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.

Shop for benefits, not premiums, when looking for health insurance

Kevin

Health Policy

June 23, 2010

by Ray Carlson

When discussing health insurance plan strategies with clients, there can sometimes be an awkward pause in the conversation after asking the client if they checked to see if their own doctor is in the network of the health insurance company whose plan they are applying for.

It’s possible that many first time shoppers for individual health coverage are applying for health plans without first verifying if a family physician …

How healthcare reform will affect Medicaid

MedPage Today

Health Policy

June 22, 2010

by Cole Petrochko

Medicaid expansion under new healthcare reform laws could add millions of participants to the program over the next nine years and greatly decrease the number of uninsured Americans — with the federal government picking up most of the tab, according to a Kaiser Family Foundation report.

One set of projections in the report, prepared by the Urban Institute for the Kaiser Commission on Medicaid and the Uninsured, estimates that …

Return control of our health system back to doctors and patients

Kevin

Health Policy

June 19, 2010

by William Lawson, MD

Representative David Price recently wrote the Chapel Hill News to “set the record straight” regarding Washington’s newly‐passed health care legislation.

Rep. Price argues that the government’s central planning will make health insurance more affordable for small businesses and individuals. Touting tax credits covering 35% of premiums for small businesses with less than 25 employees and less than $50,000 in average annual wages, Rep. Price asserts that the new …

Heart catheterization worries that every cardiologist face

John Mandrola, MD

Physician

June 18, 2010

Malpractice and heart catheterization have been in the news recently.

A spicy concoction for sure. An epidemiological study published in an online subsidiary of Circulation addresses the role of three major medical issues facing cardiologists today: malpractice, heart catheterization, and medical costs.

It is hard to get more controversial.

Heart catheterization, the invasive assessment of the coronary artery lumen, has always been a hot-potato topic. The “percent-normal” was the buzz word when I …

Should prisons require co-pays for inmate health care?

Jeffrey Knuppel, MD

Patient

June 18, 2010

In the U.S., correctional facilities are required by law to provide inmates with access to medical care. As health care costs have spiraled out of control everywhere, jails and prisons have attempted to develop innovative ways of reducing this hefty financial burden while simultaneously meeting their legal obligation to provide care.

One approach that has gained significant popularity in recent years is to require inmates to pay a small fee, usually …

Do large hospital systems increase healthcare costs?

Roy Poses, MD

Health Policy

June 16, 2010

In Rhode Island, hospitals that are part of hospital systems were paid more for the same services than independent hospitals.

The price differences could not be explained by quality of care or severity of illness. The results suggested that market power determines the price of hospital services, and that increasing concentration of power in hospital networks is likely to further increase costs, without improving quality of care.

Recently, a similar report out of the neighboring state …

Who really benefits from President Obama’s health reform plan?

Erin Marcus, MD

Health Policy

June 15, 2010

I don’t know about you, but as I watched coverage of President Obama signing the health care bill three months ago, it was hard not to notice the constant ads for power wheelchairs. Emblazoned across the ads was a flashing notice reminding viewers: Medicare may cover this!

Don’t get me wrong. As a primary care doctor who takes care of low-income patients, I was glad to see something being done to …

Doctors make far less money than most people think

Kevin

Health Policy

June 15, 2010

A video excerpt from The Vanishing Oath, a film directed by Ryan Flesher, MD.

The average physician salary in the United States is $146,000 — which is undeniably a lot of money at face value.

But it’s a lot less when you factor in the overhead costs that doctors incur. And that’s not including the medical school debt which, on average, exceeds $150,000.

This clip shows how the take home pay of …

Medical loss ratios is not all about health insurance profits

David Williams

Health Policy

June 14, 2010

The new health insurance reform law will generally require health plans to pay out at least 80 or 85 percent of premiums in medical expenses, depending on whether they are selling to individuals/small groups or to large groups. Intuitively it makes sense that purchasers would want the medical loss ratio to be as close to 100 percent as possible –- since the purchaser doesn’t derive utility a plan’s administrative expenses …

Prescription drugs and its copycats contribute to health waste

Roy Benaroch, MD

Medications

June 14, 2010

I’ve recently posted about the insane costs of health care, and about how defensive medicine is a big contributor. Prescription drugs are another huge cost, accounting for about 11% of the 2 trillion spent each year on health care in The United States. And it turns out that the marketplace for prescriptions is also rife with bizarre sources of waste and sneakery.

