Four years ago, as I was making rounds on the oncology floor, one of my patients with leukemia asked, out of the blue, “Hey, Doc, who you gonna vote for?” He had an Obama T-shirt by his bedside.
Chuckling politely, I asked him why he wanted to know. “I’m curious, Doc,” he said. “It tells me your worldview.” He said that if we agreed on who should be the next president, …
The problem with discussing politics in the exam room
American Medical News featured an article with the disturbing title, “Massive health job losses expected if Medicare sequester prevails.”
I wasn’t entirely sure what a “sequester” was, since I thought it was a verb. Sequestration, I thought, was the noun. (I hear a loud knock. It must be the grammar police.) The story, as I understand it, is that when our government decided to pull together and raise the debt ceiling, …
Why across the board Medicare cuts are a bad idea
What will health insurance cost in 2014?
Will the new health insurance exchanges be ready on time or will the law have to be delayed?
There will be sticker shock
First, get ready for some startling rate increases in the individual and small group health insurance marketplace due to the changes the law dictates.
In a November 2009 report, the CBO estimated that premiums in the individual market would increase 10% to 13% …
The cost of health insurance in 2014: Get ready for sticker shock
Costs and revenue: This is the oxygen of any business, any organization. What are your revenue streams? How much does it cost you to produce them? Life is not just about breathing, but, if you don’t get that in-out equation right, there is nothing else life can be about.
Right now this enormous sector is turning itself inside out. It has turned the “transmogrification” setting to “warp.” Why? It’s all about …
Why cost and revenue will kill independent hospitals
With notably few exceptions, the American health care system has been financed on the basis of volume rather than value. That means that we’ve been paying providers for everything that they do, rather than paying them for the outcomes they produce. This is not common in other fields.
For example, if you are in an accident and have to take your car to a body shop, you (or your insurance company) …
The loopholes around penalizing hospitals for readmissions
Recently, “60 Minutes” (in my view the last bastion of great traditional network news investigative reporting) described a for-profit hospital system that apparently uses percent targets (allegedly 20%) to encourage high admission rates by their ER doctors.
In setting up this report, the reporter commented that as much as 10% of healthcare expenditures in this country were “unnecessary.”
Actually, most health experts I have read and consulted would put that number much …
Medical homes need ready access to good data
A guest column by the American Medical Association, exclusive to KevinMD.com.
When health plans have merged, they’ve said that a bigger insurance company would drive down premiums. The casual acceptance of this economic fallacy led to more than a decade of unchecked megamergers that helped health plans cement dominant market positions across the country.
It’s now clear that when health insurers talk …
AMA: Patients are vulnerable to health plan monopoly power
When you walked into the voting booth on Tuesday, November 6, did you do so with a feeling of calm certainty that the man who would get your vote for President was unquestionably the best choice, or even the only possible choice? Did you feel confident that your candidate’s political party fully supports your political views as well as your personal values?
For many physicians, I suspect that the answer to …
Neither political party truly represents doctors or their patients
A guest column by the American College of Physicians, exclusive to KevinMD.com.
Recently, I was invited to speak at an ACP chapter meeting on the topic of shared vision. In the talk, I used as examples Dr. Martin Luther King Jr., John F. Kennedy, and Steve Jobs, leaders whose visions inspired people and helped them to achieve great things. As I wrote the talk, it occurred to me that …
ACP: Practice transformation is more than checking off boxes
Those who resist health care reform point to America’s great cancer care – instead, we should protect “the best health care system in the world.” After all, if we’re the best, other countries should change, not us.
Do we really have the world’s best cancer care?
A good indication is the American survival rate for breast cancer, the world’s longest. But …
Do we really have the world’s best cancer care?
I recently said I would describe the essential elements of “true reform.” I realize others might add or subtract from my list, but here it is – at least for today:
Payment reform. I put this first because no matter what form or structure healthcare takes, without payment reform it will be doomed to failure. And by “payment reform” I mean switching from the “fee for service” model I discussed in …
4 essential elements of true health reform
The growing concern about reducing the cost of healthcare delivery is the major focus in revamping the U.S. healthcare system.
There have been numerous attempts to better understand the key drivers contributing to rising healthcare costs, yet the ability to successfully control the rising trend has been met with consistent challenges.
A key motivating factor of the Affordable Care Act was to drive …
Price transparency is no longer a luxury, but a necessity
The 2012 Presidential election is over. Obamacare is the law of the land and is certain to remain so. There was tremendous uncertainty not knowing whether the law would be repealed, revised or remain. Many of us opposed the bill, and there certainly are negatives. Like it or not, it is time to “get over it,” and not a second later than now. …
How Obamacare will create a new normal for medicine
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Most modern American are familiar with the classic political novel, Atlas Shrugged. Love or hate it, the novel had a great impact on political thinking in the West. If you haven’t read it, or aren’t familiar, one of the fundamental questions author Ayn Rand asks is this: what if the producers and innovators of society simply stopped trying? What if they …
If Atlas shrugs off healthcare, it will be a dark day
I strolled into our noon-daily resident conference, a little late, my free burrito in hand, and noticed that “cost awareness” was the topic. The conference seemed to have the same format as our other lectures: an attending was presenting a clinical case and asking us what steps we could take to best diagnose and manage the patient. The case seemed straightforward enough—a 65-year-old healthy Caucasian gentleman with right-sided chest pain—and …
Cost should no longer be a dirty word in medicine
I was chatting with someone who asked what I did for a living, and I told him I am a doctor. “The kind that helps people?” he joked.
I knew what he meant. The MD is the practical fixer, the PhD the omphalocentric academic. Many believe in this dichotomy, as false as it is. And such a philosophy underlies the opposition to some elements of the PPACA, aka Obamacare.
There’s a board of …
Does the Independent Payment Advisory Board need physicians?
If you get sick, health insurance should cover all the “stuff” necessary to make you better, right?
While that sounds good in principle, Uncle Sam has made it a lot more complicated than that. As we continue to struggle with health reform, this New England Journal article on “Medicare’s Enduring Struggle to Define Reasonable and Necessary Care” is very timely.
According to Drs. Neumann and Chambers, Medicare has always covered medical services that …
Reasonable and necessary: 2 words Medicare has trouble with
Now that President Obama has won a second term, discussions about healthcare have seemingly disappeared from the public’s radar.
Big mistake – although I do understand the public’s shifting interest in the General’s sex life and, much more serious, the heartbreaking tragedy of the renewed hostilities between Israel and Gaza.
I do expect that healthcare costs will be back on the radar fairly soon as discussions about the fiscal cliff intensify – …
We will soon be heading for a medical cost fiscal cliff
Emergency care providers (emergency physicians and specialists on-call for the ER) are at a significant disadvantage when it comes to trying to get paid fairly for services rendered to enrollees of commercial health plans. Most other health care providers are able to: 1) screen prospective patients to make sure they will get paid appropriately for the care, 2) elect not to care for a plan’s enrollees, or participate in a …
How insurers take advantage of the EMTALA mandate
Recently, a medical student confided in me a thought that few in our profession would dare say aloud: “We may have come to medical school to help people, but we choose our specialty careers based on potential salaries.”
This in part explains why the most-prized residencies are in fields such as dermatology and radiology, whose procedures generate high fees. According to a physician survey by the Medical Group Management Association, the …
Income inequality among physicians should matter to patients
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