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.

5 questions ACOs need to ask themselves

David B. Nash, MD, MBA

Health Policy

August 18, 2013

ACO — for accountable care organization — is by now a familiar acronym within the healthcare industry and among all Americans who have followed the steady implementation of the Affordable Care Act.

Easily described but very challenging to operationalize, ACOs rely on effective partnering among healthcare providers of all shapes and sizes — health systems, hospitals, clinics, physician practices, urgent care centers — to collectively share responsibility for the health of …

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5 questions ACOs need to ask themselves

The key to medical home success: Bringing the stakeholders together

Fred N. Pelzman, MD

Health Policy

August 18, 2013

One of the greatest challenges when it comes time to affect major change in any system is figuring out who the stakeholders are, who has a vested interest in seeing a project rise or fall.

Without knowing who all the players are from the word go, there is almost no way to move things forward. But recognizing that we can’t keep everyone happy is also a big part of this process.

So …

Why the Accuracy In Medicare Physician Payment Act should pass

Brian Klepper, PhD and Paul Fischer, MD

Health Policy

August 18, 2013

With the recent release of two mainstream exposes, one in the Washington Post and another in the Washington Monthly, the American Medical Association’s (AMA) medical procedure valuation franchise, the Relative Value Scale Update Committee (RUC), has been exposed to the light of public scrutiny. “Special Deal,” Haley Sweetland Edwards’ piece in the Monthly, provides by far the more detailed and lucid explanation of the mechanics of the RUC’s arrangement with …

We need to reassess the patient note

Robert Centor, MD

Physician

August 16, 2013

I recently tweeted about Danielle Ofri’s important piece, The Doctor Will See Your Electronic Medical Record Now. I like the piece, and especially like some of the quotes, but still I believe the problem needs an expanded take.

Context represents the major advantage of 38 years experience as a physician. Over time, one sees trends come and go. Hopefully one can see the strengths of the “good old days” and …

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We need to reassess the patient note

The broken window theory in health: Examples of graffiti we can fix

Vineet Arora, MD

Physician

August 15, 2013

I just left the most unusual conference I have ever attended. First, it was small: 25 invited participants. Second, it was all women. Third, it was all women who have done amazing things …make that “trailblazing things.” They were journalists at major news outlets, retired military officers from the highest ranks, senior leaders (in some cases, the most senior leader) at major federal and state health care agencies, Fortune 500 companies, large …

The blueprint for decreasing the cost of health care

Manoj Jain, MD, MPH

Health Policy

August 13, 2013

We have done it. We have decreased the increase in the cost of health care. Let us explain. For three decades (1980-2009), the cost of health care has been increasing each year at an average rate of 7.4 percent — double the rate of inflation. However, over the past three years, the increase in health care expenditure has remained at a low 3.1 percent.

Is this decline …

Atul Gawande provides clues on how to change doctor behavior

Kevin Pho, MD

KevinMD

August 13, 2013

We’re spending an inordinate amount of time and effort trying to convince doctors to change the way they practice.

Most recently, for instance, a study came out saying that doctors aren’t following back pain guidelines. Or from a broader perspective, consider the Choosing Wisely campaign, which lists scores of tests and treatments that are ordered too frequently.

Various carrots and sticks have been used to steer …

Thousands of dollars are put at risk with a single click of a button

Wes Fisher, MD

Health Policy

August 12, 2013

There is so much entropy in health care right now. So much finagling, so much shifting, so much arguing, so much uncertainty, so much shock. Shock at prices, shock at waiting times, shock that doctors don’t know how to increase referrals, shock that doctors aren’t doing more to help. What gives?

In triage, you don’t spend time with the expectant.

Doctors are keeping their heads down. They are still seeing patients. They …

The demand apathy that doctors increasingly face

Jordan Grumet, MD

Physician

August 10, 2013

Monday afternoons are always the same. I pick up the kids from their grandparents. We drive home with their backpacks and a carton of home made food. We park in the garage, and carry all the contents of the car into the house. As the kids unload, I push the recycle container to the front for street pickup the next day.

