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Health policy and public health

4,357 articles · Since 2004

Articles, page 151

Physician voices

Why primary care is due for a renaissance

3

At a time when half of primary care doctors say they'd leave medicine if they had an alternative and the NY Times reports on a family physician who can't give away his practice this hardly seems like the obvious time…

At a time when half of primary care doctors say they’d leave medicine if they had an alternative and the NY Times reports on a family physician who can’t give away his practice this hardly seems like the obvious time to claim that primary care is positioned for a renaissance. However, if there’s one thing savvy investors have demonstrated, when everyone says to invest in something that is usually the time to …

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Why primary care is due for a renaissance

Health policy

Political approaches on how to slow Medicare’s escalating costs

How to slow Medicare’s escalating costs has been the big health care policy issue recently, with Republicans and Democrats offering competing proposals, each part of broader plans for reducing the federal deficit—projected to be $1.5 trillion this year, with the…

How to slow Medicare’s escalating costs has been the big health care policy issue recently, with Republicans and Democrats offering competing proposals, each part of broader plans for reducing the federal deficit—projected to be $1.5 trillion this year, with the government borrowing 40 cents for every dollar it spends.

Unfortunately, neither the Medicare proposal of Representative Paul Ryan’s House Budget Committee, nor that offered in response by President Obama, can …

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Political approaches on how to slow Medicare’s escalating costs

Health policy

What would an ACO would look like if it was truly patient centered?

4

Health care leaders are busy talking to attorneys and consultants about how to set up Accountable Care Organizations (ACOs). A recent Advisory Board survey found that 73 per cent of hospital finance executives said that creating such an organization was…

Health care leaders are busy talking to attorneys and consultants about how to set up Accountable Care Organizations (ACOs). A recent Advisory Board survey found that 73 per cent of hospital finance executives said that creating such an organization was a top priority for their health system.

Last year my most popular keynote topic was patient-centered medical home creation; this year everyone wants a presentation on ACOs.

However not

…

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What would an ACO would look like if it was truly patient centered?

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Health policy

Why healthcare is a responsibility, not a right

34

There is no "right" answer to the healthcare reform issue. There are facts, opinions, myths, politics and reality, all in no particular order of magnitude. Unfortunately, thus far and likely in the future, the reform will be political and thus…

There is no “right” answer to the healthcare reform issue. There are facts, opinions, myths, politics and reality, all in no particular order of magnitude. Unfortunately, thus far and likely in the future, the reform will be political and thus costly and painful and will not address the core issues involved in fixing the inherent systemic problems.

There have been many things written with regard to this topic and I …

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Why healthcare is a responsibility, not a right

Health policy

Passing along the cost of health care to consumers won’t save money

8

Republican budget guru Paul Ryan had a plan to end Medicare as we know it to be replaced with a series of less-generous vouchers. The House of Representatives has voted to implement this plan. The political side of this has…

Republican budget guru Paul Ryan had a plan to end Medicare as we know it to be replaced with a series of less-generous vouchers. The House of Representatives has voted to implement this plan. The political side of this has been written about a lot, and I am not going to rehash what has been better covered elsewhere. I do want to address what seems to be a persistent …

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Passing along the cost of health care to consumers won’t save money

Patient voices

Can health coaches help fix our healthcare system?

4

Simply put, habits are hard to break and bad habits like smoking, drinking, sedentary lifestyle and overeating are making our population sick. Who in the healthcare system can tackle these issues before they manifest into chronic disease? Doctors are trained…

Simply put, habits are hard to break and bad habits like smoking, drinking, sedentary lifestyle and overeating are making our population sick. Who in the healthcare system can tackle these issues before they manifest into chronic disease?

Doctors are trained to diagnose and treat, but they aren’t trained to help people change their behavior, nor should they be since most physicians, particularly general practitioners, are already severely overloaded. Nurses provide …

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Can health coaches help fix our healthcare system?

