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.

Practice variation from the perspective of an e-patient

Dave deBronkart

Health Policy

May 18, 2011

One of our purposes e-Patients.net is to help people develop e-patient skills, so they can be more effectively engaged in their care. One aspect is shared decision making. A related topic, is understanding the challenges of pathology and diagnosis. Both posts teach about being better informed partners for our healthcare professionals.

I’ve recently learned of an another topic, which I’m sure many …

Emergency medicine, we can do better

angienadia, MD

Physician

May 18, 2011

When someone gets sick, what are their options?

They can try to make an urgent appointment that day, but how many of your doctors actually offer that? Most people will have to wait for weeks, if not months, for a regular appointment. Even if you go to a walk-in clinic, the wait will likely be hours, and you’re not sure if clinics can take care of everything, so you head to …

Read more…

Emergency medicine, we can do better

The myth of undocumented immigrants using American health care

Brad Wright, PhD

Health Policy

May 17, 2011

I hear it all the time: “All these illegals are coming over here and they don’t pay taxes, but they get all these government handouts and they’re clogging up our health care system …”

I often point out that many undocumented immigrants actually do obtain a taxpayer identification number for the express purpose of paying taxes in hopes that if a path to …

Predictions on the future of medicine after health care reform

Wes Fisher, MD

Health Policy

May 16, 2011

Recently, an editorial from a plastic surgeon Lloyd Kreiger, MD, appeared in the Wall Street Journal entitled “ObamaCare Is Already Damaging Health Care.”

While I’m not sure I’m ready to concede that Obamacare has already damaged health care in America, I will agree the law is certainly is changing health care, aligning health care corporate interests with political interests, …

How an ACO will affect the relationship between a doctor and a patient

Randall S. Bock, MD

Health Policy

May 16, 2011

At the heart of medicine is the relationship between a doctor and a patient.

The more a doctor knows about his patients, the better. While visual changes and numbness might represent migraine symptoms for one patient, for another they could forebode a stroke. Having followed patients through the stages of life, participating in their medical experiences firsthand rather than solely reviewing those as written case-files — I can vouch that knowing …

The problem with global, or capitated, payments to doctors and hospitals

Paul Levy

Health Policy

May 15, 2011

One aspect of religious dogma that has entered the medical world is that fee-for-service pricing of medical services is bad and should be replaced by a capitated, or global, arrangement that establishes an annual budget for care for different risk groups of patients.

Like other religious beliefs, this is often offered without rigorous analytic support. Some insurance companies are particularly pleased …

How ACOs creatively destroy fee for service medicine

David K. Cundiff, MD

Health Policy

May 13, 2011

The U.S. Department of Health and Human Services (HHS) advocates the “creative destruction” of the traditional system of U.S. physicians practicing solo or in small groups operating as small businesses.

Republicans and Democrats approve of ACOs in concept. The Affordable Care Act of 2010 calls for shifting from fragmented care …

AMA: Individual responsibility for health insurance helps America’s patients, pocketbooks

Cecil B. Wilson, MD

Health Policy

May 12, 2011

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

A wise physician once said, “Health is not valued til sickness comes.” The same can certainly be said about health insurance.

This concept is at the heart of our current debate about individual responsibility for health insurance coverage. While we hope never to need surgery or chemotherapy or to have an unexpected accident or illness, it’s certain that many of …

One in four children in the United States are on chronic medications

Maggie Kozel, MD

Medications

May 10, 2011

The Wall Street Journal reported that a study of prescription patterns in 2009, conducted by IMS Health, showed that 25% of children in the US were on regular medication.

IMS Health is a firm that provides “marketing intelligence” to pharmaceutical companies. The firm’s job is to keep the $800 billion per year global pharmaceutical industry on a continued pattern of growth. Hopefully these consultants accomplished something quite different this week. Hopefully they …

Excited about the future of healthcare in the emergency department

Kevin

Health Policy

May 10, 2011

by William Schumacher, MD

Am I the only one excited about the future of healthcare?

With all the prevailing pessimism about America’s “dysfunctional” health” system, optimists (and I am one) sometimes feel stranded on our own lonely islands.

