The Centers for Medicare and Medicaid recently released its compiled data on what over 3,000 hospitals across the country charge for 100 of the most common discharge diagnostic codes under the diagnosis related group (DRG) system, and boy did the…
The Centers for Medicare and Medicaid recently released its compiled data on what over 3,000 hospitals across the country charge for 100 of the most common discharge diagnostic codes under the diagnosis related group (DRG) system, and boy did the DRG really hit the fan. Liberals, economists, and band wagoners got all upset about the enormous pricing differentials between hospitals for the same services.
An important article was recently published in the New England Journal of Medicine, titled The Oregon Experiment — Effects of Medicaid on Clinical Outcomes. This study provides a rare look at the effects of expanding Medicaid coverage (specifically, Oregon Health…
An important article was recently published in the New England Journal of Medicine, titled The Oregon Experiment — Effects of Medicaid on Clinical Outcomes. This study provides a rare look at the effects of expanding Medicaid coverage (specifically, Oregon Health Plan, Oregon’s version of Medicaid) to a population of previously uninsured patients. Having practiced medicine in Portland, …
I attended a medical staff meeting recently. These are required meetings and attendance is taken, as was done when we were in kindergarten. While some folks are interested in these meetings’ content, many are not and simply sign the attendance…
I attended a medical staff meeting recently. These are required meetings and attendance is taken, as was done when we were in kindergarten. While some folks are interested in these meetings’ content, many are not and simply sign the attendance sheet and then slither out in a stealth fashion. Sly doctors grab their pagers and then leave hurriedly pretending that they were summoned to an urgent medical situation, when they …
Arkansas is now the first state to use Medicaid expansion dollars to buy private coverage for many of its 250,000 newly eligible residents rather than enroll them in the existing Medicaid program. The Arkansas House of Representatives approved the plan,…
Arkansas is now the first state to use Medicaid expansion dollars to buy private coverage for many of its 250,000 newly eligible residents rather than enroll them in the existing Medicaid program. The Arkansas House of Representatives approved the plan, followed by the Senate, to confirm that the state will be implementing this “market-based approach” to expanding Medicaid.
The idea of buying private insurance for Medicaid recipients is emerging as a “conservative …
Much has already been written about the Oregon Medicaid study that came out in the New England Journal of Medicine. Unfortunately, the vast majority is reflex, rather than reflection. The study seems to serve as a Rorschach test of sorts,…
Much has already been written about the Oregon Medicaid study that came out in the New England Journal of Medicine. Unfortunately, the vast majority is reflex, rather than reflection. The study seems to serve as a Rorschach test of sorts, confirming people’s biases about whether Medicaid is “good” or “bad”. The proponents of Medicaid point to all the ways in which Medicaid seems to help those who were …
Recently, an article by Kate Baicker and colleagues came out in the New England Journal of Medicine. Almost immediately, the article received widespread attention in the media where headlines claimed that giving people Medicaid coverage doesn’t improve their health. This…
Recently, an article by Kate Baicker and colleagues came out in the New England Journal of Medicine. Almost immediately, the article received widespread attention in the media where headlines claimed that giving people Medicaid coverage doesn’t improve their health. This is not exactly what the article said, but most journalists aren’t scientists, so we should cut them a bit of …
We are frequently reminded by the General Accounting Office and CMS that a great proportion of Medicare health costs are incurred in the last three months of a patient’s life. Health care policy experts have tried to reduce these costs…
We are frequently reminded by the General Accounting Office and CMS that a great proportion of Medicare health costs are incurred in the last three months of a patient’s life. Health care policy experts have tried to reduce these costs by encouraging end of life planning. Living wills, health care directives and the availability of hospice and palliative services will not put a dent in these costs because of human …
“Physicians care more about their pocketbooks than taking care of patients. They are self-interested and overpaid. They want to control everything. They don’t know what life is like in the real world of patients.” By now, I am sure that…
“Physicians care more about their pocketbooks than taking care of patients. They are self-interested and overpaid. They want to control everything. They don’t know what life is like in the real world of patients.”
By now, I am sure that physician readers of this blog can feel their blood boiling, for good reason. Why would I, as the principal staff advocate for internal medicine physicians, put such pernicious, unfair, inaccurate quotes …
We all know about Medicare, the federal government health insurance program for Americans who are over the age of 65 and/or disabled. We know that as we have begun to live longer, the Medicare population has ballooned and the costs…
We all know about Medicare, the federal government health insurance program for Americans who are over the age of 65 and/or disabled. We know that as we have begun to live longer, the Medicare population has ballooned and the costs of the program are, by most estimates, “unsustainable.”
