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 ...

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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 ...

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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 ...

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“Beep,” went the machine. I left a message and hung up. My patient, Mr. G, had just been denied a medicine by his health insurer. It’s the same medication for the same condition that he had been taking last year. I was leaving a message on his behalf. You can be assured that if you hand an insurance card to the front desk employee at your doctor’s office, your doctor deals with health insurers ...

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The school year is back in session, and our student health center is busy.  As a college health doctor, I have been able to watch the rollout of the Affordable Care Act (ACA) among this population. Since its passage, more of our students are now insured, but many unique challenges still persist for this population. Young adults have historically demonstrated high rates of un-insurance. An estimated 30 percent of those 19 ...

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The British National Health Service (NHS) was born in 1948, based on legislation passed that year mandating free high-quality health care for all paid by taxes. In contrast, the U.S. started Medicare in 1966 to provide health care to the elderly and the State Children's Insurance Program (SCHIP) in 1993 to fund health care for children whose parents were unable to afford it. Health care in the UK is still ...

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One of the biggest shifts in American health care over the last several years (and we’ve only just seen the tip of the iceberg so far) is the shift of the system away from the traditional fee-for-service model, and towards a system based more on quality, outcomes, and yes, a degree of rationing. By all measures, we know that the pure fee-for-service model -- at least mostly funded by Medicare -- ...

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Physicians spend almost twice as much time each day typing on computers and filling out paperwork as they do seeing patients. That astonishing conclusion comes from research published this week in the Annals of Internal Medicine. Just think about that. How would you feel if you spent two hours documenting every hour of work that you do? How would your boss feel about it? You’d be depressed and frustrated; your boss ...

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Recently, CMS sent out press releases touting over $1 billion in savings from Accountable Care Organizations.  Here’s the tweet from Andy Slavitt, the acting Administrator of CMS: https://twitter.com/ASlavitt/status/768908822081667072 The link in the tweet is to a press release.  The link in the press release citing more details is to another press release.  There’s little in the way of analysis or data about how ACOs did in ...

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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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