Recently, the Republicans’ health insurance bill was withdrawn, partly because of some Senators’ fear of underfunding Medicaid. The media and Democrats have clearly identified Medicaid as a wedge issue that divides Republicans. Unfortunately, those Republicans that have chosen to support conventional Medicaid, as opposed to supporting a much-needed revamp of this program, have succumbed to false advertisements. So let me review some facts, and suggest some common sense changes that ...

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At this time in history, it may serve us well to reflect on the tortuous past, the harrowing present and the unpredictable future of health care in America. First and foremost we must recognize we do not have “a health care system” -- rather our health care is delivered in an uncoordinated, misaligned and exorbitantly expensive fashion. For example, 1 in 5 Medicare patients are readmitted to the hospital within 30 days of discharge, ...

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I already know I sound like a broken record. Yet, I can’t fathom why I seem to be the only person talking about this. There have been numerous articles in both syndicated journals and the blogosphere about the many things wrong with the American health care system, including the overspecialization which we know leads to higher costs (but not necessarily better outcomes). Just as I feared, the New York Times ...

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In our recent paper criticizing how industrial quality improvement has been misapplied to primary care, we didn’t just complain, we made suggestions for a better way forward. This was under the assumption that regulators and payers will continue to insist on some kind of numeric reporting of outcomes by physicians or practices whether physicians like it or not, or whether it’s really useful and fair or ...

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The Trump administration has made clear its intentions to drastically reduce the size and intrusive nature of government. Let’s hope that extends to the Medicare Access and CHIP Reauthorization Act, otherwise known as MACRA, the heavy-handed new government “value-based payment” program for medical care, enacted in 2015, and set to rear its ugly head beginning this year. MACRA must die. MACRA is administrative overkill in an industry already overburdened by ...

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Thankfully, the GOP did not pass Paul Ryan’s repeal and replace bill for Obamacare.  Immediately after, I saw a headline hopefully concluding, “Medicare for all may be next.”  In Medicare’s current form, this would be devastating for the health of America.  I am a young geriatrician; I know a heck of a lot about Medicare.  Most people don’t.  They just see it as a great perk of turning 65 in ...

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If you are planning on complying with Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), make sure to allot the appropriate time and funding necessary to update/upgrade your practice. Realize that the measures will be arbitrary, the data implementation arduous and the moments for live patient care fleeting. Expect that, no matter how Herculean the task may be, the finish line will move often and unexpectedly. Prepare to get ...

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Rationing of health care services according to an individual’s ability to pay — or, as the case may be, the inability to do so — is becoming more prevalent in the United States, both in the public and private insurance spheres. Commercial payers, for example, increasingly require doctors to follow a complex and time-consuming authorization process. Recent surveys show that 75 percent of doctors complain about this often unnecessary step. Insurance ...

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One of the popular critiques of the American health care system is that it is high-volume, low-quality, and that this is a direct result of the traditional fee-for-service approach to paying doctors for medical care. In the past, doctors and hospitals have been paid much the same way that we pay for other goods and services. When they provide a service, such as an appointment or a procedure, they are ...

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The market for medical tourism grows as Americans increasingly seek medical care outside of the United States and pay cash for services.  Patients know they can obtain adequate quality care in Mexico for out of pocket costs far lower than their insurance plans with high deductibles would cover.  Posting basic outpatient visit and simple procedure prices could benefit our independent practices in the same way.  The only thing worse than ...

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