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.

3 questions doctors should ask themselves in 2014

Natasha Deonarain, MD, MBA

Health Policy

December 25, 2013

Next year will be a landmark year for America. Since our Great Recession and its far-reaching effects on the economy, housing markets, jobs, relationships, personal savings, spreading wealth, increasing poverty, divided politics and collapsing health care system, America seems to be purging a lot of karma.

Doctors play a huge role, allowing themselves to become puppets pulled by the purse strings of politicians, conglomerates and a divided country gone wild.

As we …

Merry Christmas, American health care!

Margalit Gur-Arie

Health Policy

December 25, 2013

It’s that time of year when the OECD publishes its “Health at a Glance” comparative health indicators, and The Commonwealth Fund follows with an international survey of health care related activities. A cursory review of these documents always ends up with the customary assessment of American health care: much more expensive than all others, wasteful and inefficient.

But this is the month of December, and health care workers are people too, …

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Merry Christmas, American health care!

The sense of abandonment from my society

Robert Fogerty, MD

Health Policy

December 23, 2013

“You look nice today. People don’t come to chemo in suits very often.” The friendly and familiar receptionist mentioned as I was checking out, the always full jar of lemon flavored hard candy on the shelf between us. As I pocketed a few of the candies, I managed to swallow the nausea and metallic taste just enough to say, “Thanks. I have a job interview today.”

During my senior year in …

The cheapest form of health care is to let sick people die

John F. Hunt, MD

Health Policy

December 21, 2013

If you learn nothing else today, I would ask you to learn that moral hazard is the cause of medical price hyperinflation.

Moral hazard is not just two words that don’t seem to go together. Moral hazard is when the person who bears the economic burden of a decision is not the decision maker. In the health care setting, moral hazard is when the third party payer (insurance/government) bears the …

Is it racist to oppose Obamacare?

Peter Ubel, MD

Health Policy

December 17, 2013

It is pretty easy to be against Obamacare these days.

The federal government can’t come up with a working website to help people buy health insurance. The president misled people about whether they could hold onto their old insurance plans. And come next tax day, the least popular provision of the Affordable Care Act — the individual mandate — will be implemented for the first time.

Lost amidst all this controversy is …

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Is it racist to oppose Obamacare?

Dear lawmakers: Why aren’t doctors involved in health care reform?

Matthew Moeller, MD

Health Policy

December 16, 2013

As I was watching CNN news recently, I noted in the headlines different ways Obamacare is failing. Current problems discussed were the customers’ sticker shock of high deductible plans (up to $12,700 for families), the president blaming the insurance companies for having substandard plans, and the people blaming the president for losing their current insurance.

One patient even complained, “My new health care plan tripled in price, and now, it is …

Will fee for service ever go away?

Brian Klepper, PhD

Health Policy

December 14, 2013

The catchy title of a recent Harvard Business Review Blog post, The Big Barrier To High Value Health Care: Destructive Self-Interest, suggested that the Institute for Healthcare Improvement (IHI) is forging arrangements that can overcome fee-for-service reimbursement’s propensity to drive excess. As the honest broker, IHI could advocate for arrangements of mutual self-interest based on the right care, better outcomes and less money. Employers and unions would get lower costs, with …

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Will fee for service ever go away?

It’s time to support performance measurement in health care

Richard Patterson, MD

Health Policy

December 14, 2013

I practiced surgery for many years in a very large hospital. In the 1980s, the marketing department launched a campaign with the tagline, “A Leader in World Medicine.” About the same time, two of my colleagues created the Hernia Institute, sensing gold in them groins. They placed ads in the sports pages of our local newspaper, right next to those of the topless clubs.

These initiatives had two things in common:

they …
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It’s time to support performance measurement in health care

Health care costs are slowing: Is Obamacare responsible?

Robert Laszewski

Health Policy

December 13, 2013

Is Obamacare even partly responsible for the slowdown in health care costs?

That is silly.

First, Obamacare is not a health care reform law; it is a health insurance reform law. No one on either side of the debate has ever argued anything different.

Does the law have some limited cost containment features in it?

Yes. But these are either pilot projects or are years from being fully implemented.

I have heard the …

Why the Affordable Care Act is worth fighting for

Bob Doherty

Health Policy

December 11, 2013

Readers of my posts know that I am a passionate advocate for the Affordable Care Act, or Obamacare if you prefer. It isn’t that I have a pollyannaish view of the law itself, or the tortured political process that produced it — far from it. The ACA is an imperfect law, created by imperfect people through an imperfect process, with imperfect results. After almost 34 years of experience in …

What happens when doctors lose their calling?

