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.

A population health approach to wellness

David B. Nash, MD, MBA

Health Policy

May 28, 2012

FACT: Four determinants of health account for 40% of all deaths in the U.S. – smoking, unhealthy diet, physical inactivity, and alcohol use.

FACT: A mere 3% of Americans do all of the relatively “simple” things they should to stay healthy – i.e., exercise for 20 minutes 3 times a week, don’t smoke, eat fruits and vegetables regularly, wear seat belts regularly, and remain at their appropriate BMI.

FACT: According to the …

Our medical-industrial system is long overdue for a real shakeup

Jim deMaine, MD

Health Policy

May 25, 2012

Recently I was sent this commentary on the issue of health care costs. It seemed like a pretty good summary of the problem to me, though it didn’t delve into solutions or the current controversy about the Affordable Health Care Act. In our country, we’ve built up a huge medical-industrial system that can do lots of good but at a huge cost. It seems that we are on the brink of a …

What American medicine can learn from a cruise ship clinic

Barbara Hales, MD

Health Policy

May 25, 2012

Recently, I had a wonderful opportunity to cruise the Mediterranean and visit some fascinating cities. The land excursions were mind-expanding but quite physical. The rugged terrain and steep hills were not difficult to walk upon because I was in good shape and healthy.

But, what if I wasn’t? Questions raced through my mind such as:

What if I got sick onboard the ship?

What if I got injured?

What type of doctor signs on …

Why Priscilla Chan may become the country’s most influential doctor

Kevin Pho, MD

KevinMD

May 22, 2012

Who has the potential to be the most influential physician of our generation?

It’s Priscilla Chan, who not only recently graduated from medical school, but also married Facebook founder Mark Zuckerberg.

When I brought this up on Twitter, someone responded that it was “disappointing at the same time. I’m certain her own merits and studies would have made waves alone.”

But her influence …

Why physicians are susceptible to hardball tactics

Bradley Evans, MD

Physician

May 21, 2012

I was invited to a medical staff leadership conference sponsored by our hospital. A company specializing in training physician leaders ran the meeting. The topic was healthcare reform and its effect on hospitals and physicians. Included were discussions on patient-centered medical homes, accountable care organizations, bundled payments and physician integration and alignment with hospitals.

The course director made it crystal clear that there will be no place in the future for …

What should America’s health care vision be?

Stephen C. Schimpff, MD

Health Policy

May 21, 2012

America has this paradox of excellent biomedical science, innovative drug manufacturers and entrepreneurial device developers along with outstanding providers but at the same time has a dysfunctional care delivery system. A new vision is needed.

Vision is a leadership concept that presents an idea, garners support and then develops the coalitions to bring it to fruition. America needs to envision what its care delivery system should be and then determine, as …

Can pit crews really heal medicine?

Scrub, MD

Physician

May 17, 2012

In his recent TED talk, Atul Gawande harkens back to the central thesis of his recent book The Checklist Manifesto: How to Get Things Right that medicine has become too complex for physicians to act as cowboys and instead should adopt the paradigm of a pit crew, utilizing teamwork and the humble checklist to solve problems and avert emergencies.

Is this really true though? Can “pit …

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Can pit crews really heal medicine?

Am I going to die because I cannot afford the test?

Ralph B. Freidin, MD

Physician

May 11, 2012

On my way to the hospital last week, I heard a 26-year-old woman describe her experience of becoming deathly ill. When she first realized that the many bruises appearing spontaneously across her body were unusual, she was working as coffee shop to pay off school loans. With the urging of a friend, she went to see a physician. The diagnosis was acute leukemia.

Her job did not provide health insurance and …

Teams are key to solving the American health care crisis

Davis Liu, MD

Physician

May 10, 2012

Solving the American health care system crisis is among the most complex and important challenges facing this generation. Is it possible to provide high quality care with better access at a more affordable cost? Is this problem solvable or simply to complicated? Though that answer is not yet clear, what is increasingly apparent is that a new type leadership is needed if there is any hope in achieving this goal.

Professor …

Repairing the tear in health care’s safety net with social media

Mark Britton

Health Policy

May 8, 2012

The nation’s “safety net” hospitals are designed to ensure that uninsured, lower income and indigent populations receive adequate medical care – a noble and necessary function within the U.S. healthcare system. No one dedicated to the field of care giving can deny the importance of providing appropriate medical care for this population. The safety net is literally a lifeline for many in need.

