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.

Some patients are receiving too little care

Trudy Lieberman

Health Policy

June 28, 2013

Twelve years ago, in its landmark study Crossing the Quality Chasm, the Institute of Medicine (IOM) found that “the health care industry is plagued with overutilization of services, underutilization of services, and errors in health care practice.” In simple English, the IOM reported that health care was riddled with overuse, underuse and misuse of medical services.

The IOM also defined quality health care as “the degree to which health services for …

Obamacare fails by not listening to the voices of the caregivers

John Mandrola, MD

Health Policy

June 28, 2013

When an employee leaves a position, management might conduct an exit interview. The idea is obvious: one can learn a lot from those who are free to speak candidly.

This is why I think it’s worth listening to doctors who no longer practice medicine.

Enter Dr. Ed Marsh, a former pediatrician, who writes this poignant and relevant essay. His tone and candor is one of a man who still cares about …

Chronic care at Walgreens: Should we see how this plays out?

Ishani Ganguli, MD

Physician

June 27, 2013

Walgreens, the country’s largest drugstore chain, announced that its 330+ Take Care Clinics will be the first retail store clinics to both diagnose and manage chronic conditions like asthma, diabetes, high blood pressure, and high cholesterol. The nurse practitioners (NPs) and physician assistants (PAs) who staff these clinics will provide an entry point into treatment for some of these conditions, setting Walgreens apart from competitors like Target and CVS whose …

What will health care teams mean for patients?

Jessie Gruman, PhD

Patient

June 27, 2013

Have you heard that soon most primary care in the U.S. will be delivered by teams?

Yep. Team-based care is one of the characteristics of the patient-centered medical home, a way of organizing the care of patients that allows primary care clinicians to see more patients in a day while at the same time delivering better care. This move toward team-based care started long before health care reform and was embedded …

Providing the right amount of healthcare

Thérèse A. Stukel, PhD and Noralou Roos, PhD

Health Policy

June 23, 2013

It is easy to assume that the real problem with our healthcare system is “not enough” – not enough physicians, not enough MRIs, not enough money.

But a growing number of studies show that more healthcare is not always better and the more expensive drug or treatment option is not necessarily the right choice. In fact, sometimes more care – specifically care that you don’t need – can be harmful for …

A growing culture of hostile dependency toward doctors

Wes Fisher, MD

Physician

June 22, 2013

An interesting phenomenon is occurring in media circles these days. No doubt others have seen it, too.

Lately, doctors are being schooled by the media.

From how to learn empathy, to improving communication with patients, the breadth and depth of what we should do for our patients is endless. Why, some even have our own colleague experts tell us how we should really do things.

These efforts, while probably well-intentioned, are patronizing. …

The Affordable Care Act is more of our broken health care model

Matt McCord, MD

Health Policy

June 22, 2013

Every week we read another article on the fuzzy math and ridiculous mark-up for our routine healthcare. Do your own research; see Elizabeth Rosenthal’s article in a recent Sunday New York Times, the $2.7 Trillion Medical Bill or Steven Brill’s lengthy tome in Time, Bitter Pill.

We spend, and will continue to spend, more on healthcare than any other nation in the world and yet we are 38th in …

Will health care price transparency help reduce costs?

Peter Ubel, MD

Health Policy

June 22, 2013

Getting your appendix out can cost between $2,000 and $180,000. Hip replacements run from $10,000 to more than $100,000. Hospitals, we have also learned, frequently mark up the price of cotton swabs and routine X-rays by 300 or 400 percent, with most patients oblivious to the reason their health care bills are so large.

As a response to the hidden variability in health care prices, an increasing number of states have …

A cautionary tale of employing doctors

David Mokotoff, MD

Health Policy

June 21, 2013

For all of those out there anticipating the 2014 official roll out of Obamacare, officially known as Affordable Care Act (ACA), here is a cautionary tale.

Many years ago, as I was growing my cardiology practice, it became evident that diagnostic services for my specialty, like stress tests and echocardiograms, were done less efficiently and cost more at the local hospital, than in the office. This stimulated many groups in the …

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A cautionary tale of employing doctors

A far more interesting lesson from the Oregon experiment

Ashish Jha, MD, MPH

Health Policy

June 21, 2013

It has been a couple of weeks since the landmark Oregon experiment paper came out, and the buzz around it has subsided. So what now? First, with passage of time, I think it is worth reflecting on what worked in Oregon. Second, we should take a step back, and recognize that what Oregon really exposed is that health insurance is a small part of a much bigger story about …

A voice is missing from discussions of the patient experiences

Jessie Gruman, PhD

Patient

June 20, 2013

The demand for patient voices is on the rise as hospitals and dialysis centers, research teams and health care advisory groups face requirements to document our participation in governance and program decisions. And many of us have stepped forward to take on these roles.

