Health Policy and Public Health

Physicians writing on KevinMD about policy as it reaches the exam room: prior authorization and the state and federal rules now written for it, scope of practice laws state by state, the CDC opioid guideline and what forced tapers did to patients, and public health from vaccination to the pandemic. 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, Opioids: what physicians and pain patients say, in their own words, and Vaccines: what physicians say, in their own words.

Why rural hospitals are fighting a losing battle

Robert Pearl, MD

Health Policy

February 7, 2015

Rural hospitals are fighting for their lives. Over the past five years, more than 40 rural facilities have closed their doors due to lack of funding. And because the majority of their funds come fromMedicare and Medicaid — two government programs facing potential cutbacks in 2015 — many rural hospitals may be fighting a losing battle.

Understandably, small-town residents fear hospital closures or downsizing may leave them vulnerable when serious illness strikes. …

Is health insurance the new paternalism in health care?

Martine Ehrenclou, MA

Patient

February 6, 2015

If I could drop our health insurance altogether, I would. With a high deductible of $4,000 for in-network providers, my family of three has yet to reach our collective deductible over the last three years. This means we have to pay out of pocket for medical care until we reach that amount. To make matters worse, our health insurance premiums increased by 10 percent, forcing us to find a less …

The AMA: One medical student’s perspective

Akhilesh Pathipati, MD

Medical Education

February 4, 2015

Last year, I had the opportunity to attend the American Medical Association’s interim meeting in Dallas, one of the two annual conferences held by the organization. I went to the meeting to present at a research symposium, but I stuck around for a few extra days because I was curious about the inner workings of organized medicine. As someone interested in health care systems and the delivery of medical care, …

The financial sinkhole of health insurance complexity

James G. Kahn, MD, MPH

Health Policy

February 2, 2015

We all know that the U.S. system of paying for health care is tremendously complex and inefficient: a multitude of insurers, thousands of insurance plans, innumerable medical bills, countless incorrect and denied claims.

But just how much do we waste on this administrative morass?

I led a research team that recently reviewed all the available evidence and published our findings. The resulting numbers are staggering.

Compared with countries that have a single health …

The Affordable Care Act’s Medicaid bait and switch

Kevin R. Campbell, MD

Health Policy

January 26, 2015

As we enter year two of the Affordable Care Act, we have seen many issues arise during implementation. Through both executive order and executive memorandum, President Obama has unilaterally changed the law more than 100 times in order to advance his political agenda.

When it became important to publicize enrollment and increased coverage of the uninsured, the president, and the ACA provided for an increased payment scale for patients with Medicaid. …

Lowering health care costs is more than cost awareness

Kristeen Maurin, RN

Patient

January 22, 2015

I wish lowering health care costs was as easy as “cost awareness,” but as one patient put it, “I never pay the first few bills, because the amount changes every time a new bill is sent.” The payment system is so fragmented that it’s hard to know what will become an expense with any given illness. Even the savviest of consumers of health care have difficulty with hospital payment systems. …

5 costly health care megatrends for 2015

Robert Pearl, MD

Health Policy

January 20, 2015

Part of the fun of ringing in the New Year is looking back on the achievements of the previous one. And in 2014, there were plenty of health care success stories to celebrate: major medical advances, new technologies and the Affordable Care Act’s unexpectedly good first year.

At the same time, many of the health care changes in 2014 yield potential risks for patients, employers and the nation as a whole. …

Physicians must unionize. Here’s why.

Margalit Gur-Arie

Physician

January 12, 2015

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If F. A. Hayek were alive today, he would support the revival of labor unions in general and professional labor unions in particular. Towards the end of the Second World War, Hayek wrote a book warning us all that allowing governments to engage in extensive central planning of economic activities is nothing more than a road to serfdom for humanity. F.A. …

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Physicians must unionize. Here’s why.

Return the clinician to the center of the health care experience

Fred N. Pelzman, MD

Health Policy

January 1, 2015

I recently spent time at the New York eHealth Collaborative’s Digital Health conference.

The meeting was full of interesting seminars, informational sessions, presentations on innovative technology looming on the horizon, and talk about the future digital face of health care.

The hallways outside the conference rooms were full of administrators, legislators, consultants, and representatives of companies building and designing new resources to help transform the health care system as they see it.

Over and …

Fixing our broken health care system: Sometimes David wins

Allen Frances, MD

Health Policy

December 30, 2014

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You couldn’t invent a worse health care system than the nightmare we have created in the U.S. Our medical costs are almost twice as high per person as they are in most other similar countries but produce only mediocre outcomes.

