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.

Onsite clinics within a competitive health care marketplace

Brian Klepper, PhD

Health Policy

February 13, 2011

The recent explosion of interest in onsite clinics – not just by employers, but by health plans, hospital systems, public health programs, and others – is anything but just another health care fad. At once, clinics’ growing popularity signals purchasers’ weariness with an intransigent, self-interested health system, as well as their guarded optimism about a better way.

Today’s best clinics are single-mindedly focused on what works best for the patient and …

What physicians should believe about Accountable Care Organizations

Kevin

Health Policy

February 13, 2011

by Jeffrey L. Cohen

In the 90s, physicians were told “The sky is falling. You have to find a tree to stand under or you will be crushed.” The “trees” were things like IPAs and PHOs. The future outlook was bleak. All patients were going to be part of some system with which the physician would have no input or control. Decisions would be made on purely …

Physicians’ voices heard through AMA advocacy activities in Washington, DC

Kevin

Health Policy

February 10, 2011

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

by Ardis Dee Hoven, MD

This week, hundreds of physicians and medical students converged in Washington, D.C., for the AMA’s annual National Advocacy Conference. The current and future physicians learned about and discussed key legislative issues, including how new policy will impact physician practices, and heard from officials including CMS Administrator …

How to check your scientific paper for plagiarism

George Lundberg, MD

Medical Education

February 8, 2011

We were taught in grammar school that plagiarism is wrong. It is stealing someone else’s property.

Imagine in high school asking your mother to buy you “Cliff Notes” so you can copy it word for word. Mother would not have liked that, and it wouldn’t have been right.

To write an essay today, you’ll probably start with a search engine. Instantly, Mr. Google delivers many intelligent commentaries on anything, probably better than …

Online tools to help shop for the most affordable health care

Kevin

Health Technology

February 8, 2011

by Ray Carlson

Two recent articles posted here at KevinMD.com regarding the inclusion of discussions about the cost of health care services between doctor and patient highlighted the growing emphasis on not only the quality of care but the cost of that care to the patient as well. The first article was written by Dr. Leslie Ramirez, who advocated for a more proactive stance by doctors regarding …

Integrating doctors and hospitals may worsen cost control in health reform

Kevin Pho, MD

KevinMD

February 8, 2011

Health reformers propose the proliferation of integrated health systems, like the Mayo Clinic or Kaiser Permanente, which, according to the Dartmouth Atlas, lead to better patient care and improved cost control.

To that end, Accountable Care Organizations have been a major part of health reform, changing the way health care is delivered.

Never mind that patients may not be receptive to the new model, but the creation of these large, integrated physician-hospital …

If you’re in medicine, you’re in politics

Kevin

Medical Education

February 7, 2011

by Nicholas J. Rohrhoff

Each generation of physicians has no choice but to take on the responsibility of learning the science of medicine – how best to care for patients. But current circumstances dictate that we must also bear the burden of developing policy that creates the best system in which to provide that care.

Creation of a 21st century American healthcare system will require engagement and …

Finding out the cost of lab tests is a real challenge for patients

Brad Wright, PhD

Conditions and Diseases

February 4, 2011

In the spring of 2005, the sinus infection returned. I awoke severely congested with a pounding forehead and pain around my eyes that grew worse when I bent to tie my shoes. The feeling was familiar. Two years earlier, I had similar symptoms, but was uninsured and endured a miserable week with nothing but over-the-counter medication. Now they were back.

Fortunately, when I started graduate school, my father insisted that I …

Can President Obama and the GOP agree on improving health reform?

Bob Doherty

Health Policy

February 2, 2011

Everything seems to be pointing toward two years of partisan and ideological confrontations over health reform. The leadership of an emboldened Republican party has made it clear that it will use its newfound House majority to seek to “repeal and replace” the Affordable Care Act (ACA), and if that doesn’t work, to “defund” it. Huge GOP gains in statehouses make it likely that more states will resist implementation. Meanwhile, President …

Ethics of the individual mandate

Kevin

Health Policy

February 2, 2011

by Raymond Raad, MD, MPH

There is a remarkable inconsistency between the ethics of medical practice and the discussion about the health care reform law passed this past March, especially the individual mandate.

In medicine, it is considered unethical to force a patient to do something against his will. Patients are allowed to disagree with their doctors and to decide for themselves whether they want to heed their advice. Patients are even …

Read more…

Ethics of the individual mandate

Health reform repeal will lead to single payer, Medicare for all

Kevin Pho, MD

KevinMD

February 1, 2011

In a guest post last year, physician-author Richard Reece commented that the individual mandate may collapse health reform.

