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Health policy and public health

4,357 articles · Since 2004

Articles, page 107

Health policy

Less is more in medicine: You get what you pay for

14

You gotta hand it to our health department. They are laser focused on this one. They want 85 percent of payments made to doctors by the Centers for Medicare & Medicaid Services (CMS) to be linked to clinical quality measures…

You gotta hand it to our health department. They are laser focused on this one. They want 85 percent of payments made to doctors by the Centers for Medicare & Medicaid Services (CMS) to be linked to clinical quality measures within the next two years.

Moreover, I suspect the health department is still giddy from Congress passing a new health care …

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Less is more in medicine: You get what you pay for

Physician voices

Is health reform contributing to physician burnout?

9

Many physicians feel burnt-out from their careers A recent Medscape survey asked doctors of all specialties whether they experienced feelings of cynicism, loss of enthusiasm and low personal accomplishment with their work. Unfortunately, the percentage of physicians with burnout has…

Many physicians feel burnt-out from their careers

A recent Medscape survey asked doctors of all specialties whether they experienced feelings of cynicism, loss of enthusiasm and low personal accomplishment with their work. Unfortunately, the percentage of physicians with burnout has increased since the last survey in 2013, with 46 percent overall reporting these feelings. When looking at specific specialties, the most burnt-out physicians are critical care and emergency doctors. Half of primary …

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Is health reform contributing to physician burnout?

Physician voices

A physician spends the day on Capitol Hill.  See how it went.

Recently, I was honored to spend a day on Capitol Hill as part of an advocacy event with the Society of Hospital Medicine. The organization, which I am proud to be a part of, held their annual meeting in Washington…

Recently, I was honored to spend a day on Capitol Hill as part of an advocacy event with the Society of Hospital Medicine. The organization, which I am proud to be a part of, held their annual meeting in Washington DC. The event involved a group of hospital physicians going to Capitol Hill to meet our congressional representatives — both in the House and Senate — to discuss the issues …

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A physician spends the day on Capitol Hill.  See how it went.

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Health policy

People deserve real health care, not pseudo-insurance

28

You’re 56 years old. You’re one of the 30 million people (give or take a bunch) that you hear have received health insurance in this country as a result of the Affordable Care Act. You are a positive number in…

You’re 56 years old. You’re one of the 30 million people (give or take a bunch) that you hear have received health insurance in this country as a result of the Affordable Care Act. You are a positive number in the New York Times headlines the Department of Health and Human Services (HHS) have been wanting you to read. And, this is how it’s working …

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People deserve real health care, not pseudo-insurance

Health policy

These are the clinicians you want for your ACO

16

I am of the belief that every ACO must be physician-led. We must depend on them not only for clinical improvement, but also for developing a culture of improvement. Culture is vitally important. Culture trumps dollars, technology, data, and about…

I am of the belief that every ACO must be physician-led. We must depend on them not only for clinical improvement, but also for developing a culture of improvement. Culture is vitally important. Culture trumps dollars, technology, data, and about anything else you would use in clinical medicine.

If I was getting into the ACO business, I would start recruiting clinicians that embrace these characteristics:

1. Team leadership. Every doc is a leader to some degree, …

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These are the clinicians you want for your ACO

Health policy

Accountable care for Medicaid.  No, we need real solutions.

16

New York officials are doing an “experiment” that should strike fear, anger, and outrage in the hearts of doctors who take care of Medicare patients. (New York has the highest Medicaid budget of any state.) As any doctor who has…

New York officials are doing an “experiment” that should strike fear, anger, and outrage in the hearts of doctors who take care of Medicare patients. (New York has the highest Medicaid budget of any state.)

As any doctor who has a high volume of Medicaid patients knows, Medicaid pays practically nothing.  Doctors who take Medicaid usually have to carry a bigger patient load to survive.  Medicaid patients are often sicker than …

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Accountable care for Medicaid.  No, we need real solutions.

Health policy

Obamacare re-enrollment: What can patients do?

11

As the Obamacare machine continues to grind forward, many patients have re-enrolled in a second year of coverage. While most have not had to use their insurance (the young and healthy crowd), others have found their newly minted coverage to…

As the Obamacare machine continues to grind forward, many patients have re-enrolled in a second year of coverage. While most have not had to use their insurance (the young and healthy crowd), others have found their newly minted coverage to be far less than promised. High deductibles, and up front out of pocket expenses, forced many covered by the exchanges to avoid seeking regular preventative care. Prevention was one of …

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Obamacare re-enrollment: What can patients do?

