Health policy and public health

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Articles, page 160

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

February 1, 2011Feb 1, 201186

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…

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 …

Physician voices

Marcus Welby and the relentless growth of specialization

Jan Henderson, PhD

January 31, 2011Jan 31, 201132

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…

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 …

Health policy

Having insurance does not mean you get health care

Joseph Paduda

January 30, 2011Jan 30, 201116

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…

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 …

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Health policy

Healthcare costs can be reduced with emerging business models

Joe Flower

January 29, 2011Jan 29, 201110

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…

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

Patient voices

Haggling with your doctor about the costs of care

Jessie Gruman, PhD

January 28, 2011Jan 28, 201130

"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…

“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, …

Health policy

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

Kevin Pho, MD

January 28, 2011Jan 28, 201121

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…

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 …

Health technology

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

Kevin Pho, MD

January 27, 2011Jan 27, 201113

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…

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 …

Health policy

Government is already involved with the majority of health care

ER Stories, MD

January 26, 2011Jan 26, 201131

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,…

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 …

Health policy

How repeal and replace will affect patients

Rishi Manchanda, MD, MPH

January 25, 2011Jan 25, 20112

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…

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 …

Health policy

Payment systems must take into account the art of medicine

Marya Zilberberg, MD, MPH

January 22, 2011Jan 22, 20115

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…

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

Health policy

How effective will the physician payment national database be?

Merrill Goozner

January 21, 2011Jan 21, 20114

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…

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 …

Health policy

Personal responsibility and societal structure changes that reduce obesity

Allen Perkins, MD

January 20, 2011Jan 20, 201117

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 …

Physician voices

Worsen the nursing shortage with more nurse practitioners?

Anonymous

January 19, 2011Jan 19, 201137

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 by …

Physician voices

Your surgeon may be contemplating suicide

Kevin Pho, MD

January 18, 2011Jan 18, 20114

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…

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 …

Health policy

What health reform compromise could look like

Donald H. Taylor, PhD

January 15, 2011Jan 15, 20114

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 …

Health policy

Optimization of the new PCMH neighborhood

Matt Adamson

January 13, 2011Jan 13, 20115

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):…

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 …

Health policy

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

dr_som, MD

January 11, 2011Jan 11, 20113

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…

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 …

Health policy

A culture of fear worsens the nursing shortage and medical errors

Jeffrey I. Kreisberg, PhD

January 10, 2011Jan 10, 20116

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…

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 …

Health policy

Will health care melt down, like the mortgage industry?

Dan McCoy, MD

January 6, 2011Jan 6, 20116

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…

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? …

Physician voices

Measuring health outcomes is important but needs caution

Vipan Nikore, MD

January 5, 2011Jan 5, 20114

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 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 …

Health policy and public health

Articles, page 160

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