When the marketing of ObamaCare began in 2009, I always believed that the end game was for a federal single payer system. Since the present Affordable Care Act, (ACA), was passed in 2010, there has been nothing to convince me…
When the marketing of ObamaCare began in 2009, I always believed that the end game was for a federal single payer system. Since the present Affordable Care Act, (ACA), was passed in 2010, there has been nothing to convince me otherwise. The only reason single-payer wasn’t passed two years ago was because it was hard enough to arm-twist and bribe even …
The 21st century challenge for the American health care delivery system is to deliver higher quality care for less money. Republican and Democratic experts agree that payment reform involving transitioning from fee-for-service to global, value-based systems is necessary for us…
The 21st century challenge for the American health care delivery system is to deliver higher quality care for less money. Republican and Democratic experts agree that payment reform involving transitioning from fee-for-service to global, value-based systems is necessary for us to achieve that goal. Accountable care organizations (ACOs) are the new entities that will receive the new global payments and distribute them to the doctors, allied health professionals, hospitals, and …
“Passed by corruption, aided and abetted by the purest man in America” is how anti-slavery Congressman Thaddeus Stevens described President Lincoln’s successful effort to enact the 13th amendment, banning slavery. This historically accurate quote, which runs counter to the public…
“Passed by corruption, aided and abetted by the purest man in America” is how anti-slavery Congressman Thaddeus Stevens described President Lincoln’s successful effort to enact the 13th amendment, banning slavery. This historically accurate quote, which runs counter to the public image of “Honest Abe” Lincoln, is among the many fascinating stories recounted in the Steven Spielberg’s masterpiece “Lincoln” playing …
The debate over pay for performance in healthcare gets progressively more interesting, and confusing. And, with Medicare’s recent launch of its value-based purchasing and readmission penalty programs, the debate is no longer theoretical. Just in the past several months, we’ve…
The debate over pay for performance in healthcare gets progressively more interesting, and confusing. And, with Medicare’s recent launch of its value-based purchasing and readmission penalty programs, the debate is no longer theoretical.
Just in the past several months, we’ve seen studies showing that pay for performance works, and others showing that …
It seems both ironic and inevitable: I won’t be getting any more “meaningful use” checks. It’s not that I didn’t qualify for the money; I saw plenty of patients on Medicare and met all of the requirements. I was paid…
It seems both ironic and inevitable: I won’t be getting any more “meaningful use” checks. It’s not that I didn’t qualify for the money; I saw plenty of patients on Medicare and met all of the requirements. I was paid for my first year money without much hassle. The problem I am facing is this: I am probably going to be “opting out” of Medicare, and once I do that …
I wanted to expand on something I wrote recently, which relates to my other sort-of-recent post on upcoding. I wrote, about scribes and compliance: Knowing that the scribe cannot document a complete ROS unless I actually did that ROS, I…
I wanted to expand on something I wrote recently, which relates to my other sort-of-recent post on upcoding. I wrote, about scribes and compliance:
Knowing that the scribe cannot document a complete ROS unless I actually did that ROS, I am more compulsive about making sure I hit all ten systems. (Even when it’s not clinically relevant. Such is the Kafkaesque world we live in.) And I make sure to do
American Medical News featured an article with the disturbing title, "Massive health job losses expected if Medicare sequester prevails." I wasn't entirely sure what a "sequester" was, since I thought it was a verb. Sequestration, I thought, was the noun.…
American Medical News featured an article with the disturbing title, “Massive health job losses expected if Medicare sequester prevails.”
I wasn’t entirely sure what a “sequester” was, since I thought it was a verb. Sequestration, I thought, was the noun. (I hear a loud knock. It must be the grammar police.) The story, as I understand it, is that when our government decided to pull together and raise the debt ceiling, …
I’ve been getting emails about the New York Times piece and my quotation that the penalties for readmissions are “crazy.” It’s worth thinking about why the ACA gets hospital penalties on readmissions wrong, what we might do to fix it—and…
I’ve been getting emails about theNew York Times piece and my quotation that the penalties for readmissions are “crazy.” It’s worth thinking about why the ACA gets hospital penalties on readmissions wrong, what we might do to fix it—and where our priorities should be.
A year ago, on a Saturday morning, I saw Mr. “Johnson,” who was in the hospital with a pneumonia. He was still breathing …
With notably few exceptions, the American health care system has been financed on the basis of volume rather than value. That means that we’ve been paying providers for everything that they do, rather than paying them for the outcomes they…
With notably few exceptions, the American health care system has been financed on the basis of volume rather than value. That means that we’ve been paying providers for everything that they do, rather than paying them for the outcomes they produce. This is not common in other fields.
For example, if you are in an accident and have to take your car to a body shop, you (or your insurance company) …
For the first 20 years of practice, assigning a code to the services I offer has been easy. I see most patients for “90807” – a 50 minute psychotherapy session with medication management. It all gets mushed together, a patient…
For the first 20 years of practice, assigning a code to the services I offer has been easy. I see most patients for “90807” – a 50 minute psychotherapy session with medication management. It all gets mushed together, a patient may talk about an upsetting event in their lives (psychotherapy) and then mention they are having trouble sleeping or a side effect to a medication (medication management), then go on …
If you get sick, health insurance should cover all the “stuff” necessary to make you better, right? While that sounds good in principle, Uncle Sam has made it a lot more complicated than that. As we continue to struggle with…
If you get sick, health insurance should cover all the “stuff” necessary to make you better, right?
