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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It is no secret that mental health conditions are prevalent, and recent years have seen an increase in the dialogue on their causes and consequences. However, we do ourselves a disservice when discussing mental health outside the context of the broader system in which care is provided, and the insurance constraints that drive shortcomings in health care delivery. SAMHSA estimated that 58 percent of adults have a medical condition ...

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Why must we keep repeating history? NCLB significantly increased the federal role in education by holding schools accountable for the academic progress of all students. NCLB held teachers responsible for education of children; MACRA-proposed changes will hold physicians responsible for the medical progress of our patients.  The largest problem with this approach is students and patients go home each day to whatever environment in which they live.  Neither teachers nor physicians ...

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Recently, physicians in small private practices and rural areas breathed a collective sigh of relief.  There is a possibility the implementation of changes to physician reimbursement (known as MACRA) could be delayed.  Thank you, Mr. Slavitt, for listening.  I am grateful to Orrin Hatch (R-UT) and Ron Wyden (D-OR) for keeping our rural needs in mind.  We have a window of opportunity for rural health care to survive, but we ...

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