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.

National reporting isn’t the answer to reduce medical errors

Kevin R. Campbell, MD

Health Policy

October 21, 2012

Two articles recently addressed medical errors.

In the Wall Street Journal, surgeon Dr. Marty Makary discusses the alarming costs of medical errors and offers suggestions to improve the system. In medicine, particularly during the training years of residency and fellowship, young doctors are not given the opportunity or security to report shortcomings of their superiors.

As discussed in the article, all of us have a memory of a particular surgeon …

Democrats versus Republicans: Two different approaches to Medicare

Stephen C. Schimpff, MD

Health Policy

October 21, 2012

The two party’s approaches are quite different. Politicians realize that Medicare will not be able to continue on its current track. Something has to change since the country will simply not be able to afford the inexorable growth and expenditures. But politicians do not like to take away entitlements so proposals generally are couched in vague terms and often with positions that are unrealistic.

The Democrats’ plans are contained generally in …

Why upcoding isn’t necessarily fraud

Juliet K. Mavromatis, MD

Physician

October 19, 2012

Over the past several decades medical costs in the United States have escalated rapidly, exceeding the pace of inflation and threatening bankrupt to Medicare. As we heard in last week’s presidential debate, different solutions have been proposed on how to slow Medicare’s growth and reduce cost. President Obama highlighted his administration’s success in tackling fraud and waste within the system. This strategy appears to be supported across party lines. On …

Read more…

Why upcoding isn’t necessarily fraud

Having our own doctor treat us in the hospital is a thing of the past

John Schumann, MD

Physician

October 19, 2012

Health care reform is a locomotive barreling down America’s tracks. In two years, the Affordable Care Act (ACA) will cover some 30 out of 50 million of us that currently lack health insurance. Political beliefs aside, it would seem that supplying insurance to protect the health of more people is a societal good. Though the costs of reform will be debated for years to come, one major question remains that …

Why clinical decision making in psychiatry is difficult

Julia Frank, MD

Medications

October 17, 2012

“All psychiatrists do is push drugs!”

I have heard this repeatedly, from students, wary patients, even family members who don’t pick up on a carefully worded hint that they just might benefit from getting help. For some reason, no one makes the same complaint about infectious disease specialists, or oncologists, though I wager that the success rates of our drug treatments are roughly equivalent.

As a psychiatrist, I try to treat people …

AMA: Prescription for the future of medicine

Jeremy Lazarus, MD

Health Policy

October 17, 2012

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

As our nation’s health care system undergoes historic reforms, the American Medical Association (AMA) has embarked on a long-term strategic plan that seeks a better future for medicine – both for the physicians who make it their profession and the patients who count on us for care. Our focus is …

Will Medicare as we know it persist or will it change?

Stephen C. Schimpff, MD

Health Policy

October 16, 2012

Since the nomination of Congressman Paul Ryan as the vice presidential candidate of the Republican Party, Medicare has become front and center in the political discussions. To understand the dialogue requires an understanding of Medicare, how it works, where the money comes from, how it is spent and why there is such concern for its future costs. Here is an overview.

Medicare was designed in 1965 to serve as “major medical” …

Doctors need to be part of the digital revolution

Margaret Polaneczky, MD

Physician

October 15, 2012

There’s a big discussion going on in the health tech community about a controversial keynote speech given by Vinod Khosla at the Health Innovation Summit (HIS), in which he stated that 80% of what doctors do could be replaced by machines.

If you’re a doc like me who has no idea who the heck Vinod Khosla is (he’s a venture capitalist and co-founder of Sun Microsystems), why he’d be a keynote speaker at a …

Reduce health waste through deregulation and free market principles

WhiteCoat, MD

Health Policy

October 14, 2012

Emergency Physicians Monthly has an important debate between ACEP President David Seaberg and EP Monthly founder Mark Plaster about the “Choosing Wisely” program.

Choosing Wisely is being pushed by the ABIM Foundation as a way to get specialty societies to label certain tests as “unnecessary” or of questionable benefit.

I side with Dr. Seaberg in this argument.

I disagree with the concept some people advance …

What Republicans and Democrats can agree on about Medicare

Bob Doherty

Health Policy

October 12, 2012

Republicans and Democrats don’t agree on much about Medicare, except for getting rid of the fee-for-service system for paying doctors.

“If reducing the growth of Medicare spending to sustainable rates and moving away from fee-for-service are ‘ending Medicare as we know it,’ then both parties have embraced that goal, writes former OMB Budget Director Alice Rivlin in a Daily Beast commentary.

