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.

How the Affordable Care Act will affect emergency department payments

Cedric Dark, MD, MPH

Health Policy

January 25, 2014

A recent article in the Annals of Emergency Medicine analyzed the revenue increases due to emergency physicians for services delivered to currently uninsured individuals when they begin to receive coverage (via either Medicaid or private plans) under the Affordable Care Act.

The authors analyzed payments for outpatient emergency department (ED) visits using the Medical Expenditure Panel Survey from 2005-2010. They looked into characteristics of charges and payments for the following groups: …

Learning about Obamacare from a car accident

Bob Doherty

Health Policy

January 24, 2014

Just a little over a week into 2014, my new year started off with a bang — literally — as I got into an automobile accident that involved my car sideswiping another vehicle and then crashing my car into a tree at 30 MPH. The car was totaled, but fortunately, I (mostly) walked away from the accident with only a fractured sternum and bruising.

Just a little over a week from …

When doctors complain: How to resonate with the public

Margalit Gur-Arie

Health Policy

January 22, 2014

There is a dark cloud of discouragement, dejection, disheartenment, and all other synonyms of despair, hanging over the medical profession. It’s not that all physicians live in constant gloom and doom, although quite a few do, particularly those still in private practice, but the profession itself seems to be losing its luster.

Some doctors seem content to pragmatically adapt to the new and duller definition of their old profession, but in …

The New York Times takes a cheap shot at specialists

Wes Fisher, MD

Health Policy

January 22, 2014

Most of us would agree that health care costs are too high in America. They must be controlled or else we won’t have a sustainable health care system here. And we should acknowledge that, on average, all doctors in America are paid higher than their overseas counterparts. But we should also agree that expenses for doctors to earn a degree, maintain that degree and licensure, and pay their malpractice premiums …

Why the Oregon Medicaid study ultimately won’t matter

Angelo Falcone, MD

Health Policy

January 19, 2014

2014 has dawned, and with it more than 2.1 million people have new health insurance under the Affordable Care Act. This, as they say, is where the rubber meets the road. But a new study out of Oregon is challenging a key argument for extending health insurance to millions: that doing so will reduce costly emergency room visits.

The study in question showed that when health insurance was extended to Oregon residents …

How should we define the success of the Affordable Care Act?

Brad Wright, PhD

Health Policy

January 15, 2014

In recent months, news reports focused on the number of new enrollees as a key test of the law. Although the troubled performance of the Healthcare.gov website during October and November delayed enrollment for hundreds of thousands of potential subscribers, Obama administration officials and congressional Democrats hailed a surge in enrollment at the end of the year as proof that the law would fulfill its promise of providing affordable coverage to …

4 scenarios that would dramatically improve health care

Robert Pearl, MD

Health Policy

January 14, 2014

Radical change often happens suddenly, the result of a single decision or event.

The fall of the Berlin Wall and the dissolution of the USSR stand out as two dramatic political examples. In a social context, Supreme Court decisions in Brown v. Board of Education or Roe v. Wade both radically changed our society.

Then there’s the U.S. health care system. We know it can take 17 years for a new, proven treatment to …

Why Obamacare isn’t at risk for a death spiral anytime soon

Robert Laszewski

Health Policy

January 14, 2014

If the Obamacare health insurance exchanges are not able to get a good spread of risk — many more healthy people than sick — the long-term viability of the program will be placed in great jeopardy.

Given the early signs — far fewer people signing up than expected, enormous negative publicity about website problems, rate shock, big average deductibles, narrow provider networks, and a general growing dissatisfaction over the new health …

3 health care predictions for the New Year patients should know

Wes Fisher, MD

Health Policy

January 10, 2014

As we enter the New Year, I like to reflect on where we’ve been and where we’re heading in medicine. By far and away, this is the most tumultuous time I have ever experienced in health care.

It’s strange really.

I thought I’d try to make some realistic predictions of what patients should expect in the year ahead now that the “Patient Protection and Affordable Care Act” (PPACA) begins to sink it’s …

Price transparency alone won’t solve our health system’s ills

Renee Y. Hsia, MD

Health Policy

January 8, 2014

His right testicle had jumped into his abdomen after he lost control of his motorcycle on the highway. My 43-year-old patient, whom I’ll call Richard, in otherwise healthy condition, was brought to the ER with severe pain. Fortunately, his testicle was still intact and only needed to be put in the proper place.

