At UC Berkeley in the 70s, the secretary in the Department of Psychology pasted a bumper sticker on her desk positing the question: “… yes, but are we asking the right questions?”
For some reason, this subtle invitation remains with me today, echoing amidst the ACO fervor of “… better care at lower costs.”
… the good news is we’re making great time, the bad news is we don’t know where …
Are ACOs putting form ahead of function?
With sixteen million more Americans expected to gain health care coverage in the coming years as a result of the Affordable Care Act, access to actual health care providers may become more difficult. This may be especially true for patients with marginal coverage such as Medicaid.
The Kaiser Family Foundation recently explored the role of non-physician clinicians – specifically nurse practitioners (NPs) and physician assistants (PAs) …
The role of non-physician clinicians in primary care
I couldn’t pass up the opportunity to comment on Dr. Karen Sibert’s recent op-ed piece in the New York Times. She argues that, especially given the current shortage of primary care doctors in this country, being part of the medical profession confers one with the moral obligation to serve and, as such, conflicting interests, such as raising a family, should take lower priority. I worked …
How much medical care are doctors obliged to provide?
A guest column by the American Medical Association, exclusive to KevinMD.com.
Billions of dollars in administrative waste would be eliminated each year if health insurers sent a timely, accurate and specific response to each physician claim, and while this year’s AMA National Health Insurer Report Card shows promising improvements in denial rates, more work needs to be done.
The AMA’s fourth annual check-up …
AMA: Health insurers’ denial rates are down, but error rates are up
We all know, broadly speaking, the mission of comparative effectiveness research (CER), now sometimes called patient-centered outcomes research. Such studies should inform clinical and health policy decisions made by physicians, payers, and regulators to help determine treatment guidelines, coverage policies, and the therapeutic value of new therapies relative to standard-of-care in real-world settings.
But dive deeper, and it’s clear there remains an uncomfortable level of confusion as to what CER …
The confusion surrounding comparative effectiveness research (CER)
In the Chicago Tribune recently, Bruce Japsen has an excellent article addressing Accountable Care Organizations, quality of care issues, and the change in how physicians will be paid in the future.
Clearly, the government and insurers have decided that physicians will not be paid for services rendered. Physicians will be paid based on patient outcomes and will share in any losses insurers sustain due to poor patient outcomes. There are …
There have been scores of recent articles about Congresswoman-elect Kathy Hochul’s upset win in New York’s 26th Congressional District special election. They all seem to share a thread of incredulity, followed either by chortling or spin depending on the source. These stories also share the sense that her victory was truly an underdog performance destined to become legend.
According to The New York Times, “Two months ago, the Democrat … was …
Our growing ability to prolong life and our shrinking ability to pay for it
Does it really matter how many ribs Michelle Obama ate on her vacation? For too many conservatives, the answer seems to be yes, with pundits poking fun at the anti-obesity guru’s dinner choice. But conservatives need to give it a rest: many seem to prefer scoring easy points against the First Lady to arguing about the best way to attack the obesity epidemic — and some even claim that …
Why obesity should concern conservatives
What if I were to tell you that Washington is trying to balance the budget by making cuts to a program that covers 70% of the nation’s nursing home costs and 43% of all births in California? Well they are.
The rancorous debate over how to balance the federal budget includes drastic cuts to Medicaid. And while this program may seem distant to people in power and the general public, …
Medicaid represents our nation’s moral commitment to help the poor
by J.E.B. Johnson, MD
Let me preface this comment by stating I am not an actuarial. I hated statistics and am no fan of insurance companies. That said I would like to know why patients and the US government think that health insurance companies should accept unlimited risk? My car insurance has limits, my homeowners insurance has limits, my malpractice insurance has limits. Why …
A private sector solution for wider, more affordable health coverage
Perhaps you are just beginning a quality improvement program or project. Perhaps you have several project improvement projects successfully completed at your healthcare site.
No matter what your level of experience, you have encountered staff who are roadblocks to your efforts. What are you to do? Ignoring them or doing nothing will imperil your quality efforts eventually. Let me share some ideas on what to do based upon my own …
Staff who resist quality improvement efforts
Although the medical profession has been harming unlucky patients for centuries, the patient safety movement didn’t take flight until 1999, when the Institute of Medicine published its seminal report, To Err is Human. And that report would have ended up as just another doorstop if not for its estimate that 44,000-98,000 Americans each year die from medical mistakes, the equivalent of a jumbo jet crashing each …
The radiation delivered by CT scanners has gone largely unregulated
by Sara Billings, RN
I believe knowledge is power. There is no more complex topic in the healthcare debate than end-of-life care. I have been a Registered Nurse for thirty years. I deal with this every day. All of us will confront this issue eventually. When it’s your turn, I hope the medical profession will guide you to the best options for you and your family.
Often I see patients who have …
Our health system defaults toward treatment rather than compassion
ADVERTISEMENT
by Sam Wainwright
There’s a fascinating blog post over at the New York Times math blog that has the health policy program here at New America scratching our heads, sharpening our No. 2 pencils, and dusting off our calculators.
Turns out, German mathematicians have been studying how and why the human brain seems to struggle with comprehending risk. We find it difficult to translate the …
Why the human brain seems to struggle with comprehending risk
The creation of consumer-driven health plans (CDHPs), health insurance policies with high deductibles linked to a savings option and with more financial responsibility shouldered by patients and employees and less by employers, was completely inevitable.
The American public likes to have everything, whether consumer electronics or other services, as cheap as possible. With escalating health care expenses rising far more rapidly than wages or inflation, it’s not surprising employers …
Consumer driven health care will only shift costs if implemented poorly
It strikes me that in developing payment reform related, compensation driven cost-containment strategies aimed at constraining the cost of emergency care, policy makers, emergency physicians, and health insurers should adhere to certain principles.
The American College of Emergency Physicians should be at the forefront when it comes to establishing these principles, which I hope will be focused on protecting our patients first, and our specialty second.
The concept and practice of …
Cost containment strategies for emergency care
Much is being written about the ever increasing cost of health care in the US, especially compared to the rest of the developed world.
As a nation, we spend nearly 16% of our GDP on health care. All estimates predict that this amount will continue increasing unless costs can be controlled now. Hence the passage of the Affordable Care Act. Not only was it designed to extend coverage to more …
Cost of care is related to the advancements in medicine
by John Kaegi
We all complain about the cost of health care and health insurance. Ours is by far the most expensive health care system in the world. And for the money, our health isn’t so hot either. On the world stage, the U.S. ranks 37th in health care efficiency (a measure of health outcomes such as infant mortality, incidence of chronic disease, etc.) as reported by the World Health Organization. America …
Reverse our attitudes and values to control health costs
by Grayson Wheatley, MD
It was supposed to be a routine office visit for my patient.
Unexpectedly, it turned into a real-world health economics lesson for me, the treating physician. The old adage “listen to your patients; they will always give you the answer” became exceedingly true in this case, even when it dealt with an issue beyond a medical diagnosis, such as lack of transparency …
The challenge of pre-authorization for an elective procedure
The following op-ed was published on June 7, 2011 in USA Today.
More than ever, I find myself fielding questions from patients about the health care reform law. The most common one is, “How will reform affect me?” It’s a complicated question, with a different answer for each patient. But as the law’s full effects unfold, one of the more significant changes will be in how patients interact with their …
Team based care in health reform needs patient involvement
Get free updates delivered free to your inbox.