Some of us do so as victims of horrific medical errors or uncoordinated care resulting in injury or from disrespectful care that undermines all confidence in health …

Will health reform address the racial disparity of the uninsured?

Brad Wright, PhD

Health Policy

June 19, 2013

For all intents and purposes, the Affordable Care Act (ACA), the president’s signature piece of legislation, will provide more health care coverage to poor and underserved populations. Persistently disadvantaged communities have much further to go than those with insurance, and new means of accessing and paying for care will benefit them disproportionately. Nevertheless, with more than 20 percent of the nation’s black population uninsured, more than 30 percent of Hispanics …

Who’s truly responsible for the $2.7 trillion medical bill?

Kent Bottles, MD

Health Policy

June 16, 2013

As someone who professionally closely tracks the debate over the transformation of the American health care clinical delivery system, I did not learn much new from the New York Times article: The $2.7 Trillion Medical Bill. I did find the article’s approach useful in explaining how the wide variations in price for procedures contribute to the unnecessary high cost of American health care.

Although the article did document many procedures …

What if doctors worked for free?

Hans Duvefelt, MD

Health Policy

June 15, 2013

Today I am going to write about how the US could save up to 10% on its healthcare bill.

The US spends more on health care than any other nation, $8,500 per person per year. Multiply that by 300 million people and try to grasp the vast sum of $2,5 trillion.

A lot of changes are taking place with the intent to save healthcare dollars. So far, many of those changes have …

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What if doctors worked for free?

A more realistic approach to achieving accountable care

Sreedhar Potarazu, MD, MBA

Health Policy

June 15, 2013

Hospitals that are already struggling financially to stay afloat face significant challenges in the coming months and years under some of the provisions of Obamacare.

Under the Affordable Care Act’s Hospital Readmissions Reduction Program, hospitals that readmit certain patients within 30 days of discharge could face significant penalties.

The question is whether hospitals really have that much control over factors leading to readmission and whether they are really at fault.

Some readmissions are …

Quality, cost, and value in health care: How to solve the puzzle

Robert Wachter, MD

Health Policy

June 14, 2013

I sometimes explain to medical students that they are entering a profession being transformed, like coal to diamonds, under the pressure of a new mandate.

“The world is going to push us, relentlessly and without mercy, to deliver the highest quality, safest, most satisfying care at the lowest cost,” I’ll say gravely, trying to get their attention.

“What exactly were you trying to do before?” some have asked, in that wonderful way …

The dual narratives that define health reform

Wes Fisher, MD

Health Policy

June 10, 2013

Doctors are trying to rationalize our current story line: the loss of autonomy and pay cuts are a necessary evil for the greater good. We’re taking one for the excess-health care cost team. We’re willing to take this personal sacrifice for our fellow man and woman. It is the noble thing to do. It will be good for America’s healthcare system if we do our part, work harder …

How the Oregon Medicaid experiment is a failure

Thomas Santo, MD

Health Policy

June 8, 2013

T.Santo - Oregon Medicaid (media)

An important article was recently published in the New England Journal of Medicine, titled The Oregon Experiment — Effects of Medicaid on Clinical Outcomes. This study provides a rare look at the effects of expanding Medicaid coverage (specifically, Oregon Health Plan, Oregon’s version of Medicaid) to a population of previously uninsured patients. Having practiced medicine in Portland, …

Cultivate more upstreamists to transform health care

Rishi Manchanda, MD, MPH

Health Policy

June 6, 2013

An excerpt from The Upstream Doctors: Medical Innovators Track Sickness to Its Source.

There’s a story widely known in public health circles about three friends and a river. I retell it this way:

Three friends approach a wide, beautiful river leading to a waterfall. The idyllic scene is shattered by the cries of a small child in the water, flailing his arms while struggling to stay afloat. He’s fast approaching the …

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Cultivate more upstreamists to transform health care

What should medical students expect from health reform?

Italo M. Brown, MPH

Health Policy

June 5, 2013

In an ad-hoc poll among classmates, I recently inquired about the most important date (in 2013) to a 2nd year medical student. The overwhelming majority cited their respective USMLE Step 1 exam dates as most important, followed closely by the season finales of ABC’s Scandal and Grey’s Anatomy. While the top three responses all are worth their respective weights, the one date that should bear the most gravity in the minds …

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