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.

Can the airline industry teach customer service lessons to medicine?

Michael Kirsch, MD

Physician

October 3, 2012

“Your call is important to us. Please listen carefully because our options have changed.”

During your current or any prior lifetime, has any phone menu option ever changed?

I have more than once experienced an option not offered on the robotic phone menu option choices – a dead phone line after a 30 minute wait.

Have you tried this customer plea as I have? Could you pretty-please jot down my cell phone number in …

To fix health care, we need to be screwed

Peter Ubel, MD

Health Policy

October 3, 2012

“We need to be screwed!”

Not altogether surprising words to spill out of a college student’s mouth. But this particular student was not talking about sex. She was discussing the U.S. healthcare system—more specifically what she thought it would take for our two political parties to come together to find a reasonable way to control our nation’s healthcare costs.

It was the last day of the semester, the last class discussion in …

How the surplus of patients will impact primary care

Dike Drummond, MD

Health Policy

October 2, 2012

I believe the projected shortage of physicians caused by the Affordable Care Act will drive primary care into two opposite tracks. Each is a distinct and logical response to the patient overload and each points out gaping holes in our medical education that must be addressed.

The Association of American Medical Colleges estimates that there will be a shortage of 63,000 doctors by 2015 and 130,600 by 2025 in the wake …

What happens if Medicaid expansion is undermined

Erin Marcus, MD

Health Policy

October 1, 2012

He was a “frequent flyer” — a patient with multiple health problems who gets admitted to the hospital repeatedly. It was usually because he hadn’t taken his medicine correctly, if at all. When he left the hospital 10 days earlier, he told his physician that he wouldn’t have problems filling his prescriptions, because he had Medicaid. But when he arrived at his local drug store, it wasn’t so easy.

“I was …

The Accountable Care Organization: Think opportunity, not threat

Charles Kennedy, MD

Health Policy

September 30, 2012

Accountable care is here – both as a way of doing business and an approach to providing high quality health care. With accountable care, the potential for reducing overall health care costs, realigning incentives and focusing clinical resources on prevention and disease management is now a real opportunity. Physicians who aren’t ready to transition their practices to operate in a manner required under accountable care models will increasingly find themselves …

Why is there a primary care shortage?

John Schumann, MD

Health Policy

September 28, 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, provided neither the Supreme Court nor a new president overturns the law. 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 …

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Why is there a primary care shortage?

Are insurance companies responsible for increasing health costs?

Stephen C. Schimpff, MD

Health Policy

September 28, 2012

The insurance system for healthcare is perverse. The individual is not the customer of the healthcare company; in most cases it is the employer or the government (i.e., Medicare, Medicaid). They physician works for the insurer who determines for what and for how much the doctor is paid. But are the insurance companies the blame that is often placed on them for our current state of affairs?

This system abrogates the …

Can the AMA be fixed?

George Lundberg, MD

Physician

September 27, 2012

There is nothing more powerful than an idea whose time has come. There is nothing less powerful than an idea whose time has come and gone.

In 1846, and for more than 100 years after that, the American Medical Association as a nationwide organization for all physicians was a powerful idea whose time had come. It worked well for many things and OK for many more.

Then, in the 1970s, 80s, 90s, …

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Can the AMA be fixed?

Both sides are spewing nonsense when they talk Medicare

Bob Doherty

Health Policy

September 19, 2012

Medicare has suddenly become a centerpiece issue in the 2012 election—but not in a good way. Instead of an informed debate about Medicare’s present and future place in our health care system, the politicians have subjected us to a daily assault of nonsense over substance:

Let’s start with the nonsense accusation by Governor Romney that “There’s only one president that I know of in history that robbed Medicare, $716 billion to …

Physicians need to embrace change to fix health care

Eugene Spiritus, MD

Health Policy

September 18, 2012

Several interesting facts crossed my computer screen recently. The first was a Tweet by American Medical News that the first CT scan was performed on August 25th 1973. The second focused on the large number of practicing physicians who suffer from burnout, and the third was an article, which cited a talk given by Vinod Khosia in which he is quoted as saying “80 percent of doctors could …

What can we learn about health care from Europe?

John Mandrola, MD

Health Policy

September 18, 2012

May I tiptoe onto a ledge for a moment?

Some (just-back-from-Europe) thoughts on health care policy, perhaps?

