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.

The value of comparative effectiveness reviews is locally based

Kevin

Health Policy

July 20, 2010

by Craig A. Umscheid, MD, MSCE

In its 2010 comparison, the Commonwealth Fund has rendered the verdict yet again: the United States leaves other nations in the dust when it comes to healthcare costs — and yet provides its residents with the worst outcomes overall. In the study, the U.S. underperformed on virtually every front in comparison to Australia, Canada, Germany, Netherlands, New Zealand, and the United Kingdom.

The …

How Massachusetts can set hospital payment rates

Paul Levy

Health Policy

July 19, 2010

My suggestion last year that Massachusetts move away from the “free market” approach it uses to set hospital reimbursement rates was not well received by the hospital world.

But, this year, as people notice that their rates are being set by insurance companies in an unaccountable and unreviewable fashion, more and more are saying, “Well, maybe. What would it look like?”

There is a range of options. Let me lay out …

What libraries and community centers have to do with health care

Marya Zilberberg, MD, MPH

Health Policy

July 19, 2010

Our grandparents used to tell us, “if it ain’t broke, don’t fix it”.

Management gurus, in their race to the finish line have turned this sentiment on its head by telling us that, if it ain’t broke now, it will be soon, and if you do not fix it before it breaks, you will be behind the competition. This sentiment drives the annual corporate reorganization at every corporation that I or …

A new primary care payment model with health savings accounts

Kevin

Health Policy

July 18, 2010

by Charles Smith, MD

Everybody seems to be dissatisfied with the current model of primary care.

Concierge and retainer practices are all the rage, but they serve too few patients. While some highly integrated systems (Mayo Clinic, maybe Kaiser Permanente) may be thriving, they are difficult to replicate. Most primary care physicians are demoralized by a system that overburdens them with administrative hassles and liability while providing insufficient revenue to improve …

Why general internists are quitting clinical medicine

Glenn Laffel, MD, PhD

Health Policy

July 16, 2010

The Association of American Medical Colleges predicts that by 2025, the US health system will have 46,000 fewer primary care physicians than it needs.

If the prediction proves correct and we fail to develop effective mitigation strategies, the manpower shortage will create quite a mess. Ironically, the health reform law signed by President Obama in March will exacerbate the problem by increasing demand for services provided by primary care physicians.

The American …

Poliomyelitis doesn’t make the health reform cut

Jeffrey Hall Dobken, MD, MPH

Health Policy

July 16, 2010

Early in paralytic poliomyelitis, the patient exhibits weakness; hyperesthesia; muscular pain, frequently quite severe; antalgic (reflexive) immobilization (spasm) of involved muscles; and normal or accentuated tendon reflexes.

This phase is rapidly followed by loss of motor function, which is usually asymmetric and noncontiguous: one or both legs in 60 percent of the cases; one or both arms in 25 percent. Involvement of the diaphragm and intercostal muscles reduces ventilatory capacity. Cranial …

Free clinics need more government funding

MedPage Today

Health Policy

July 14, 2010

by Cole Petrochko

The nation’s free clinics provide medical service to 1.8 million patients annually — more than half of those clinics operate without government funding and serve patients who are almost all uninsured — according to the first census of free clinics in 40 years.

Responses to a national mail survey by 764 free clinics in the U.S., reported in the June issue of the Archives of Internal Medicine, revealed that …

Final meaningful use rules for electronic health records reaction

Kevin

Health Technology

July 14, 2010

by Joyce Frieden

The Department of Health and Human Services has released its final rule on “meaningful use” of electronic health records with the goal of making it easier for physicians to comply.

“We want these objectives to be ambitious but achievable,” David Blumenthal, MD, MPP, the department’s National Coordinator for Health Information Technology, said at a press conference on Tuesday announcing the release of the …

The individual mandate and the impending Supreme Court challenge

Roger Collier

Health Policy

July 13, 2010

The individual mandate is the single most controversial feature of the Patient Protection and Affordable Care Act (PPACA). Everyone who can afford coverage—unless an undocumented immigrant or exempted on religious grounds—is required to have it or pay a penalty of $695 or 2.5 percent of income.

The rationale is straightforward: without a mandate, many people would wait until they needed care before buying insurance, driving up premiums for those with ongoing …

Healthcare reform: Who’s getting stuck with the bill?

Kevin

Health Policy

July 13, 2010

by Shelly Towns

Many people have the mistaken idea that “socialized healthcare” means that medicine and care will now be free for everyone, but in all actuality, nothing could be further from the truth.