Occasionally, I stop and socialize. Yesterday, I waited at the edge …

To change health care, we need more physician leaders

Davis Liu, MD

Physician

August 9, 2013

There is a stunning gap between what we know and what we need to do in health care to make it more affordable, accessible, and higher quality. In a recent piece by NPR, research shows that when it comes to treatment of low back pain, doctors are prescribing more powerful pain medications (narcotics) and ordering more imaging tests like MRI and CT scans when there is no evidence these are …

My health care wish list if I were king

Bob Doherty

Health Policy

August 9, 2013

I think we all have fantasies from time-to-time what we might do it we were made King for a day (only benevolent kings, of course—no despots need apply!) What decrees might we issue to make the world a better place? What changes would we order to make our politics better? What improvements would we institute to make health care better? Well, here’s my (health care) list:

1. I would decree that every …

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My health care wish list if I were king

For patients, reforming the RUC matters

David Margolius, MD

Health Policy

August 6, 2013

“Doc, if I have cancer, I don’t want to know. Stop bugging me about this colonoscopy.”

Mr. H said to me, his primary care physician, during our appointment. He folded his arms and nodded his head, indicating that his decision was final.

“Mr. H, as uncomfortable as colonoscopies seem, they can actually find lumps that might grow into cancer, and cut them out before they ever become cancer. That’s why I’m bugging you so much about this.”

I …

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For patients, reforming the RUC matters

Limiting your choice of doctors: Is Obamacare to blame?

Trudy Lieberman

Health Policy

August 6, 2013

The specter of loss of choice and freedom to select the doctor you want haunts again. This time it’s being raised on the airwaves with an ad from Americans for Prosperity, a group that advocates limited government and free markets. The ad, an attack on Obamacare, plants doubt in viewers’ minds about whether they can choose their own doctor, a theme that continues to resonate with both the public and …

Technologists versus doctors: Who wins?

Robert Pearl, MD

Physician

August 5, 2013

The notion that doctors can be replaced by technology has sparked a series of brawls between doctors and technologists over the last couple of years. Today, both sides continue to throw punches in the press and online.

As health care technologies become more sophisticated, the opportunity to automate medical decisions becomes more seductive. Yet, physicians are unwilling to throw in the towel. They point to the importance of human interaction and …

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Technologists versus doctors: Who wins?

Our patients pay for dumbed down American medicine

Jordan Grumet, MD

Health Policy

August 4, 2013

I guess what is so utterly frustrating is that the guys up there don’t see what is going on down here. The march of health care reform continues with little realization of what it feels like to be one of the tiny peon foot soldiers on the ground. We are not deaf. We hear the politicians and policy wonks. We read as non-clinician “doctors,” ivory towered administrators, and the business …

Are we unfair to the RUC? A view from the inside

Yul Ejnes, MD

Health Policy

August 3, 2013

A guest column by the American College of Physicians, exclusive to KevinMD.com.

I will begin this month’s column with a confession on something that most people don’t know about me. I hope it doesn’t lose me any friends. I am a member of the AMA/Specialty Society Relative Value Scale Update Committee, better known as the RUC. Actually, I’m an alternate, but …

What Detroit’s bankruptcy means for patients

Birju Rao

Health Policy

August 3, 2013

Detroit

On July 18th 2013, the city of Detroit filed for bankruptcy. Early estimates size up Detroit’s as the biggest in history with composite debt figures approaching the ballpark of $20 billion. Through the eyes of a clinician why should we care and what does this mean for our practices.

Detroit is dying.

While filing for Chapter 9 bankruptcy may give the city an extra lifeline, …

Are doctors ethically obligated to sign patients up for Obamacare?

Bob Doherty

Health Policy

August 2, 2013

One of the most disheartening developments in the unrelenting political fight over the health reform law is the organized effort by its opponents to dissuade the public from signing up for coverage. Having failed in efforts to block Obamacare in the Supreme Court, or to elect a president or Senate that would work for its repeal, they are now working to kill the law by persuading people to not sign …

How the government has spurred the adoption health care technology

David Lee Scher, MD

Health Technology

July 31, 2013

Both World War II and the race to the moon were events which pushed commercial development of technologies. I would submit that the ACA and HITECH have had the same effect on the development of many sectors of the digital health technology industry. I will cite five such areas.

Government mandates usually have unintended consequences and they certainly exist in healthcare. The rapid proliferation of some of these technologies has itself …

Break the cycle of event centered care

Fred N. Pelzman, MD

Health Policy

July 28, 2013

Creating a patient-centered medical home within our existing system seems, at times, like a Herculean task. Getting all the pieces in place so that we can make the needed changes sometimes seems too vast to get it all right.

We find ourselves asking: Why bother? Is our healthcare system that broken? Is the way we take care of patients now failing, satisfactory, or outstanding? If we just continue on the path …

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Break the cycle of event centered care