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.

A physician’s health policy advice to Donald Trump

Dr. Saurabh Jha

Health Policy

April 11, 2016

It is possible that in a few months from now, only Nate Silver’s prediction models will stand between Donald Trump and the White House. I will leave it to future anthropologists to write about the significance of that moment. For now, the question, “What will President Trump be doing when he is not building a wall?” has assumed salience.

This is relatively easy to answer when it comes to health policy. …

Physicians need to get involved or risk irrelevance

John Gonzalez, MD, MBA

Health Policy

April 1, 2016

What is happening in medicine? How will these changes affect our patients? How will they affect how we deliver health care? These seem to be the questions asked most often amongst physicians across the country. I do not profess to have a crystal ball nor can I state with any certainty what the profession we chose to dedicate our lives to will look like in the near future. However, there …

How employers can lead the way for health reform

Pradhan Bhat

Health Policy

April 1, 2016

American businesses hold a solution to one of the most fundamental flaws of American health care: misalignment of incentives. We live in a nation where profit-seeking behavior can be more alluring than high-quality patient care. To date, major health care reform efforts have paid little attention to the business community’s potential to address this issue.

Status quo

Currently, the status quo is such that health insurance companies and health care providers act …

Who do presidential candidates blame for high health costs?

Peter Ubel, MD

Health Policy

March 16, 2016

The United States far outspends peer countries on health care. When American politicians complain about these high health care costs, they often vilify pharmaceutical and insurance companies for profiting at the expense of the general public. As I wrote earlier, such vilification is misguided, pushing too much of the blame on individual actors rather than on the system that incentivizes individuals to act those ways.

So what it is …

Explaining the physician anxiety behind performance measures

Bob Doherty

Health Policy

March 1, 2016

Just as the U.S. health care system is about to make performance measurement a central feature of … well, just about everything doctors do … some prominent and highly influential physicians are asking for a pause and reassessment.

Writing for the New York Times, Dr. Bob Watcher argues that, “Two of our most vital industries, health care, and education, have become increasingly subjected to metrics and measurements. Of course, …

Fix high-deductible health insurance. But it won’t be easy.

Michael Kirsch, MD

Physician

February 25, 2016

May I whine for a few sentences, please? My staff and I have a high-deductible medical insurance plan. As the costs of coverage increased each year, we had to find a product that we could afford for our small private practice. As any small business owner knows, margins are tight, revenue is declining and expenses inexorably rise. And physicians, unlike other retailers, cannot raise our fees. Would you want to …

Slow health costs with grade-appropriate body education

Barbara Berkeley, MD

Conditions and Diseases

February 5, 2016

We physicians live in the shadow of rising health care costs. Hospitals want us to cut length of stays and somehow become more efficient. Insurance companies ask us to accept less money for patient visits, forcing us to see more people in fewer hours. The government wants us to check a slew of electronic boxes to prove that we’ve performed what they deem to be best practices, even though there is …

The straight face test of our health care system

Hans Duvefelt, MD

Health Policy

January 27, 2016

Health care in America is fracturing right down the middle, and doctors are going to have to figure out if or how long they can straddle the divide between what patients want and what the government and corporate America want them to have.

Up until this point, the momentum has been with the payers, Medicare, and the insurance industry. But the more heavy-handed they become, the more inevitable the public backlash …

Meaningful use is dead. Is it time to celebrate?

Margalit Gur-Arie

Conditions and Diseases

January 14, 2016

At the J.P. Morgan Healthcare Conference in San Francisco, Mr. Andrew Slavitt, acting administrator at the Centers for Medicare & Medicaid Services (CMS), announced on January 11th that, “The meaningful use program as it has existed will now effectively be over, and replaced with something better,” and later clarified on Twitter that, “In 2016, MU as it has existed– with MACRA– will now be effectively over and replaced with something …

Want to help fix health care? First you have to care about costs.

Chris Trimble, MBA

Health Policy

January 11, 2016

An excerpt from How Physicians Can Fix Health Care: One Innovation at a Time.

I’ve studied lots of industries. In general, cost and quality compete on equal terms. Some companies emphasize cost, others quality, but both are always in the picture.

And then there is health care. Uniquely among industries, health …

These are the reasons why health insurers have to change

Robert Pearl, MD

Health Policy

January 8, 2016

Consumers spend 16 times as long choosing a computer as they do selecting a health plan for themselves and their family. And it should not be a big surprise.

