During my college years, we loved the album Bat Out of Hell by Meat Loaf. We would wail along with Meat Loaf as he screamed out his passionate interpretation of Paradise by the Dashboard Lights. Another memorable song on that album was Two out of Three Ain’t Bad, which offers an important lesson to those of us interested in health care reform.
No, Meat Loaf was not a medical policy wonk …
Are ACOs merely repackaged HMOs?
Across the nation, the medical calendar starts in July, not January. Every July 1, hospitals are infused with new, eager interns who have just graduated from medical school. To get off to a good July start, I give a talk to the obstetrical and gynecology interns and residents about medical professionalism. It is mandated (and rightly so) by the ACGME (Accreditation Council for Graduate Medical Education) that we teach, mentor …
Moral professionalism should include advocacy and duty
At academic medical centers (AMCs) all over the country, health care delivery and payment reform are becoming reality. AMCs need to think in a new way about the markets they serve. Timing for AMCs transforming care delivery is critical. We need to find the perfect middle ground, or what I like to call the “Goldilocks Factor.” AMCs need to transform delivery, definitely not too slowly, but not too fast for …
Changing health care delivery at academic medical centers
Most doctors will tell you that Medicare payments to doctors haven’t increased in a decade, and that doctors are turning away Medicare patients in droves. But they would be mistaken on both counts.
An authoritative compilation of current data from the Medicare Payment Advisory Commission shows what is really happening with Medicare physician spending:
Medicare spending per beneficiary on physicians’ fee schedule services steadily increased from 2001 to 2011. In 2001, Medicare …
The truth about Medicare physician spending
“The plural of anecdote is not data.”
A recent lead editorial in the Sunday edition of the New York Times was entitled “A Formula for Cutting Health Costs” and contained the byline “Alaska natives have something to teach doctors and patients in the rest of the world.”
I read the editorial with interest, hoping that a new perspective, vision, idea, or insight would be mentioned that would provide a sustainable cost solution …
Mainstream media’s sinister undertone against doctors
In today’s healthcare environment, nearly half of all new physicians are salaried employees of a hospital or healthcare system. Now, more than ever, physician leadership is of paramount importance. With increasing pressure to increase care quality and simultaneously lower healthcare delivery cost, it is essential that physicians and administrators work together. Physicians must continue to grow into executive roles and lead both healthcare systems as well as manage other doctors …
How to train more physician leaders
Most of the attention given to the nascent state health insurance exchanges has largely focused on their role in improving access to insurance for individuals and small employers, not on the role they can play in improving health care quality.
As envisioned by the Affordable Care Act, health insurance exchanges provide an opportunity to create more organized and competitive insurance markets by offering a choice of plans, establishing rules on the …
How health insurance exchanges can improve quality
The dream of reason did not take power into account – modern medicine is one of those extraordinary works of reason – but medicine is also a world of power.
-Paul Starr, The Social Transformation of American Medicine, 1984
How can primary care’s position be reasserted as a policy leader rather than follower? Even though it is a linchpin discipline within America’s health system and its larger economy – …
How can primary care be a policy leader?
When I first got interested in medicine, I also got interested in health policy. I was already out of college and so I decided to educate myself – not a bad discussion topic for med school interviews, after all – and found it much, much harder than expected. There were so many topics, so many opinions, and so little that seemed to connect up to give me the big picture. …
4 things every medical student should know about health policy
A guest column by the American Medical Association, exclusive to KevinMD.com.
As the new president of the AMA, I’m excited to help lead the nation’s largest physician organization during this important time for our health care system. The year is off to a positive start – only two weeks after I was inaugurated at the AMA’s Annual Meeting, the Supreme Court declared …
AMA: Working to move medicine forward in the coming year
I recently had the privilege of joining the Yale Cancer Center’s contingent on a visit to University College London in the U.K., where we share a number of scientific collaborations.
Between discussions of pathways, particles, and personalized medicine, some of the “tea time” conversation turned to policy and how uninsured patients with cancer in the U.S. get care. We talked about …
Stop searching for the health reform silver bullet
My initial reaction to the Supreme Court’s ruling to uphold The Affordable Care Act was to breathe a sigh of relief. The law, particularly the individual mandate – the cornerstone provision – is constitutional and now we can get on with the real task at hand of transforming the U.S. health care system into one in which high-quality and safe care is delivered in an effective, timely, and patient-centered manner. …
This is a historic time for American health care
On the surface, two Wall Street Journal articles painted a gloomy and depressing picture of US healthcare, now and beyond.
That wasn’t my take. I felt a rush of optimism. Let me explain.
In, ObamaCare’s Lost Tribe: Doctors, deputy WSJ editor, Daniel Henninger wrote about the (forgotten) plight of doctors in the Affordable Care Act. He critiqued the mainstream media coverage of the Supreme Court decision because it left out mention of …
Mainstream media can foster an engaged public on health issues
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A guest column by the American College of Physicians, exclusive to KevinMD.com.
In early June I participated in ACP Services 2012 Leadership Day on Capitol Hill in Washington, D.C. I sincerely believe that we have an obligation to share our experiences with elected representatives. Internists through ACP have been doing this for years and have raised awareness of the high …
ACP: A Senate intern turned internist seeks solutions to better patient care
If the government was a physician, it wouldn’t be an ordinary doctor like you or I.
It would be a sexy actor like the ones we see on those medical melodramas that have become so popular over the last few years. His hair coiffed, his jacket pressed and free of stains, and his manor confident he would rush into the trauma bay. As the beeping monitor flat lines, he would sweep the nurses …
If the government was a physician
Is it possible that health care can become more effective, more personalized, more attuned to real health and wellness in a manner that truly benefits the patient as a customer/client?
The answer is “yes” but it will require understanding the dysfunction in the delivery system today, dealing with the growing shortage of primary care physicians and their non-sustainable business model, changing the insurance paradigm from prepaid medical care to (high deductible) …
You deserve superb integrative health care
The Supreme Court has spoken. The Affordable Care Act is upheld. So what does this mean for those of us actually involved in health care?
First, there is a lot of work to do. The Court has reached its decision with regard to the legal issues; what remains are the challenges of improving the quality of care, lowering its cost, providing access to those who need the care, integrating technology into …
Embrace a basic truth about health care reform
The drama surrounding the Supreme Court decision upholding the ACA as constitutional has ended. As legions of reporters and bloggers have written, the law has far-reaching effects. In my corner of medicine it will greatly help (already has, really) a small but not insignificant number of children and families. These families are those who have a child with a severe chronic medical condition. Many of these children spend time in …
How ObamaCare affects critically ill children
Dear Ms. Patient,
I hope this letter finds you well.
Let me begin by saying that it is such a privilege to care for your family. It has been a joy to watch your children grow and your family thrive. I’m sure you will agree that we have been through a lot together.
As you know, I am devoted to help in keeping your family healthy, despite the many obstacles that have arisen. …
Dear Patient, great things are happening in health care
President Obama enjoyed a towering victory that I feel leaves the GOP reeling, although they are spinning the Supreme Court’s validation of Obamacare as a great gust of wind at their backs. While I would not have expected a different response from them, I fear that there is a developing wind that may blow them away in November. I offer this analysis as a tepid Romney supporter who will be voting more …
While constitutional, does the Affordable Care Act have merit?
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