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.

Why did Canadian premier Danny Williams come to the United States for heart surgery?

Kevin

Health Policy

February 4, 2010

Originally published in MedPage Today

by Michael Smith, MedPage Today North American Correspondent

It is rare that a simple matter of patient choice causes an international flap.

But that’s what happened when 60-year-old Danny Williams of St. John’s, Newfoundland, decided to go to the U.S. for heart surgery.

That’s because Williams isn’t just any old Newfoundlander — he’s the premier of Canada’s easternmost …

Why primary care doctors need to practice insurance free medicine

Matthew Mintz, MD

Physician

February 3, 2010

I never thought I would be in academic medicine for so long.

When I was hired about 12 year ago, I figured I would stay in academics for a few years and then join a private practice Internal Medicine group. Now, I can’t even fathom that idea. One of the reasons I have stayed at my institution for so long is that I love teaching and the academic environment.

However, a second …

Why there are so few leaders in medicine and how to fix it

Kevin

Health Policy

February 3, 2010

Originally published in HCPLive.com

by Jeff Brown, MD

A quick look at a newspaper will tell any doc just how important physician leadership has become, and increasingly so, in having a say in our economic futures. But our titular leaders are in a historically weak system complicated by being only one group of voices struggling to be heard in the rush to deal with national health care reform. There are many docs …

How can doctors make America a better place to live?

Richard Reece, MD

Health Policy

January 29, 2010

What can physicians do to make American a better place to live, die, afford, and receive care? What can we do to bring about practical reform? What can we contribute?

These may seem odd questions, After all, we deliver care. Care goes through us. But Medicare, Medicaid, and private third parties are big players. They dictate terms of engagement and payment. But the answers lie at the core of the physicians’ …

Nobody will be held accountable if healthcare reform fails

Edwin Leap, MD

Health Policy

January 28, 2010

I must admit I’m a little weary of the entire debate on health-care reform. But something still haunts me. And that something is accountability. Of course, over the almost twenty years that I have borne the title ‘MD,’ I’ve learned a few things about accountability.

I understand that, almost without fail, the buck stops with me. The nursing home director knows the elderly lady wasn’t seriously hurt in that fall, but …

How President Barack Obama’s State of the Union speech will impact healthcare reform

Kevin

Health Policy

January 27, 2010

Originally published in MedPage Today

by Emily P. Walker, MedPage Today Washington Correspondent

President Barack Obama’s State of the Union speech Wednesday night will likely focus on job creation and the economy and not — as many Democrats once hoped — on congratulations for the passage of healthcare reform.

In the week following the election of Republican Scott Brown to the U.S. …

How should patients decide which hospitals are best for them?

Zackary Berger, MD, PhD

Physician

January 26, 2010

Johns Hopkins Hospital is consistently named one of the best in the country. I can’t disagree with that; after all, I just started working there as an internist in September. Coincidentally, in the midst of the raging debate around health care reform, the past few months have seen increasing discussion of a small but crucial question: why do some of the best hospitals spend more money than others? If other …

10 ways United States health reform may fail

Richard Reece, MD

Health Policy

January 26, 2010

One, develop a plan that the presently privately insured Americans, estimated at 200 million, pay more in premiums, and to just make sure you succeed, immediately starting raising taxes by $400 billion over the next decade.

Two, alienate those over 65, the most dependable voting bloc, by promising to cut Medicare by $500 billion over the next ten years with the false promise, which you know you cannot …

10 cost effective preventive medicine services

Dr. Charles

Conditions and Diseases

January 25, 2010

Here are the top 10 preventive services. These items were chosen by the National Commission on Prevention Priorities, and highlight those preventive services including immunizations, screenings, preventive medications, and counseling that give “the most bang for the buck.”

For an in depth discussion of methods and results, read Am J Prev Med 2006;31(1):52–61

Discuss Daily Aspirin Use

This counseling does not mean everyone should take aspirin to prevent heart attack and stroke, but …

Why the Mayo Clinic is refusing to see Medicare patients

Toni Brayer, MD

Health Policy

January 25, 2010

Medicare, the government insurance company for everyone over age 65 (and for the disabled), pays fees to primary care physicians that guarantee bankruptcy.

Additionally, 70 percent of hospitals in the United States lose money on Medicare patients. That’s right, for every patient over age 65, it costs the hospital more to deliver care than the government reimburses. That is why Mayo Clinic has said it will not accept Medicare payments for …

Did the government get it right on EHR certification?

