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.

Diminishing primary care leads to excessive health spending

Brian Klepper, PhD and Paul Fischer, MD

Health Policy

September 3, 2012

Excessive health care spending is overwhelming America’s economy, but the subtler truth is that this excess has been largely facilitated by subjugating primary care. A wealth of evidence shows that empowered primary care results in better outcomes at lower cost. Other developed nations have heeded this truth. But US payment policy has undervalued primary care while favoring specialists. The result has been spotty health quality, with costs that are double …

Why doctors complain: A history of physician income

Richard Patterson, MD

Physician

September 2, 2012

We’re not going for sympathy here. Doctors as a whole enjoy less sympathy than many other professional groups (members of Congress enjoy the least, I would think), and that’s probably appropriate. They have high incomes and many prerogatives and rank highly in esteem polls as individuals, if not as a group. It’s not where they are that is causing the grieving, it is where they are coming from.

Let’s deal with …

Patient care is not meal preparation

Art Fougner, MD and Kira Geraci-Ciardullo, MD

Physician

September 2, 2012

Dr. Atul Gawande has written a much-ballyhooed essay in the New Yorker, entitled “Big Med.” His piece proposes The Cheesecake Factory as a model for healthcare. For me, a physician, Dr. Gawande’s message left a bad taste in my mouth.

The Cheesecake Factory succeeds because of standardization and efficiencies, with complete control over purchasing and production. What recipes work become menu items throughout the chain. What recipes don’t work are …

Read more…

Patient care is not meal preparation

If you’re not an AMA member, you have no right to complain

George Lundberg, MD

Physician

September 1, 2012

All American physicians should be members of the American Medical Association (AMA). And, while they are at it, they should also be members of their county, state, and principal specialty societies.

Why? Because they are the only games in town, and both security and safety are top Maslow imperatives.

The only real political power any physician has is the individual power of persuasion and participation (or not) and the power of a …

Stop paying McDonald’s wages if you want Cheesecake Factory medicine

Kenneth Lin, MD

Physician

August 30, 2012

In “Big Med,” his latest article on health care in The New Yorker, surgeon-writer Atul Gawande added the Cheesecake Factory to his running list of health care analogies (which have included, among others, farming, pit crews, and airline safety). Observing that the Cheescake Factory and other upscale restaurant chains successfully lower costs and improve quality by “studying what the best people are doing, …

An evidence based assessment of universal coverage

Bob Doherty

Health Policy

August 30, 2012

A staple of conservative critiques of universal coverage is that having health insurance doesn’t equal access. The corollary is that the uninsured already have access to care—from doctors and hospitals willing to take care of them on a charitable basis and from “safety-net” institutions.

This argument isn’t new, having been made years before the Affordable Care Act became law. In 2007, the Council for Affordable Health Insurance opined that universal coverage …

While politicians are fighting, patients are being ignored

Rob Lamberts, MD

Health Policy

August 24, 2012

Us and Them
And after all we’re only ordinary men

The wanna-be congressman appeared with his neat hair and pressed suit, a competent yet compassionate expression on his face. ”The first thing I am going to do when I get to congress is to work to repeal Obamacare,” he said, expression growing subtly angry. ”I will do everything I can to give you back the care you need from those who think big …

What the Romney-Ryan and Obama Medicare plans have in common

Bob Doherty

Health Policy

August 23, 2012

Which of the candidates for President proposes to give people a defined amount of federal money (call it a voucher) to buy coverage from competing qualified private insurers (under federal benefit mandates) offered through a health insurance marketplace run by government?

The answer: Mr. Romney, and his new running mate, Paul Ryan. And President Obama.

How is that, you say? Isn’t the Romney/Ryan vision of how to reform health care diametrically opposed …

Curbing Medicare costs: Are seniors or the government responsible?

Merrill Goozner

Health Policy

August 23, 2012

Medicare has moved to the center of this year’s presidential campaign for a single overriding reason: shrinking the nation’s long-term government deficit demands dealing with health care costs. No one – left, center or right – disagrees with that analysis.

What they also agree on is that limiting health care’s inexorable growth will require cutting future payments to those who deliver care – the doctors and hospitals, the nursing homes and …

Will physicians be caught in the ACO web?

Kerry A. Willis, MD

Health Policy

August 23, 2012

I’m a big fan of the current Direct TV ads. One of my favorites involves a guy who goes to a self-help seminar, becomes overconfident, goes to Las Vegas and loses everything, and has to sell his hair to eat. The ads are all based around the theme of avoiding making mistakes by becoming something that you are not intended to become.

