Most hospital managers have never had the power to exert leverage over their most valuable resource, the physician, who, after all, admits the patients who make the hospital’s economic existence possible in the first place.So I wrote in introducing a chapter in my first book in 1988. I hastened to add, however, at the close of that chapter, these admonishments:1. The economic powers of the hospital is shifting from those ...
Richard Reece, MD
How health reform is like accident reform
"Do you know how many people died in car crashes in the United States in 2010? 32,000. That’s the lowest number since 1949. That’s impressive, but wait: It’s far more impressive than it sounds at first, because people in the United States drove about 10 times as many vehicle miles in 2010 as they did in 1949. In other words, if you drove a car or truck in 2010, you ...
Do American medical specialists really make too much money?
Whether specialists make too much money depends on whom you ask.Policy expertsIf you ask policy experts, most of whom are progressives, they will say "yes, of course, specialists make too much money." Too many specialists making too much money spoil the national health care broth.Just look at any other country, especially countries with government-run systems.Specialists there make one-half of what our specialists bring home. Look at their total ...
Why cognitive doctors need to be paid more
Everybody has a theory of what’s wrong with American health care and why costs are high.I have my own theory – talk is cheap. By this, I mean Americans and third party payers are unwilling to pay more for what mere talk is worth.They do not want to pay more for a visit to the family doctor, ...
Huge holes exist in the health reform law
Huge holes exist in the health reform law you can drive an 18-Wheeler through. These holes are not "devils in the details." They are so obvious nobody talks about them. They are the proverbial elephants in the room. I suppose this makes sense. It takes an 18-wheeler to transport ...
Why doctors should profit from dispensing medications
Hold onto your hats. I am about to enter dangerous territory. I am about to suggest maybe doctors should profit from dispensing medications from their office to offset declining reimbursements and rising expenses by using prescriptions as a source of ancillary revenues.Why dangerous? For a number of reasons.One, physicians still grapple with the perception that it is improper for a physician to make money from ...
Why EHRs aren’t meaningful to doctors and hospitals
Electronic health record (EHR) advocates in Washington don’t seem to get it. They don’t seem to understand that hospitals and doctors aren’t rushing to install EHRs because many EHRs, despite the constant talk that EHRs are a prerequisite for good care. Caregivers are not walking the talk, because in their view, EHRs,
- aren’t ready for prime time
- slow productivity
- decrease revenues,
- show scant returns on investment
- don’t talk to one ...
How judging doctors by the numbers may be meaningless
How do you judge how good a doctor is? By personal interaction? By what relatives and friends say? By whether he or she is on time when you go for your visit? By doctor rating websites on the Internet? By patient satisfaction surveys conducted by doctors themselves or rating agencies?Or do you do it by the numbers? The federal ...
Checks and balances in health reform
What follows are ten thoughts on checks and balances in health reform.I am writing from Oak Ridge, Tennessee, where I am attending a high school class reunion. My son Spencer, a nationally known poet and a candidate for the Episcopal priesthood, is with me. He is checking on my past, and I am trying to provide balance so he can understand his father's legacy.There ...
How seniors will accept cuts in Medicare from health reform
Everybody knows politics is a balancing act. One must balance promises against reality.For example, how does government keep Medicare intact for seniors while cutting $500 billion out of Medicare when government has no track record of cutting entitlement spending?And how one do it without losing the vote of seniors, who hold the key to the balance of power?The Obama administration and the Democrats hope to keep power by winning the ...
Why Obamacare scares this cardiologist
I recently visited my cardiologist. It was a routine follow up after a heart attack a year ago. I enjoy our relationship. As a token of my regard, I came bearing a gift. It was a copy of my book Obama, Doctors, and Health Reform.I knew he had qualms about Obamacare. He expressed doubts about the health reform bill’s merits. The bill will roll out over the next ten years. ...
Machine and technology fixation is why health costs are high
Obsession with medical technologies and machines characterizes American’s cultural expectations. We tend to think of our bodies as perpetual motion machines, to be preserved in perpetuity.If the face of our machines sag, we lift it up. If our pipes clog, we roto-rooter or stent them. If impurities gum up our machinery, we filter them out. If our joints give out or lock up, we replace them. If we want to ...
Doctors are focusing on lifestyle when practicing medicine
An interview with Elizabeth Chase, MD, obstetrician-gynecologist in Dover, New HampshireElizabeth Chase, better known as Betsy, is a close and enduring college friend of my son, Spencer. She is a solid, pragmatic, hard working obstetrician-gynecologist, with two sons, and an architect husband, who spends his time caring for their children and their house in Dover, New Hampshire. She represents many of changes that occur when women become full-time physicians. The ...
Health reform winners and losers, and how it affects doctors
I congratulate President Obama and the Democrats on their historic health reform achievement.Will this bill be able to win approval as it runs the parliamentary gauntlet? Is it an act of political suicide that will become manifest in November? Will it bankrupt the country because of lack of cost controls?Regardless of where one stands, the bill is a political act of vast ambition and colossal risk.Now may be a good ...
The individual mandate may collapse health reform
Obamacare faces a shaky future because of its call for an individual mandate. This mandate requires people to buy insurance or face income tax penalties, which the IRS would presumably enforce.As I write, attorney generals in 35 states are in the process of challenging the individual mandate as unconstitutional.The individual mandate issue is important. Kill it, and you kill Obamacare.Why? Because the individual mandate is the political mechanism for controlling ...
President Obama bets big on health care reform
President Obama has decided to place all his bets on an “up and down vote” on his health care bill.The stakes are enormous and rests on ten risky Obama bets.Bet One – His legacy depends on the outcome. If he loses, he may be a one-term president, and Democrats may lose their majorities in the House and Senate come November.Bet Two - The American people will ultimately recognize this is ...
Medicare cuts will strengthen doctors’ negotiating position
Doctors will soon be wagging the reform dog.Look at it this way. Expansion of insurance coverage to the 31 million more Americans, as envisioned in the current reform bill, will require more doctors to care for them. The starting entry of 78 million baby boomers in the Medicare pool, starting in 2011, will also take more doctors.As everybody knows, coverage does not equal access. This is most vividly illustrated in ...
How can doctors make America a better place to live?
What can physicians do to make American a better place to live, die, afford, and receive care? What can we do to bring about practical reform? What can we contribute?These may seem odd questions, After all, we deliver care. Care goes through us. But Medicare, Medicaid, and private third parties are big players. They dictate terms of engagement and payment. But the answers lie at the core of the physicians’ ...
10 ways United States health reform may fail
One, develop a plan that the presently privately insured Americans, estimated at 200 million, pay more in premiums, and to just make sure you succeed, immediately starting raising taxes by $400 billion over the next decade.Two, alienate those over 65, the most dependable voting bloc, by promising to cut Medicare by $500 billion over the next ten years with the false promise, which you know you cannot ...
How ideology is shaping health care reform
I’m an ideological pragmatist. I believe in what works and what suits the temperament of American people, rather than what is politically correct or what passes some moral litmus test.Whatever reform measure passes, it will be a public-private mix and will superimpose more government regulations on our private system. It will have uneven effects. It will cost more than the status quo. And it will expose the reality, that when ...
