Policy

Should health care come with a warranty?

It’s no secret that one of the keys to cutting health care costs is changing the way doctors are paid.

One proposal that has been used in some integrated health systems, like the Geisinger Health System in Pennsylvania which uses a similar model, is to not pay for complications. Known as the Prometheus model, the system proposes that “half of the costs from avoidable complications must be paid for by …

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The unintended consequences of preventing patient falls

When it comes to preventing Medicare’s so-called “never” events, sometimes the solution is worse than the problem.

I wrote about it last year in the USA Today, saying, “While withholding payment for inexcusable medical mistakes is a sensible concept, Medicare’s decision to penalize hospitals for more nuanced complications raises the bar too high. You cannot regulate perfection.”

And preventing patient falls has nuance written all over it.

The New England Journal of …

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Should doctors support Congress’ health reform efforts?

The American Medical Association recently gave unqualified support to the House health reform bill, H.R. 3200, and that is drawing the ire of some of their supporters.

To be sure, H.R. 3200 is the most left-leaning of the proposals, and there is clear ideological opposition to the so-called “public plan,” which expands the government’s role in our health care system. It’s a tremendously sensitive topic, with some expressing their outrage …

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Health Care Reform: Putting Patients First, medical bloggers at Washington, DC

Well, that was fun.

kevinmd This past Friday, I participated in Health Care Reform: Putting Patients First, an event put together by Better Health’s Dr. Val Jones. It was an impeccably organized gathering, and provided medical bloggers a valuable opportunity to discuss health care reform. Great timing too, given the fact that two major reform bills were introduced earlier …

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Improve primary care access before guaranteeing universal health coverage, my address at the National Press Club

The following are my prepared remarks at Health Care Reform: Putting Patients First, held at the National Press Club in Washington, DC, on July 17th, 2009.

President Obama recently declared that, “We are not a nation that accepts nearly 46 million uninsured men, women, and children.” And indeed, finding a way to provide universal health coverage to every American is one of the focal points in today’s health care debate. …

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Can doctors resist the temptation of money?

That’s a tall order for many American physicians.

Atul Gawande recently addressed the graduating class of the University of Chicago medical school. In his speech, which is an extension of his celebrated New Yorker piece, he looks at so-called “positive deviants,” or doctors who practice higher value, higher quality care, than everyone else.

What makes these doctors so special? In essence, they have to “resist the tendency built into …

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AMA victory on the road to permanent Medicare payment reform

The following is part of a series of original guest columns by the American Medical Association.

by J. James Rohack, M.D.

Physicians started this month with some good news from the White House. After intense AMA education and outreach, the administration announced that it would remove physician-administered drugs from the archaic formula used to determine Medicare physician payment rates.

This important development will significantly lower the costs of a permanent repeal of …

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Can you separate the businessman from the doctor?

An investment banker recently told a doctor, “I’d love a job where I didn’t have to constantly think about money.”

Oh, how wrong he was.

In a recent essay in The New York Times, cardiologist Sandeep Jauhar talks about the difficulty divorcing revenue from medical decision making. While moonlighting, he writes that, “It is hard not to order a heart-stress test when the nuclear camera is in the next room. …

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Why health reformers and politicians should listen to medical bloggers

“If you aren’t at the table, then you are on the menu.”

That’s a priceless quote from Dr. Val Jones, who primary care physician Rob Lamberts cites in a piece from MedPage Today. With health reform dominating Washington D.C. this summer, both patients and doctors “on the ground,” so to speak, are missing from the table. Many physician organizations are composed of doctors who may not be practicing …

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Discussing health care reform at the National Press Club, Friday, July 17th at 9am

Thanks to Dr. Val Jones for organizing Health Care Reform: Putting Patients First, a panel discussion where health reform will be discussed from a medical blogger perspective.

I have graciously been invited to speak and participate in the ensuing discussion, which also includes other prominent primary care and specialist physician and nurse bloggers like Rob Lamberts, Alan Dappen, Valerie Tinley, Kim McAllister, Westby Fisher, Rich Fogoros, and Jim …

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ACR: Reducing medical imaging costs requires a short term investment

The following is a guest post from the American College of Radiology.

by James H. Thrall, M.D.

