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.

The threats to profit in academic medical centers

Robert Wachter, MD

Health Policy

September 27, 2011

My hospital, UCSF Medical Center, is thriving. Our profits this year will be nearly $200 million. We’re building a sparkling clinical complex – a combined women’s, children’s, and cancer hospital – adjacent to our new downtown biomedical research campus.

We are installing a state-of-the-art computer system. US News & World Report calls us the 7th best hospital in the country. Our students, residents, and fellows have never been better.

Yet angst is in the air, borne …

Patients need help to navigate the health care system

Benjamin Geisler, MD, MPH

Health Policy

September 22, 2011

The New York Times recently ran an op-ed by Paul Krugman with the intriguing title, “Patients Are Not Consumers.”

Here’s an open letter to him:

Dear Dr. Krugman,

As a comparative effectiveness researcher, I agree with many of the arguments that you are making in your most recent article. However, I disagree with your main point that patients are not consumers.

I understand your sentiment and agree that patients are more …

Unintended consequences of standardizing physician practice

Steve Wilkins, MPH

Physician

September 22, 2011

Turns out there is an unintended consequence of many of the current efforts to standardize the way doctor’s practice medicine. It is called de-skilling. De-skilling can occur when physicians and other providers try to adapt to standardized, new ways of doing things. Examples of such standardization include clinical based care guidelines, electronic medical records (EMRs), pay for performance (P4P), patient centered medical home (PCMH) requirements and so on.

Examples of …

Why an ACO is essentially an American product

David Harlow

Health Policy

September 21, 2011

There has been a significant outcry against the proposed ACO regulations: everything’s wrong and nothing’s right about them, or so some would have us believe.

Today’s “nattering nabobs of negativism” focus on: the estimated price tag for complying with the regulatory requirements (IT and other infrastructure included), the slim chance of success by ACOs in righting the wrongs of decades of bloat in the health care system, the …

Should Medicare pay for procedures that have no proven benefit?

Bob Doherty

Health Policy

September 18, 2011

“Doctors, with the consent of their patients, should be free to provide whatever care they agree is appropriate. But when the procedure arising from that judgment, however well intentioned, is not supported by evidence, the nation’s taxpayers should have no obligation to pay for it.”

So argues Dr. Rita Redberg, a cardiologist and professor of medicine at the University of California, in a provocative op-ed published in the New …

The root cause of why our health system is unsustainable

Donald H. Taylor, PhD

Health Policy

September 16, 2011

An excerpt from Balancing The Budget is a Progressive Priority.

It is our cultural fear of death and inability to discuss the limits of medicine to forestall death that enables the politics of health reform to be so potent.

When I did a post-doctoral fellowship in England in the mid-1990s, a professor I met who had lived in the U.S. explained to me why he thought health policy discussions in that nation …

Primary care gets caught in the physician pay crossfire

Robert Bowman, MD

Health Policy

September 16, 2011

Major journals have slipped in another article that apparently was designed for controversy and for widespread distribution to media outlets. The New York Times rapidly picked it up. As the nation enters the final months before 29.5% fee cuts for Medicare physician services, there will be many more of these that reach the light of day – too many if this is an indication.

What is common to major journals, media …

United States health care may need reverse innovation

Kent Bottles, MD

Health Policy

September 15, 2011

The realization that the American health care system must simultaneously decrease per-capita cost and increase quality has created the opportunity for the United States to learn from low and middle-income countries. “Reverse innovation” describes the process whereby an inexpensive innovation is used first in countries with limited infrastructure and resources and then spreads to industrialized nations like the United States.

The traditional model of innovation has involved the creation of …

AMA: A new opportunity to fix the SGR

Peter W. Carmel, MD

Health Policy

September 15, 2011

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

Every year since 2001 the threat of severe physician payment cuts, imposed by Medicare’s failed sustainable growth rate formula (SGR), have jeopardized the stability of the Medicare system and compromised access to care for patients. And every year – sometimes several times a year – Congress has put in place short-term …

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AMA: A new opportunity to fix the SGR

How health reform is reshaping health care markets

Joe Flower

Health Policy

September 15, 2011

The current reorganization of health care could make it better and cheaper for everyone, harnessing real creative and competitive energies to build the “next health care” —or it could lead to local monopolies, higher prices and less real competition where it matters. The many and various moves toward accountability, competition and transparency could defeat themselves.

