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.

How effective will the physician payment national database be?

Merrill Goozner

Health Policy

January 21, 2011

ProPublica.org did some interesting frontrunning on the physician payment national database that will become operable sometime around 2013 as part of health care reform.

In the first of a series of stories that has been picked up by several mainstream media outlets, the New York-based investigative journalism non-profit culled all the physician payments that have been publicly posted by seven drug companies to date. It aggregated the dollars …

Personal responsibility and societal structure changes that reduce obesity

Allen Perkins, MD

Health Policy

January 20, 2011

I visited my parents this past week. The are both in their 80s and in relatively good health although my mother received a diagnosis of diabetes while having a medical exam for an unrelated problem. I spent some time educating her about Type 2 Diabetes, the causes (genetics and weight gain) and the options (medication and/or weight loss and exercise). I stayed with my brother-in-law and sister and the conversation …

Worsen the nursing shortage with more nurse practitioners?

Kevin

Physician

January 19, 2011

by mdstudent31

One of the hot topics occurring in the health care debate deals with figuring out appropriate leaders of the Patient Centered Medical Home (PCMH). With the recent report by the IOM advocating for independent practice by nurse practitioners, many physician groups, including the AAFP and AMA, have come forth with strong statements advocating against the IOM report and independent practice by CRNPs.

A recent editorial …

Your surgeon may be contemplating suicide

Kevin Pho, MD

KevinMD

January 18, 2011

I wrote last year in USA Today about the impact of physician burnout. Not only do doctors suffer, but so do their patients.

Burnout starts early in residency, with entering interns having a depression rate of 4%, similar to the general public. But after the first year of residency, that number balloons to 25%.

Now, another study adds fuel to this disturbing trend.

A paper published in the Archives of General Surgery …

What health reform compromise could look like

Donald H. Taylor, PhD

Health Policy

January 15, 2011

While the rhetoric around health reform has been incendiary from day one, in policy terms, a compromise between Democrats and Republicans using the outline of the Affordable Care Act (ACA) has always been available. The two primary problems with the health care system are costs and lack of coverage. The ACA does pretty well on the second, and is a start on the first, but much more is needed. It …

Optimization of the new PCMH neighborhood

Kevin

Health Policy

January 13, 2011

by Matt Adamson

There are a number of care models now being explored to improve the manner in which healthcare can be delivered. Let’s take a quick look at a few of the well known options:

Accountable Care Organization (ACO): The ACO model has the ability to provide, and manage with patients, the continuum of care across different institutional settings, including at least ambulatory (outpatient) and inpatient …

5 reasons doctors should love the Healthy, Hunger-Free Kids Act

dr_som, MD

Health Policy

January 11, 2011

The Healthy, Hunger-Free Kids Act provides increased funding beyond inflation for school meals for the first time in 30 years and addresses both food insecurity and obesity in children. Here are the details:

1. Growing bodies and brains need good nutrition, the best medicine for our patients. Children at or below 185% of the poverty level qualify for free or reduced cost meals. Although children compose only 25% of …

A culture of fear worsens the nursing shortage and medical errors

Jeffrey I. Kreisberg, PhD

Health Policy

January 10, 2011

There has been a lot talk about changing how we reimburse providers for healthcare from one that pays for services performed, to another that reimburses providers depending on what happens to the patient.

I think we must take a couple of steps back and first tackle the public health crises we are facing that is putting our healthcare in danger, namely, medical errors and the growing nursing shortage. Despite identifying work …

Will health care melt down, like the mortgage industry?

Dan McCoy, MD

Health Policy

January 6, 2011

Clearly, one issue dominated the election this past fall: the economy, and more specifically the lack of jobs.

So I would like to pose a few questions and ideas on just how government actually performs in creating economic growth and in kick starting job growth. I don’t necessarily have the answers, but I’m real good at asking questions.

Did government assisted mortgages help the economy? …

Measuring health outcomes is important but needs caution

Vipan Nikore, MD

Physician

January 5, 2011

I sat at home with a sense of relief. I had just finished my first month of residency – a grueling inpatient hospital month where I was pushed to new limits.

