CMS states it wants to increase pay to primary care physicians.  And while we might quarrel with their strategies or with the speed of achieving the goal, few would quarrel with the goal itself.  In recent years, CMS has developed HCPCS codes and adopted CPT codes, some limited to primary care and some not specialty restricted but all likely to be reported by primary care practices. Meanwhile, although payment systems ...

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A recent article suggested that the use of observation status for a hospitalized veteran was a dishonor to his years of service to our country because observation was going to subject him to higher out of pocket costs. This post created quite a lot of discussion and debate. While I agree with the author and commenters that observation is confusing to all and that there has to be ...

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My dad was recently diagnosed with cancer. Overnight, he found himself faced with tough care decisions, small insurance crises, and the overwhelming bureaucracy of cancer. He was also about to become tasked with managing a daily care routine far outside the scope of his usual morning ritual. Since his diagnosis, he has returned to the hospital twice with pneumonia. While many cancer patients become prone to bacterial infections due to a ...

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Lena Wright’s best friend was hunched over like a character from a French novel, with spinal bones so thin they would fracture with a fit of sneezing. Determined to avoid that fate, Wright (a pseudonym) asked her primary care doctor to test her for osteoporosis with a DEXA scan, also known as dual energy x-ray absorption. The scan would send two x-ray beams through her bones, one high-energy and the ...

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It is possible that in a few months from now, only Nate Silver’s prediction models will stand between Donald Trump and the White House. I will leave it to future anthropologists to write about the significance of that moment. For now, the question, “What will President Trump be doing when he is not building a wall?” has assumed salience. This is relatively easy to answer when it comes to health policy. ...

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A few weeks ago I wrote a piece about my hero patient, a World War II veteran who landed on Normandy beach, and how he had been left in a difficult position by the whole observation versus inpatient situation while he was hospitalized. My intention was to draw attention to these types of scenarios and how they cause intense anxiety and concern to our elderly. It’s a horrible and ...

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Policy makers who are responsible for shaping how the federal government (the country’s biggest payer of health care services) pays physicians are pushing CMS on a rapid path away from traditional fee-for-service (FFS). As I discussed last year, CMS intends to have 50 percent of its payments flow through “alternative payment models” such as ACOs and bundled payments by 2018, with nearly all of the rest of the ...

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What is happening in medicine?  How will these changes affect our patients? How will they affect how we deliver health care?  These seem to be the questions asked most often amongst physicians across the country.  I do not profess to have a crystal ball nor can I state with any certainty what the profession we chose to dedicate our lives to will look like in the near future.  However, there ...

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American businesses hold a solution to one of the most fundamental flaws of American health care: misalignment of incentives. We live in a nation where profit-seeking behavior can be more alluring than high-quality patient care. To date, major health care reform efforts have paid little attention to the business community’s potential to address this issue. Status quo Currently, the status quo is such that health insurance companies and health care providers act ...

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Health care is often really costly. And with increasing frequency, a significant chunk of those costs is being passed on to patients in the form of high deductibles, copays, or other out-of-pocket expenses. As a result, millions of Americans struggle to pay medical bills each year. What’s a poor patient to do? For starters: They can talk to their doctors about these costs. According to a study my colleagues and ...

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