The theme of the reorganization is clear: new types of cooperation between physicians, hospitals and other …

Targeting physician salaries is a poor strategy for health care costs

Kevin Pho, MD

KevinMD

September 14, 2011

A recent study from Health Affairs took aim at physician salaries.

Well, not exactly their salaries, but fees. It’s a subtle difference, but that nuance is lost in the mainstream media narrative.

According to the study, “American primary care and orthopedic physicians are paid more for each service than are their counterparts in Australia, Canada, France, Germany and the United Kingdom.”

Thankfully …

ACP: Current and future payment and practice trends in medicine

Fred Ralston Jr., MD

Health Policy

September 13, 2011

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

In April 2011 I finished seven years on the Board of Regents of the American College of Physicians (ACP) including two years as Chair of the ACP Health and Public Policy Committee and serving during the last year as President. During that time I had the opportunity to …

Can cost accounting save health care?

Barry C. Dorn, MD and Eric J. McNulty

Health Policy

September 12, 2011

In the September 2011 issue of Harvard Business Review, Harvard Business School professors Robert Kaplan and Michael Porter argue that a better understanding of the actual cost of care patient-by-patient can have a dramatic impact in the effort to control health care costs. They maintain that actual costs are poorly understood, that there is a mistaken belief that many costs are too complex to allocate accurately, and that …

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Can cost accounting save health care?

Human capital makes doctors special

Douglas Perednia, MD

Physician

September 9, 2011

If you’ve ever been sick, especially with anything serious, you quickly realize that doctors, nurses and their ilk are an unusual and precious resource.

First you have to find smart people with personalities willing and able to put up with a lot of guff in the service of their fellow man. Then they have to be willing to (usually borrow, and) spend tens or hundreds of thousands of dollars for …

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Human capital makes doctors special

Government austerity with Medicare reform as a top priority

Nathanael Heckmann

Health Policy

September 7, 2011

Medicare needs to be reformed, but there’s no easy solution to the problem. As the average life expectancy increases, more-and-more politicians have proposed an increase in the Medicare eligibility age. This increase in life expectancy, however, is an issue that only affects the wealthiest half of America — the people that need Medicare the least — because the life expectancy has only increased significantly in the richest half of …

Slipping through the cracks in our health care system

Kelly Cheramy

Patient

September 6, 2011

Between the cracks is a frightening place to be.

During the course of trying to improve our family’s financial stability, my husband and I were blind-sided by one hidden detail: We’d face $10,000 in costs to continue my husband’s serious medical treatment because we found ourselves unexpectedly without coverage for 30 days.

This was money we simply did not have. We had been prepared to foot the full bill for good health …

Improving efficiency and requiring Congress to live under our healthcare rules

Mitchell Brooks, MD

Health Policy

September 3, 2011

Here are my next two principles of affordable healthcare reform.

First, medicine must be practiced in a manner and in a place that is consistent with economic efficiencies, evidence based outcomes and the needs of the specific community that it serves.

In healthcare delivery, quantitative must be balanced by qualitative. Specific community needs and the culture of that particular community must have equal and in certain cases, greater value than the …

Overcoming barriers to building a direct primary care practice

Dave Chase

Physician

September 2, 2011

The federal health reform bill included a little-noticed clause allowing for Direct Primary Care (DPC) models to be a part of the state health exchanges. I believe this will fundamentally alter the health insurance market and is leading to what I call a “Do it Yourself Health Reform” movement. That little-noticed clause (item #3 in 1301(a) of HR 3590) should have the effect of massively …

Will replacing fee for service really reduce costs?

Jaan Sidorov, MD

Health Policy

September 2, 2011

In this enlightened era of evidence-based medicine, you’d think that the progressive academics, viziers, and mandarins who are cluttering the policy making commentariat would pay more attention to what was tried before. That should be doubly true if those lessons come from that health care nirvana called Europe, where enlightened central bureaucracies wisely allocate health care for its caffè sipping, plaza strolling and beret adorned citizenry.

Case in point is …

The medical legacy of Rick Perry

Robert Luedecke, MD

Health Policy

September 1, 2011

While liability reforms have been good for the health of Texans, many laws favored by Governor Perry have damaged health. As a physician on the Committee on Public Health of Bexar County Medical Society, I have been trying for many years to help not only my patients, but also Texans in general. San Antonio, my home for the last 30 years, is reported to have a population mix very similar …

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The medical legacy of Rick Perry