There is massive overtreatment of people who don’t need it, while many who desperately do have no coverage at all.

The payment incentives …

Hospital consolidation: 4 reasons why bigger isn’t better

Alexandra S. Brown, MD

Health Policy

December 18, 2014

Last year, hospitals and health systems underwent 98 consolidations, a 51 percent increase from 2010. Many of these mergers and acquisitions arose in response to declining government reimbursement and the Affordable Care Act. Smaller hospitals are having increasing difficulties maintaining a margin and many face high debt burdens, bankruptcy or even closure.

But is consolidation the clear-cut answer?

Here are 4 reasons bigger actually may not be better for all hospitals:

1. Disparate …

Health reform and Gruber: We want simple solutions to complex problems

Dr. Saurabh Jha

Health Policy

December 17, 2014

In the giddy days after the passage of ACA, I was chatting with a PhD student in health economics. He was in love with the ACA. He kept repeating that it would reduce costs, increase quality and increase access. Nothing original. You know the sort of stuff you heard at keynotes of medical meetings; “Healthcare post-Obamacare” or “Radiology in the new era.” Talks warning us that we were exiting the …

Physicians must be the architects of health care change

John Leifer

Health Policy

December 13, 2014

An excerpt from The Myths of Modern Medicine: The Alarming Truth about American Health Care (Rowman & Littlefield).

Myth 1: “The United States boasts the best health care in the world.”

Betsy Lehman trusted her life to the American health care system. An award-winning journalist, Lehman was a rising star at the …

Is there really a doctor shortage, and what can we do about it?

Tanya Feke, MD

Health Policy

December 12, 2014

There is controversy about whether or not there will be a doctor shortage in the near future. I wonder why there is so much speculation. The Association of American Medical Colleges estimates that we will be short 90,000 physicians by 2020 and 130,000 physicians by 2025. If things stay as they are now, of course there will be a shortage. The …

Jonathan Gruber: What if he’s right?

Margalit Gur-Arie

Health Policy

December 11, 2014

So there is this guy from MIT or Harvard, or some other place where they teach our leaders how to lead, and his name is Jonathan Gruber. Mr. Gruber, it seems, was hired to consult with the Obama administration during the time the Affordable Care Act (ACA) was created because of his extensive expertise in designing the Massachusetts health care system. In recent weeks, people who don’t particularly like our …

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Jonathan Gruber: What if he’s right?

Obamacare: What did Jonathan Gruber really say?

Peter Ubel, MD

Health Policy

December 11, 2014

Jonathan Gruber went from unknown to infamous in the last few weeks, a result of disparaging comments he made about the Affordable Care Act (Obamacare) and even more disparaging ones he made about the American people. According to Gruber, the Obama administration counted on “the stupidity of the American voter” to pass the bill. In fact, the Obama team’s “lack of transparency” was deliberate, because they believed the law would …

Health care’s future: An interview with a hospital CEO

Trudy Lieberman

Health Policy

December 10, 2014

Not long ago I interviewed Dr. Todd Sorensen, the CEO of Regional West Medical Center, a 184-bed facility serving a large swath of rural western Nebraska. I’ve known Dr. Sorensen since junior high school, and we’ve kept in touch over the years to discuss the health care system from his perspective as a physician and administrator and mine as a health …

Medical schools fail to teach students about the health care system

Nathan Moore, MD

Health Policy

December 5, 2014

Any health care provider can tell you that clinical knowledge isn’t the only thing that determines how well you care for your patients. We’ve all seen — many times — the patient that can’t afford the correct antibiotic, doesn’t get preauthorization for the necessary CT scan, and can’t find a specialist who will take his or her insurance. Making the correct diagnosis is only the first step in helping a …

5 questions to ask before buying health insurance

Christine K. Cassel, MD

Health Policy

December 5, 2014

While millions of Americans are re-enrolling in Obamacare, signing up for health insurance for the first time, or double-checking the plans their employer offers, many will undoubtedly ask what’s affordable for them.

Good luck defining affordability. Like beauty, it’s in the eye of the beholder.

To better understand what affordability in health care means from the vantage point of the ‘kitchen table,’ the National Quality Forum, with support from the Robert Wood …

ACOs: Another layer of oversight for physicians?

Fred N. Pelzman, MD

Physician

November 29, 2014

A sleeping dragon awakes.

At our weekly health policy colloquium recently, the presenter described plans for our organization to form its own accountable care organization, or ACO.

The idea behind an ACO is to find patients who get the majority of their primary care within our system, and then “attribute” their health care and all of its attendant costs to that system, making the providers ultimately responsible for providing both high-quality and …

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