I am an attending physician in the emergency department and trauma center at San Francisco General Hospital. I …

What can physicians expect from Obamacare in 2014?

Bob Doherty

Health Policy

January 7, 2014

Tthe ACA will now begin to transform how millions of Americans get health insurance coverage. Most of us will find that the plans offered by our employers are mostly unchanged because they measure up to federal standards. To the extent that some employers are imposing “negative changes, which include higher premiums, co-pays and deductibles, they’ve all been happening for more than a decade” because of employers wanting to …

5 health care resolutions to make in 2014

Robert Pearl, MD

Physician

January 7, 2014

This is the time many of us make resolutions about our lives — often tied to our health and wellness.

As the health care industry enters a new era of consumerism, people are seeking more and more ways to take ownership over their health and health care. While data about doctors, hospitals and health outcomes are becoming more available and transparent, we still have a long way to go.

Perhaps in a …

Are we successfully moderating health care spending?

Janice Boughton, MD

Health Policy

January 6, 2014

David Blumenthal and others recently published a paper in the New England Journal of Medicine entitled “Health Care Spending — A Giant Slain or Sleeping?”

In it they look at the ongoing, and rarely discussed, phenomenon of slowing of health care spending, which has persisted over several years. Health care spending grew remarkably after the establishment of Medicare and Medicaid in the 1960’s, resulting in the fact that health care …

We must rise up against the hospital-industrial complex

Gene Uzawa Dorio, MD

Health Policy

January 5, 2014

In his farewell address to the nation on January 17, 1961, President Dwight D. Eisenhower warned the American people about the looming “military-industrial complex” which would sway public mindset and enhance money flow from government to the defense industry. This concept persists today with the practice re-adapted and launched against the health and welfare of the American people through the “hospital-industrial complex.”

Health care organizations like the California and American Hospital …

Real market reforms for health care

Duncan Cross

Health Policy

January 4, 2014

Whatever the problems with the roll out of Healthcare.gov, the fact is that the government take-over of health care has been happening for more than a century. If we want a truly free market for health care, we have to think in broader and bolder terms than simply rolling back the ACA. With that in mind, here is a short list of patient-focused ways to get the government out of …

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Real market reforms for health care

The impact of Obamacare on small business

Stephen C. Schimpff, MD

Health Policy

January 3, 2014

The Affordable Care Act is not so affordable if you own or if you are an employee of a small business. Here is why.

Consider the owner of a small service business with one or multiple outlets (e.g., a large restaurant or a small chain of sit down restaurants, a chain of barber shops, a taxi company.) The owner has more than 50 employees but the business is still “small” with …

Why Medicaid patients use the emergency department for primary care

Kevin Pho, MD

KevinMD

January 3, 2014

A study from Science found that those on Medicaid in Oregon made 40% more visits to the emergency department.

The Oregon Health Insurance Experiment included about 90,000 low-income people and assigned 30,000 of them to Medicaid by lottery. It’s essentially a naturally-occurring randomized controlled trial.

The result seems to have caught the public policy experts by off guard:

“I suspect that the finding will be surprising to many in the …

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Why Medicaid patients use the emergency department for primary care

Is Obamacare finally on track and moving toward success?

Robert Laszewski

Health Policy

January 1, 2014

After the disastrous launch of Obamacare the enrollment of 1.1 million people in the 36 state exchanges run by the feds is a major accomplishment. It is likely that the enrollment in the 14 state-run exchanges will take total Obamacare’s private insurance enrollment to near 2 million for the year.

Does this mean that Obamacare is finally on track and moving toward success?

At least the front-end of Healthcare.gov is now clearly …

4 health stories that deserve more attention

Robert Pearl, MD

Health Policy

December 30, 2013

The Affordable Care Act (ACA), sometimes called “Obamacare,” dominated health care media coverage this year. And rightly so. It is the most significant change in American medicine in more than half a century. But the legislation is just one aspect of a complex and highly fragmented system. It is also just the beginning (not the end) of the process to fix U.S. health …

Why a physician shortage is inevitable

Kevin R. Campbell, MD

Health Policy

December 27, 2013

This week in the New York Times, Drs. Scott Gottlieb and Ezekiel Emanuel make the case that there will not be a physician shortage as a result of the Affordable Care Act (ACA). Both have extensive experience in policy and have held respected positions in government.

Based on a projected need of nearly 90,000 more physicians by 2020, I have difficulty seeing how a shortage will not occur. The …

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Why a physician shortage is inevitable