But for all of the vital and positive …

Look to technology to reduce health costs

Stephen C. Schimpff, MD

Health Policy

May 7, 2012

Technology to lower costs rather than accelerate them. Smart phones to increase physician and other providers’ productivity. Fewer primary care physicians but more involvement by nurse practioneers and others. And increasing appreciation of the value of integrative medicine. These are but a few of the disruptive changes in care delivery that are coming.

I have posted concepts on how the health care delivery system will change in coming years – quite …

How to save a trillion dollars in health care

George Lundberg, MD

Health Policy

May 5, 2012

It is both conventional wisdom and factual truth that, unimpeded, American healthcare cost inflation will bankrupt the United States economically, educationally, socially, and politically in the not too distant future.

The inexorable upward trend line is unsustainable.

In 2009, I described six ways to save nearly $1,000,000,000,000 per year without serious harm, and with positive benefit to the public health.

They were:

Use intensive medical therapy instead of coronary artery bypass grafts and invasive …
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How to save a trillion dollars in health care

Should electronic medical records be considered medical devices?

Wes Fisher, MD

Health Technology

May 4, 2012

In our rush to establish a national electronic medical record (EMR) system as part of the American Recovery and Reinvestment Act of 2009, powerful silos of independent EMR systems have sprung up nationwide. While most systems are being developed responsibly, like the Wild, Wild West, many have been developed without an objective eye toward quality and the potential harm they may be causing our patients.

As most readers of this blog are aware, …

How the Affordable Care Act combats preventable hospital infections

Christian John Lillis

Health Policy

May 4, 2012

As the Supreme Court deliberates the Affordable Care Act, Americans should take a closer look at the commonsense reforms embedded in the law, including those that strengthen public health. Fixation on the law’s individual mandate has overlooked the law’s very important benefits for public health.

Lost amid the rhetoric about individual liberty is the public interest and common good of protecting all Americans from the costly and deadly menace of preventable …

Being insured does not equate to being covered

Richard Just, MD

Health Policy

May 3, 2012

A few weeks ago, my wife and I attended “A Conversation With David ‘Sonny’ Lacks” at the California Center for the Arts, Escondido. The event was a sellout with 900 attendees. As it turns out, most of the colleges and universities in San Diego County designated “The Immortal Life of Henrietta Lacks” as the book discussed by students and …

How single payer can improve the access to cancer care

Aldebra Schroll, MD

Physician

May 3, 2012

The call came in the middle of a busy office day; the radiologist had found a suspicious area on the mammogram. I had received similar calls many times in my primary care practice. This time was different; the patient was me.

My first thought “thank God I’m insured.” My second thought was for all those who are not. It was hard enough waiting the week, until further testing could be performed; …

A doctor has difficulty making sense of medical bills

Manoj Jain, MD, MPH

Physician

May 2, 2012

Rarely do people think about medical costs when there is a medical emergency or an urgent need for a test. Recently, I was in such a situation.

A few days after a 22-hour international flight, the calf muscle in my right leg began to ache. If it were not for the recent flight, or if I were not a doctor, I would have just let it pass.

But long periods of sedentary …

What do patients want from the health care delivery team?

Stephen C. Schimpff, MD

Health Policy

May 2, 2012

Ours is a provider-oriented system. Doctors like me and (former) hospital executives like me hate to admit it but it is true. Consumerism will slowly but surely drive it toward being a patient-oriented service model. What do patients and their families want from the health care delivery team? First and foremost is respect followed by service given in a high quality, very safe manner. Patients expect that the information gap …

ACP: If I were health care king

Fred Ralston Jr., MD

Health Policy

May 2, 2012

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

In preparation for a panel discussion at Internal Medicine 2012, the annual scientific meeting of the American College of Physicians, I was asked some questions about changes I would make in health care if I were king. That stimulated some serious thinking. For those of us in practice it is more usual to think about what new regulation …

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ACP: If I were health care king

Asking about price is an essential part of a patient’s responsibility

Suzanne Nesmith

Patient

May 1, 2012

My husband and I have been self-employed for many years, and though our income is quite limited, we have always been careful with our finances, have always managed to live within our means, and have always paid our bills without assistance. We had private health insurance coverage and saw premium increases each year. Then to avoid further increases, coverage of office visits outside of deductible was dropped, and our deductible was raised to $4500. Finally, …

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