The new healthcare bill represents one of the largest, most sweeping domestic policy changes in a generation, and aims to provide an estimated $940 billion in healthcare to over 32 million uninsured Americans (and that’s only for the …

AMA health insurer report card finds need for more accuracy

Kevin

Health Policy

July 12, 2010

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

There has been some notable progress in just two years since the American Medical Association’s first National Health Insurer Report Card evaluated the claims processing performance of the nation’s largest insurers. Health plans have made improvements in the efficiency and transparency of their claims processes, but there is still a lot of room for improvement – and the AMA …

Is health care experience mandatory for a pharmaceutical CEO?

Roy Poses, MD

Medications

July 11, 2010

A persistent theme for Health Care Renewal has been how concentration and abuse of power in health care trap patients and heath care professionals in a maze of bureaucracy, perverse incentives, deception, and conflicts of interest.

To anyone who has to make the transition from person to patient, some of these problems become immediately obvious.

Consider, for example, this account of “going into a hospital for a minor procedure”:

The very idea of …

Read more…

Is health care experience mandatory for a pharmaceutical CEO?

Practical barriers for comparative effectiveness studies

David Williams

Health Policy

July 10, 2010

Writing in the New England Journal of Medicine three authors share their experience in running a head-to-head trial of Avastin (bevacizumab) versus Lucentis (ranibizumab) for wet age-related macular degeneration (AMD).

They describe the barriers they faced and suggest that the barriers will need to be removed for comparative effectiveness research to succeed. They make good points and may well be correct in their policy recommendations.

However the case of Avastin and Lucentis …

Emergency room waits grow as more people become insured

Kevin Pho, MD

Health Policy

July 8, 2010

Remember when I wrote, way back when, that expanding health coverage without a concurrent increase in primary care access will only worsen emergency room waits?

For instance, consider this, from CNN.com:

What good is having health insurance if you can’t find a doctor to see you? …

… The Massachusetts Medical Society reported that the average wait time for a new patient looking for a primary care doctor ranged from 36 to …

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Emergency room waits grow as more people become insured

Op-ed: Empowered e-patients are failed by our health system

Kevin Pho, MD

Physician

July 6, 2010

The following op-ed was published on June 7th, 2010 in CNN.com.

“I read all about my condition on the Internet,” a recent patient proudly told me. Like other doctors, I’m seeing more patients research their symptoms thoroughly before setting foot in the exam room.

Patients are using the Web in unprecedented ways for their own health empowerment. According to the Pew Internet & American Life Project, 61 percent of American adults …

Does prevention improve health care outcomes and lower costs?

Kevin

Health Policy

July 5, 2010

by Joseph W. Stubbs, MD, FACP

The eighth paragraph of the modern Hippocratic Oath reads: “I will prevent disease whenever I can, for prevention is preferable to cure.”

Support and encouragement of prevention are deeply rooted among physicians. Intuitively, to prevent a deadly or disabling disease from occurring or stop it at an early stage seems like a bread-and-butter concept with obvious health benefits.

But it should also accrue cost savings by avoiding …

A medical home does not guarantee increased patient satisfaction

Steve Wilkins, MPH

Physician

July 2, 2010

One of the more notable findings from the special report on the TransforMED National Medical Home Demonstration project was that “patient satisfaction doesn’t automatically go up.”

Terry McGeeney, CEO of TransforMED, attributed the lack of increased patient satisfaction experienced by the 18 participating physician practices to a variety of factors, chief of which “was the turmoil of change experienced by patients as practices implemented after-hours access, quick access to laboratory results …

Why the medical home may not save primary care money

Jaan Sidorov, MD

Health Policy

June 29, 2010

When the Disease Management Care Blog saw the flurry of news reports about the Patient Centered Medical Home (PCMH) “saving money,” it couldn’t wait for the full print version of Health Affairs to arrive at the DMCB World Headquarters.

The DMCB had previously reviewed Group Health’s negative “no statistically significant…. cost differences” one year study and was looking forward to seeing researchers Robert Reid et al’s reportedly positive two …

Why Obamacare scares this cardiologist

Richard Reece, MD

Health Policy

June 27, 2010

I recently visited my cardiologist. It was a routine follow up after a heart attack a year ago. I enjoy our relationship. As a token of my regard, I came bearing a gift. It was a copy of my book Obama, Doctors, and Health Reform.

I knew he had qualms about Obamacare. He expressed doubts about the health reform bill’s merits. The bill will roll out over the next ten years. …

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Why Obamacare scares this cardiologist

Healthcare reform’s focus on outcome and how that affects doctors

David B. Nash, MD, MBA

Health Policy

June 25, 2010

With the signing of national healthcare reform into law, the U.S. healthcare system faces almost immediate — and substantial — transformation. I spent a recent Sunday reading all that I could find in order to get my arms around this massive piece of legislation and to understand its health policy implications.

Here is my view from 50,000 feet.

I needn’t list all of the aspects relating to expanded coverage and insurance reform …