Health policy and public health

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Articles, page 162

Medicare rates will be influenced by comparative effectiveness

December 5, 2010Dec 5, 20106

From its inception, Medicare has been agnostic about the effectiveness of different treatments when it sets payment rates. Once a treatment is found to be "reasonable and necessary," Medicare establishes a payment rate that takes into account complexity and other…

From its inception, Medicare has been agnostic about the effectiveness of different treatments when it sets payment rates. Once a treatment is found to be “reasonable and necessary,” Medicare establishes a payment rate that takes into account complexity and other “inputs” that go into delivering the service. But it is prohibited by law from varying payments based on how well an intervention works.

This would change under a “dynamic pricing” approach …

Health policy

Why the Pre-Existing Condition Insurance Plan (PCIP) fails

Ray Carlson

December 4, 2010Dec 4, 20107

As we all know, this past March Congress passed and the President signed The Affordable Care Act. One component of the new legislation was the creation of a program called the Pre-Existing Condition Insurance Plan (PCIP). This is a federally funded high risk pool for state residents who – having been denied individual insurance coverage within the past 12 months for a pre-existing condition – would now, theoretically, have ready …

Health policy

Learning from the Massachusetts experiment in universal coverage

Joseph Paduda

December 2, 2010Dec 2, 20105

We're learning a lot from Massachusetts' experiment in universal coverage - and some of the lessons are rather enlightening. According to Bestwire, Lora Pellegrini, president of the Massachusetts Association of Health Plans, said something along the lines of "That's the…

We’re learning a lot from Massachusetts’ experiment in universal coverage – and some of the lessons are rather enlightening.

According to Bestwire, Lora Pellegrini, president of the Massachusetts Association of Health Plans, said something along the lines of “That’s the problem with the new U.S. health care reform law … it offers millions of uninsured Americans access to health insurance but doesn’t address underlying medical costs, which are contributing to costly …

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Health policy

Integration and virtual accountable care organizations in health reform

Joe Flower

December 2, 2010Dec 2, 20104

They are coming in fast under the radar, out of peripheral vision, in the magician’s other hand—and they will change everything. New ideas, surprising networks, stealth business models that may change health care profoundly, are bubbling up in pilot programs, experiments and full-on corporate transformations. There is something here that does not yet have a name, that no one is yet calling a movement, that no one is yet seeing …

Health policy

How a plumber charges more than a neurosurgeon

S. Irfan Ali, MD

November 30, 2010Nov 30, 2010118

So there was a neurosurgeon who called a plumber for a house visit. The plumber arrived and after spending an hour bestowed the neurosurgeon a bill of $500. The surgeon was stunned; he said, “Even I don’t charge this much…

So there was a neurosurgeon who called a plumber for a house visit.

The plumber arrived and after spending an hour bestowed the neurosurgeon a bill of $500. The surgeon was stunned; he said, “Even I don’t charge this much after a surgery.” The plumber stood up, gave him a sly look and said, “well that is why I am a plumber now; I used to be a neurosurgeon.”

I mention this …

Health technology

Scribes lead to unintended consequences from electronic medical records

Douglas Perednia, MD

November 29, 2010Nov 29, 201020

Recently, Dr. Scot Silverstein over at Health Care Renewal published this update to the ongoing story of electronic medical records that are so simple, intuitive and easy to use that doctors and hospitals everywhere are being forced to hire "scribes"…

Recently, Dr. Scot Silverstein over at Health Care Renewal published this update to the ongoing story of electronic medical records that are so simple, intuitive and easy to use that doctors and hospitals everywhere are being forced to hire “scribes” to run them.

We’d looked at the resurgence of scribes in a previous post, and Dr. Silverstein’s article seems to confirm that the phenomenon is is here to stay …

Health policy

Why comparing healthcare access to food is a false analogy

Marya Zilberberg, MD, MPH

November 23, 2010Nov 23, 201056

When I was in training as a resident and a fellow, I remember taking only a couple of sick days over the entire 6-year period. And I had to stay home because I could not stop praying to the porcelain…

When I was in training as a resident and a fellow, I remember taking only a couple of sick days over the entire 6-year period.

