Washington has been touting Accountable Care Organizations (ACOs) as the end-all solution to health care’s woes. Designed to reduce Medicare spending and increase care coordination across a large number of patients, members of an ACO – hospitals, primary care physicians, specialists – would be paid if and when their patient population received outstanding quality of care. However, as the Centers for Medicare and Medicaid Services (CMS) finalize their ACO ...

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At UC Berkeley in the 70s, the secretary in the Department of Psychology pasted a bumper sticker on her desk positing the question: "… yes, but are we asking the right questions?" For some reason, this subtle invitation remains with me today, echoing amidst the ACO fervor of "… better care at lower costs."

… the good news is we’re making great time, the bad news is we don’t know where ...

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AMA: Health insurers denial rates are down, but error rates are upA guest column by the American Medical Association, exclusive to KevinMD.com. Billions of dollars in administrative waste would be eliminated each year if health insurers sent a timely, accurate and specific response to each physician claim, and while this year’s AMA National Health Insurer Report Card shows promising improvements in denial rates, more work needs to be done. The AMA’s fourth annual ...

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We all know, broadly speaking, the mission of comparative effectiveness research (CER), now sometimes called patient-centered outcomes research. Such studies should inform clinical and health policy decisions made by physicians, payers, and regulators to help determine treatment guidelines, coverage policies, and the therapeutic value of new therapies relative to standard-of-care in real-world settings.

But dive deeper, and it’s clear there remains an uncomfortable level of confusion as to what CER ...

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In the Chicago Tribune recently, Bruce Japsen has an excellent article addressing Accountable Care Organizations, quality of care issues, and the change in how physicians will be paid in the future. Clearly, the government and insurers have decided that physicians will not be paid for services rendered.  Physicians will be paid based on patient outcomes and will share in any losses insurers sustain due to poor patient outcomes.  There ...

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There have been scores of recent articles about Congresswoman-elect Kathy Hochul's upset win in New York's 26th Congressional District special election.  They all seem to share a thread of incredulity, followed either by chortling or spin depending on the source.  These stories also share the sense that her victory was truly an underdog performance destined to become legend. According to The New York Times, "Two months ago, the Democrat ... was ...

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Does it really matter how many ribs Michelle Obama ate on her vacation? For too many conservatives, the answer seems to be yes, with pundits poking fun at the anti-obesity guru's dinner choice. But conservatives need to give it a rest: many seem to prefer scoring easy points against the First Lady to arguing about the best way to attack the obesity epidemic -- and some even claim that ...

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What if I were to tell you that Washington is trying to balance the budget by making cuts to a program that covers 70% of the nation's nursing home costs and 43% of all births in California? Well they are. The rancorous debate over how to balance the federal budget includes drastic cuts to Medicaid. And while this program may seem distant to people in power and the general public, ...

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by J.E.B. Johnson, MD Let me preface this comment by stating I am not an actuarial. I hated statistics and am no fan of insurance companies. That said I would like to know why patients and the US government think that health insurance companies should accept unlimited risk? My car insurance has limits, my homeowners insurance has limits, my malpractice insurance has limits.  Why ...

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Many of you are familiar with the famous "invisible gorilla" experiment, wherein an audience, being instructed to watch closely for the number of passes made with a basketball, fails to  see a rather large and deliberate gorilla march slowly across the screen, stop in mid  picture and thump its chest. In fact over 1/2 of those tested failed to notice this obvious action.  The predominant response is one of suspicion and ...

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