Wes Fisher, MD

Physician

December 10, 2013

The field of medicine is one of the most rewarding occupations out there. Few occupations allow such an incredible opportunity to directly impact the life of a fellow human being and see the amazing results of something you did. Few occupations are allowed inside the most intimate and vulnerable moments of the human condition. In a word: amazing.

But medicine for people has quickly given way to medicine for business.

Business needs …

What leaders can learn from the failure of Healthcare.gov

Amy Edmondson

Health Policy

December 9, 2013

It’s lonely at the top. The buck stops here. I take full responsibility.

Noble sentiments. But the idea that one person, at the top, or elsewhere in an organization, is solely to blame for a complex failure in novel territory is as unhelpful as it is limited. In fact, the blame game is less useful today than ever before. Consider Healthcare.gov.

The idea that a project as complex, new, and large as the Healthcare.gov website …

Health care transparency as more than an amenity

Oliver Kharraz, MD

Health Policy

December 9, 2013

Would you purchase a new phone without knowing its data plan? For almost everybody, the answer is an obvious “no.” We simply cannot make a good choice if we don’t know how much coverage the phone will offer, or how much money it will end up costing us.

Unfortunately, this type of blind decision is exactly the sort that many could face when purchasing a plan in the new health insurance …

Direct pay primary care and the ACA still don’t mix

Rob Lamberts, MD

Health Policy

December 9, 2013

Lately I’ve gotten hooked on watching the reality TV show, the Deadliest Catch. It’s astounding to me what these guys go through to catch crab in the Bering Sea.

One of the recurring themes on the show is the new crop of “greenhorns” — new recruits to the profession of working crab boats — that try to show they can hack “the world’s most dangerous job” each year. They often come with …

Change will happen when millennial doctors step into leadership roles

Davis Liu, MD

Physician

December 6, 2013

I recently stumbled across a blog post by Dr. Jay Parkinson, an entrepreneur and founder of Sherpaa, who reflected on a recent private breakfast with New Yorker and best selling author Dr. Atul Gawande.

The question posed by Gawande: Can technology be a change agent for health care?

The inevitable answer is yes, with one important caveat. It’s not the technology that will change the practice of medicine, it’s the doctors who …

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Change will happen when millennial doctors step into leadership roles

Healthcare.gov is fixed, or is it?

Robert Laszewski

Health Policy

December 6, 2013

From 27,000 enrollments in October to a reported 100,000 enrollments in November, the Affordable Care Act’s website is apparently working better and getting more people signed up.

But is it fixed well enough to handle the expected wave of at least many hundreds of thousands of people eager to get guarantee issue health insurance for the first time or replace a canceled policy by January 1?

Here are some of the press …

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Healthcare.gov is fixed, or is it?

A doctor quits the AMA and his state medical society

Mike Sevilla, MD

Health Policy

December 6, 2013

Everywhere in the news these days, you read of stories where physicians are being cancelled from insurance plans, and groups like the American Medical Association, and state based medical societies fighting to reverse these decisions. Does anyone think these actions will really make a difference? I certainly don’t.

Since this is the start of December, this is the time of year where I look at certain expenses and wonder if they are …

An anesthesia practice is sold, and a warning to young doctors

Karen S. Sibert, MD

Physician

December 6, 2013

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We were startled to learn recently that Sheridan Healthcare Inc., a physician services company based in Florida, has bought one of the largest private anesthesiology group practices in California, the Medical Anesthesia Consultants Medical Group Inc. (MAC) of San Ramon.

The deal, which closed November 14, is Sheridan’s first in California, and “provides a platform that will accelerate our expansion in the California …

What happened to doctors serving as advocates for their patients?

Wes Fisher, MD

Physician

December 4, 2013

The Hippocratic Oath. Most medical students in America recite some version of this oath at their medical school graduation. Its text implies a sacred and overriding respect (ethic if you will) for the individual.

Doctors are currently witnessing the profession of medicine moving from the ethic of the individual to the ethic of the collective. The passage of the Affordable Care Act has solidified this treatment ethic and, as a consequence, …

How Obamacare will creatively destroy primary care as we know it

Margalit Gur-Arie

Health Policy

December 4, 2013

As Obamacare is winding its way through a hellish bureaucratic labyrinth of its own creation, accompanied by cheers and boos from the blood thirsty spectator crowds, confusion, fear, trepidation, despair and exhilaration, are gripping America’s doctors all at once, because whatever else is accomplished in the next decade, medicine will never be the same.

At the confluence of cutting edge technology, great poverty and unimaginable fortunes, a new vision for the practice of …