Here we go again. There is yet another round of evidence of how the physician workforce hole we’ve dug for ourselves keeps getting deeper, but there has been still no substantive payment reform on the government side (Medicare/Medicaid) or the private payer side. One recent study appeared in Academic Medicine. Clese Erikson and colleagues surveyed a random sample of 4th-year medical students in 2010. Only 13% of the students stated they ...

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The interpretation of results of a policy study lies in the political inclination of the beholder. If one likes the results they are “ground breaking.” If they are not in line with our world view there are “nuances” of hypothesis testing that detractors have overlooked, it’s too “premature” to draw conclusions and “further research” is needed. Statisticians, like lawyers, can be recruited to argue any point of view to meaningless insignificance. This ...

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Whatever the problems with the roll out of Healthcare.gov, the fact is that the government take-over of health care has been happening for more than a century. If we want a truly free market for health care, we have to think in broader and bolder terms than simply rolling back the ACA. With that in mind, here is a short list of patient-focused ways to get the government out of ...

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A study from Science found that those on Medicaid in Oregon made 40% more visits to the emergency department. The Oregon Health Insurance Experiment included about 90,000 low-income people and assigned 30,000 of them to Medicaid by lottery. It's essentially a naturally-occurring randomized controlled trial. The result seems to have caught the public policy experts by off guard:

“I suspect that the finding will be surprising to many in the policy ...

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This week in the New York Times, Drs. Scott Gottlieb and Ezekiel Emanuel make the case that there will not be a physician shortage as a result of the Affordable Care Act (ACA). Both have extensive experience in policy and have held respected positions in government. Based on a projected need of nearly 90,000 more physicians by 2020, I have difficulty seeing how a shortage will not occur. The ...

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At a time when Republicans and Democrats, House and Senate, can't seem to agree on anything, Medicare physician payment reform is the exception to the rule.  Recently, the House Ways and Means and Senate Finance committees reported out nearly identical bills to repeal the Medicare SGR formula and begin to move Medicare more rapidly toward paying physicians based on quality improvement activities -- the closest Congress has ever gotten to ...

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As a pain physician, I would like to personally explain to President Barack Obama, Kathleen Sebelius, senior citizens and any disabled American suffering in pain, the devastating effects that will result from the drastic Medicare cuts in chronic pain care that are scheduled to take effect January 1, 2014.  These cuts will severely, drastically and unfairly cut access to chronic pain care for senior citizens and other Medicare beneficiaries and ...

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If we in the U.S. ever hope to get a grip on Medicare costs, our society will first have to navigate a steep learning curve. That’s the lesson to take from three recent publications. Despite the fact that Medicare is expected to represent 18% of the federal budget in 2020 (up from 15% in 2010), and that the Medicare Part A trust fund is projected to have insufficient funds to cover ...

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From MedPage Today:

  1. Most Treated for C Diff Don't Have Infection. Fewer than one in six patients treated with powerful antibiotics for a Clostridium Difficile (C. Diff) infection actually had lab-confirmed infections despite high costs and negative outcomes of unnecessary treatments.
  2. Bisphosphonates Useful in Older Women With Breast Cancer. Use of bisphosphonates benefits postmenopausal women with breast cancer the most, a meta-analysis that scrutinized ...

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Is Obamacare even partly responsible for the slowdown in health care costs? That is silly. First, Obamacare is not a health care reform law; it is a health insurance reform law. No one on either side of the debate has ever argued anything different. Does the law have some limited cost containment features in it? Yes. But these are either pilot projects or are years from being fully implemented. I have heard the ...

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