For 11 years, Congress has failed to reform the Medicare physician payment system, and appears prepared yet again (for the 17th time) to fall back on another one-year patch for the unpopular sustainable growth-rate (SGR) formula to avoid a 24% cut in payments to doctors.  As House minority leader Nancy Pelosi said recently, “Instead of reforming the Medicare physician payment system, Congress seems intent on imposing yet another round of arbitrary provider ...

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I came across a really good post on the Daily Beast written by a pediatrician in New England, griping (appropriately) about parents who were unwilling to trust his judgment about vaccinating their children.

Why have so many patients lost trust in their doctors?

You might challenge the assumption that patients used to trust their doctors more, and that would be a fair question.  I haven’t found any ...

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When the American College of Emergency Physicians (ACEP) decided not to join the Choosing Wisely campaign, I was among those who expressed disappointment with this decision, in part because I have long been a proponent of efforts to encourage more cost-effective care in the ED.   In fact I had already independently done a significant amount of work in the Read more...

Emergency care providers (emergency physicians and specialists on-call for the ER) are at a significant disadvantage when it comes to trying to get paid fairly for services rendered to enrollees of commercial health plans.  Most other health care providers are able to: 1) screen prospective patients to make sure they will get paid appropriately for the care, 2) elect not to care for a plan’s enrollees, or participate in a ...

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I believe the greatest challenge in medicine today is keeping the "care" in healthcare. One of the most frustrating aspects of practicing medicine for me had to do with how difficult it had become to incorporate caring into my practice. I am not necessarily talking about the kind of caring associated with having a long-term, close and mutually appreciated association with my patients: if that had motivated me, I would ...

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Have you ever been in a negotiation with a health plan for a network participation contract and had the impression that the plan knew all the rates that you had agreed to in confidential negotiations with other health plans?  Allow me to reassure you:  you are not being paranoid.  It is quite likely that the plan you are negotiating with knows exactly what rates and terms you have agreed to ...

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A couple of months ago, I was dragging a large suitcase that got hung up on a curb, giving my arm and shoulder a good yank.  Over the next few days, my shoulder began to ache a bit.  Applying the very reasonable ‘tincture of time’ principle, I rested it a bit, hoping that with time the symptoms would resolve.  Two months later, I was getting an MRI and anticipating surgery ...

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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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Boondoggle – a scheme that wastes time and money. Perhaps this is not the best way to describe the many efforts that are being made to try to keep patients with non-urgent problems from using the emergency department, but from where I sit, deferral of ED care is a cost-saving tactic that not only fails to deliver much in the way of cost savings, it also is a strategy that ...

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It strikes me that in developing payment reform related, compensation driven cost-containment strategies aimed at constraining the cost of emergency care, policy makers, emergency physicians, and health insurers should adhere to certain principles. The American College of Emergency Physicians should be at the forefront when it comes to establishing these principles, which I hope will be focused on protecting our patients first, and our specialty second. The concept and practice of ...

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