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.

With the patient hemorrhaging, doctors are backed into a corner

Jordan Grumet, MD

Physician

September 23, 2013

We were pretty damn lucky that she was young and healthy.

The surgery had been technically successful. I watched as the resident finished with the last sutures. Although the attending had already left the room, I looked on with the eagerness of a third year student. Orders were written, and the patient was transferred to recovery.

It was a routine hysterectomy. None of the pizazz and flare of a gynecology-oncology surgery, but …

Who will pressure physicians to join the 21st century?

Robert Pearl, MD

Physician

September 22, 2013

A Bank of America ATM can figure out who you are and how much money is in your account in seconds. It can spit out cash in virtually any currency from nearly any spot in the world — even if you’re a Chase customer. It’s a technological convenience we’ve all come to expect.

Hospitals and doctors’ offices are starting to replace hard copy patient records with computerized heath systems. Some U.S. …

How physicians can fight obstructivism over Obamacare

Bob Doherty

Health Policy

September 18, 2013

Soon, millions of uninsured Americans will be able to enroll in qualified private health insurance plans offered through their state marketplaces, with federal dollars to help them afford it. The state marketplaces, created by the Affordable Care Act (Obamacare) will begin enrolling eligible people on October 1, and eligible persons will have until March 31 to sign up. The coverage and subsidies for those who sign up will start on …

Who gets left out of Obamacare?

Trudy Lieberman

Health Policy

September 17, 2013

The main purpose of health reform, said the president at a recent press conference, was to provide health insurance to people at affordable rates. He meant the nub of Obamacare — the state shopping exchanges with their smorgasbord of insurance policies — would give coverage to millions of Americans who did not have insurance.

Whether that coverage will be affordable or comprehensive for families remains to be seen. What is crystal …

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Who gets left out of Obamacare?

The Affordable Care Act ignores simple issues of human nature

Edwin Leap, MD

Health Policy

September 17, 2013

The Affordable Care Act (ACA), aka Obamacare, is law. And its implementation is moving along slowly, but steadily.

You have to give credit to the folks who believed in it, whether grass-roots supporters or highly placed politicians. They rammed it down the American gullet like a lead ball down the muzzle of a Hawken rifle. The problem is, once it goes off, the whole thing is going to explode.

The reasons are …

The Triple Aim is vital to our collective health

David B. Nash, MD, MBA

Health Policy

September 15, 2013

In 2008, a couple of years before the Affordable Care Act became the law of the land, Donald M. Berwick, MD, and his colleagues at the Institute for Healthcare Improvement (IHI) introduced the Triple Aim concept and set to work on ways to (1) improve population health, (2) increase patient satisfaction and (3) reduce per capita healthcare costs.

In pursuit of these goals, IHI encouraged the exploration of a variety of …

The role of physicians is set to evolve again

Hans Duvefelt, MD

Physician

September 11, 2013

Talking with an insurance doctor, who denied a vertebroplasty for my patient with a spontaneous compression fracture, I started thinking about the dilemma of defining what a doctor-patient relationship is.

A couple of years ago a local doctor with a dwindling private practice joined an Internet medical site that promoted drugs like Viagra and offered online consultations with physicians who prescribed the medications when they felt it was appropriate. The state …

Can American doctors get off the hamster wheel?

John Mandrola, MD

Health Policy

September 10, 2013

What follows are not complaints. These are just the facts.

Here’s a recent exchange from an enlightened physician leader, one who has yet to give up: “My colleagues are discouraged and frustrated every day, leaving the office defeated and fatigued. There are other ways to practice.”

High health care costs get most of the attention, but there’s a more important crisis coming your way.

First a review, then to the looming crisis.

When Americans travel …

Use the Internet to create a competitive medical marketplace

Allen Frances, MD

Health Policy

September 9, 2013

An enemy intent on ruining the U.S. economy and sabotaging our public health could do no better than burden us with our current system of health care. The crushing costs of our health expenditures almost double per person those of other developed countries, with health outcomes that fall somewhere between mediocre and lousy.

There is no single cause for our medical fiasco and no single cure — especially since all solutions …

Our dysfunctional system: Both doctors and patients are at fault

James C. Salwitz, MD

Health Policy

September 6, 2013

I do not argue with my patients. Rather, I teach, outline options and explain my point of view, as each person must choose their path. However, the other day, Audrey and I got in a tiff when she was in the office to discuss her breast cancer. We had an enthusiastic discussion not of chemotherapy, x-rays or surgical options. Nope, we disagreed about what is wrong with healthcare.

