A guest column by the American College of Physicians, exclusive to KevinMD.com.
Whether we call them “unnecessary,” “not indicated,” “inappropriate,” or “overused,” certain tests and procedures add little or no clinical benefit to patients and in some cases they cause harm. They also contribute to the cost of care without improving care. At a time when payers are challenging payment …
ACP: 5 excuses physicians and patients should question
A collision is coming.
Scratch that.
The collision is here.
I’m not quite sure how to describe this, but I’ll try.
Every day, I look at a computer screen for health care delivery with an increasing number of menu options. I tried counting these menu options once and after scrolling through them, I never reached all of them after counting up to 275 items.
Yes, there are …
Why malpractice reform will happen, whether lawyers like it or not
Rapid change is engulfing health care across the United States, but the strategic responses of organizations to these changes are sharply divided. In the shift that has been broadly shorthanded “from volume to value,” many organizations across the country are deeply engaged in moving toward “value” by building new partnerships, affiliations, capacities and economic structures, striving to bring better health and health care to more people for less money.
At the …
Is a winning health reform strategy best for patients?
These should be the best of times for the patient safety movement. After all, it was concerns over medical mistakes that launched the transformation of our delivery and payment models, from one focused on volume to one that rewards performance. The new system (currently a work-in-progress) promises to put skin in the patient safety game as never before.
Yet I’ve never been more worried about the safety movement than I am …
Physician burnout is an obstacle to patient safety
As a physician who is involved in educating medical students, I am often asked for career advice. Medical students are by nature smart and ask very good questions. “Will I be able to pay of my student loans if I choose primary care?” “Will I have a balanced lifestyle if I decide to go into primary care?”
I try to be both encouraging and realistic. However, far too often I have …
Primary care trends in the health reform era
The weakest aspect to Obamacare is in its cost control strategies, or lack thereof. The predicted savings from converting to electronic medical records (EMR) have failed to materialize. And the Rube Goldberg-esque plan to save money by penalizing hospitals and doctors for having poor HCAHPS scores has reaped its own set of unforeseen complications.
HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) is the Press-Ganey …
How Obamacare penalizes safety net hospitals
Somewhere between the 20th century bank ATM and the 25th century Tricorder, lays the EMR that we should have today. Somewhere between the government-designed meaningful use EMR and the holographic doctor in Star Trek, there should be a long stretch of disposable trial-and-error cycles of technology, changing and morphing from good to better to magical. For this to happen, we must release the EMR from its balls and chains.
We must …
EMRs cannot fix the financial and physical health of the nation
It can be difficult to keep up with the jargon, countless proposals and complicated policies that surround the debate over Medicare reform. Whether you are discussing premium support, changing the eligibility age or Medicare for All, there is one relatively simple concept that patients should make a point to pay attention to – one that directly impacts them – and is the …
Medicare patients should care about the way we pay providers
The electronic medical record (EMR)’s promised contribution to health care cost savings got a second look recently, and the results were poor at best. But what I found interesting was the “second look” was from the same organization that did the first look: the corporately-funded, non-profit think-tank called the RAND Corporation.
From their second and more recent report:
A team of RAND Corporation researchers projected in 2005 that rapid …
When EMR interactions trump patient care
Of the 2.7 trillion dollars that will be spent on health care in these United States in 2012, more than $600 billion will be wasted. Excess testing and procedures, inflated charges, archaic business models, futile end-of-life care and exploding drug costs are some of many reasons. Predicted 25 years ago this crisis has been the focus of extensive academic analysis. It is reasonable to assume that with the primary goal …
Learning about costs: A gross failure in medical education
Over the past decade, there has been yet another debate about whether pay-for-performance, the notion that the amount you get paid is tied to some measure of how you perform, “works” or not. It’s a silly debate, with proponents pointing to the logic that “you get what you pay for” and critics arguing that the evidence is not very encouraging. Both sides …
One way to think correctly about P4P programs
California doesn’t have enough doctors to provide healthcare to newly insured patients.
California state senator Ed Hernandez asks, “What good is it if they [state citizens] are going to have a health insurance card but no access to doctors?”
Wait. Health care insurance doesn’t mean that patients will have access to health care? Where have I heard that being said for more than 3 years?
The government is going to …
Providers who want the authority of doctors: Let them have it
An excerpt from Pet Goats and Pap Smears.
My dad is eighty-eight years old. He finally retired from medicine at eighty-six. I call to check on him. “What are you up to, Dad?”
“I just returned from synagogue a few hours ago. Right now I’m catching up on my reading. I’m finishing up the fiftieth anniversary issue of Medical Economics.
That’s Dad living it up on a Saturday night.
“It …
The solo family doc isn’t extinct: I’m proof of that
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A response to The creative destruction of the American family physician.
Dr. Brooks’ column shines a bright light on the misconception that some subspecialists have about the core of primary medical care and family medicine. As a former nurse practitioner and current family physician, I’d like to point out the flaws of his argument.
At a time when the health care community is working to end the fragmentation, duplication and gross …
Destroying the family physician: An AAFP member responds
From 1974 to 1982, a group of researchers conducted the RAND Health Insurance Experiment. In lay terms, what they did was assign people to different levels of insurance coverage, with a particular focus on the amount of co-payments, co-insurance, and deductibles that people had to pay, and then they observed their use of the health care system. As you might expect, those who had to pay more out of their …
Expanding Medicaid and cost sharing: A recipe for disaster?
Over the past several months, the state of Oregon has been pursuing an aggressive approach to solving the healthcare crisis that many states are dealing with.
A couple of years ago Oregon was facing a $2 billion deficit in their Medicaid program, with few solutions to repair the situation. The governor was reluctant to take the obvious step of cutting doctors’ pay for …
Look to Oregon to see if Obamacare will succeed
When I was in medical school in the 1990s, students were given a bleak picture of the life of a subspecialist. We were told that there would be few job opportunities and that the only way to ensure a job was to pursue a career in primary care. Many of my classmates did go into primary care but the majority of us accepted residency positions in surgery, neurosurgery and other …
Medical education: Reform the investment of tuition and time
Consumerism in health care is coming to mean patients must shop around for the best price — for a doctor’s visit, Cipro, health insurance and maybe even your next operation. The marketplace gurus are telling us we can buy health care like TV sets and search for the lowest price tag.
But can you really choose a place for surgery based on the …
Can you really choose a hospital based on the best price?
Should marijuana be legal, for either medical or recreational use? I think the best initial answer to this is: It’s a crummy question! We are good at those.
It’s a crummy question, because it calls for answers based on unsubstantiated opinion. Answering it does not invoke or even encourage any relevant evidence, or precedent. So what would a better question be? How about: On what basis should any particular substance be …
The path to data driven public policy: Ask the right questions first
Cleveland and northeast Ohio are not hospitable to private practice medicine. I should know. I’m one of them. Private practice is fading as health care reform suffocates it by design. When this occurs, the public will have lost physicians who, in my view, have practiced patient advocacy and service at a higher level than our employed counterparts.
Keep in mind that the first half of my professional career was spent as …
Reform is suffocating private practice by design
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