“Paying providers on a fee-for-service basis offers incentives to …

Why hospital pricing practices concern me

Peter Ubel, MD

Health Policy

October 12, 2012

The gynecologist made several incisions and inserted the laparoscope. With the help of her surgical team of nurses, students and anesthesiologists, she removed the patient’s uterus, which had been bleeding uncontrollably for the past six months despite aggressive medical therapy. The price tag of the procedure? Around $6,000.

Meanwhile in a nearby hospital, another gynecologist removes another woman’s uterus, in a procedure no more complicated or time consuming than the first …

A patient is not a dish off the menu

Zackary Berger, MD, PhD

Health Policy

October 12, 2012

Atul Gawande, MD, is a technophile and a believer in the checklist, and he yokes these ideologies to an attractive metaphor in his newest essay for the New Yorker. The article is worth reading in its entirety, but it can be easily paraphrased.

The Cheescake Factory, like other successful restaurant chains, has “brought chain production to complicated sit-down meals.” They’ve done it by far-reaching standardization of the best possible …

Read more…

A patient is not a dish off the menu

Stop setting hospital benchmarks at the state average

Ashish Jha, MD, MPH

Health Policy

October 12, 2012

Recently, I discovered the statewide report on quality of stroke care in Massachusetts. It’s a plain document, mostly in black and white, much of what you might expect from a state government report. Yet, this 4-page document is a reminder of how we have come to accept mediocrity as the standard in our healthcare delivery system.

The report is about 1,082 men and women in Massachusetts unfortunate enough to have a stroke …

Align employers with doctors, hospitals and insurance companies

Manoj Jain, MD, MPH

Health Policy

October 11, 2012

I once thought that only the federal government in Washington could effect changes that would impact the cost of health care in the United States, especially with so much attention on the recent Supreme Court decision on the 2010 health care reform law. But now I think differently.

Now I believe that emboldened employers in places like Memphis can use their clout. They can influence insurers and work directly with doctors …

Reform needs more than expanding health care coverage

Steve Balt, MD

Physician

October 10, 2012

Whatever your opinion of the Affordable Care Act, you must admit that it’s good to see the American public talk about reducing health care costs, offering more efficient delivery systems, and expanding health care services to more of our nation’s people. There’s no easy (or cheap) way to provide health care to all Americans, particularly with the inefficiencies and absurdities that characterize our current health care …

The cost of health care is different from its price

Jessie Gruman, PhD

Health Policy

October 8, 2012

“Health care costs are sky-rocketing!”

“The percentage of the U.S. GDP devoted to heath care costs is the highest in the world.”

“The cost of Medicare is unsustainable.”

For most of us, the cost of health care (i.e., the dollars required by the system to produce and deliver care) isn’t what brings us the most anxiety.

It’s when we’re patients or helping a loved one find care that so many of us are deeply …

How America’s healthcare system will keep you sick

Natasha Deonarain, MD, MBA

Physician

October 7, 2012

Have you ever worried about how you’re going to get healthy these days? Has your doctor recommended diet and exercise? Well, if you’re like millions who are struggling to find health, you’re going to need a lot more than just diet and exercise. You’re going to have to fight like crazy against a mind-set of disease that’s paradoxically disguised as health care.

America’s healthcare system – health insurance companies, government health …

Why health insurance is the problem and not the solution

David Mokotoff, MD

Health Policy

October 6, 2012

Recently a neighbor backed into my car while I was leaving a food store. The damage was minimal, but she offered to have her insurance company pay for the repair. After contacting the company, I was offered several body shops, and chose the one closest to my home. The work was completed in only two days, and while it was in the shop, I decided to also have some dents …

The AAFP picks a fight with nurse practitioners

Brian Klepper, PhD

Health Policy

October 5, 2012

The American Academy of Family Physicians (AAFP) recently issued a new report describing its vision of primary care’s future. Not surprisingly, the report talks about medical homes, with patient-centered, team-based care.

More surprisingly, though, it makes a point to insist that physicians, not nurse practitioners, should lead primary care practices. The important questions are whether nurse practitioners are qualified to independently …

Are Medicare vouchers a good idea for patients and their physicians?

Bob Doherty

Health Policy

October 4, 2012

Trying to figure out whether Medicare vouchers are a good idea for patients and their physicians? Then consider these two basic questions:

1. How much will the federal government contribute?
2. Who is at risk for health care cost increases?

How much will the government contribute? The traditional Medicare program has no set limit on how much the federal government will contribute to a beneficiary’s health care, although there are limits on how …

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