It seems to …

What health care in the United States can learn from Nepal

Brad Wright, PhD

Health Policy

September 5, 2013

Beautiful Nepal Photos (10)

In the US, many health care woes are blamed on the federal or state government. Whether there is too little oversight and lack of transparency or too much interference and regulation, it seems that policy and politics often end up getting blamed for health care system troubles. But what happens when one lives in a country with no functioning …

To the legislators blocking Medicaid expansion

Chris Lillis, MD

Health Policy

September 1, 2013

As a primary care doctor I typically see 20-25 patients a day in my private practice. My community is gearing up for changes and is planning measures to integrate the many private practices locally. I was asked to serve on a committee evaluating software solutions to connect the disparate electronic medical records in the community, and had several hours of meetings at the hospital at the beginning of the week. …

What good is Medicaid expansion if no doctor sees Medicaid patients?

Peter Ubel, MD

Health Policy

August 29, 2013

With its expansion of Medicaid eligibility, the Affordable Care Act (a.k.a. Obamacare) was supposed to go a long way towards providing healthcare coverage to millions of uninsured Americans. That accomplishment was dealt a large blow by the Supreme Court, when it forbade the federal government from requiring states to expand Medicaid coverage. Nevertheless, many states plan to offer Medicaid to anyone with incomes at or below 138% of the Federal …

Do we need less art in medicine?

Vipul Kella, MD

Health Policy

August 28, 2013

After eating at my favorite restaurant last week, I started to think why I enjoyed it so much. I have been eating at the same place regularly for years, but never stopped to think about what makes it special. After thinking about it for a bit, I came up with one word: consistency. I know that every time I eat there I can expect the same dish prepared the exact …

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Do we need less art in medicine?

Will delays pose a big problem for Obamacare?

Bob Doherty

Health Policy

August 27, 2013

“What, me worry?” could pretty much characterize how Obamacare supporters are reacting to the news that the administration is delaying or modifying the implementation of some of its requirements. Like Alfred E. Neuman, they are expressing a public confidence that there is no reason to worry, everything is fine, the announced delays aren’t really that important, and Obamacare will be up and running and ready to start enrolling people on October 1. No worries.

“The …

Aviation doesn’t hold all the answers to patient safety in health care

Suneel Dhand, MD

Health Policy

August 24, 2013

Slowly but surely, patient safety is taking its’ rightful place at the forefront of American medicine. Ever since the landmark report from the Institute of Medicine in 1999, To Err is Human: Building a Safer Health System, the issue has been gaining increased traction year on year. Dismal patient safety statistics in some hospitals are correctly being highlighted by the media, with pressure growing on senior leadership and administrators to vigorously …

How will primary care handle the influx of patients in 2014?

Edward Pullen, MD

Health Policy

August 23, 2013

As a family physician I look forward to the next few years in practice with a sense of uncertainty. One of biggest of these uncertainties is how to help meet the anticipated demand for primary care I expect. A number of changes are coming that will alter the supply and demand equation for patients and primary care providers. These include significant projected population demographics, and others that are due to …

Doctor, if this were your child, what would you do?

Robert Truog, MD

Physician

August 22, 2013

Doctors are often asked what treatment options they would opt for if their patient was their own child.

Perhaps the most gratifying question I am ever asked as a pediatrician is, “Doctor, if this were your child, what would you do?” So often today, being a physician can feel like being a technician — parents come in believing they already know their child’s diagnosis from their Internet search. They know what …

We have the potential to have the best health care system in the world

Aaron E. Carroll, MD

Health Policy

August 22, 2013

Every once in a while, I’m forced to engage the health care system in a more personal way. Yesterday was one of those days. First, one of my children (who shall remain nameless), decided to take a stroll in the mulch on Monday without any shoes. He managed to lodge an enormous splinter in his foot which I couldn’t get out. By the time I saw it that night, it …

Why does Ezekiel Emanuel have such a low opinion of physicians?

Jordan Grumet, MD

Health Policy

August 20, 2013

A study in JAMA suggested that physicians feel that other players (lawyers, insurance companies, hospitals, etc.) are more responsible than doctors for reducing healthcare costs. Furthermore, they are hesitant to promote reforms that eliminate the current fee for service payment system.

Although I would bet the no one would be surprised by these findings, a scathing editorial by Ezekiel Emanuel and Andrew Steinmetz caught my eye. Before I get …

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