Health policy

ER physicians can help meet the triple aim

It is amazing to me how far emergency medicine has come as a specialty. Until the 1970s, emergency rooms were staffed by low-level resident interns who moonlighted for extra money or physicians who couldn’t find work elsewhere. After finally getting…

It is amazing to me how far emergency medicine has come as a specialty. Until the 1970s, emergency rooms were staffed by low-level resident interns who moonlighted for extra money or physicians who couldn’t find work elsewhere. After finally getting recognized as a specialty, the specialty still spent a few decades finding its way: developing training programs, improving quality, and generally trying to raise the bar on emergency care in …

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ER physicians can help meet the triple aim

Health policy

Is there a role for doctors in the brave new health care world?

16

Like most of my age cohort, I was brought up to believe that the great Satan threatening to undermine the bloated American health care system was our broken-down, antiquated, self-interested model of reimbursement for care provided called "fee-for-service." Being a…

Like most of my age cohort, I was brought up to believe that the great Satan threatening to undermine the bloated American health care system was our broken-down, antiquated, self-interested model of reimbursement for care provided called “fee-for-service.”  Being a professional who, to the best of my ability, tries to maximize the value of the care I provide to my patients, I subscribed wholly to the notion that the cause …

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Is there a role for doctors in the brave new health care world?

Health policy

What exactly is value in health care?

21

Recently, I had the opportunity to sit at the table with some of the nation’s top thought leaders. We convened at the Newseum in Washington, DC, for the Healthcare Leadership Council’s National Dialogue for Healthcare Innovation; it was like a…

Recently, I had the opportunity to sit at the table with some of the nation’s top thought leaders. We convened at the Newseum in Washington, DC, for the Healthcare Leadership Council’s National Dialogue for Healthcare Innovation; it was like a health policy nerd red carpet. Center for Medicare Director Sean Cavanaugh was there. Leapfrog Group CEO Leah Binder was there. America’s favorite bioethicist–oncologist–provocateur Zeke Emanuel was there. The chief executives …

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What exactly is value in health care?

Health policy

Health care consumer products need not contain real doctors

56

One of the most revolting pleasures in life is to read learned opinions and in-depth analyses of consumers’ behavior written by beautiful people clad in designer clothing, dining at eclectic chic trattorias or enjoying the occasional canapé under crystal candelabra…

One of the most revolting pleasures in life is to read learned opinions and in-depth analyses of consumers’ behavior written by beautiful people clad in designer clothing, dining at eclectic chic trattorias or enjoying the occasional canapé under crystal candelabra at their favorite charity gala. These wondrous creatures, having pored over a few disjointed numbers selectively allowed to escape from our struggle with health care, are informing us that there …

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Health care consumer products need not contain real doctors

Health policy

The unsustainable SGR: It’s time to stop kicking the can

2

SGR has been the bane of my time in policy. And I want it to be yours. SGR, formally known as the sustainable growth rate, is a formula developed under none other than the Balanced Budget Act (the same one…

SGR has been the bane of my time in policy.  And I want it to be yours.

SGR, formally known as the sustainable growth rate, is a formula developed under none other than the Balanced Budget Act (the same one that set the cap for GME-funded residency slots at 100,000) to determine the Centers for Medicare And Medicaid Services (CMS) reimbursement payments to physicians.  And because the universe loves a good …

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The unsustainable SGR: It’s time to stop kicking the can

Physician voices

Our health system is changing, and it’s a damn shame

45

I understand that there is a difference between perception and reality. I also get that the kind of people one meets on a tropical vacation in the middle of March are of a certain economic and sociopolitical status. Nonetheless, I…

I understand that there is a difference between perception and reality.  I also get that the kind of people one meets on a tropical vacation in the middle of March are of a certain economic and sociopolitical status.

