Health policy and public health

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Articles, page 136

My wish list for a perfect ACO

September 16, 2012Sep 16, 201210

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…

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

Health policy

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

Wes Fisher, MD

September 14, 2012Sep 14, 20129

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…

Seriously?

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

Physician voices

Practices are getting larger to provide micropractice service

Lucy Hornstein, MD

September 13, 2012Sep 13, 20124

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 …

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Health policy

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

American Medical Association & Jeremy Lazarus, MD

September 13, 2012Sep 13, 20124

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…

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 Association (AHA) and the American Nurses Association (ANA) to release …

Health policy

Matching Medicaid payments to Medicare: From pitiful to pathetic

Rob Lamberts, MD

September 13, 2012Sep 13, 20126

“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…

“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 …

Health policy

Care delivery transformation requires an upfront investment

Kyle Bradford Jones, MD

September 12, 2012Sep 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. …

Health policy

The secret sauce of great health care organizations

Robert Allan Bear, MD

September 9, 2012Sep 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…

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 …

Physician voices

Did Atul Gawande unwittingly support specialty hospitals?

Jaan Sidorov, MD

September 6, 2012Sep 6, 20125

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…

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 …

Health policy

How will doctors handle the flood of newly insured patients?

Albert Fuchs, MD

September 5, 2012Sep 5, 201242

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.…

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 …

Health policy

Diminishing primary care leads to excessive health spending

Brian Klepper, PhD & Paul Fischer, MD

September 3, 2012Sep 3, 20126

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 …

Physician voices

Why doctors complain: A history of physician income

Richard Patterson, MD

September 2, 2012Sep 2, 201211

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 …

Physician voices

Patient care is not meal preparation

Art Fougner, MD & Kira Geraci-Ciardullo, MD

September 2, 2012Sep 2, 20123

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.…

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 …

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Patient care is not meal preparation

Physician voices

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

George Lundberg, MD

September 1, 2012Sep 1, 201230

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,…

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 …

Physician voices

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

Kenneth Lin, MD

August 30, 2012Aug 30, 201222

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…

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, …

Health policy

An evidence based assessment of universal coverage

Bob Doherty

August 30, 2012Aug 30, 20123

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…

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 …

Health policy

While politicians are fighting, patients are being ignored

Rob Lamberts, MD

August 24, 2012Aug 24, 20126

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…

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 …

Health policy

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

Bob Doherty

August 23, 2012Aug 23, 20125

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…

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 …

Health policy

Curbing Medicare costs: Are seniors or the government responsible?

Merrill Goozner

August 23, 2012Aug 23, 201210

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 …

Health policy

Will physicians be caught in the ACO web?

Kerry A. Willis, MD

August 23, 2012Aug 23, 20126

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 …

Health policy

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

Robert Laszewski

August 22, 2012Aug 22, 201211

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…

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 …

Health policy and public health

Articles, page 136

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