I think there is much for doctors to learn …

Will Obama or Romney save Medicare? And who’s telling the truth?

Robert Laszewski

Health Policy

August 22, 2012

They both are and they both aren’t.

I’ve never seen a week in health care policy like last week. The media reports have to be in the thousands, all trying to make sense of the furious debate between Obama and Romney over Medicare.

As someone who has studied this issue for more than 20 years, it has also been more than exasperating for me to watch each side trade claims and for …

In a financial squeeze, a way forward for academic cardiologists

Wes Fisher, MD

Physician

August 21, 2012

If you want to succeed in academic cardiology, get a federal grant for research.

Better yet: get a few well-paid industry grants, too.

These days lower-paid academic cardiologists are finding it tougher to find protected time for research and speaking because grants are harder to come by and money from their academic center is getting tight. For instance, the National Heart, Lung and Blood Institute (NHLBI) of the NIH no longer accepts investigator-initiated innovative …

What can basketball teach us about health policy?

Andrew Boozary, MD, MPP

Health Policy

August 19, 2012

Basketball imposed my first patient experience in the American health care system. A loose ball and flying elbow saw me to an x-ray machine and a consult with a respected surgeon in New York City. The wait at the hospital was long. CNN blazed through the speakers and the only reading material was a sea of People magazine. For hours, I found myself in a blinking contest between Blitzer or Kardashian.

Once in …

Chief Justice Roberts’ health reform ruling analysis: A win-win?

David B. Nash, MD, MBA

Health Policy

August 18, 2012

The decision is in – and it is likely to have a substantial impact on this year’s elections, the Congress, the Court, the healthcare industry, and all Americans.

Of all the commentary I’ve read in the wake of the recent Supreme Court decision, Time Magazine‘s “Special Report: The Health Care Decision” struck me as the most balanced and comprehensive.

In the lead article, “Roberts Rules,” author David Von Drehle skillfully dissected the …

Real health reform cannot happen without a primary care foundation

Andrew Morris-Singer, MD

Health Policy

August 16, 2012

Annie Lowrey’s July 28 article “Doctor shortage likely to worsen with health law” in the New York Times noted the growing shortage of primary care doctors particularly in economically disadvantaged communities, both in rural and inner-city America. This problem will likely get worse before it gets better as more Americans gain coverage and seek a regular source of care. As the article suggests, training more doctors and incentivizing them …

Why must medical care be provided for free?

Edwin Leap, MD

Health Policy

August 16, 2012

Our septic tank backed up recently. When I say backed up, I mean, into the basement. And when I say into the basement, I mean, out of the bathroom and onto the carpet. And under the walls. The stars were aligned, and I had to go to work. My wife borrowed a Shop-Vac and rented a steam cleaner. I was assigned to call the septic-tank guy. The kids helped clean …

AMA works to reduce administrative burden for physicians

Jeremy Lazarus, MD

Physician

August 15, 2012

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

Since the American Medical Association launched our National Health Insurer Report Card in 2008, there has been noticeable progress by health insurers in response to the AMA’s call to improve the accuracy, efficiency and transparency of their claims processing.

The AMA has been working constructively with insurers, and as a result the …

Why medical management is critical to health reform

Brian Klepper, PhD

Health Policy

August 14, 2012

Several years ago I had dinner with a woman who had served in the late 1990s as the national Chief Medical Officer of a major health plan. At the time, she said, she had developed a strategic initiative that called for abandoning the plan’s utilization review and medical management efforts, which had produced heartburn and a backlash among both physicians and patients. Instead, the idea was to retrospectively analyze utilization …

How will Paul Ryan change Medicare?

David Pittman

News

August 13, 2012

The selection of Wisconsin congressman Paul Ryan as the running mate for presumptive Republican Presidential nominee Mitt Romney could have serious consequences for the Medicare program.

Ryan, Budget Committee chair for the House of Representatives since Republicans gained control of the chamber 2 years ago, is best known for budget proposal, which includes a plan to overhaul Medicare and transform it …

Read more…

How will Paul Ryan change Medicare?

For health care to be better, doctors must lead the change

Davis Liu, MD

Physician

August 13, 2012

Recently New Yorker staff writers and best-selling authors Malcolm Gladwell and Atul Gawande addressed the question of whether the problem in health care is that patients are too reliant on doctors and don’t have the ability to make decisions. In reading between the lines, is that the reason health care is not affordable and care not commoditized or consumer driven like other industries?

At a conference for America’s Health Insurance Plans, …