from the Medicare Payment Advisory Commission shows what is really happening with Medicare physician spending:

Medicare spending per beneficiary on physicians’ fee schedule services steadily increased from 2001 to 2011. In 2001, Medicare …

Is there a future for smaller physician practices after health reform?

Bob Doherty

Policy

June 10, 2012

The medical profession has always been marked by division: town versus gown, primary care versus specialty medicine, states versus national. But the real fault line today is not defined by specialty, geography, or teaching versus practice, but by size of practice.

Physicians in smaller practices, without regard to specialty or where they are located, are embattled and defensive—and therefore are more skeptical when someone tries to peddle the need for delivery …

Chaos for doctors if the Affordable Care Act is struck down

Bob Doherty

Policy

April 16, 2012

Imagine you’re a physician, and you have a full schedule of patients to see the day after the Supreme Court has thrown out the entire Affordable Care Act. Imagine you never liked “Obamacare” in the first place, so you are feeling pretty good about the Supreme Court decision.

Your first patient, an elderly retiree named Mrs. Jones, comes in for her annual Medicare wellness visit—one of the new Medicare preventive benefits …

Doctors lobby Congress to repeal the SGR

Bob Doherty

Policy

February 8, 2012

One of the things that I like most about my job is engaging with ACP’s physician leadership—the internal medicine doctors who dedicate enormous amounts of time, at great personal sacrifice, to represent the interests of our members and their patients.

One of the things that I like least is when an ACP member (or non-member physician) caustically dismisses their efforts, usually because they disagree with some aspects of ACP policy. It …

Should Medicare pay for procedures that have no proven benefit?

Bob Doherty

Policy

September 18, 2011

“Doctors, with the consent of their patients, should be free to provide whatever care they agree is appropriate. But when the procedure arising from that judgment, however well intentioned, is not supported by evidence, the nation’s taxpayers should have no obligation to pay for it.”

So argues Dr. Rita Redberg, a cardiologist and professor of medicine at the University of California, in a provocative op-ed published in the New …

A transparent process to allocate resources based on evidence

Bob Doherty

Policy

June 27, 2011

The New York Times reports on Washington state’s efforts to “to determine which medical devices and procedures Washington will cover for state employees, Medicaid patients and injured workers, about 750,000 people in all.”

An expert panel, appointed by the state, is getting national attention, writes the Times, “in part because its process is public and open. . . [and] provides a living laboratory of the complexities of applying evidence-based …

Physicians referring patients to a diagnostic facility they own

Bob Doherty

Policy

April 10, 2011

Federal law generally prohibits physicians from referring their own patients to a diagnostic facility in which they have an ownership issue – a practice called “self-referral” – unless the facility is located in their own practice.

This exemption exists to allow patients with access to a laboratory test, x-ray, or other imaging test at the same time and place as when patients are seeing their physician for an office visit. Less …

Can President Obama and the GOP agree on improving health reform?

Bob Doherty

Policy

February 2, 2011

Everything seems to be pointing toward two years of partisan and ideological confrontations over health reform. The leadership of an emboldened Republican party has made it clear that it will use its newfound House majority to seek to “repeal and replace” the Affordable Care Act (ACA), and if that doesn’t work, to “defund” it. Huge GOP gains in statehouses make it likely that more states will resist implementation. Meanwhile, President …

Medicare rates will be influenced by comparative effectiveness

Bob Doherty

Policy

December 5, 2010

From its inception, Medicare has been agnostic about the effectiveness of different treatments when it sets payment rates. Once a treatment is found to be “reasonable and necessary,” Medicare establishes a payment rate that takes into account complexity and other “inputs” that go into delivering the service. But it is prohibited by law from varying payments based on how well an intervention works.

This would change under a “dynamic pricing” approach …

How the Affordable Care Act helps Medicare

Bob Doherty

Policy

October 19, 2010

One of the more effective criticisms of the health reform law (Affordable Care Act, or ACA) is that it hurts Medicare. It also is wrong.

Effective, in that it has been widely reported that seniors are more likely to express negative views of the ACA than other age groups. (Although the Kaiser Family Foundation’s Drew Altman, citing the group’s most recent tracking polls, writes that seniors’ opposition to health …

Why are most physicians writing their prescriptions by hand?

Bob Doherty

Policy

September 8, 2010

Is the pen mightier than the PC?

When it comes to prescribing, it appears so. A new report from the Center for Studying Health System Change finds that most physicians write their RX scripts by hand, despite financial incentives for physicians to adopt electronic prescribing. Even those who have e-RX systems do not always use them, and when they do, they may not to use the features that were …

Will Medicare really lose physicians because of the SGR?

Bob Doherty

Policy

August 6, 2010

For years, physicians have argued that the specter of annual cuts in Medicare will cause many of them to leave the program, or at the very least, to limit how many new Medicare patients they will accept in their practices. Yet, for the most part, measures of seniors’ access show that the vast majority enjoy good access to care.

For instance, in May of this year, the Medicare Payment Advisory Commission …