I usually write about healthcare reform from a pediatrician’s viewpoint, but what grabbed my attention recently was a story my husband, Randy, told me about an adult in his practice – a patient on Medicaid. Randy is a neurologist in…
I usually write about healthcare reform from a pediatrician’s viewpoint, but what grabbed my attention recently was a story my husband, Randy, told me about an adult in his practice – a patient on Medicaid.
Randy is a neurologist in a private practice, and Medicaid patients come from every corner of Rhode Island to see him. They make this cumbersome pilgrimage because he is a member of a dying breed: …
As I point out in The Medical Profession Is Dead and the Doctor Is "Critically Ill!", more factions are able to charge for and be reimbursed for healthcare delivery than ever before. This has come about through creating boutique health…
As I point out in The Medical Profession Is Dead and the Doctor Is “Critically Ill!“, more factions are able to charge for and be reimbursed for healthcare delivery than ever before. This has come about through creating boutique health care niches. The demand for boutique care is being driven by entrepreneurial interests, and, once brought to fruition, then being managed with corporation business tactics — i.e., for profit.
So, here we are, between a Medicare rock and budget hard place. Costs are clearly a problem. Our healthcare system is the most expensive in the world. Take a look at the 2003 figures from the Kaiser Family Foundation. Per…
So, here we are, between a Medicare rock and budget hard place.
Costs are clearly a problem. Our healthcare system is the most expensive in the world. Take a look at the 2003 figures from the Kaiser Family Foundation. Per capita costs, in 2003, in the US were $3,394 above those of the UK.
Hospitalists save money. Until the patient leaves the hospital, at least. A recent study from the Annals of Internal Medicine ignited debate over the cost effectiveness of hospitalists. Looking at Medicare patients from 2001 to 2006, researchers found that "those…
Hospitalists save money. Until the patient leaves the hospital, at least.
A recent study from the Annals of Internal Medicine ignited debate over the cost effectiveness of hospitalists. Looking at Medicare patients from 2001 to 2006, researchers found that “those who were followed by a primary care physician spent about half a day more at the hospital, costing Medicare …
Recently, we marked the 66th birthday of Medicaid, the jointly funded but State-run program that supports health care for the poor. Medicaid plays a huge role in selected populations: 70% of nursing home inhabitants, 56% of low-income children and 42%…
Recently, we marked the 66th birthday of Medicaid, the jointly funded but State-run program that supports health care for the poor. Medicaid plays a huge role in selected populations: 70% of nursing home inhabitants, 56% of low-income children and 42% of adults, and 44% of people living with HIV/AIDS all have their health care paid for by Medicaid. Medicaid is much talked about these days, and the reason is of course …
If you're a physician or hospital that relies on Medicare payments, grim times are ahead. Yes, even worse than the scheduled 29% payment cut that's scheduled to go into effect in 2013. Emergency physician Shadowfax calls the debt deal "a…
If you’re a physician or hospital that relies on Medicare payments, grim times are ahead. Yes, even worse than the scheduled 29% payment cut that’s scheduled to go into effect in 2013. Emergency physician Shadowfax calls the debt deal “a terrible deal for health care providers.”
Under the contentious debt ceiling agreement, significant cuts in Medicare dollars will be made. But …
Not only is Social Security on the chopping block in order to respond to Republican extortion. So is Medicare. But Medicare isn’t the nation’s budgetary problems. It’s the solution. The real problem is the soaring costs of health care that…
Not only is Social Security on the chopping block in order to respond to Republican extortion. So is Medicare.
But Medicare isn’t the nation’s budgetary problems. It’s the solution. The real problem is the soaring costs of health care that lie beneath Medicare. They’re costs all of us are bearing in the form of soaring premiums, co-payments, and deductibles.
Medicare offers a means of reducing these costs — if Washington would let …
How to slow Medicare’s escalating costs has been the big health care policy issue recently, with Republicans and Democrats offering competing proposals, each part of broader plans for reducing the federal deficit—projected to be $1.5 trillion this year, with the…
How to slow Medicare’s escalating costs has been the big health care policy issue recently, with Republicans and Democrats offering competing proposals, each part of broader plans for reducing the federal deficit—projected to be $1.5 trillion this year, with the government borrowing 40 cents for every dollar it spends.
Unfortunately, neither the Medicare proposal of Representative Paul Ryan’s House Budget Committee, nor that offered in response by President Obama, can …
There have been scores of recent articles about Congresswoman-elect Kathy Hochul's upset win in New York's 26th Congressional District special election. They all seem to share a thread of incredulity, followed either by chortling or spin depending on the source.…
There have been scores of recent articles about Congresswoman-elect Kathy Hochul’s upset win in New York’s 26th Congressional District special election. They all seem to share a thread of incredulity, followed either by chortling or spin depending on the source. These stories also share the sense that her victory was truly an underdog performance destined to become legend.
According to The New York Times, “Two months ago, the Democrat … was …
What if I were to tell you that Washington is trying to balance the budget by making cuts to a program that covers 70% of the nation's nursing home costs and 43% of all births in California? Well they are.…
What if I were to tell you that Washington is trying to balance the budget by making cuts to a program that covers 70% of the nation’s nursing home costs and 43% of all births in California? Well they are.
