After four years working as a child and adolescent psychiatrist in Brooklyn treating the underserved, I decided it was time to dedicate myself fully to my growing private practice. Functioning solely as an out of network provider in private practice, as expected, my clientele grossly changed. Unlike my hospital patients, a majority of my patients are upper class to wealthy. Finances are not concerns or stressors. Wealth does not predict a decrease ...

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One of the goals of the Affordable Care Act (a.k.a. Obamacare) was to increase access to primary care physicians. The notion is that if people have insurance it would be easier for them to get appointments with primary care physicians. This is because many physicians are unwilling to accept new patients who are uninsured. Further, a key component of the ACA was to increase physician reimbursement for Medicaid because this program ...

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The buzzwords many use in medicine today are "personalized," "individualized," or "targeted." Rather than doctors prescribing tests or treatments that work in most people but might not work for you, proponents argue, we should tailor medical interventions to unique patient characteristics, such as genomic data. (The White House's Precision Medicine Initiative is an example of this kind of thinking.) Although I am skeptical that big data-driven genetic ...

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It’s very hard to find a product or service that is both lousy and unaffordable. Such expensive duds are usually quickly replaced by cheaper and better competitors. Prior to the Affordable Care Act, health care was becoming more expensive every year while simultaneously becoming less convenient, less personal, and less satisfying. In 2009, I wrote a series of four posts explaining how the health care marketplace reached such ...

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In October, 2013, at the launch of the Affordable Care Act, I predicted that the health insurance exchanges about to go into effect would grow in popularity and improve the health insurance marketplace, then so imperfect. Twenty months later, the exchanges are proving effective in reducing the number of uninsured and are beginning to provide the information people need to make an informed selection about which plan is best ...

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Now that we no longer have to worry about the SGR, we have a new worry. The law consolidates several measurement tools into one big tool. CMS has declared that it wants to pay for value. The law provides a blueprint for paying for value. The underlying assumption of this approach is that we can define and measure value through measuring quality components. Can we define health care value through measurement? ...

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Recently, the new surgeon general of the United States, Vivek Murthy, was officially sworn in by Vice President Joe Biden. Congratulations to him, it’s quite an achievement at the relatively young age of 37. Nobody can doubt the hard work, intelligence and passion that must have gone into reaching such a height. His nomination was first put forward at the end of 2013, and he faced something of an uphill political ...

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shutterstock_209415490 You gotta hand it to our health department. They are laser focused on this one. They want 85 percent of payments made to doctors by the Centers for Medicare & Medicaid Services (CMS) to be linked to clinical quality measures within the next two years. Moreover, I suspect the health department is still giddy from Congress passing a new health care ...

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Inscribed on a plaque just below a statue of an eagle in front of my hospital is a famous quote from President Abraham Lincoln that begins, “To care for him who shall have borne the battle ...” It is the reason why the Veterans Affairs (VA) system exists. It is the reason why we VA physicians come to work each day. I am honored to care for our special patient population, ...

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It has been known for a long time that “health care” -- all the stuff that we do, prescribe and provide -- is a minor determinant of how “healthy” any of us is. Overall health, or more technically, the variability in health outcomes, is much more dependent on the combination of genetics, personal behavior (think smoking and seat belts), environmental factors and socioeconomic status than it is on health care. I ...

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