Glenn Laffel, MD, PhD

Health Technology

January 22, 2010

Last week, the Office of the National Coordinator for Health Information Technology (ONC) released criteria that will be used to certify EHRs as appropriate support tools for providers who want to qualify for Bonanza Days.

The criteria are subject to a 60-day comment period before being finalized.

I congratulate ONC on its elegant piece of rule making. Its so-called Interim Final Rule (IFR) provides a foundation that can support years of progress …

How ideology is shaping health care reform

Richard Reece, MD

Health Policy

January 21, 2010

I’m an ideological pragmatist. I believe in what works and what suits the temperament of American people, rather than what is politically correct or what passes some moral litmus test.

Whatever reform measure passes, it will be a public-private mix and will superimpose more government regulations on our private system. It will have uneven effects. It will cost more than the status quo. And it will expose the reality, that when …

Did Martha Coakley kill health reform, and what Senator Scott Brown means for healthcare

Kevin

Health Policy

January 20, 2010

In case you haven’t heard, in a stunning result in yesterday’s special election in Massachusetts, Republican Scott Brown won the Senate seat previously occupied by the late Edward Kennedy.

Needless to say, pundits are going crazy analyzing the results, and its implications on health reform. I’ll leave the political commentary to them, but I’ll comment on what this means for health reform’s future.

In essence, what turned into a 95% likelihood …

Tips for doctors who negotiate reimbursement rates with insurance companies

Kevin

Physician

January 19, 2010

Originally published in HCPLive.com

by Ed Rabinowitz

When it comes to negotiating fees with health plans, practices and physicians have more leverage than they realize. The problem, says John Schmitt, a managed care expert with EthosPartners Healthcare Management Group, is that practices often don’t even try. “Groups negotiate an agreement with a payor and then, for whatever reason, just file it away. Most medical groups do not have a good, proactive methodology …

How doctors can look for the right non-clinical medical job

Joseph Kim, MD, MPH

Physician

January 17, 2010

How many physicians do you know who have chosen to leave their clinical practice?

There’s no doubt that physicians are getting burned out. Many are tired of fighting insurance companies and even more physicians are getting discouraged about reductions in reimbursement. This has caused some physicians to drop Medicare and Medicaid. Others have switched to cash-only or concierge/boutique practice models. Then you have your group of physicians who have simply decided …

What doctors should expect with health care reform

David Harlow

Health Policy

January 14, 2010

What should health care providers be doing in anticipation of the likely passage of an historic health reform bill?

There are at least three possibilities: (1) Lament the passing of the good old days and oppose it; (2) Insist that it isn’t good enough because it is lacking some key provision (tort reform; SGR replacement; robust public option); or (3) Embrace it, because incrementalism works, and prepare for what’s coming down …

The history of Medicare and its influence on American health care

Kevin

Health Policy

January 13, 2010

Originally published on MedPage Today

by Emily P. Walker, MedPage Today Washington Correspondent

As Congress stands poised to make the most sweeping change to the U.S. healthcare system since the creation of Medicare, a look back at the incremental growth in that program may serve as a harbinger for the progress of healthcare reform.

The program — which provides insurance for some 43 million …

Protecting the security of electronic patient data

David Harlow

Health Technology

January 12, 2010

Originally published on HCPLive.com

If your patient records aren’t already stored digitally, they are likely to be digitized soon. There is a tremendous push by the federal government—as well as by some private payors and self-insured employers—to get all healthcare providers wired in the near future, in order to better coordinate patient care, improve outcomes, and “bend the cost curve” all at the same time. There are some financial incentives in …

The American College of Cardiology (ACC) sues Medicare over physician rate cuts

Kevin

Health Policy

January 11, 2010

Originally published in MedPage Today

by Kristina Fiore, MedPage Today Staff Writer

The American College of Cardiology (ACC) has filed suit against U.S. Department of Health and Human Services Secretary Kathleen Sebelius charging that the 2010 Medicare Physician Fee Schedule was adopted unlawfully.

The complaint seeks an injunction that will prevent the cuts — which the association claims used a flawed survey for …

Op-ed: Ways to make primary care the key to health reform

Kevin

Health Policy

January 9, 2010

The following op-ed, co-written with Rahul Parikh, was published on December 16th, 2009 in CNN.com.

America is closer to meaningful health care reform than at any time in its history. As we have all witnessed, finding a way to both provide every American access to affordable health care while seeking to control health care costs has not been easy.

Many of the proposed solutions have led to sharp disagreements, with contention …