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.

What’s next for health reform after the House passed their bill, H.R. 3962?

Kevin

Health Policy

November 8, 2009

Originally published in MedPage Today

by Emily P. Walker, MedPage Today Washington Correspondent

The House of Representatives voted 220 to 215 to pass historic healthcare reform legislation late Saturday night, after 11 hours of debate before a packed gallery of spectators.

H.R. 3962 passed by a narrow margin: Democrats needed 218 votes to pass the bill and wound up with just two …

How the health care system is corrupting doctors

Kevin

Health Policy

November 7, 2009

Originally published in HCPLive.com

by Jeff Brown, MD

I had the same reaction . . . shock at seeing an almost obscene claim about our profession in a national newspaper. But it got me thinking, which no doubt was its intended purpose. While we are thinking and feeling our way through this wide-ranging debate on health care, we might as well examine …

Support for the patient centered medical home in the House health reform bill

Kevin

Health Policy

November 6, 2009

by Thomas C. Bent, MD

As the House of Representatives prepares to vote on its historic health care reform bill on Saturday, family physicians are heartened to see the support it gives to the emerging new model of care, the patient centered medical home.

The House bill is good news on many fronts. It would provide health insurance coverage for some 96 percent of Americans and would reduce the federal deficit by …

Saving what’s good about the United States’ health care system

Kevin

Health Policy

November 4, 2009

by Bruce Goldman

The U.S. health care system, although it’s the costliest in the world, doesn’t even deliver the goods when it comes to delivering health. That’s the conventional wisdom. But is it true?

At least a few well-researched studies by credentialed and respected experts suggest we might want to pause to consider whether, in the mad dash now underway to fix our ailing health care system, we could inadvertently end up …

Health reform ignores primary care doctors at its own peril

Richard Reece, MD

Health Policy

October 30, 2009

I would like to introduce you a remarkable article by Edward J. Volpintesta, MD, a 65-year old solo primary care doctor in Bethel, Connecticut. Dr. Volpintesta is a veritable writing machine and has been published in The Wall Street Journal, the New York Times, medical journals, and other publications. His articles cry for a deeper understanding of primary care dilemmas.

In the October issue of Connecticut Medicine, Dr. Volpintesta hits the …

ACP: How to fix the primary care problem in health care

American College of Physicians

Physician

October 29, 2009

The following is part of a series of original guest columns by the American College of Physicians.

by Steven Weinberger, MD, FACP

Many would argue that lack of universal coverage is the primary problem with health care in the United States, accompanied by the logistical and financial difficulties of obtaining coverage for someone with a pre-existing medical condition. Others would argue …

Discussing end-of-life care in the ICU and saving Medicare money

Marya Zilberberg, MD, MPH

Health Policy

October 25, 2009

I think by now there is not a person in the US who cannot quote at least approximately how much we spend annually on healthcare. Fewer people appreciate that nearly 1/3 of this $2.2 trillion bill is eaten by hospitalizations, amounting to about $680 billion. Although the data in the diagram below represent a single year, the overall distribution of expenses is remarkably constant over time.

When compassion meets progress in American health care

Edwin Leap, MD

Health Policy

October 24, 2009

Does anyone realize that the chaos of modern American health-care is not a tragedy, but a triumph? We’re so busy trying to fix what isn’t broken and ignoring what is, so busy casting stones and casting doubts that we are blind to what we have.

I have practiced medicine in this labyrinth for 16 years. I am an emergency physician. I practice in what may be considered the ‘epicenter’ of modern …

How to take money out of health care, and is a single-payer system inevitable?

Kevin

Health Policy

October 22, 2009

by Bruce Douglas, MD

I’ve been practicing my health care specialty for sixty years and have enjoyed almost every minute of it. The minutes I have not enjoyed all have to do with “money.”

Financial transactions in doctors’ offices are the root of most evils in the relationship between doctor and patient. Along with that evil goes an additional detraction from good, humane health care called the fee-for-service system, which …

What health reform can learn from Regina Holliday

Rahul K. Parikh, MD

Health Policy

October 19, 2009

If you want to get insights into the problems of our health care system, look at a mural by Washington DC resident Regina Holliday.

