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.

Emergency departments will remain a safety net for decades to come

Edwin Leap, MD

Health Policy

October 23, 2013

Former South Carolina Senator, and current Heritage Foundation president, Jim DeMint recently angered supporters of the Affordable Care Act by stating that uninsured patients will “get better healthcare just going to the emergency room,” than they will receive through Obamacare.

That’s a sweeping assertion. However, the ACA supporters offended by Sen. DeMint need to understand the supreme irony that without America’s emergency departments and their dedicated personnel, the ACA will fall …

Getting health insurance is not about your ideology

Manoj Jain, MD, MPH

Health Policy

October 22, 2013

Standing in the dimly-lit cave-like radiology reading room, I was looking at a CT scan which was done in the emergency room on a man in his 40s who had a testicular mass — likely a cancer — which had spread through out his body. It wasn’t that the man did not know the mass was present — earlier CT scans from the emergency room clearly showed the mass in …

Emerging enterprises of health care management

Brian Klepper, PhD

Health Policy

October 20, 2013

A new class of health care management organization is emerging that thrives by taking advantage of health care’s rampant and institutionalized waste. These firms mine the market dysfunction that has developed over decades, which will almost certainly yield enough fuel to drive a new way to manage care and cost.

The founders of these organizations have deep health care experience, and they understand the mechanisms of excess. More important, the ones …

Advice to the next national coordinator for health IT

John Halamka, MD

Health Technology

October 18, 2013

Over the next few months, Jacob Reider will serve as the interim National Coordinator for Health Information Technology (ONC) while the search continues for Farzad Mostashari’s permanent replacement.

What advice would I give to the next national coordinator?

David Blumenthal led the ONC during a period of remarkable regulatory change and expanding budgets. He was the right person for the “regulatory era.”

Farzad Mostashari led ONC during a period of implementation when resources peaked, grants were …

Pay for performance: Not everything that can be counted counts

James Marroquin, MD

Health Policy

October 17, 2013

There is a lot of talk these days about changing our health care system from “pay for volume” to “pay for value.” The idea is that we currently reimbursement doctors and hospitals according to the number of services delivered rather than how well they make us. This perverse system of incentives results in runaway health care spending that doesn’t necessarily result in a more healthy citizenry.

There is certainly truth in …

Health IT will dictate how health is provided in the future

Margalit Gur-Arie

Health Technology

October 16, 2013

Health IT is booming, or so they say. The hotly debated and highly politicized health care reform, a.k.a. Obamacare, has been shining bright lights on a segment of our economy that is quickly approaching $3 trillion per year, and is in dire need of improvement, or so they say. Depending on who you ask, some say that health care resources must be redistributed in a more equitable manner, while others …

How Medicare can fix the shortage of primary care physicians

Stephen C. Schimpff, MD

Health Policy

October 15, 2013

Primary care physicians (PCPs) have been marginalized by Medicare for decades with low reimbursement rates for routine office visits which has led to the 15-20 minute office visit with 10-12 minutes of actual “face time” and a panel of patients that well exceeds 2000.

Is there a good solution to the Medicare cost and quality issues? Setting aside either the Democrats’ approach to basically enact price controls by ratcheting down reimbursements or …

Hostile dependency: The real reason for physician burnout

Wes Fisher, MD

Physician

October 14, 2013

A piece recently appeared in the New York Times entitled “Who Will Heal the Doctors?”

The piece is written by Donald Borstein and I encourage all to read it. Mr. Bornstein offers a solution to the doctor burnout problem in health care, a course called “The Healers Art,” now being promoted in US medical schools that uses “mindfulness” as his means of creating compassionate, caring doctors as a way forward.

I should say …

Is it worth it? A question providers need to be asking

John Ly, MD

Physician

October 14, 2013

“Will you charge me?” he asked quietly, between labored breaths. He sat in the hospital bed with his legs over the side in what is known as a “tripod” position — his elbows resting on a nearby stool to prop his chest up as much as possible. His head was hunched over, with his eyes pointed down; clearly he was in agony.

He had been admitted to the hospital two weeks …

What the Apple Store can teach health exchanges

Carmine Gallo

Health Policy

October 12, 2013

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The Affordable Care Act is a hefty 2,000 page law that is extraordinarily complex. Actually, have you ever seen a 2,000 page anything that’s not complex? It should come as little surprise that just over half of U.S. adults struggle to explain any of the components of the law. The survey conducted by the American Institute of CPAs, also found 48 percent of younger …

Medical students may find themselves without a job

Christy Duan

Medical Education

October 12, 2013

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“Well, if medicine doesn’t work out, you can always fall back on waiting tables,” I joked with my waiter, who, like me, happens to be a medical student. We were bonding over completing our first year of medical school — he, in Detroit, and myself, in the Bronx. He liked waiting tables and decided to work during his last summer of …

Will the Affordable Care Act worsen physician burnout?

