MACRA -- the Medicare Access and Chip Reauthorization Act of 2015 -- is a disaster. It will take the joy out of practicing medicine without significantly improving patient outcomes (except in a circular way) or reducing cost, by moving medical decisions from the bedside to the C-suite. It benefits primarily the health policy community -- consultants, academics, executives -- who designed it. Ironically, MACRA was one of the few major pieces ...

Read more...

One thing I’ve learned is that physicians who have gone into direct primary care (DPC) practices are passionate about their decision: they not only believe that DPC is better for their patients and their own professional and career satisfaction, many assert it is the answer to just about everything ailing primary care. There is an evangelical fervor among some DPC advocates to spread the word and convert other ...

Read more...

In the last decade, the federal government has undertaken considerable steps to control the way doctors care for their patients. Its goal is to improve healthcare quality and lower costs, but the very regulation tasked with achieving this has created a paperwork nightmare that actually does the opposite: it impedes care and increases costs. I’m referring to the Physician Quality Reporting System, or PQRS, which originated with the Tax Relief and ...

Read more...

Americans spend more per capita on medical care than just about any other country and, yet they often have little to show for it. Americans have worse access to care than people in other countries, and are often less likely to receive primary care services, like preventive therapies and screening tests. Determined to address these problems, Medicare leaders have been testing out new models of primary care, hoping to find ...

Read more...

Recently, a federal audit found that the Obama administration has illegally redirected funds related to collections from the Affordable Care Act that, by law, should have been deposited in the U.S. Treasury. President Obama, under the guise of executive order, used these tax dollars to bail out insurance companies that have experienced hundreds of millions of dollars in losses due to their participation the Affordable Care Act (ACA) exchanges. In their ...

Read more...

For all the media’s (and candidates’) attention to candidate health over the course of this presidential campaign, we seem to be spending precious little time in the presidential debates discussing the candidates’ actual health plans. Those on the left have “diagnosed” Mr. Trump as unhinged and mentally unstable, calling attention to a narcissistic personality consistent with a DSM diagnosis, though in violation of the “Goldwater Rule.” They have further raised the 
Read more...

For me, the saddest part of the 2016 presidential election is not that we have two of the most disliked presidential candidates in history but that so little attention is being paid to health care. You may have noticed that health care rarely comes up in campaign speeches or in debates, and when it does it’s often scripted empty promises. Donald Trump has a plan entitled “Healthcare Reform to Make America ...

Read more...

There is lots to love about American health care. We have some of the best clinicians in the world, as evidenced by the huge number of people who come to the U.S. from other countries when they are sick. Yet the American people are less satisfied with their health care system than are citizens of the majority of other developed countries. Why do people in the land of the Mayo Clinic ...

Read more...

Publishing in the BMJ, Vinay Prasad, an oncologist and health care’s leading evidence-based iconoclast, found that over half of medical reviewers who leave the FDA work for device and pharmaceutical industries. Prasad’s findings created disquiet amongst purists of various stripes. The media was shocked and tried shocking people by showing how shocked it was. The Lown Institute, which has been fighting physician conflict-of-interest ...

Read more...

Helping our patients make better health decisions can be a challenge. Whether we aim to get them out of bed in the hospital or off of the couch at home, factors contributing to follow-through may be complicated, and the best strategies to facilitate the right choices are seldom clear. As providers, we would hope that a long and healthy life would serve as the most powerful incentive for behavior change, but ...

Read more...

Most Popular