Health policy

Executive compensation and the rising cost of health care

7

The revelations about the huge golden parachute given the outgoing CEO of ostensibly non-profit Massachusetts Blue Cross Blue Shield induced some public discussion about the disconnect between executive compensation and the mission of health care organizations. First, new proxy statements…

The revelations about the huge golden parachute given the outgoing CEO of ostensibly non-profit Massachusetts Blue Cross Blue Shield induced some public discussion about the disconnect between executive compensation and the mission of health care organizations.

First, new proxy statements revealed the compensation of executives of two large for-profit health care insurers/managed care companies.

Cigna

As reported by the AP, via ABC News, the CEO got a big raise:

Cigna Corp. CEO David

…

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Executive compensation and the rising cost of health care

Health policy

Policy makers aren’t doctors, and why that’s a problem

10

Sometimes you just don't want to be right. Over the past 5 years, I have seen an alarming pattern arise in my profession. Many of my patients have heard me talk about Soylent Green, an old Charleton Heston movie. The…

Sometimes you just don’t want to be right.  Over the past 5 years, I have seen an alarming pattern arise in my profession.  Many of my patients have heard me talk about Soylent Green, an old Charleton Heston movie.  The premise of the movie seems absurd.  Can you imagine the government of the United States providing for all the needs of its people including healthcare, food, clothing, and even death?

David …

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Policy makers aren’t doctors, and why that’s a problem

Health policy

Medical malpractice doesn’t address patient safety

2

Medical malpractice reform is one of the few health care policy issues where there is a real possibility of agreement between the White House and Congress. A common refrain is that the fear of lawsuits leads physicians to practice defensive…

Medical malpractice reform is one of the few health care policy issues where there is a real possibility of agreement between the White House and Congress. A common refrain is that the fear of lawsuits leads physicians to practice defensive medicine, ordering too many tests just to cover their behinds in case of a lawsuit. It drives up costs without creating benefits. There’s some truth to this argument, …

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Medical malpractice doesn’t address patient safety

Health policy

The value of Accountable Care Organizations (ACOs)

2

Washington has been touting Accountable Care Organizations (ACOs) as the end-all solution to health care’s woes. Designed to reduce Medicare spending and increase care coordination across a large number of patients, members of an ACO – hospitals, primary care physicians,…

Washington has been touting Accountable Care Organizations (ACOs) as the end-all solution to health care’s woes. Designed to reduce Medicare spending and increase care coordination across a large number of patients, members of an ACO – hospitals, primary care physicians, specialists – would be paid if and when their patient population received outstanding quality of care. However, as the Centers for Medicare and Medicaid Services (CMS) finalize their ACO …

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The value of Accountable Care Organizations (ACOs)

Health policy

Are ACOs putting form ahead of function?

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…

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

…

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Are ACOs putting form ahead of function?

Physician voices

The role of non-physician clinicians in primary care

9

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 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) …

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The role of non-physician clinicians in primary care

Physician voices

How much medical care are doctors obliged to provide?

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…

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 …

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How much medical care are doctors obliged to provide?

Health policy

AMA: Health insurers’ denial rates are down, but error rates are up

3

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…

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 of the nation’s health insurers shows that claims denial rates …

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AMA: Health insurers’ denial rates are down, but error rates are up

Health policy

The confusion surrounding comparative effectiveness research (CER)

2

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,…

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

…

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The confusion surrounding comparative effectiveness research (CER)

Health policy

ACOs and the modern day leper

10

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…

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 …

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ACOs and the modern day leper

Health policy

Our growing ability to prolong life and our shrinking ability to pay for it

16

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.…

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 …

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Our growing ability to prolong life and our shrinking ability to pay for it

Health policy

Why obesity should concern conservatives

32

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…

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 …

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Why obesity should concern conservatives

Health policy

Medicaid represents our nation’s moral commitment to help the poor

31

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.…

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, …

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Medicaid represents our nation’s moral commitment to help the poor

Health policy

A private sector solution for wider, more affordable health coverage

20

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…

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 should my health …

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A private sector solution for wider, more affordable health coverage

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