The rancorous debate over how to balance the federal budget includes drastic cuts to Medicaid. And while this program may seem distant to people in power and the general public, …
The New York Times recently published an opinion editorial entitled "Squandering Medicare’s Money"in which Dr. Rita Redberg, professor of cardiology at UCSF, proposes that much of Medicare’s financial deficit could be reduced if the government did not spend "a fortune…
The New York Times recently published an opinion editorial entitled “Squandering Medicare’s Money“in which Dr. Rita Redberg, professor of cardiology at UCSF, proposes that much of Medicare’s financial deficit could be reduced if the government did not spend “a fortune each year on procedures that have no proven benefit.”
To support her contention, Redberg cites several studies which indicate that many routinely performed tests and treatments …
Anyone who thinks America has the best health care system in the world ought to take a look at its miserable record on caring for end stage renal disease patients on dialysis. About one of every five people who go…
Anyone who thinks America has the best health care system in the world ought to take a look at its miserable record on caring for end stage renal disease patients on dialysis.
About one of every five people who go on dialysis dies in the first year here, compared to less than one in seven in Europe and one in sixteen in Japan. Even after adjusting for age, gender, race …
Doctors who do not successfully e-prescribe 10 times for Medicare patients in the first six months of 2011 using claims-based reporting may be hit with a 1% penalty on their Medicare Part B payments for covered professional services in 2012.…
Doctors who do not successfully e-prescribe 10 times for Medicare patients in the first six months of 2011 using claims-based reporting may be hit with a 1% penalty on their Medicare Part B payments for covered professional services in 2012.
The penalty will increase to 1.5% in 2013 for those who don’t e-prescribe for 25 Medicare patients during 2011.
Part one of the three-part series, Let's Pay Popular People More! My patient only had 20 minutes to wait for the van headed to detox. The people who had worked to get him into a detox program already numbered in…
Part one of the three-part series, Let’s Pay Popular People More!
My patient only had 20 minutes to wait for the van headed to detox. The people who had worked to get him into a detox program already numbered in the double digits. Sam (not his real name) was the classic public inebriate — he woke on sidewalks with the shakes, vomited blood on a regular basis, had lost most of …
One aspect of religious dogma that has entered the medical world is that fee-for-service pricing of medical services is bad and should be replaced by a capitated, or global, arrangement that establishes an annual budget for care for different risk…
One aspect of religious dogma that has entered the medical world is that fee-for-service pricing of medical services is bad and should be replaced by a capitated, or global, arrangement that establishes an annual budget for care for different risk groups of patients.
Like other religious beliefs, this is often offered without rigorous analytic support. Some insurance companies are particularly pleased …
After all the ridiculous fear-mongering about "death panels," Congress dropped a proposal to encourage end-of-life planning from the health reform legislation passed last March. But the administration had in fact quietly included reimbursing doctors for end-of-life counseling along with a…
After all the ridiculous fear-mongering about “death panels,” Congress dropped a proposal to encourage end-of-life planning from the health reform legislation passed last March.
But the administration had in fact quietly included reimbursing doctors for end-of-life counseling along with a host of new Medicare regulations. The provision, which authorizes payment for “voluntary advance care planning,” went into …
A version of this op-ed was published on April 12, 2011 in USA Today. “Would you like to discuss your end-of-life plans today?” It’s a question that I ask my patients, although not as often as I would like. Talking…
A version of this op-ed was published on April 12, 2011 in USA Today.
“Would you like to discuss your end-of-life plans today?”
It’s a question that I ask my patients, although not as often as I would like. Talking about death may be uncomfortable, but it’s a conversation that needs to happen more often.
Medicare is thinking of using patient satisfaction scores in part to determine bonuses to hospitals. According to Kaiser Health News, ... patient gripes soon will affect how much hospitals get paid by Medicare. The Centers for Medicare & Medicaid Services…
… patient gripes soon will affect how much hospitals get paid by Medicare.
The Centers for Medicare & Medicaid Services is finalizing details for the new reimbursement method, required by last year’s health care law. Consumer advocates say tying patient
On January 1, the White House announced a new policy that would have paid doctors for discussing end-of-life planning during their Medicare patients’ annual wellness visit. Under this policy, physicians would be paid to encourage their patients to establish an…
On January 1, the White House announced a new policy that would have paid doctors for discussing end-of-life planning during their Medicare patients’ annual wellness visit.
Under this policy, physicians would be paid to encourage their patients to establish an advance directive, which would guide medical care if the patient became incapacitated from illness, and could …
The new healthcare reform law appears to be using the idea of improved quality to justify the enormous expense of changing the way care is delivered in the United States. As a justification for the need for change is the…
The new healthcare reform law appears to be using the idea of improved quality to justify the enormous expense of changing the way care is delivered in the United States.
As a justification for the need for change is the reporting currently being touted as a great measure of quality. This information is gathered in many different ways and …