Nonetheless, I am amazed at how history seems to repeat itself.  Year after year, while sitting in the shade and relaxing by the pool, …

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Our health system is changing, and it’s a damn shame

Health policy

Why you should help your local hospital improve

6

As we begin the journey to value-based health care, the relationships between a hospital and its medical staff are changing. For decades, these relationships were straightforward: doctors admitted patients to the hospital, performed procedures and delivered therapies, and at some…

As we begin the journey to value-based health care, the relationships between a hospital and its medical staff are changing. For decades, these relationships were straightforward: doctors admitted patients to the hospital, performed procedures and delivered therapies, and at some point, sent the patients home. This simple formula was the business model for hospitals, and it worked well.

Same with the doctors. The hospital would pretty much let us do what …

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Why you should help your local hospital improve

Health policy

The health care safety net: Put patients first

For many of the millions of low-income families seeking quality health care in the safety net, the quest can be bewildering. They may walk into a drab, disorganized and unwelcoming clinic, with the staff, signage, and endless medical forms all…

For many of the millions of low-income families seeking quality health care in the safety net, the quest can be bewildering. They may walk into a drab, disorganized and unwelcoming clinic, with the staff, signage, and endless medical forms all using unfamiliar language, with unexplained, lengthy waiting times, and with providers burying them in information they can’t understand. On a second visit, they may feel even worse when they end …

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The health care safety net: Put patients first

Health policy

Raising minimum wage directly impacts health

33

I admittedly don’t understand much about the intricacies of economics. But I don’t have to in order to recognize the significance of Walmart’s decision to raise the minimum pay for its lowest paid hourly employees. In the week following the…

I admittedly don’t understand much about the intricacies of economics. But I don’t have to in order to recognize the significance of Walmart’s decision to raise the minimum pay for its lowest paid hourly employees. In the week following the company’s announcement, plenty has been written about the impact that such a move will have on the company’s success and on local economies. It goes beyond that, however. What I see is …

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Raising minimum wage directly impacts health

Health policy

Providing health care to the poor: It’s time to get creative

9

When I speak with colleagues about ways to provide primary care to the poor, they generally fall into one of two camps. The first camp, generally supporters of the Affordable Care Act, contends that the ACA's originally mandatory (but later…

When I speak with colleagues about ways to provide primary care to the poor, they generally fall into one of two camps. The first camp, generally supporters of the Affordable Care Act, contends that the ACA’s originally mandatory (but later ruled optional) expansion of Medicaid insurance eligibility and a temporary federally-funded increase in Medicaid fee-for-service rates to Medicare levels provided enough incentives to attract family physicians to patient-centered medical homes that …

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Providing health care to the poor: It’s time to get creative

Health policy

The transition to value-based care: Think Starbucks

69

Whether you like it or not health care financing is transitioning from payment for discrete services to global payment for value. Whether you agree with this trend, or comprehend its meaning, if it has one, is largely irrelevant in the…

Whether you like it or not health care financing is transitioning from payment for discrete services to global payment for value. Whether you agree with this trend, or comprehend its meaning, if it has one, is largely irrelevant in the short term. The government of the United States, the Chamber of Commerce, both political parties, all health care stakeholders, and even your own medical associations are fervently supporting, and actively …

Read more…

The transition to value-based care: Think Starbucks

Medical education

How to make outpatient population health more exciting

5

In a recent grand rounds on the future of medicine, the buzzwords were “collaboration” and “managing of the health of populations.” The same day, a group of ten residents were presented with their patient data about cancer screening rates. In…

In a recent grand rounds on the future of medicine, the buzzwords were “collaboration” and “managing of the health of populations.” The same day, a group of ten residents were presented with their patient data about cancer screening rates. In both venues, the call to “population health” elicited sighs of exasperation. It’s just another checkbox we are being asked to click off. How can we be assessed on that as …

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How to make outpatient population health more exciting

Health policy

How Medicaid’s bait and switch fooled doctors

14

Medicaid expansion “is one of the biggest milestones in health care reform,” according to the Obamacare Facts website. The goal was to provide insurance coverage to low-income Americans, specifically the uninsured. The major problem with Medicaid is low reimbursement. “Due…

Medicaid expansion “is one of the biggest milestones in health care reform,” according to the Obamacare Facts website. The goal was to provide insurance coverage to low-income Americans, specifically the uninsured. The major problem with Medicaid is low reimbursement. “Due to low payouts, many doctors don’t take Medicaid, and the quality of care tends to be poor,” admits the website. The solution was to raise the amount doctors get paid under …

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How Medicaid’s bait and switch fooled doctors

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