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.

With the ACA, put politics aside and focus on the facts

Manoj Jain, MD, MPH

Health Policy

July 9, 2012

On the day the U.S. Supreme Court delivered its historic decision on the Affordable Care Act (ACA), aka Obamacare, I was rounding on my hospital patients: a man on the ventilator with pneumonia who had private insurance, one elderly woman with abdominal pain going for gall bladder surgery on Medicare, and one middle aged obese woman with a skin infection without any health insurance.

On my patients’ TV screens I watched …

After the Affordable Care Act, don’t lose sight of the Medical Home

Lauren Chasin, MD

Health Policy

July 6, 2012

Nothing in life is free.

In the midst of all the turmoil and excitement surrounding the newly passed Affordable Care Act, I believe we should not lose sight of the bigger picture: providing better healthcare at a lower cost for more people. The idea of the Patient Centered Medical Home, although in its trial stages thus far, is what we should be focusing on as physicians and health care providers.

Much has been …

Take the time to educate yourself before forming an opinion

Alex Lickerman, MD

Physician

July 5, 2012

Student loan debt is at an all-time high at a little over 1 trillion dollars, a figure that now, for the first time ever, exceeds our nation’s credit card debt. Higher education has never cost more, the rate of rise of college tuition having exceeded in recent years the rate of rise of many other services. Perhaps as a result of this, as well as of the difficulty in obtaining …

Doctors see little of the money patients pay towards health insurance

Juliet K. Mavromatis, MD

Physician

July 3, 2012

I was recently struck by two conversations that I had with acquaintances about recent experiences that they had had with their primary care physicians. The first occurred at my local pool. A fellow swimmer asked me if I took new Medicare patients. She bemoaned that she was abandoned — her beloved physician of over 20 years had sent out a letter announcing that she would no longer accept Medicare patients. My …

Doctors and patients are both losing in our health system

W. Ryan Neuhofel, DO, MPH

Health Policy

June 28, 2012

Early in my medical training I envisioned myself as an old-fashioned family doctor. Marcus Welby, MD was well before my time, but he seemed like a good fictional role model for a naive student-doctor. (Especially considering Dr. Cox of Scrubs was my alternate choice.) After finishing my primary classroom studies, I was eager to leave the stacks of paper behind and to learn from real clinicians caring for real people. After donning my short white coat …

The Supreme Court on health reform: Everybody wins!

Kevin Pho, MD

KevinMD

June 28, 2012

The Supreme Court upheld the Affordable Care Act.

I’ll leave the detailed legal analysis to other commentators that you’ll no doubt find elsewhere.

Although some may not feel this way, this is an outcome everybody should be happy with.

Most important, patients should be happy. As I wrote in the New York Times Room for Debate recently, the ACA has already …

A Supreme Court split decision will cause health confusion

Emily P. Walker

News

June 27, 2012

Utter confusion could result if the Supreme Court invalidates the Affordable Care Act’s (ACA) individual mandate while upholding other parts of the law, a physician expert predicted ahead of Thursday’s expected decision.

And a split decision is, indeed, likely, said Randy Wexler MD, MPH, of Ohio State University in Columbus.

That will create chaos, he said, which is something other …

Health care change will have to come from the public

Natasha Deonarain, MD, MBA

Health Policy

June 25, 2012

Most of us want to know how to fix this healthcare mess these days. We’re scared about the future and how we’re going to afford costs that never, ever seem to stop skyrocketing. We’re scared about the world our kids are going to inherit and the phenomenal debt they’ll be haunted by throughout their lives. We’re scared about living in a country that’s cowering under the hefty weight of fear …

Health is not Democratic or Republican, it resonates with both sides

Trishul Reddy, MD

Health Policy

June 24, 2012

A better approach to primary care is imperative for improving the delivery of health services to our nation’s population. As a family medicine resident, I see the need first hand in the mountains of East Tennessee.

It’s 11:30pm on a Sunday night when the medical student and I receive the ER call.

“A thirty-two-year-old diabetic male with uncontrolled sugars and right arm cellulitis, I think he needs admission.”

When I reach the ER, …

Will health reform survive the Supreme Court?

Merrill Goozner

Health Policy

June 21, 2012

The Supreme Court’s imminent decision on the Affordable Care Act will trigger a political firestorm whether they accept the legislation in its entirety, throw out every page of the 906-page bill or do something in between, which is the most likely outcome.

