Patient-centered primary care medical homes (PCMHs) are all the rage. A frequently-touted part of the Affordable Care Act (ACA), they have received literally hundreds of millions of dollars in federal incentive and demonstration-project funding. They’ve been around for decades. In fact, the more you know about the intention behind the creation of a primary care patient-centered medical home (PCMH), the more you want to ask, “Well, of course – how ...

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In addition to providing coverage to millions of uninsured Americans, one of the key attributes of the Affordable Care Act (aka Obamacare) is reforming the way that we finance health care in the U.S. Since the rise of the health insurance industry (as a job benefit or under Medicare), we have operated under a system known as “fee-for-service,” in which every little nugget of health care provided (from an operation to ...

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Recently, another installment was published from the research team of the Oregon Health Insurance Experiment. The major finding -- Medicaid coverage results in a 40% increase in emergency department (ER) use. Many of the health care pundits quickly sifted through the scientific results to support their opinions. You can read some of them here: Sarah Kliff reports the facts: Expanding Medicaid doesn’t reduce ER trips. It increases them. Scott Gottlieb claims that 
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While the Affordable Care Act, or Obamacare, has been criticized by its opposition as “socialized medicine,” it relies heavily on private health insurance. On the other end of the political spectrum is the idea that a government-run single payer system, similar to Canada’s, is the best way to deliver health care. (This is sometimes shorthanded in the U.S. as “Medicare for All.”) However, this system has been believed politically impossible ...

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The primary debate in health care reform this past year centered on insurance coverage. The next great debate will focus on the cost of providing health care. For decades, the way we’ve paid doctors and hospitals has driven up health care costs. And while the pace of health care spending has slowed the last four years, it continues to rise faster and more noticeably than improvements in U.S. health care outcomes. The reason is not ...

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The Affordable Care Act was enacted all the way back in 2010. But, even before then, critics were asserting that this new law would more or less destroy the American economy, insert Uncle Sam squarely between patients and providers, and initiate the end of freedom as it ushered in socialized medicine. That was nearly 4 years -- and 40 repeal attempts -- ago, and yet, the sky remains intact above ...

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A version of this column was published on January 26, 2014 in the New York Times’ Room for Debate blog. The president should invite someone crucial to the success of the Affordable Care Act: a practicing primary care physician. Obamacare admirably expands the opportunity to purchase affordable health insurance to the previously uninsured tens of millions, either by expanding Medicaid or through health exchanges like HealthCare.gov.  Yet without a strong primary care backbone, those ...

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A recent article in the Annals of Emergency Medicine analyzed the revenue increases due to emergency physicians for services delivered to currently uninsured individuals when they begin to receive coverage (via either Medicaid or private plans) under the Affordable Care Act. The authors analyzed payments for outpatient emergency department (ED) visits using the Medical Expenditure Panel Survey from 2005-2010. They looked into characteristics of charges and payments for the following groups: ...

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Just a little over a week into 2014, my new year started off with a bang -- literally -- as I got into an automobile accident that involved my car sideswiping another vehicle and then crashing my car into a tree at 30 MPH. The car was totaled, but fortunately, I (mostly) walked away from the accident with only a fractured sternum and bruising. Just a little over a week from ...

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There is a dark cloud of discouragement, dejection, disheartenment, and all other synonyms of despair, hanging over the medical profession. It’s not that all physicians live in constant gloom and doom, although quite a few do, particularly those still in private practice, but the profession itself seems to be losing its luster. Some doctors seem content to pragmatically adapt to the new and duller definition of their old profession, but in ...

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