Now that President Obama has won a second term, discussions about healthcare have seemingly disappeared from the public's radar. Big mistake – although I do understand the public's shifting interest in the General's sex life and, much more serious, the…
Now that President Obama has won a second term, discussions about healthcare have seemingly disappeared from the public’s radar.
Big mistake – although I do understand the public’s shifting interest in the General’s sex life and, much more serious, the heartbreaking tragedy of the renewed hostilities between Israel and Gaza.
I do expect that healthcare costs will be back on the radar fairly soon as discussions about the fiscal cliff intensify – …
Recently, a medical student confided in me a thought that few in our profession would dare say aloud: “We may have come to medical school to help people, but we choose our specialty careers based on potential salaries.” This in…
Recently, a medical student confided in me a thought that few in our profession would dare say aloud: “We may have come to medical school to help people, but we choose our specialty careers based on potential salaries.”
This in part explains why the most-prized residencies are in fields such as dermatology and radiology, whose procedures generate high fees. According to a physician survey by the Medical Group Management Association, the …
I told you so. Three months ago, I blogged about the Medicare (CMS) “never events” list, diagnoses that Medicare will no longer reimburse hospitals for. In Medicare’s eyes, these diagnoses are totally preventable, should never happen and will not be…
I told you so.
Three months ago, I blogged about the Medicare (CMS) “never events” list, diagnoses that Medicare will no longer reimburse hospitals for. In Medicare’s eyes, these diagnoses are totally preventable, should never happen and will not be reimbursed. I pointed out that several were in fact not 100% preventable despite any institution’s best efforts, and the rates of many of these occurrences would not fall to zero.
There’s a lake in Northern Arizona where I jog. I call it “my” lake. It used to be filled to the brim, a playground for ducks, geese, Monarch butterflies, rabbits, and squirrels. Over the years when I’d jog in the…
There’s a lake in Northern Arizona where I jog. I call it “my” lake. It used to be filled to the brim, a playground for ducks, geese, Monarch butterflies, rabbits, and squirrels. Over the years when I’d jog in the cold mornings, my lake dried away from drought, measured by bathtub rings on the boulders that surrounded it. Today, rust-colored grass …
A guest column by the American Medical Association, exclusive to KevinMD.com. Every physician caring for Medicare patients knows that the current payment system isn’t working. Most seniors know it too. For much of the last decade, patients and physicians have…
Every physician caring for Medicare patients knows that the current payment system isn’t working. Most seniors know it too. For much of the last decade, patients and physicians have joined together to tell their elected officials that the system is broken. The response from members of Congress has been to …
Not long ago, Secretary of Health and Human Services Sibelius and US Attorney General Holder issued a stern warning to healthcare providers who are using electronic health records (EHRs). The federal officers maintain there has been an alarming increase in…
Not long ago, Secretary of Health and Human Services Sibelius and US Attorney General Holder issued a stern warning to healthcare providers who are using electronic health records (EHRs). The federal officers maintain there has been an alarming increase in the charges to Medicare in institutions where EHRs have been implemented, and they warn that those behaviors will be treated as “fraud,” an illegal gaming of the system to increase …
Seniors need more Medicare choices, or do they? The answer depends, of course, on who’s doing the asking. Republicans and others advocating a voucher plan for Medicare invoke the choice argument as the rationale for transforming Medicare from social insurance…
Seniors need more Medicare choices, or do they? The answer depends, of course, on who’s doing the asking.
Republicans and others advocating a voucher plan for Medicare invoke the choice argument as the rationale for transforming Medicare from social insurance provided by the government to privatized arrangements between individuals and the marketplace. Under a voucher system, the government would give seniors and people who are disabled a fixed amount of money …
Does your doctor use a computer instead of a paper chart? Chances are that she does. The rate of adoption of electronic medical records (EMRs) over the last three years has been very steep. The main driver of this is…
Does your doctor use a computer instead of a paper chart?
Chances are that she does. The rate of adoption of electronic medical records (EMRs) over the last three years has been very steep.
The main driver of this is a government subsidy from a part of the 2009 Stimulus Act (called the HITECH Act) that incentivizes doctors and hospitals to make the conversion to electronic record-keeping.
As new Medicare rules kick in, some 2,200 hospitals nationwide are facing financial penalties for high 30-day readmission rates for myocardial infarction, congestive heart failure and pneumonia. Medicare payments will be lowered by as much as 1%. Investigators at the…
As new Medicare rules kick in, some 2,200 hospitals nationwide are facing financial penalties for high 30-day readmission rates for myocardial infarction, congestive heart failure and pneumonia. Medicare payments will be lowered by as much as 1%.
Investigators at the Skeptical Scalpel Institute for Evidence-Based Outcomes and Advanced Research (SSIEBOAR, catchy acronym, don’t you think?) have come up with a plan that is certain to lower readmission rates across the board. …