If the high court follows the polls, it probably will rule the requirement that individuals purchase insurance – the mandate – is unconstitutional but leave the rest of “Obamacare” …

Is rationing necessary to reduce health care costs?

Stephen C. Schimpff, MD

Health Policy

June 21, 2012

Healthcare costs keep rising. Your insurance premiums go up, your deductible and co-pays go up, pharmacy benefits go down. Despite the high cost you get little time with your physician, insurance statements are complex beyond belief and “customer service” seems to be a foreign concept. To combat high costs we are often told that rationing will be necessary. Is that true?

Why are costs so high in this very dysfunctional healthcare …

Become not just a physician, but a great physician

Michael Mank

Medical Education

June 20, 2012

As the nation, physicians, hospitals, and political pundits await the Supreme Court’s decision on the Affordable Care Act, I find myself waiting for something else: to begin medical school. I will be hitting the books, studying vigorously, and desperately trying to remember the myriad of information being thrown at me well after the justices decide the fate of President Obama’s landmark legislation. So what does this mean for me, or …

Do we have too many hospital beds?

Joanne Conroy, MD

Health Policy

June 16, 2012

Stranded capital is a new term, a derivation of the term stranded costs that emerged from the deregulation of electric companies. It refers to “the existing investments in infrastructure for the incumbent utility which may become redundant in a competitive environment.” Many academic medical centers are weighing the importance of meeting current demand while considering the risk that, in a future competitive environment, dramatic declines could occur in the need …

Read more…

Do we have too many hospital beds?

Our health problems will remain, despite how the Supreme Court rules

Ricky Choi, MD

Health Policy

June 13, 2012

I was recently honored to attend a discussion at the White House, convened by Health and Human Services Secretary Kathleen Sebelius. It was one of those rare “clear my schedule immediately” invitations; I thank my patients and family for allowing me to take this last minute trip.

Physician leaders from around the country were invited to the White House for a dialogue with lead government health officials (specifically administrators from the …

AMA: Moving past a failed Medicare formula to focus on quality care

Peter W. Carmel, MD

Health Policy

June 11, 2012

The Medicare physician payment formula is a case-study in failed policy. Physicians have long known that it is not working. Polls show that an overwhelming 94 percent of Americans believe the massive cuts it schedules are a serious problem for seniors. Even members of Congress from both parties agree – and that is no small accomplishment – that it is …

The impact of prescription drug costs on health spending

Cathleen London, MD

Medications

June 10, 2012

I am employed by a hospital, and have health insurance through my job. The coverage is comprehensive, and the cost has an employer contribution and employee contribution. I still get confused (though I have the hospital’s own plan) about what is covered and what is not. I can only imagine how hard it must be for my patients.

The prescription plan that comes with this insurance is straight forward: $40 for …

Is there a future for smaller physician practices after health reform?

Bob Doherty

Health Policy

June 10, 2012

The medical profession has always been marked by division: town versus gown, primary care versus specialty medicine, states versus national. But the real fault line today is not defined by specialty, geography, or teaching versus practice, but by size of practice.

Physicians in smaller practices, without regard to specialty or where they are located, are embattled and defensive—and therefore are more skeptical when someone tries to peddle the need for delivery …

What does an ACO mean in small town America?

Robert Provenzano, MD

Health Policy

June 9, 2012

At the end of long days I often stand gazing out my window at the beautiful, timeless Rocky Mountains in Colorado Springs and am taken by their sense of permanence. I recently returned from Nampa, Idaho, where I presented hospital Grand Rounds on Accountable Care Organizations.

The parallels between the timeless mountains and the physicians I met in Nampa struck me. Strange, you say? Maybe, but I am accustomed to the …

ACP: Reducing expenses at the ground level of health care

Fred Ralston Jr., MD

Health Policy

June 2, 2012

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

I will never forget asking my teenage son what appeared to be a simple question. His answer, after a long pause, was “It’s complicated.” If you ask many of us about health care in the U.S., there is often an answer that points quickly to a particular villain …

Isn’t caring for your child worth as much as caring for your parents?

Nilesh Kalyanaraman, MD

Health Policy

May 30, 2012

I love it when I see Medicaid patients on my schedule for the day. Working at a community health center, our doors are open to all people, regardless of their ability to pay. It’s hard to run a medical office when you get $20 for a visit, which is what our uninsured patients pay. So when a patient has Medicaid we know we’ll get paid a decent reimbursement for that …

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