We have all seen people exhibit flagrantly unhealthy behavior. Some of us–though we’d never admit it–derive a certain, smug satisfaction by observing them. At least I don’t do that!Somewhere in the course of our daily lives though, most of us do exhibit behavior that suggests at least some disregard for our health. We don’t change our diet, though we know we should. We don’t floss, take medications as prescribed, or ...
Glenn Laffel, MD, PhD
A surge in demand for physicians from newly insured patients
The Affordable Care Act is the most important piece of federal health care legislation since the Social Security Act of 1965 established the Medicare program. It assures that 32 million Americans will have access to health insurance for the first time. But who will care for these people?Our health care system was plagued by a severe and worsening physician shortage even before the new law took effect. In fact, a ...
Physicians should establish rules with their patients before using a PHR
These days, it seems that for every consumer advocate out there who promotes the personal health record (PHR) as The Patient Empowerment Ubertool, there’s at least 10 physicians worried sick that the technology will further complicate their frazzled work lives.The fear and loathing derives from an increasingly common and distinctly distasteful experience in which a patient presents the physician with a thumb-drive, computer disk or Web-link to a site containing ...
Health reform vaults the USPSTF into prominence
The most visible impact of Affordable Care Act is surely the expansion of health insurance coverage to 30 million uninsured Americans, but a lesser known provision in the overhaul will have far-reaching implications as well.The provision catapults the US Preventive Services Task Force (USPSTF) from an obscure agency that produced unenforceable guidelines about screening and preventive services into one whose recommendations directly impact reimbursement.According to the terms of the new ...
The July Effect and causes of the spike in medication errors
"An apple a day keeps the doctor away," or so goes the old adage.People who believe there’s some truth behind the saying are crunching on a great big Macintosh right now, or at least they will be once they hear about the results of a study from UC-San Diego which showed that every July, there’s a 10% spike in fatal medication errors in hospitals.The scientists behind the study suggested that ...
Why general internists are quitting clinical medicine
The Association of American Medical Colleges predicts that by 2025, the US health system will have 46,000 fewer primary care physicians than it needs.If the prediction proves correct and we fail to develop effective mitigation strategies, the manpower shortage will create quite a mess. Ironically, the health reform law signed by President Obama in March will exacerbate the problem by increasing demand for services provided by primary care physicians.The American ...
Did the government get it right on EHR certification?
Last week, the Office of the National Coordinator for Health Information Technology (ONC) released criteria that will be used to certify EHRs as appropriate support tools for providers who want to qualify for Bonanza Days.The criteria are subject to a 60-day comment period before being finalized.I congratulate ONC on its elegant piece of rule making. Its so-called Interim Final Rule (IFR) provides a foundation that can support years of progress ...
The billions spent on electronic health records, and why there’s no way to know if EHRs will save money
Barack Obama is certain that electronic health records (EHRs) can improve the quality of care and the efficiency with which it is delivered. How certain? Certain enough to have bet billions on a program that pays providers to adopt and meaningfully use EHRs.Of course there are many ways to improve quality and efficiency. The Pennsylvania Health Care Cost Containment Council (PHC4) for example, publishes outcomes data for the states’ ...
Are specialists preventing the government from spending more on primary care?
After a painful, summer-long labor, Senate Finance eventually had to be induced before it gave birth to a health reform bill of its own. But give birth it finally did, and the products of its conception now stand alongside the offspring of 4 other proud Congressional committees.But please! Save the silver spoons and bunting! None of the quintuplets does enough to assure there will be enough PCPs out there to ...
Does the Max Baucus health reform plan do enough for doctors?
Max Baucus’ decision to release his solo album—subtitled the Senate Finance Committee’s proposal on health reform—was timed with the precision of a 4th grade marching band.Physicians could live with that, but the bill contained gornisht on tort reform and not much more than that on Medicare reimbursement. Upon seeing that, the Long White Coats reacted as if they’d seen earwax on their stethoscopes."The feeling of most doctors is ...