I now finally had my first “golden weekend” (meaning I had both Saturday and Sunday off). More importantly, I had survived my first month without any patient deaths on my service. Given how sick people are when they come to …

An ACO primer and get started on forming an Accountable Care Organization

Donald Tex Bryant

Health Policy

January 5, 2011

In early 2011 Department of Health and Human Services will be issuing guidelines for the formation of Accountable Care Organizations (ACO’s) for CMS (Medicaid and Medicare).

I know of several organizations looking into this type of organization as they anticipate the new guidelines. There seems to be great anticipation of the guidelines in various health care publications that I have recently read. On December 18, 2010 on the Health Affairs website …

Government and health insurance intrusion penalizes efficient doctors

Jordan Grumet, MD

Health Policy

January 4, 2011

I wish I knew how to express myself. I wish I knew how to put this into words. How the direction of things has just become depressing. How each day makes me wonder how we got to where we are today. And I think back. Back to the beginning.

I think back to my childhood. And how I looked up to my father … the physician. How he died when I …

Childhood obesity and chronic illnesses that result from being overweight

David B. Nash, MD, MBA

Patient

January 4, 2011

Our national health status is in imminent danger from the effects of a condition that most population health experts acknowledge is out of control.

I am speaking of obesity — and, in particular, its increasing prevalence in American adolescents and children.

Almost every study that has been done concerning obesity shows a correlation with soda consumption. As a result, some states and municipalities have tried to implement initiatives that make it more …

ACP: Clinical decision support – is it time?

American College of Physicians

Health Technology

January 3, 2011

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

by John Tooker, MD, MBA, MACP

The recently enacted American Recovery and Reinvestment Act (ARRA, 2009) and Patient Protection and Affordable Care Act (PPACA, 2010) contain provisions that, if implemented, will fundamentally change the way that medicine will be practiced in the future.

As I indicated in a …

What will become of health insurance companies after reform?

Paul Levy

Health Policy

January 1, 2011

The talk around the country among health insurance companies is that their insurance business is dying.

What is happening? First, the consolidations in other industries, resulting in large, multistate corporations, already mean that many companies self insure their employees. Even many local firms have large enough work forces that they can be self-contained risk pools. (One source I found says that in 2008, 89 percent of workers employed in …

Health care economics and the relationship between doctor and patient

Maggie Kozel, MD

Patient

December 29, 2010

I used to practice pediatrics. It has been several years since I decided to leave medicine, but people still ask me about it, and I find myself offering neat explanations between gulps of coffee. Of course, the full truth is much more complicated. The full truth has as much to do with our health care system and our culture as it does with me.

My journey in pediatrics was not entirely …

How American physicians should be paid

George Lundberg, MD

Health Policy

December 29, 2010

How do you think American physicians should be paid?

I think many of the current methods are insane. Case in point:

In the 1980s, during a meeting of the board of trustees of the American Medical Association, I experienced sudden unexpected unilateral loss of hearing. You might say that was lucky. But I was scared and went right to my ENT’s office.

He looked in my ear and extracted a large wad of …

Read more…

How American physicians should be paid

Posts of the year on KevinMD.com, 2010 edition

Kevin

Potpourri

December 25, 2010

Merry Christmas!

I’d like to thank everyone for your continued readership.

Doctors, patients and other health care professionals need to be heard, and there’s no better place to do so than here, on social media’s leading physician voice.

This year, KevinMD.com had a regular rotation of 175 guest contributors, and surpassed 1.75 million visits, 2.95 million pageviews, 33,000 followers on Facebook and Twitter, and 40,000 RSS subscribers.

I am truly …

A surge in demand for physicians from newly insured patients

Glenn Laffel, MD, PhD

Health Policy

December 23, 2010

The Affordable Care Act is the most important piece of federal health care legislation since the Social Security Act of 1965 established the Medicare program. It assures that 32 million Americans will have access to health insurance for the first time. But who will care for these people?

Our health care system was plagued by a severe and worsening physician shortage even before the new law took effect. In fact, a …

Maximizing enrollment in insurance exchanges is essential

Roger Collier

Health Policy

December 22, 2010

Massachusetts’ Connector, operational since 2006, is the prototype for PPACA’s insurance exchanges. Connector boosters have claimed it is a vital and successful part of Massachusetts’ health care reform; its critics have noted its failure to influence either benefit or administrative costs or to attract significant enrollment. However, whether success or failure, the Connector offers lessons for other states.

Low enrollment means failure

As Massachusetts discovered, it’s impossible for the exchange to influence …