Health policy and public health

4,357 articles · Since 2004

Articles, page 123

For patients, reforming the RUC matters

August 6, 2013Aug 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…

“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

Health policy

Limiting your choice of doctors: Is Obamacare to blame?

Trudy Lieberman

August 6, 2013Aug 6, 201310

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 …

Physician voices

Technologists versus doctors: Who wins?

Robert Pearl, MD

August 5, 2013Aug 5, 20138

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…

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?

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Health policy

Our patients pay for dumbed down American medicine

Jordan Grumet, MD

August 4, 2013Aug 4, 201370

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…

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 …

Health policy

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

American College of Physicians & Yul Ejnes, MD

August 3, 2013Aug 3, 201319

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 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 that’s close enough. I just completed my first year …

Health policy

What Detroit’s bankruptcy means for patients

Birju Rao

August 3, 2013Aug 3, 20137

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…

Detroit is dying.

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

Health policy

Are doctors ethically obligated to sign patients up for Obamacare?

Bob Doherty

August 2, 2013Aug 2, 201360

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 …

Health technology

How the government has spurred the adoption health care technology

David Lee Scher, MD

July 31, 2013Jul 31, 201312

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…

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

Health policy

Break the cycle of event centered care

Fred N. Pelzman, MD

July 28, 2013Jul 28, 20136

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…

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

Health policy

Turning health care into a giant used car lot

Naomi Freundlich

July 28, 2013Jul 28, 201313

I’m not a big fan of bargaining and my half-hearted attempts to get a better price for a used car, garage sale find or contractor’s service have been mostly unsuccessful. There’s always that nagging feeling that the seller is laughing…

And so it has come as somewhat of a shock to me that medical care has become …

Health policy

How to aggressively pursue population health

David B. Nash, MD, MBA

July 27, 2013Jul 27, 20139

A good recipe is one that combines high-quality ingredients in appropriate quantities to produce a savory main course or a decadent dessert. It strikes me that, in order to answer the Affordable Care Act's call for us to aggressively pursue…

A good recipe is one that combines high-quality ingredients in appropriate quantities to produce a savory main course or a decadent dessert.

It strikes me that, in order to answer the Affordable Care Act’s call for us to aggressively pursue population health, we must first understand what the recipe calls for.

Dichotomous as it may seem, the primary ingredient for population health is accurate, comprehensive data on the individuals who comprise the …

Health policy

Reform creates new incentives in health care

Kohar Jones, MD

July 24, 2013Jul 24, 201316

I advocated for the Affordable Care Act, and celebrated when it was passed. It’s good to have everyone covered, I thought. Insurance for everyone is the first step to health care for all. Alas, access to health insurance isn’t the…

I advocated for the Affordable Care Act, and celebrated when it was passed.

It’s good to have everyone covered, I thought.

Insurance for everyone is the first step to health care for all.

Alas, access to health insurance isn’t the same as access to health care.

First there is the niggling detail of providers. We already have a primary care provider shortage. Internists, pediatricians, family physicians are already working at full capacity in caring for …

Health policy

Are Cadillac plans responsible for rising health costs?

Chris Rangel, MD

July 23, 2013Jul 23, 201318

If there’s anything that liberals hate it’s inequality – unless it’s the Federal tax code – and health care is a prime offender. The liberal mantra is that everyone should have the same access to basic health care. But this doesn’t just involve improving health care access and affordability for millions of uninsured Americans. It also involves limiting or impairing (through taxes) those health care plans liberals have decided are …

Health policy

Navigating the shopping troubles with insurance exchanges

Trudy Lieberman

July 23, 2013Jul 23, 20132

One could easily make a case that health care is today’s biggest consumer problem—not unlike those that sparked the consumer movement of the 1960s and 70s. Back then, consumer issues centered on problems with using credit, buying cars and home improvement services, and obtaining the best price for food, appliances, and just about every other new-fangled and expensive product that sprang from the post-war economy.

Like many old consumer problems, health …

Health policy

Why Obamacare is a marketing fail

Toni Brayer, MD

July 22, 2013Jul 22, 20136

The massive confusion about Obamacare (the Affordable Care Act) is much worse than I thought. The Kaiser Family Foundation came out with a poll that shows 42% of Americans don't even know that Obamacare is the law. Seven percent of…

The massive confusion about Obamacare (the Affordable Care Act) is much worse than I thought. The Kaiser Family Foundation came out with a poll that shows 42% of Americans don’t even know that Obamacare is the law. Seven percent of people think the Supreme Court struck it down and 12% think Congress repealed it.

I understand that there is confusion about the way it will work and who will be affected. …

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Why Obamacare is a marketing fail

Health policy

Is the hospital readmission rate a measure of quality?

Brad Wright, PhD

July 20, 2013Jul 20, 201312

Unplanned readmissions to the hospital have been the focus of much attention in recent years for obvious reasons. First, they are relatively easy to measure using administrative claims data. Second, like all inpatient hospitalizations, they cost a lot of money–and are therefore a target for reducing spending. Third, they are a proxy for quality of care, as at least some portion of them are likely avoidable if the hospital does …

Physician voices

Confessions of a recovering doctor

Rob Lamberts, MD

July 18, 2013Jul 18, 201312

Hi. I’m Rob and I am a recovering doctor. Yeah, I am recovering ... doing a lot better, actually. Things are tough, but they are a lot better since I left my destructive relationship with Medicare, Medicaid, and insurance companies.…

Hi.

I’m Rob and I am a recovering doctor. Yeah, I am recovering … doing a lot better, actually. Things are tough, but they are a lot better since I left my destructive relationship with Medicare, Medicaid, and insurance companies. I’ve had to learn how to manage my own money (now that I can’t count on them to bail me out any more), but things are looking a lot better. I …

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Confessions of a recovering doctor

Physician voices

How big data is affecting medical judgment

Wes Fisher, MD

July 17, 2013Jul 17, 20133

Decisions in medicine are supposed to rest on concrete observations and hard evidence. Often, hard evidence does not exist or when it does, it isn't used. Why is this? Concrete observations, too, are increasingly missed as we stare at computer…

Decisions in medicine are supposed to rest on concrete observations and hard evidence.

Often, hard evidence does not exist or when it does, it isn’t used. Why is this?

Concrete observations, too, are increasingly missed as we stare at computer screens longer and patients less. Yet we persist. Why?

This is our reality now, our evolving medical world.

But if we stop and think about it, medicine, by definition, is a world of technological …

Health policy

Protecting us from the terrors of unhealthy lifestyles

Margalit Gur-Arie

July 16, 2013Jul 16, 201315

If a mosquito lands on someone’s head and you hit the mosquito with a shovel, is the death of the guy under the mosquito considered an unintended consequence? So now we know that the government of the United States of…

If a mosquito lands on someone’s head and you hit the mosquito with a shovel, is the death of the guy under the mosquito considered an unintended consequence?

So now we know that the government of the United States of America is spying on its own citizens, not specifically on any one in particular, but massively and indiscriminately collecting troves of data on all American people. All perfectly legal, …

Health policy

Health care price transparency should receive bipartisan support

Bob Doherty

July 12, 2013Jul 12, 20133

Most Republicans hate Obamacare for what they consider to be government over-reach, most Democrats support it because they believe only a strong policy of government intervention can extend coverage to the millions of uninsured—and there are no signs that their ideological battle will abate anytime soon. But there may be one sweet spot that both parties could agree on: providing consumers (or patients, if you prefer) information on the prices …

Health policy and public health

Articles, page 123

Real physician voices, twice a week

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