We also know that Medicare, despite being a government program, is beloved by America’s seniors. If it was an unpopular program, Congress would …
An elderly doctor passes away, and he find himself standing before the Pearly Gates. The Almighty greets him and says, “In recognition of your stellar life of service to your patients, family and community, I welcome you to paradise. And…
An elderly doctor passes away, and he find himself standing before the Pearly Gates. The Almighty greets him and says, “In recognition of your stellar life of service to your patients, family and community, I welcome you to paradise. And because I know that doctors have a great sense of curiosity about all things, you can now ask me any question—any—and I will answer it.” The doctor ponders for a …
It can be difficult to keep up with the jargon, countless proposals and complicated policies that surround the debate over Medicare reform. Whether you are discussing premium support, changing the eligibility age or Medicare for All, there is one relatively…
It can be difficult to keep up with the jargon, countless proposals and complicated policies that surround the debate over Medicare reform. Whether you are discussing premium support, changing the eligibility age or Medicare for All, there is one relatively simple concept that patients should make a point to pay attention to – one that directly impacts them – and is …
From 1974 to 1982, a group of researchers conducted the RAND Health Insurance Experiment. In lay terms, what they did was assign people to different levels of insurance coverage, with a particular focus on the amount of co-payments, co-insurance, and…
From 1974 to 1982, a group of researchers conducted the RAND Health Insurance Experiment. In lay terms, what they did was assign people to different levels of insurance coverage, with a particular focus on the amount of co-payments, co-insurance, and deductibles that people had to pay, and then they observed their use of the health care system. As you might expect, those who had to pay more out of their …
Over the past several months, the state of Oregon has been pursuing an aggressive approach to solving the healthcare crisis that many states are dealing with. A couple of years ago Oregon was facing a $2 billion deficit in their…
Over the past several months, the state of Oregon has been pursuing an aggressive approach to solving the healthcare crisis that many states are dealing with.
A couple of years ago Oregon was facing a $2 billion deficit in their Medicaid program, with few solutions to repair the situation. The governor was reluctant to take the obvious step of cutting doctors’ pay for …
On January 7, 2013, a federal appeals court rejected six Georgia primary care physicians’ (PCPs) challenge to the Centers for Medicare and Medicaid Services’ (CMS) 20-year, sole-source relationship with the secretive, specialist-dominated federal advisory committee that determines the relative value…
On January 7, 2013, a federal appeals court rejected six Georgia primary care physicians’ (PCPs) challenge to the Centers for Medicare and Medicaid Services’ (CMS) 20-year, sole-source relationship with the secretive, specialist-dominated federal advisory committee that determines the relative value of medical services. The American Medical Association’s (AMA) Relative Value Scale Update Committee (RUC) is, in the court’s view, not subject to …
This week, hundreds of our fellow physicians and medical students gathered in Washington, D.C., for the AMA’s National Advocacy Conference, which is held in the capital city each February. Attendees heard from members of Congress, top administration officials including HHS…
This week, hundreds of our fellow physicians and medical students gathered in Washington, D.C., for the AMA’s National Advocacy Conference, which is held in the capital city each February. Attendees heard from members of Congress, top administration officials including HHS Secretary Kathleen Sebelius, journalists and other experts about the health policy issues affecting …
I know. I know. Medicare is the insurance that all of us love to hate. But being both an internist and geriatrician, I have learned to see the good side of the sometimes annoying government program for several reasons: 1.…
I know. I know. Medicare is the insurance that all of us love to hate. But being both an internist and geriatrician, I have learned to see the good side of the sometimes annoying government program for several reasons:
1. Medicare’s fee schedule. It’s bad, but not that bad. Sure, Medicare’s fee schedule has only increased 3.1% over the past 12 years, while …
“Pay for performance” made headlines again this week, when Health and Hospitals Corporation (HHC), the multi-billion dollar corporation which operates New York City’s public hospitals, announced that they will be linking physician reimbursement to pre-determined “quality” metrics and patient satisfaction…
“Pay for performance” made headlines again this week, when Health and Hospitals Corporation (HHC), the multi-billion dollar corporation which operates New York City’s public hospitals, announced that they will be linking physician reimbursement to pre-determined “quality” metrics and patient satisfaction scores.
This announcement comes quickly on the heels of details recently released by the Centers for Medicare and Medicaid Services (CMS) regarding its first Medicare payment adjustment to hospitals under the …
Seven months ago, in Carbondale, Colorado, staff at the skilled nursing facility where my mother had resided for over a year recommended that she be placed on hospice. My mother has severe advanced dementia and can no longer walk, speak,…
Seven months ago, in Carbondale, Colorado, staff at the skilled nursing facility where my mother had resided for over a year recommended that she be placed on hospice. My mother has severe advanced dementia and can no longer walk, speak, feed herself or recognize her family members.
As much as I know about hospice care for cancer patients here in San Diego, I knew nothing about hospice care in Carbondale for …
A recent New York Times headline read that "Medicare Is Faulted on Shift to Electronic Records." The story describes an Office of Inspector General (OIG) report, released November 29, 2012, that faults the Centers for Medicare and Medicaid Services (CMS)…
A recent New York Times headline read that “Medicare Is Faulted on Shift to Electronic Records.” The story describes an Office of Inspector General (OIG) report, released November 29, 2012, that faults the Centers for Medicare and Medicaid Services (CMS) for not providing adequate oversight of the Meaningful Use incentive program. Going after “waste, fraud, and abuse” always makes good headlines, but in this case, the story is …
Today, I come back to the tragedy of medical economics in this country. And I would apply that word "tragedy" in at least two ways. The first tragedy is that we are headed for fiscal disaster in this country because…
Today, I come back to the tragedy of medical economics in this country. And I would apply that word “tragedy” in at least two ways.
The first tragedy is that we are headed for fiscal disaster in this country because of healthcare costs.
We now spend twice as much per person on healthcare as the average per person cost of all developed countries. During the past several decades, the inflation rate for …
