A guest column by the American College of Physicians, exclusive to KevinMD.com. In 1998 I started a period of national service to the American College of Physicians leading to my term as President for 2010-2011. During that time I kept an almost full time private practice in Fayetteville, Tennessee. Moving between the worlds of health policy and "the trenches," I ...

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Any ruling by the Supreme Court on the constitutionality of the Affordable Care Act's controversial individual mandate isn't likely for at least another several months, but it's worth thinking about what might happen after the case is decided. The first scenario is easy: If the Court upholds the mandate, the ACA goes forward as planned to the continued objections of many conservative Americans and politicians. The second scenario is less ...

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A quality-driven MD colleague writes with frustration about two problems in his academic medical center.  I often hear similar comments from nurses and doctors, and so I present the examples for your consideration. This hospital has a poor record with regard to hand hygiene (in the 30% range), and my colleague suggested at an infection control meeting suggested that the rates be publicly posted in the hospital to provide an impetus for ...

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A guest column by the American Medical Association, exclusive to KevinMD.com. Anyone making a major purchase wants to maximize value by exploring their options. Shopping for the best option drives market competition and promotes innovation and efficiency. Shopping for competitive health insurance options can be difficult when a market is controlled by one or two large commercial insurers. The lack a competitive ...

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Why do we need to occupy healthcare?  Why are we here, on this website, calling for change?  We are so often told that America has the best healthcare system in the world.  If that were so, then there would be no need to change anything.  We could continue running things as we currently are, and all would be well ... Except that we do not have the best healthcare system in ...

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While we are talking about things that drive health care costs up, this one has bothered me since I was in practice years ago. I am a believer in competition, I think it forces us to be creative and provide better, cheaper, more efficient products and services. But there is the mindset of leadership at play as well. Are we competing to provide better patient services to improve patient care, or ...

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There are two crises in America, both of which have a profound effect on the economy.  The cost of healthcare is eating away at our ability to finance other needy areas.  Poor performance of our educational system is weakening our international competitiveness. Both healthcare and education are at the precipice of complete collapse.  They both deliver glaringly inferior results with prohibitive expenditures.  The performance of our healthcare system relative to ...

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Recently the Michigan Task Force on Nursing Practice hosted a regional forum in my area.  I was fortunate enough to attend and hear from the RN’s there the many issues that they face, which are varied and challenging.  The state wanted to hear from this forum of RN’s what changes were needed in the state’s nursing regulations so that certification could be updated to reflect the current nursing environment.  It ...

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The recent budget crisis in many state Medicaid programs has led the directors of these health care programs for the poor to cast about for ways to cut their costs, and many have landed on a ‘solution’ that puts lives at risk and undermine the financial viability of an emergency care safety net that is already severely underfunded and overwhelmed.  Some 21 states use a variation of the old definition ...

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Why can’t the United States have a smarter health care system? That was the frustrating question that kept poking through my train of thought as I read a study from the most recent issue of Pediatrics, the official journal of the American Academy of Pediatrics (AAP).  The study, out of UCLA, examined the association between length of well-child visits and quality of the visits, including things like developmental screening and ...

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