As Americans we believe we have the best healthcare system in the world. But think again, it’s really not the truth. We do have superb medical schools, very well trained providers, superb science and technology but the delivery of medical care is just not what it should be. We spend more for healthcare than any other country does on a per capita basis.And yet when we compare ourselves to other ...
Policy
Reading between the lines of breast cancer treatment studies
Between the Susan G. Komen-Planned Parenthood debate and the study on treatments released by the Journal of the American Medical Association recently, breast cancer has certainly gotten a lot of play in the media as of late.Every major news outlet in America covered the breast cancer study released by JAMA which said that nearly half of the women who had second surgeries for breast cancer may not have needed the ...
Why are labor and deliveries closing?
Labor and deliveries are slowly closing across the United States: California, Pennsylvania, and Ohio. In regional areas where there have been no closures, conversations in hospital boardrooms are probably questioning whether they should be. But why? Because of health care reform, increasing medical expenditures, hospitals are making less money due to reduced reimbursement, and because of the financial margin of obstetrics. To explain the complex answer further, we need to ...
America has a health care paradox
We have a real paradox in American healthcare. On the one hand we have exceptionally well educated and well trained providers who are committed to our care. We are the envy of the world for our biomedical research prowess, funded largely by the National Institutes of Health and conducted across the county in universities and medical schools. The pharmaceutical industry continuously brings forth life saving and disease altering medications. The ...
Take patients away from the overtreaters
A few months ago I was introduced to a gentleman who had been a corporate VP for employee benefits at a Fortune 100 company for many years. I was impressed with his knowledge of health care. He shared some of his experiences with company employees, who lived all over the country.The company had a policy that when employees were informed they had a very serious medical condition, the company paid ...
AMA: Advocating for Medicare, military and fiscal responsibility
A guest column by the American Medical Association, exclusive to KevinMD.com.This week, I’m joining hundreds of physicians and medical students in Washington, DC during the American Medical Association’s National Advocacy Conference to talk to our federal lawmakers about an end to what has become an annual chore of stopping drastic scheduled Medicare physician payment cuts to preserve access to health ...
A critical look at value driven health care
Everyone in the world is talking about “value-driven health care.” Or so it might seem if you pick up a medical journal or attend a lecture about health care here in Boston. “Maximizing value for patients” is on the tip of every administrator’s tongue and an interest in cost containment is de rigueur for young physicians who aspire to leadership positions in medicine. For those of us who are intimate with the ...
Surviving the new landscape of physician reimbursement
CNN recently posted an article titled "Doctors Going Broke." It described several cases of independent physicians who are near bankruptcy although they once were quite well off. For instance, the article detailed the case of Dr. William Pentz, a cardiologist in a small group practice, who had to borrow money last month to make payroll. He and the other cardiologists have cut their salaries in order to meet overhead. Dr. ...
Doctors lobby Congress to repeal the SGR
One of the things that I like most about my job is engaging with ACP’s physician leadership—the internal medicine doctors who dedicate enormous amounts of time, at great personal sacrifice, to represent the interests of our members and their patients.One of the things that I like least is when an ACP member (or non-member physician) caustically dismisses their efforts, usually because they disagree with some aspects of ACP policy. It ...
Why physicians may not buy into ACOs
I’m sure Ezekiel Emanuel hates being referred to as Rahm Emanuel’s brother, so I won’t describe him as such. After working as one of Obama’s main health care advisors, he’s now at U-Penn in a job spanning medicine, economics, and ethics. He’s also been writing engaging essays in JAMA about health care reform and economic change, that give us an augur into where health care reform might lead us.Here, ...
How to avoid HMO gatekeeper problems in medical homes
There's a great deal of planning and testing of new models of care and delivery to respond to healthcare's ever increasing costs. We've all heard about Accountable Care Organizations (ACO) and medical homes. The common concern is that they become a repeat of HMOs with the accompanying misaligned incentives undermining their effectiveness. An exciting new medical home model is rapidly expanding that avoids the dreaded "gatekeeper" that was the undoing of ...
Patient preferences may not be rational, but they are not irrelevant
Everyone in our industry -- policymakers, clinicians, healthcare facility administrators, public and private payers, technicians, pharmacists -- shares concerns about the state of healthcare in the U.S., each of us from a slightly different viewpoint.The thread that joins us all is that one day each of us will be a patient.As its title suggests, patients are central to almost every provision of the Patient Protection and Affordable Care Act (Act), ...
Identical twins with different ideas about healthcare
Jack and John are identical twins, but have varying interests in life. One day Jack, 43-years old, decides he has had enough of these headaches and calls his family doctor and asks what he should do. He is told that his doctor can see him in 4 days and to take some over the counter ibuprofren. And to definitely go to the ER if the headaches worsen.John, who has also ...
Analyzing what the President said about health care
President Barrack Obama delivered a 6,944 word State of the Union address to the American people. Of the speech, less than .01% was devoted to healthcare, which is remarkable considering the major changes in healthcare that are on the horizon if Obamacare survives a challenge in an upcoming U.S. Supreme Court case. During the speech, there were only three sentences that mentioned healthcare.The first was this: “I will not ...
Improve patient safety to improve healthcare quality
It has taken 13 years for us to revisit the issues in To Err Is Human, the 1999 landmark government report that shocked our nation with its revelation that 98,000 people died yearly in hospitals due to doctors' errors. For decades, and through one administration after another, the lack of safety in our healthcare system has gone un-addressed, placing us at greater and greater risk. Hospitals have disappeared, ...
A lack of incentive for medical schools to train primary care doctors
A social media movement is happening before our eyes with action starting to take shape. The #occupyhealthcare movement has begun within to the blogosphere and through various areas of social media by storm.What does the #occupyhealthcare movement mean to me? My main focus in advocacy for family medicine is the production of an adequate primary care workforce distributed adequately to best serve our country. Those close to me also ...
What should be the stated aim of health care in America?
The triple aim of health care, as defined by the Center for Medicare and Medicaid Services (CMS) is: improving the experience of care, bettering the health of populations, and reducing the per capita costs of health care.This struck me as odd when I first read it. Why should the stated aim of any system become to decrease the costs associated with that system?Which led to the next logical questions: What should be the stated aim of ...
How Moneyball applies to healthcare
The storyline is familiar. An organization is challenged to achieve better results without spending more money. An executive is committed to obtaining these better outcomes and recognizes that more financial resources aren’t forthcoming . Faced with the option of near-certain failure if he continues to work within the historic operating framework, he decides that a different approach is necessary. With the help of a young and visionary analyst, they decide ...
The problem of insurance gaps in cancer patients
Why are cancer organizations waiting until it starts to rain before they suggest buying an umbrella?“Join my Medicare Advantage plan and get free membership to a local health club, free glasses and dental care.” This time of year, during Medicare Advantage Annual Enrollment period, the only TV commercials that annoy us more often are for lawyers who want to help us if we were injured at work or in a ...
Implementing strategies to encourage patient accountability
While payers and providers are usually in the spotlight when it comes to accountable care, the most successful models will be the ones that place a strong focus on patient accountability. More and more frequently patients are selecting doctors with the best outcomes, asking proactive questions, and taking an active role in their lifestyle and behaviors. Empowering patients with the support and tools to be responsible for and more involved ...