Health care reform cannot be approached with a “one size fits all” cost-cutting mentality. Reducing costs in the long term often requires an investment in the short term — particularly, in regard to medical imaging.

Medical imaging saves lives. Imaging also saves dollars through earlier disease diagnosis, less invasive medical procedures, shorter hospital stays, and …

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Rationing care is inevitable to control health care costs

Those on the left will pretty much sacrifice everything to attain their goal of universal coverage.

But, in this well-reasoned piece by conservative economist Tyler Cowen, expanding coverage won’t necessarily control costs, which is a more imperative issue. The bandied about means of cost control, such as electronic medical records, cutting provider payments, and preventive care, all will have little nor no impact in controlling costs.

Take physician reimbursements, for …

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Poll: How should we pay doctors, and why we need to change the financial incentives

Medicare currently pays doctors in a “fee for service” system, with little regard for quality of care or patient outcomes. The more procedures or office visits, the more revenue a physician generates.

Instead of spending time with patients or counseling them in preventive care, there is financial pressure to see as many patients as possible. And this financial pressure is a fundamental reason why health care costs are spiraling out of …

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5 top medical comments, July 5th, 2009

Here are some of the more interesting comments readers have left recently.

1. Rogue Medic on how Oprah should be handling medical issues:
If she is going to give medical advice, and she is giving medical advice, and she is going to focus on giving advice contrary to the guidelines of reputable medical organizations, maybe some of her viewers need to start suing her for the bad medical advice.

I am guessing …

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Ten top medical blog posts, June 2009

Here are the top posts from the past month, based on the number of times they were viewed.

1. How did Michael Jackson die, and the medicine behind sudden cardiac death

2. Did Demerol cause Michael Jackson’s cardiac arrest and death?

3. A surgeon dumps post-op patients to hospitalists

4. The worst medical malpractice cases you can possibly imagine

5. My reaction to President Obama’s speech to the AMA

6. Read more…

Op-ed: Doctors are forced into running a business

A version of this op-ed was published on June 18th, 2009 in The New York Times’ Room for Debate blog.

In his recent address to the American Medical Association, President Obama noted that our health care system “rewards the quantity of care rather than the quality of care.” This perverse incentive leads to unnecessary and potentially harmful medicine, while also being a major contributor to spiraling health care costs.

Doctors …

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America’s failed attempt at a single-payer system, the Indian Health Service

Contrary to what you may have been led to believe, the United States has already tried its hand at a pseudo-single-payer system. The VA is one example. Another, albeit less highly publicized, is the Indian Health Service. (via WhiteCoat)

Based on an agreement in 1787, the government is responsible to provide free health care to Native Indians on reservations. And, as you can see from this scathing story …

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Can the American Medical Association still be an influential voice in health reform?

The repercussions after Obama’s speech to the AMA’s delegates continue to be felt.

Not least of which are the murmurings of the other professional physician groups, who say that the AMA does not represent a majority of physicians. In this piece from pediatrician Rahul Parikh, he notes that about 30 percent of physicians are AMA members. Remaining doctors belong to groups with more liberal political leanings, including the American …

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The biggest threat to President Obama’s healthcare reform efforts comes from his own party

I wrote back in February that one of the biggest threats to health reform was not from conservatives and the right, but from within President Obama’s own party.

Today, some four months later, the Washington Post reports that that’s pretty much what’s happening. In its report, the Post writes:

In the high-stakes battle over health care, a growing cadre of liberal activists is aiming its sharpest firepower against Democratic senators …

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ACP: Embracing a culture of cost-effective health care

The following is part of a series of original guest columns by the American College of Physicians.

by Steven Weinberger, MD, FACP

In his column in the June 1 issue of The New Yorker, Dr. Atul Gawande used the example of McAllen, Texas, to illustrate the widely disparate spending on health care around the country. This oft cited article captured the attention of President Obama, who reportedly has made it required …

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