Health care in America is a perfect example of the Pareto principle, because 80 percent of our gargantuan expenditures on health care are due to only 20 percent of us who are very sick, elderly, disabled and vulnerable in many other ways. If we genuinely wished to reduce health care expenditures, common sense dictates that we would leave the 80 percent alone and zero in on those 20 percent, trying to ...

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shutterstock_74638591 You’re 56 years old. You’re one of the 30 million people (give or take a bunch) that you hear have received health insurance in this country as a result of the Affordable Care Act. You are a positive number in the New York Times headlines the Department of Health and Human Services (HHS) have been wanting you to read. And, this is how it’s working ...

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I am of the belief that every ACO must be physician-led. We must depend on them not only for clinical improvement, but also for developing a culture of improvement. Culture is vitally important. Culture trumps dollars, technology, data, and about anything else you would use in clinical medicine. If I was getting into the ACO business, I would start recruiting clinicians that embrace these characteristics: 1. Team leadership. Every doc is a leader to some degree, ...

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Yeah, it happened. The SGR is finally dead. Hooray! Sort of. I mean, it's great and all that -- we'll no longer have the annual threat of a massive payment cut from a poorly crafted piece of legislation from the 1990s; we'll no longer have to endure the annual ritual of last-minute legislative theatrics to avert the yearly cuts, we'll no longer have to waste our lobbying time and effort ...

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The 92-8 vote in the United States Senate to join the House in passing the Medicare Access and CHIP Reauthorization Act (MACRA), H.R. 2, represents a remarkable milestone for the Medicare program, and for ACP advocacy on behalf of internists and patients. It is remarkable not only because it eliminates the failed Medicare SGR -- how often does Congress admit it made a mistake, and then correct it? -- but because it ...

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New York officials are doing an “experiment” that should strike fear, anger, and outrage in the hearts of doctors who take care of Medicare patients. (New York has the highest Medicaid budget of any state.) As any doctor who has a high volume of Medicaid patients knows, Medicaid pays practically nothing.  Doctors who take Medicaid usually have to carry a bigger patient load to survive.  Medicaid patients are often sicker than ...

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As the Obamacare machine continues to grind forward, many patients have re-enrolled in a second year of coverage. While most have not had to use their insurance (the young and healthy crowd), others have found their newly minted coverage to be far less than promised. High deductibles, and up front out of pocket expenses, forced many covered by the exchanges to avoid seeking regular preventative care. Prevention was one of ...

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As the CMS Innovation Center rolls out the Next Generation ACO Model, I wonder what doctors are thinking. The Next Generation ACO model ups the ante on risk and reward and is the next delivery model iteration as CMS marches on to 30 percent at risk Medicare in 2016. Some of the docs will generally acknowledge that medicine is changing, but there is often no corresponding change in behavior. Other ...

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It has become perhaps the silliest four letters in health care: PQRS. It stands for Physician Quality Reporting System. It’s another this and another that created by the Centers for Medicare & Medicaid Services (CMS). After you read this, you’ll be like me, scratching your head trying to understand why anyone thinks our health care system is better under CMS’s leadership. CMS has setup a thing called PQRS, so physicians across the country ...

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It is amazing to me how far emergency medicine has come as a specialty. Until the 1970s, emergency rooms were staffed by low-level resident interns who moonlighted for extra money or physicians who couldn’t find work elsewhere. After finally getting recognized as a specialty, the specialty still spent a few decades finding its way: developing training programs, improving quality, and generally trying to raise the bar on emergency care in ...

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