And I had to stay home because I could not stop praying to the porcelain Goddess during a bout of a particularly nasty flu, despite a vaccination. I actually took pride in my health record, and attributed it directly to being rather sickly as a child. …

Conditions and diseases

Diabetes and leg amputations in McAllen, Texas

Merrill Goozner

November 23, 2010Nov 23, 20106

The Dartmouth Atlas of Health is once again throwing a harsh spotlight on McAllen, Texas. This time the Mexican border town has the highest rate of leg amputations in the nation, a new report released recently showed. McAllen's rate was…

The Dartmouth Atlas of Health is once again throwing a harsh spotlight on McAllen, Texas.

This time the Mexican border town has the highest rate of leg amputations in the nation, a new report released recently showed. McAllen’s rate was ten times the rate of Provo, Utah, which had the lowest rate of leg amputations among the Medicare eligible population. The national average was one-third of McAllen’s rate.

McAllen became notorious earlier …

Health policy

ACP: Health care innovation in the Affordable Care Act

American College of Physicians

November 23, 2010Nov 23, 20107

A guest column by the American College of Physicians, exclusive to KevinMD.com. by John Tooker, MD, MBA, MACP The Patient Protection and Affordable Care Act (PPACA) has important provisions – improved access, safety and quality among them – that have…

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

by John Tooker, MD, MBA, MACP

The Patient Protection and Affordable Care Act (PPACA) has important provisions – improved access, safety and quality among them – that have the real potential to improve health and health care and, lower costs.

Two recent reports remind us of the urgent need to improve safety and quality: A report from …

Physician voices

Will primary care be saved by the community health center?

Allen Perkins, MD

November 22, 2010Nov 22, 20104

As I have written before, the Teaching Health Center is seen as a way to move education into the community (using Community Health Centers as a training resource) and out of the Academic Health Center. Currently, 20 million Americans receive…

Currently, 20 million Americans receive care in a CHC. They serve Americans who are unable to obtain access through more traditional means, either because of location (the community will not support traditional healthcare) or socioeconomic …

Health policy

Do posters in the hospital really help patients?

Jaan Sidorov, MD

November 21, 2010Nov 21, 20104

The Disease Management Care Blog received this posting from an experienced nurse with a background in clinical and administrative medicine. We’ve all seen them. Those vacuous workplace posters exhorting teamwork, creativity and other forms of inspiration and accomplishment. A version…

The Disease Management Care Blog received this posting from an experienced nurse with a background in clinical and administrative medicine.

We’ve all seen them. Those vacuous workplace posters exhorting teamwork, creativity and other forms of inspiration and accomplishment. A version has begun to creep into our nation’s health care facilities. reminding everyone of the need for privacy, how infections can be spread and the importance of patient service. And if my …

Physician voices

Cardiothoracic surgery has a shortage of surgeons

Shawn Vuong

November 20, 2010Nov 20, 20104

Some time in the years 2002-2005, cardiothoracic surgery hit the wall. The specialty's big time claim to fame, the CABG (coronary artery bypass graft), surgery was on a huge decline. The field of cardiothoracic surgery became super saturated with over…

Some time in the years 2002-2005, cardiothoracic surgery hit the wall.

The specialty’s big time claim to fame, the CABG (coronary artery bypass graft), surgery was on a huge decline. The field of cardiothoracic surgery became super saturated with over trained surgeons who were no longer in demand. The interventional cardiologist had come along and started stenting coronary arteries, saving patients from the chest opening surgery known …

Physician voices

Our malpractice system needs to focus on patient safety

Donald H. Taylor, PhD

November 18, 2010Nov 18, 201020

A malpractice lawsuit claims that a doctor treated a patient negligently and that this treatment caused harm, and it seeks monetary compensation. Negligence means that a physician failed to provide the standard of care expected by the prevailing medical custom. Juries decide cases that are tried, but most cases are settled or dropped. Lawyers get paid (typically 35 percent) only when they win or settle a case.