Holliday is a 37-year old mother of two and an art teacher. Last summer, her husband, Fred, died from kidney cancer at the age of 39. The Hollidays’ experience is a case study in …

How the patient-centered medical home can improve our health care system

David Harlow

Physician

October 17, 2009

Dr. Paul Grundy is on a mission — a mission to promote the patient-centered medical home model that he has been instrumental in developing and rolling out, in his dual role as Director of Healthcare, Technology and Strategic initiatives for IBM Global Wellbeing Services and Health Benefits, and President of the Patient-Centered Primary Care Collaborative.

I had the opportunity to speak with him last month (here’s the transcript and …

Doctors need to fix the health care system that they had a hand in breaking

Kevin

Health Policy

October 16, 2009

by Daniel A. Graubert, MD

Medicine has changed so dramatically since I graduated medical school in the 1980’s, that it is hardly recognizable.

Certainly, there has been an enormous growth in knowledge which is often beneficial, but has often led us down the wrong path. For example, when advanced imaging techniques such as CT scans and MRIs became available, we were able to see the inside of large numbers of patients …

Embracing the change coming to our health care system

Donald Tex Bryant

Health Policy

October 15, 2009

As Bob Dylan sang so long ago, The Times They Are A-Changin’. Some like change; some do not.

Consider these change scenarios:

* One of the important scenes of change for health care providers is the national debate on health care coverage currently playing out in Washington D.C. Some are very vocal in their support. The media covers many of the vocal opponents. Certainly some sort of change will come out of …

How health care reform can improve public health

Kevin

Health Policy

October 13, 2009

by Paula Hartman Cohen

Have we overlooked the public health aspect of health care reform?

In the health care reform debate, we’ve heard and read how health care reform will or will not work, what it will or will not cost, and how it will or will not impact each one of us as individuals.

We’ve also heard from those who have great faith in our current system, and sincerely believe we should …

Does the Max Baucus health reform plan do enough for doctors?

Glenn Laffel, MD, PhD

Health Policy

October 10, 2009

Max Baucus’ decision to release his solo album—subtitled the Senate Finance Committee’s proposal on health reform—was timed with the precision of a 4th grade marching band.

Physicians could live with that, but the bill contained gornisht on tort reform and not much more than that on Medicare reimbursement. Upon seeing that, the Long White Coats reacted as if they’d seen earwax on their stethoscopes.

“The feeling of most doctors is that …

AMA: Permanent repeal of the Medicare physician payment formula must be part of health reform

Kevin

Health Policy

October 8, 2009

The following is part of a series of original guest columns by the American Medical Association.

by J. James Rohack, M.D.

All eyes are on the Senate Finance Committee this week as they prepare to vote to move health reform legislation forward. The AMA is committed to health reform, and as the process moves to the Senate floor, it’s crucial that the Senate include permanent repeal of the current Medicare …

CBO cost analysis of the Baucus health reform plan

Kevin

Health Policy

October 7, 2009

Originally posted in MedPage Today

by Emily P. Walker, MedPage Today Washington Correspondent

In its much-anticipated cost estimate, the Congressional Budget Office (CBO) said the Senate Finance Committee’s healthcare reform bill would cost $829 billion over 10 years and begin to drive down the federal deficit after that first decade.

The price tag is lower than Sen. Max Baucus’ (D-Mont.) previous …

When political discourse is like borderline personality disorder

Marya Zilberberg, MD, MPH

Health Policy

October 7, 2009

When I was a kid in Odessa my Dad and I went to see The Sound of Music at least 17 times in the span of 3 months. Remember that song sung by the nuns when Maria is late for the vespers, “How do you solve the problem like Maria?” One nun says “She’s an angel”, another one counters “She’s a demon”, when the voice of reason from Mother Superior …

Analysis of the Senate Finance Committee health care reform bill

Kevin

Health Policy

October 3, 2009

Originally posted in MedPage Today

by Emily P. Walker, MedPage Today Washington Correspondent

The Senate Finance Committee finished work on its healthcare reform bill in the wee hours of Friday morning, paving the way for a committee vote next week.

After considering hundreds of amendments, the committee is now waiting for a cost-estimate from the Congressional Budget Office (CBO) before it …

Health care reform analysis from a former insurance and hospital executive

Kevin

Health Policy

October 3, 2009

by Marie Cooper

I have been in senior executive management in both managed care and a major hospital system. I find the hysteria over “reform” bitterly amusing because it is so misdirected.

The real problem with health care in America? Greed, indifference and incompetence, pure and simple. But not in the places everyone is pointing.

Insurer side

Insurance companies have to maximize their revenue because they answer to their boards. They …