One of the many differences between the European Society of Cardiology (ESC) Congress and a typical American cardiology meeting was the scarcity of healthcare policy sessions at the ESC. That’s hard to explain; perhaps European countries are settled on their own systems and do not wish to — or can’t — influence their neighbors.

It goes …

My wish list for a perfect ACO

Keegan Duchicela, MD

Health Policy

September 16, 2012

If you believe what most people are saying about health care reform and future practice models, you or your physician, will soon be part of an accountable care organization (ACO).

Health policy experts tell us that as physicians, we’ll be embarking on a wonderful journey that bears no resemblance to the HMO/managed care heyday of the early 1990s. Of course, there’ll be similarities, like limited networks, top down implementation of health protocols, and …

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My wish list for a perfect ACO

No politician has to deal directly with Granny, but I do

Wes Fisher, MD

Health Policy

September 14, 2012

It’s impossible to watch the news these days. Whether you’re conservative, liberal, independent or non-committed, it’s impossible to avoid the political bickering these days as the US Presidential campaign enters its final countdown. As a physician, seeing the video of Granny being pushed off a cliff is about all I can handle.

Seriously?

No politician I know has to deal directly with Granny, but I do. I have to …

Practices are getting larger to provide micropractice service

Lucy Hornstein, MD

Physician

September 13, 2012

Medicine has gone down Alice in Wonderland’s rabbit hole. Looking at the size of practices today, it seems like some of them have taken red pills and the rest have taken blue ones: most of them are getting bigger and bigger and bigger, while some are getting smaller and smaller. As the giant practices gobble up their competition to become ever more gargantuan, others are shrinking down into micropractices.

Everyone has …

AMA: Cuts to physicians who treat Medicare patients hurt jobs, patient access and Medicare modernization

Jeremy Lazarus, MD

Health Policy

September 13, 2012

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

Physicians contribute significantly to both the health of our patients and the economic health of our nation, and a new report shows that the 2 percent Medicare spending sequestration cut will put the jobs supported by the health care industry in jeopardy.

The AMA recently teamed up with the American Hospital …

Matching Medicaid payments to Medicare: From pitiful to pathetic

Rob Lamberts, MD

Health Policy

September 13, 2012

“The specialist rescheduled me again,” the patient told me, looking embarrassed. ”I think he doesn’t want to see me any more.”

“I’m sure that it isn’t that he doesn’t want to see you,” I replied. ”This has to be a miscommunication with the front desk. It happens all the time; it drives doctors crazy.”

“I don’t know,” he continued. ”I just got on Medicare, and I wonder if maybe he doesn’t want …

Care delivery transformation requires an upfront investment

Kyle Bradford Jones, MD

Health Policy

September 12, 2012

When I was traveling around the country interviewing for a residency spot in family medicine in the fall of 2008, I was eager to find a patient-centered medical home (PCMH). At every interview, I asked whether the program’s clinic was a certified PCMH or whether it was moving in that direction. “Well, we don’t yet know what that looks like” was the answer that I heard at nearly every destination. …

The secret sauce of great health care organizations

Robert Allan Bear, MD

Health Policy

September 9, 2012

Greg Smith, formerly of Goldman Sachs, has described a positive organizational culture as being the “secret sauce of greatness.” What is the nature of this secret sauce? A simple, popular definition is that “organizational culture is the way we do things here.”

The relationship between organizational culture and organizational success is unassailable. In our commercial dealings, has not each of us easily recognized when a business culture is truly customer-focused, and …

Did Atul Gawande unwittingly support specialty hospitals?

Jaan Sidorov, MD

Physician

September 6, 2012

If you’re a fan of star surgeon overachiever Atul Gawande, then reading his New Yorker article “Big Med” is a must. The rest of us skeptics should still use the article to signal our health care adroitness by knowingly referring to the “Cheesecake Factory” in our policy medical meetings, conferences, PowerPoints and bloggery.

What he wrote

Dr. Gawande uses the successful restaurant chain to extract lessons and draw health system parallels, ultimately …

How will doctors handle the flood of newly insured patients?

Albert Fuchs, MD

Health Policy

September 5, 2012

If you think health care is expensive now, wait until you see what it costs when it’s free.
-P.J. O’Rourke

I distinctly remember that in first grade I had an idea of breathtaking wisdom and profundity. Candy should be free. You may have had a similar thought at the same age. This idea was supported by an incontrovertible rationale, namely that I really liked candy. Tragically, it only took a moment for …

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