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.

Why patients should pay doctors directly

Stephen C. Schimpff, MD

Health Policy

November 25, 2012

There are distinct advantages for the patient who pays the primary care physician (PCP) directly: higher quality, lower cost and greater satisfaction.

The fundamental problem in health care delivery today is a payment system that is highly dysfunctional leading to higher costs, lesser quality and reduced satisfaction. The core problem? The patient is no one’s customer. With employer-based insurance, the physician’s customer is the insurance company that sets the rates, defines the rules and accepts …

Society must come to a conclusion on how important human suffering is

Pinak S. Joshi

Physician

November 23, 2012

The art and practice of medicine is built around lessening the suffering of our fellow man. The method of doing this however, has changed dramatically throughout human history. Western medicine had its beginnings in the restoring balance to the body that was not in sync with the environment. As scientific reasoning found its way into medical practice after the dark ages, the benefits of medicine quickly became a cornerstone of …

A spectrum of medical talent to solve the primary care shortage

Anthony Brenneman, PA-C

Physician

November 23, 2012

We’ve all seen the data projecting a shortage of physicians in the United States, expected to reach a shortfall of more than 90,000 by 2020. The lack of nurses is equally well documented. These trends raise concern for all medical specialties, but especially for primary care.

More and more Americans are expected to need these services in the coming years, at a time when fewer and fewer students are committing to …

Why the VCs aren’t the bad guys

Halle Tecco and Malay Gandhi

Health Technology

November 23, 2012

Venture capitalists (VCs) … are a combination of professional gamblers and loan sharks. The secret to success is pure luck and ruthlessness, and when the combination works and the ball lands on the exact number on the spinning roulette, venture capitalists make lots of money.
-Margalit Gur-Arie, via KevinMD.com

The tone of this article, Why venture capitalists shouldn’t try to solve health care, exemplifies what is wrong with healthcare. In …

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Why the VCs aren’t the bad guys

How physician executives will drive value for hospitals

Michael N. Sills, MD and James Merritt

Physician

November 22, 2012

“Value” is the pot of gold at the end of the rainbow that health care professionals everywhere are seeking, but which few can seem to find.

Policy makers, hospital executives, physicians, consultants – all are looking for a means to pivot away from a system that rewards volume of services provided to one that rewards quality and cost effectiveness (i.e., “value”).

How far we are from achieving this goal can be gauged …

The new standard of an exceptional physician

Wes Fisher, MD

Physician

November 20, 2012

There are so many changes in medicine these days, but it takes a bit of time away from the keyboard to appreciate them.

So glued have I become to looking at computer screens, it’s been hard to pull my head from them any more. Doctors lives are spent staring at these damn screens now. I wonder how many of my youngest colleagues know how to start an IV, a foley, place a central …

The futile attempt to provide cheaper care to poor people

Margalit Gur-Arie

Health Policy

November 20, 2012

Wherever health care reformation and transformation is discussed, sooner or later the imperative of patient engagement is sure to materialize. Patients, it seems, are no longer content to be passive spectators while care is administered to them, and instead are demanding to be active participants in their own health care decisions. Gone are the paternalistic days of doctor knows best, replaced by informed and educated patients on an equal footing …

Physicians need to be more cost aware

Lauren Demosthenes, MD

Physician

November 15, 2012

I had lunch with my old college roommate last week. She’s a new grandmother and was telling me about her daughter who lives in another state. Her daughter is self pay because she and her husband own a restaurant and have opted out of insurance due to the cost. She received her hospital bill in the mail and she was surprised at the cost of some of the items. As …

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Physicians need to be more cost aware

A new organizational structure is coming in health care

Brian Klepper, PhD

Health Policy

November 15, 2012

At our first meeting years ago, Tom Emerick, Walmart’s then VP of Global Benefits, told me, “No industry can grow continuously at a multiple of general inflation. It will eventually become so expensive that purchasers will simply abandon it.”

He said it casually, as though it was obvious and indisputable.

Health care is playing out this way. From 1999 to 2011, health care premium inflation grew steadily at 4 times the general inflation rate. During …

Inappropriate care requests: The role of health care professionals

Yul Ejnes, MD

Physician

November 15, 2012

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

How to reduce the cost of medical care while improving quality is the focus of several initiatives, including the American College of Physicians’ High Value Care initiative, the ABIM Foundation’s Choosing Wisely campaign, and Consumer Reports’ Consumer Health Choices.