It’s not that we don’t know what the challenges are. I have been practicing emergency medicine for over 30 years, and there …

Implementation of a rational system of medical care

Joel Sherman, MD

Health Policy

May 9, 2011

The patient entered her private solo physician’s office and handed her medical ID card to the doctor. He put the card in his desktop reader and reviewed her medical history. All of her visits, vaccinations, medications, tests, x-rays etc from all providers were inscribed on the data chip in the card. The card also included insurance and billing information. At the end of the visit, he updated her information on …

Health care coordination under the rules of an ACO

Donald Tex Bryant

Health Policy

May 9, 2011

On March 31, 2011 CMS issued its proposed rules for Accountable Care Organizations (over 400 pages).

There is now a 60-day comment period. Shortly thereafter, the final rules will be issued. I am sure there will be changes in the proposed rules as there were changes in the “meaningful use” rules for electronic health records (EHR’s). Yet, much of the intent of …

Fewer choices for patients with health care consolidation

John Mandrola, MD

Health Policy

May 6, 2011

As a specialist, one of the saddest truisms about practicing medicine in the private world has always been how little one’s clinical skills determines referrals. Unfortunately, as our present healthcare climate pushes “providers” to consolidate along the lines of major hospital networks this injustice will only worsen.

A decade-or-so ago when I started private practice it was obvious that referrals came to me because of my association with an established …

National Quality Strategy and Partnership for Patients to improve care

David B. Nash, MD, MBA

Health Policy

May 6, 2011

One year after passage of the Affordable Care Act, the Department of Health and Human Services (HHS) has unveiled two programs that will most certainly be transformative for U.S. healthcare, affecting both quality and safety.

With the announcement of the first-ever National Quality Strategy in March, HHS signaled a strong commitment to improving the quality of healthcare.

In essence, …

The government reversal on end of life planning

Naomi Freundlich

Health Policy

May 5, 2011

After all the ridiculous fear-mongering about “death panels,” Congress dropped a proposal to encourage end-of-life planning from the health reform legislation passed last March.

But the administration had in fact quietly included reimbursing doctors for end-of-life counseling along with a host of new Medicare regulations. The provision, which authorizes payment for “voluntary advance care planning,” went into …

The future of primary care in an ACO model

Kunmi Sobowale, MD

Health Policy

May 5, 2011

Primary care is a unique field of medicine.

Primary care physicians (PCPs) are the gatekeepers to specialized care, provide preventative care, and most importantly, they have the ability to manage patients with multiple chronic conditions. Thus, primary care physicians are in prime position to become the point men in the Read more…

The future of primary care in an ACO model

Cooperation between patient and doctor is essential today in health care

Paul Dorio, MD

Physician

May 4, 2011

There are many aspects to being a doctor. Just as important are the many aspects that go into being a patient. Of course, the difference is that one has been perceived as being a position of power and the other one has not. I don’t believe this distinction is useful or true in today’s world.

Patients and doctors work …

Why patient satisfaction scores won’t decrease health care costs

Edwin Leap, MD

Physician

May 4, 2011

So now, in addition to the many other bits of medical meddling we have from CMS (Centers for Medicare and Medicaid Services), there’s this.

Reimbursements to hospitals, from Medicare, will be partly tied to patient satisfaction scores. We’ve seen payments already being tied to ‘quality indicators,’ as dictated by the federal government; rewards for doing a better job on care for heart attacks, pneumonia, etc. At least that’s quantifiable, whether scientifically …

Why quality did not improve with hospital EHR implementation

Roger Collier

Health Technology

May 4, 2011

The 2009 Health Information Technology for Economic and Clinical Health Act (HITECH) authorized incentive payments, potentially totaling some $27 billion over ten years, to clinicians and hospitals when they implement electronic health records in such a way as to achieve “meaningful use,” in terms of advances in health care processes and outcomes.

But, are EHRs really “meaningfully useful” or are …

Direct primary care and a do it yourself health plan

Dave Chase

Health Policy

May 4, 2011

Now that I’m well out of my reckless youth phase of my life, I try to preserve the efficacy of my brain. With my lifestyle, there’s three actions I take to ensure the integrity of my brain.