For decades, nearly all insurance companies offered similar choices of in-network physicians and hospitals. And as a result, plans differed only minimally in clinical quality, access and service. And even when clinical outcomes varied, consumers had no easy way to access comparative data.

So …

Innovation in health care delivery can be boiled down to these 4 ideas

Chris Trimble, MBA

Health Policy

December 29, 2015

An excerpt from How Physicians Can Fix Health Care: One Innovation at a Time.

In 2011, Shreya Kangovi hired her first two community health workers, or CHWs, at the University of Pennsylvania Health System. Their role was to develop partnerships with low-income hospitalized patients who were at high risk of …

How we can move to value-based health care delivery

Robert Rowley, MD

Health Policy

December 22, 2015

A recent study of health care organizations showed that most are not prepared to deliver standardized longitudinal care across multiple provider systems. Shared care plans will be the centerpiece of coordinated care delivery, incentivized by the move from fee-for-service to value-based care. In 2015, Medicare unveiled its plan to transition to quality-based payments via the Merit-Based Incentive Payment System (MIPS), which will sunset and subsume earlier quality-encouraging programs, and …

Fragmentation is behind health care’s biggest problems

Jeff Kane, MD

Health Policy

December 11, 2015

My friend Jeremy went to an emergency room with belly pain, and soon learned he’d been blessed with a kidney stone. The staff summoned a urologist, but none was available, so they sent him home with a pain prescription. Continuing nevertheless to writhe in agony, Jeremy phoned urologists and learned to his dismay there were only three in the region who accepted his insurance, and none at all in his …

Why is UnitedHealthcare thinking of bailing on Obamacare?

Brian C. Joondeph, MD

Health Policy

December 7, 2015

UnitedHealthcare (UHC), the nation’s largest health insurer, will likely pull out of Obamacare in 2017. Citing high costs and huge potential losses, they warned that 2016 will probably be their last year offering health insurance through the Obamacare exchanges.

Is this another example of greedy insurance companies with fat cat CEOs gouging the system? Or are economic realities interfering with the “hope and change” of Obamacare?

UHC isn’t really selling insurance. Instead …

5 health questions every presidential candidate should answer

Robert Pearl, MD

Health Policy

December 2, 2015

With fewer than 100 days until the first primaries, the leading candidates have received ample airtime to address the important issues our nation faces. But even though health care accounts for around 18 percent of our nation’s GDP and consumes close to half of the total tax revenue collected by the federal government, their silence on providing solutions to the most pressing health care challenges our nation faces continues with …

How butterflies are bad omens for health care

Rocky Bilhartz, MD

Health Policy

November 26, 2015

After reading my latest post about conflicts of interest in health care, my wife suggested that I write a piece about butterflies. Something pretty, she said. Natural. Peaceful.

Since hostility is never my goal, I thought I’d give it a try.

I read for an entire evening on butterflies — their life cycle, behavior, mechanisms for protection, and how different cultures view them. All I could keep thinking about was how much my grandmother …

Value to patients and value to society: How can doctors balance the tension?

Joshua Liao, MD

Health Policy

November 19, 2015

Amid ongoing health care transformation, clinicians will increasingly face the tension that the late physician and health services researcher John M. Eisenberg, MD, MACP, described over 30 years ago: providing high-value care with simultaneous commitments to patients and society.

Physicians have always been charged as patient agents to advocate for patients’ best interests. Simultaneously, however, they are tasked with considering the societal good by using resources wisely. While these commitments often …

What health care can learn from forest preservation

Birju Rao

Health Policy

October 15, 2015

Health care providers and patients alike have been physically and emotionally frustrated when dealing with health care’s rising cost. Legislative restrictions based on cost often defy logic and common sense in a way that most people have never encountered. But what is it specifically about the health care market that gives us these fundamentally perverse situations? Many point fingers at insurance companies, big pharma, hospitals owned by private equity firms, …

We need full transparency for hospital chargemaster prices. Here’s why.

Peter Ubel, MD

Health Policy

October 13, 2015

If she had been eligible for Medicare, the hospital would have charged the government $10,000 for the services it provided to her, with Medicare picking up most of the tab. But lacking insurance, she was billed directly from the hospital, and not for a mere $10,000. The total charge: $120,000!

That 1,200 percent markup is extreme. But out of the 50 U.S. hospitals with the largest price markups, 49 are for-profit …