The common message is that we …

A Medicare payment system focused on quality

Jeremy Lazarus, MD

Health Policy

November 15, 2012

A guest column by the American Medical Association, exclusive to KevinMD.com.

Every physician caring for Medicare patients knows that the current payment system isn’t working. Most seniors know it too. For much of the last decade, patients and physicians have joined together to tell their elected officials that the system is broken. The response from members of Congress has been to …

Using the F-word when it comes to EHRs

Richard Patterson, MD

Health Technology

November 14, 2012

Not long ago, Secretary of Health and Human Services Sibelius and US Attorney General Holder issued a stern warning to healthcare providers who are using electronic health records (EHRs). The federal officers maintain there has been an alarming increase in the charges to Medicare in institutions where EHRs have been implemented, and they warn that those behaviors will be treated as “fraud,” an illegal gaming of the system to increase …

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Using the F-word when it comes to EHRs

Does Medicare provide too many choices for seniors?

Trudy Lieberman

Health Policy

November 13, 2012

Seniors need more Medicare choices, or do they? The answer depends, of course, on who’s doing the asking.

Republicans and others advocating a voucher plan for Medicare invoke the choice argument as the rationale for transforming Medicare from social insurance provided by the government to privatized arrangements between individuals and the marketplace. Under a voucher system, the government would give seniors and people who are disabled a fixed amount of money …

In the battle of life, a joy that only the ferocious can comprehend

Edwin Leap, MD

Physician

November 12, 2012

I recently treated two young men, both injured in the same football game. On the way out, one passed the other in the hall, injuries treated and dressed. “See you next game!” they said. They laughed and looked forward to the struggle.

My wife and I have tried to raise our kids that way. To enjoy life, to move through difficulty and injury. They suffer from having a physician father, so …

What Instagram and Kodak have to do with health reform

Rob Lamberts, MD

Health Policy

November 12, 2012

I grew up in Rochester, NY. Statistically, this means that I probably had a family member who worked at Eastman Kodak, as the company employed over 62,000 people in Rochester at its peak. I did, in fact, have two: my father and my brother-in-law. My brother and I both worked there during two fun and profitable summers of our college years in the delightful “roll coating” division. It actually paid …

Take advantage of the vision of primary care physicians

William Rawlings, MD

Health Policy

November 10, 2012

In the ancient and oft-told story of the blind men and the elephant, several sightless men seek to learn the nature of the great beast, none of them familiar with it prior to the encounter. One, who feels the trunk, describes the elephant as powerful and snake-like. Another who examines one of the mighty legs, opines that the animal is like a great tree. Still another, having first touched a …

2 C-words that explain the rising cost of health

Timothy Johnson, MD, MPH

Health Policy

November 10, 2012

Having established that the U.S. spends twice as much per person on healthcare as the average per person cost in all other developed countries – but with no better overall results – it is time to ask how this happens.

Obviously, there are many factors contributing to this dangerous cost escalation, but in my mind two stand out.

The first is our unrealistic expectations as American healthcare consumers. Here are a bunch …

Doctors can play a major role to reduce waste

Manoj Jain, MD, MPH

Health Policy

November 9, 2012

Thirty percent of health care spending — amounting to $750 billion a year — is wasted, according to a recent report by the Institute of Medicine.

I know. As a doctor, I am party to this waste, and I think doctors can play a major role in recovering it.

In a private conversation, a cardiologist tells me about his partners — “loose guns” he calls them. “At the hint of chest pain …

Is it really fair to penalize hospitals for readmissions?

Skeptical Scalpel, MD

Physician

November 8, 2012

As new Medicare rules kick in, some 2,200 hospitals nationwide are facing financial penalties for high 30-day readmission rates for myocardial infarction, congestive heart failure and pneumonia. Medicare payments will be lowered by as much as 1%.

Investigators at the Skeptical Scalpel Institute for Evidence-Based Outcomes and Advanced Research (SSIEBOAR, catchy acronym, don’t you think?) have come up with a plan that is certain to lower readmission rates across the board. …

The volume of low acuity patients in the ER is not a myth

Shadowfax, MD

Physician

November 8, 2012

I had an interesting twitter chat the other day with one of my colleagues, a young ER grad studying healthcare policy by the name of Seth Trueger. The Twitter conversation wound up involving about a dozen ER docs and nurses. You can review an edited summary over at Storify.

The point in contention is an interesting one: we know the nation’s ERs are overwhelmed and overcrowded. That’s old news. We also …