One of the biggest shifts in American health care over the last several years (and we’ve only just seen the tip of the iceberg so far) is the shift of the system away from the traditional fee-for-service model, and towards a system based more on quality, outcomes, and yes, a degree of rationing. By all measures, we know that the pure fee-for-service model -- at least mostly funded by Medicare -- ...

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Physicians spend almost twice as much time each day typing on computers and filling out paperwork as they do seeing patients. That astonishing conclusion comes from research published this week in the Annals of Internal Medicine. Just think about that. How would you feel if you spent two hours documenting every hour of work that you do? How would your boss feel about it? You’d be depressed and frustrated; your boss ...

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Recently, CMS sent out press releases touting over $1 billion in savings from Accountable Care Organizations.  Here’s the tweet from Andy Slavitt, the acting Administrator of CMS: https://twitter.com/ASlavitt/status/768908822081667072 The link in the tweet is to a press release.  The link in the press release citing more details is to another press release.  There’s little in the way of analysis or data about how ACOs did in ...

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acp new logoA guest column by the American College of Physicians, exclusive to KevinMD.com. This will not be another article focused on the Medicare Access and CHIP Reauthorization Act (MACRA) and its Merit-Based Incentive Payment System (MIPS). Everyone else is writing about that. (But I can’t promise that I won’t mention MIPS at all.) Hopefully, by now, most of you ...

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If the emergency room is the most expensive place to receive health care, then why are more patients visiting the ER than ever before? There are no local doctors’ offices that can charge $1,000 to put a Band-Aid on your finger or $8,000 to tell you that your abdominal pain is due to drinking too much coffee.  But, I don't think you would mind paying this premium if you were having ...

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In 1978, the Institute of Medicine published A Manpower Policy for Primary Health Care: Report of a Study where they defined primary care as “integrated, accessible services by clinicians accountable for addressing a majority of heath care needs, developing a sustained partnership with patients, and practicing in the context of family and community.” The four main features of “good” primary care based on this definition are: 1. First-contact access for new medical ...

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We all want this sometimes, don’t we?  We want the things in our daily lives that bug us the most, like long lines at the DMV, to just go away.  But how often does that really happen? As the senior staff person for ACP’s governmental affairs team in Washington, DC, I often hear from exasperated physicians who want ACP to just make things they don’t like go away, whether it's MACRA ...

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The federal government has been trying to control the health of citizens for nearly a century, increasingly separating patients and their physicians. WWII wage controls firmly established health insurance as an employee “benefit” in lieu of salary.  This gave the employer power to choose coverage based on its needs, not the employee’s: the first degree of separation. Since WWII, government has imposed a multitude of programs that add degrees of separation: Medicare, ...

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Born in Canada, our mother came to the United States after World War II and blended into the Greatest Generation. Raising a family in the second half of the 20th century saw her contribute to a thriving American society then maintain retirement health on Medicare. But in her early 90s, this tranquility was threatened when her HMO hospital tried to kill her. She went to the emergency room with symptoms of ...

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As clinicians continue to debate the merits and limitations of retail clinics, it is increasingly clear that they are here to stay. These nontraditional sites have proliferated around the country, appealing directly to patients' desires for convenience in ways that many traditional primary care practices do not. A report by the Robert Wood Johnson Foundation found that retail clinics have increased by 900 percent over the last decade, an expansion ...

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