First, some good news: prescription medications are …

Primary care is more than just office visits

Robert Wachter, MD

Physician

June 13, 2010

If you’ve ever been on a diet, you know that it really helps to keep a food log. Seeing your consumption chronicled in one place is illuminating – and often explains why those love handles aren’t melting away despite two hours on the treadmill each week.

In a recent issue of the New England Journal of Medicine, internist Rich Baron Rich Baron chronicles the work of his 5-person Philadelphia office practice …

Government and marathon runner motivation

Jeffrey Hall Dobken, MD, MPH

Health Policy

June 13, 2010

Giving advice is usually a thankless business. I have always been mindful of the unconsciously profound summation given by a six-year-old when she was asked to identify Socrates. “Socrates,” she stated, “was a really old Greek guy who went around giving people good advice. They poisoned him.”

But here goes: We do not need government intervention to improve our health, and, by extension, the quality of our lots in life.

This essay …

AMA: Senate fails to stop a Medicare meltdown

Kevin

Health Policy

June 11, 2010

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

by J. James Rohack, MD

Unbelievable as it is, for the third time this year the Senate failed to act on time to stop this year’s 21 percent Medicare physician payment cut. Senators cut and ran on America’s seniors and their physicians, heading home for the Memorial …

Clinical judgment and when neurologists should order an MRI

Vernon Rowe, MD

Conditions and Diseases

June 8, 2010

With healthcare reform dominating the news recently, MRI and other imaging tests have become the (misguided) targets of many critics.

Although MRI makes up only one-half of one percent of total healthcare expenditures, it is easy to demonize since the average healthcare consumer can understand imaging much easier than the diagnosis related groups (DRGs), hospital facility fees or insurance contracts that have a much greater impact on the cost of health …

MRI abuse can be dangerous and expensive for patients

Chris Rangel, MD

Conditions and Diseases

June 7, 2010

What is “MRI Abuse”? This is when the health care provider orders MRIs (Magnetic Resonance Imaging) in excess or for the wrong reasons. There are many causes of MRI abusive behavior but most evolve out of a significant misunderstanding of how to properly utilize this diagnostic tool. MRI imaging has a high sensitivity to detect anatomic abnormalities, does not expose the patient to high doses of radiation like a CAT …

Whistleblowers endure stress and personal hardship

Charles Bankhead

Health Policy

June 7, 2010

by Charles Bankhead

Whistle-blowers in the healthcare industry endure substantial hardship and often pay a high personal price for cooperating with Justice Department investigations, according to a report based on detailed interviews with more than two dozen informants.

Loss of employment, financial ruin, divorce, and a host of mental and physical health problems were common consequences of individuals’ decisions to report corporate fraud.

Cases can drag on for years before reaching a resolution, …

Tort reform for doctors in exchange for less salary

Jeffrey Parks, MD

Health Policy

June 7, 2010

Matt Steinglass at The Economist has interesting take on tort reform, specifically that limiting physician liability for adverse patient outcomes must come with an equable cost to doctors.

In Europe, the costs accrued due to medical errors are covered by the wide-ranging social safety net; the lottery system of massive medical malmalpractice judgments is virtually absent.

It’s part of the social contract: doctors accept limited salaries in exchange for limited liability; …

Read more…

Tort reform for doctors in exchange for less salary

The New York Times changes the Dartmouth Atlas narrative

Kevin

Health Policy

June 7, 2010

Several have asked me to comment on the New York Times versus Dartmouth Atlas spat.

In summary, the Dartmouth Atlas comprises of studies showing variation in care for Medicare recipients. Their main, take home message is that high-spending areas of the country sometimes had poorer outcomes than lower-spending ones.

Their work has been influential with the current administration, and among progressive health reformers. Last week however, the New York Times published a …

Should Americans be forced to buy health insurance?

MedPage Today

Health Policy

June 6, 2010

by Joyce Frieden

When it comes to the healthcare reform law, no provision is more controversial than the individual mandate – the part that requires every citizen to purchase health insurance or pay a penalty.

More than 20 state attorneys general are suing the federal government over the health reform law, in large part because of this provision. Several states have already passed laws declaring an individual mandate unenforceable in their state, …

Will healthcare reform survive the Supreme Court?

MedPage Today

Health Policy

June 5, 2010

by Joyce Frieden

Partisan wrangling aside, the Supreme Court will have to address serious constitutional questions about the healthcare reform law, and it’s far from clear how the justices will decide the issues, legal scholars say.

So far, 21 state attorneys general are suing to overturn the law on constitutional grounds. One of their arguments is that by forcing individuals to either buy health insurance or pay a fine, the law violates …

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