Those words came to mind as Judge Vinson not only ruled the individual mandate unconstitutional, but the entire Affordable Care Act, as well.

Nobody likes to be mandated to do anything, least of all purchase health insurance, and this was always the sticking point with the current iteration of health reform.

So, what …

Marcus Welby and the relentless growth of specialization

Jan Henderson, PhD

Physician

January 31, 2011

In the very first episode of the TV series Marcus Welby, MD, our hero delivers an after dinner speech to a group of young interns. As he’s introduced, he hastily scribbles the title of his talk and hands it to the hospital director: “The future of the general practice of medicine, if any.” The year was 1969.

In his introduction, the director somewhat tactlessly remarks that many “eminent specialists” have addressed …

Having insurance does not mean you get health care

Joseph Paduda

Health Policy

January 30, 2011

There’s no question the Accountable Care Act needs work – everyone agrees on that.

So let’s talk about the specifics – what needs fixing, why, and how can we get those fixes passed.

First, let’s understand how bad our current system is. Some who want to repeal and/or replace the ACA continue to publicly state we have “the best health care in the world.”

While that may – or may not – have …

Healthcare costs can be reduced with emerging business models

Joe Flower

Health Policy

January 29, 2011

Here’s a simple key to parsing the future economics of healthcare. We have been trying for over 30 years to control healthcare costs. And there is little evidence that any of these efforts have had much effect. For decades the rise in healthcare costs has been consistently several times higher than the general inflation level.

There have been dozens of schemes used in various parts of the industry — inpatient, ambulatory, …

Haggling with your doctor about the costs of care

Jessie Gruman, PhD

Patient

January 28, 2011

“How to Haggle With Your Doctor” was the title of a recent Business section column in the New York Times. This is one of many similar directives to the public in magazines, TV and Websites urging us to lower the high price of our health care by going mano a mano with our physicians about the price of tests they recommend and the drugs they prescribe. Such articles provide simple, …

What’s next for doctors if pay for performance fails?

Kevin Pho, MD

KevinMD

January 28, 2011

I recently pointed to a BMJ study concluding that pay for performance doesn’t seem to motivate doctors. It has been picking up steam in major media with TIME, for instance, saying, “Money isn’t everything, even to doctors.”

So much is riding on the concept of pay for performance, that it’s hard to fathom what other options there are should it fail. And there’s mounting evidence that it will.

Aaron Carroll, a …

Electronic medical records and pay for performance don’t improve care

Kevin Pho, MD

KevinMD

January 27, 2011

Electronic medical records and pay for performance are among the ways health reformers are going to improve patient care.

It’s a fundamental shift in how doctors practice, with more practices adopting expensive EMRs. And with the advent of Accountable Care Organizations, doctors will soon be compensated in part by quality measures.

But will they work? Well, the jury’s still out.

Two articles caught my eye recently.

The first, from the WSJ’s Health Blog, reports …

Government is already involved with the majority of health care

ER Stories, MD

Health Policy

January 26, 2011

US District Judge George Steeh of Michigan ruled last year that the constitution permits the federal government to require individuals to obtain health insurance coverage.

This lawsuit was filed by a Christian legal organization called the Thomas More Law Center, as well as others. Other lawsuits are in the works in numerous other states. These suits are filed primarily by Libertarian-types who don’t want to be forced to buy health insurance …

How repeal and replace will affect patients

Rishi Manchanda, MD, MPH

Health Policy

January 25, 2011

by Rishi Manchanda, MD

As a primary care doctor for working families, I am interested in anything that can tangibly address my patients’ health problems. But how do I prescribe repeal?

The House effort to repeal and replace last year’s health care law is not just an untested placebo with major potential side effects, like increasing the number of Americans without health coverage. For those of us on …

Payment systems must take into account the art of medicine

Marya Zilberberg, MD, MPH

Health Policy

January 22, 2011

You know that joke about the farmer whose cows are not producing enough milk? A university panel gathers under the leadership of a theoretical physicist. They analyze each aspect of the problem thoroughly and carefully, and after much deliberation produce a report, the first line of which is “First, assume a spherical cow in a vacuum.”

This joke has become short-hand for some of the reductionist thinking in theoretical physics, but …