As we enter year two of the Affordable Care Act, we have seen many issues arise during implementation.  Through both executive order and executive memorandum, President Obama has unilaterally changed the law more than 100 times in order to advance his political agenda. When it became important to publicize enrollment and increased coverage of the uninsured, the president, and the ACA provided for an increased payment scale for patients with Medicaid. ...

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In his popular tome, The Innovator’s Prescription, Clayton Christensen proposes several cures to health care’s cost disease, known as disruptive innovations. One is the replacement of physicians by advanced practice clinicians (APCs). That is, by nurse practitioners and physician assistants. APCs meet the requirements for Christenson’s disruptive innovators: They cost less (than physicians) and are good enough. There is little doubt that APCs are good enough to deal with common clinical presentations. ...

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You may not be ready to admit it even to yourself, but you know it’s changing. Permanently. Some say it’s for the better. Others say it’s for the worse. Most don’t really care much one way or the other. After all, health care has been evolving and changing over thousands of years, and the experts best positioned to evaluate the health care turmoil of our times are yet to be ...

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Part of the fun of ringing in the New Year is looking back on the achievements of the previous one. And in 2014, there were plenty of health care success stories to celebrate: major medical advances, new technologies and the Affordable Care Act’s unexpectedly good first year. At the same time, many of the health care changes in 2014 yield potential risks for patients, employers and the nation as a whole. ...

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In defiance of dire predictions, children haven’t been sent to workhouses and women haven’t been chained to utensils after the GOP gained strength in the House and the Senate. And Vivek Murthy, the unabashed Obamaphile, was finally confirmed surgeon general. To be honest, I always thought the controversy surrounding Murthy’s nomination because of his stance on gun control was rather daft. Stopping doctors from pontificating over guns, such as the docs ...

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Medicaid is a federal program for the very poor implemented by grants to states, which do the administration.  Medicaid typically pays doctors about 60 percent of what Medicare pays.  In Florida, a typical primary care visit might pay the doctor $32.  In Alabama, doctors who agree to be the primary care physicians of record for Medicaid patients get a whopping $2.60 per beneficiary per month, a fee with which the ...

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I recently spent time at the New York eHealth Collaborative's Digital Health conference. The meeting was full of interesting seminars, informational sessions, presentations on innovative technology looming on the horizon, and talk about the future digital face of health care. The hallways outside the conference rooms were full of administrators, legislators, consultants, and representatives of companies building and designing new resources to help transform the health care system as they see it. Over and ...

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You couldn't invent a worse health care system than the nightmare we have created in the U.S. Our medical costs are almost twice as high per person as they are in most other similar countries but produce only mediocre outcomes. There is massive overtreatment of people who don't need it, while many who desperately do have no coverage at all. The payment incentives for doctors are perversely misaligned to produce the wrong ...

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Whatever happened to “first, do no harm?” One of the findings included in a Senate investigative committee’s report on the U.S. government’s post-9/11 torture program was that it was designed by two psychologists.  They were paid “$80 million to develop torture tactics that were used against suspected terrorists in the wake of the September 11 attacks on the Pentagon and the World Trade Center” -- including “waterboarding and mock burial on some of ...

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Last year, hospitals and health systems underwent 98 consolidations, a 51 percent increase from 2010.  Many of these mergers and acquisitions arose in response to declining government reimbursement and the Affordable Care Act.  Smaller hospitals are having increasing difficulties maintaining a margin and many face high debt burdens, bankruptcy or even closure. But is consolidation the clear-cut answer? Here are 4 reasons bigger actually may not be better for all hospitals: 1. Disparate ...

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