Kevin R. Campbell, MD

Health Policy

October 10, 2013

As the Affordable Care Act (ACA) is implemented, many physicians are beginning to take stock in their own professional and personal lives. The practice of medicine is a privilege but it is also an occupation that can consume nearly all aspects of a physician’s life. In the past I have struggled with my own “work-life balance” and I have shared my thoughts on burnout in my previous blogs.

As a …

Obamacare: There is risk for the American public to be worse off

Davis Liu, MD

Health Policy

October 10, 2013

With the implementation of health insurance exchanges in October 2013 and the beginning of the Affordable Care Act (ACA), also known as Obamacare, there is tremendous risk for the American public to be worse off. Certainly the millions of Americans who currently are uninsured because their employers do not offer insurance coverage and those with pre-existing conditions unable to purchase affordable individual coverage, will benefit. It is those with employer-based …

The great irony of health care reform

Wes Fisher, MD

Health Policy

October 7, 2013

The great irony of health care reform is that really, nothing is new. Everything, it seems, remains cloaked in secrecy.

Yes, there are things called exchanges now. And millions upon millions of dollars will be spent on Internet, social media, TV, print, and radio advertising touting the law. There will be counselors there to help people make an informed choice.

But there’s still a new complicated, unreadable law that promises much, but …

Read more…

The great irony of health care reform

I support the Affordable Care Act, but not Obamacare

Kenneth Lin, MD

Health Policy

October 7, 2013

More than three years after being signed into law, and more than a year after surviving a Supreme Court challenge, the Affordable Care Act, more commonly known as Obamacare, finally begins to fulfill its promise. Most of this country has long since taken sides, despite appalling gaps in popular understanding of what the law means, what it does, and what it doesn’t do.

Let me admit that I’ve never had particularly …

Why your premium may rise under Obamacare

Edward Pullen, MD

Health Policy

October 7, 2013

The Affordable Care Act (ACA) will make insurers unable to exclude Americans with serious health problems from enrolling in insurance plans. This is among the most popular aspects of Obamacare. It is also the most likely explanation for huge premium increases in plans for individuals not on employer group policies.

Persons employed by companies with insurance plans for their employees, usually called group plans, routinely accept all eligible employees, regardless of …

How the Obamacare exchanges will transform health care

Robert Pearl, MD

Health Policy

October 7, 2013

When the next phase of the Affordable Care Act (ACA) kicks into gear January 1, 2014, each state will be required to offer its residents access to health care insurance through an online marketplace, often referred to as a “health insurance exchange.” These exchanges are now open for business on Oct. 1, 2013, allowing individuals to sign up online, by phone or in-person, with health insurance coverage starting next year.

Until now, buying health …

The problem with Obamacare is that it doesn’t do enough

John Mandrola, MD

Health Policy

October 7, 2013

Obamacare is here. It’s really here.

You might be wondering what’s been going on in the hospital or office — the contact points where health care actually happens.

The funny thing is: nothing seems any different.

And this is the problem with Obamacare. It hasn’t, won’t, or perhaps couldn’t, change the fundamental problem with US health care. Namely, that it is too big, too disruptive, and too devoid of nuance. In this way, health care …

Why physicians will never learn to like EMRs

Margalit Gur-Arie

Health Technology

October 1, 2013

EMRs are not designed for patient care. Is there anyone working in health IT who can honestly say that he or she never heard this statement being made hundreds or thousands of times? Is there any clinician actually working with patients and EMRs who can state that such thought never crossed his or her mind? This includes health IT evangelists and physicians spearheading IT initiatives at the most excellent of …

What Obamacare means to my family

Frugal Nurse, RN

Health Policy

September 28, 2013

The anticipated and dreaded letter from my health insurance company arrived yesterday.

Dear Member:

We are writing to let you know about some important changes to your individual health insurance coverage … Your health insurance plan will no longer be available after December 31, 2013.

We very much want to continue serving you and so have selected a new ACA-compliant Regence plan for you. Your new plan has more benefits and a different …

Read more…

What Obamacare means to my family