A successful malpractice system …

Physician voices

How the health care industry competes for patients

Shantanu Nundy, MD

November 17, 2010Nov 17, 20105

On my drive in to work this past week I came across this: A bus-side advertisement for a local hospital (sadly, not mine) claiming that it was “home to the city’s best transplant outcomes.” Normally I drive right by these…

On my drive in to work this past week I came across this:

A bus-side advertisement for a local hospital (sadly, not mine) claiming that it was “home to the city’s best transplant outcomes.” Normally I drive right by these moving billboards without paying much attention. But this time I immediately got excited, whipped out my cell phone and snapped …

Health policy

What does the NYC Marathon have to do with health reform?

Jeffrey Hall Dobken, MD, MPH

November 16, 2010Nov 16, 2010

Legend tells of an Athenian named Pheidippides who, in 490 B.C., ran from the battlefield at Marathon to Athens, telling of the victory over the Persians. Proclaiming the news that Athens would be spared pillage and fire, the Athenian dropped…

But the marathon, like most things worth doing, does offer both risks and rewards. Because it gives a chance to go beyond usual boundaries, with …

Health policy

Design solutions by truly understanding how humans use tools

Jay Parkinson, MD

November 16, 2010Nov 16, 2010

The Futurama exhibit from the 1939 World’s Fair, although pretty in exhibition form, looks like a terrible place to live. It’s a world of machines, concrete, and efficiency. How boring! Futurists have always imagined the “what can we do?” scenarios.…

What should we do?
What do people want that would make them feel more alive and more happily human?

Jane Jacobs, in her excellent book The Death …

Medical education

Physicians the government wants to see

Edwin Leap, MD

November 15, 2010Nov 15, 201030

I was talking with a pre-med student recently. He had completed his very first medical school interview and was, understandably, excited. But he told me the interviewer had asked him what he thought would be the outcome of the current…

I laughed to myself. After 17 years in practice, even I don’t know the outcome, though I have my suspicions. It seemed a loaded, almost unfair question. After …

Read more…

Physicians the government wants to see

Health policy

Preventive care as a cost saving measure is a fallacy

Lucy Hornstein, MD

November 12, 2010Nov 12, 201056

I like reading Maggie Mahar’s Health Beat. She usually gets it, from the function of insurance to the complexities of assorted payment systems, I get the sense that she is generally rational when it comes to paying for health care.…

I like reading Maggie Mahar’s Health Beat.

She usually gets it, from the function of insurance to the complexities of assorted payment systems, I get the sense that she is generally rational when it comes to paying for health care. This doesn’t mean there aren’t times when she gets it wrong. Her embrace of primary care provided by nurse practitioners shows a truly spectacular …

Health policy

Why patients in Grand Junction, Colorado have better health outcomes

Gary Levin, MD

November 12, 2010Nov 12, 20104

The New England Journal of Medicine analyzed Medicare statistics from the beloved Dartmouth Atlas of Health Care study revealing a wide disparity in the number of coronary bypass procedures in Golden Colorado compared to other areas. The report reveals a…

The New England Journal of Medicine analyzed Medicare statistics from the beloved Dartmouth Atlas of Health Care study revealing a wide disparity in the number of coronary bypass procedures in Golden Colorado compared to other areas.

The report reveals a 60% reduction in the number of procedures as compared to Miami, Florida. The Dartmouth Atlas Study has been used to justify changes in payment systems by Medicare. The study has …

Health policy

AMA: Patients and physicians call on Congress to stop Medicare cut

American Medical Association & Cecil B. Wilson, MD

November 11, 2010Nov 11, 201012

A guest column by the American Medical Association, exclusive to KevinMD.com. Medicare physician payment cuts are once again looming in the immediate future, with a cut of 25 percent now threatening to hurt access to care for seniors and military…

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

Medicare physician payment cuts are once again looming in the immediate future, with a cut of 25 percent now threatening to hurt access to care for seniors and military families. As many doctors know all too well, the looming cut is forcing physicians to make difficult decisions about the continuing role Medicare can play in their practices.

The AMA is working on …

Health policy and public health

Articles, page 162

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