Policy

Physician payment reform is the key to fixing the health care system

Changing the way doctors are paid is more important than the debate over the public insurance option, or the arguments over whether we should adopt a single-payer system or not.

Atul Gawande’s recent New Yorker article is a tour de force, and gets down to the core of why American health care is so expensive. I won’t bother summarizing it here – it deserves to be read in its …

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Will diabetes derail Sonia Sotomayor’s chance to become a Supreme Court justice?

Sonia Sotomayor has been named as a potential favorite to fill the upcoming Supreme Court opening.

But she has type I diabetes, and diabetes blogger Amy Tenderich discusses whether this will work against her.

As she puts it, this can be a ground-breaking decision, “where survivorship with chronic illness meets the glass ceiling.” There are arguments in the blogosphere back and forth, but Ms. Tenderich raises some interesting points.

For instance, when …

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Open a landscape business for health insurance

There’s no doubt that those with pre-existing conditions find it difficult to obtain individual health insurance.

In a minority of states, some are able to become a so-called “group of one,” where they become a company. All in the name of obtaining health coverage.

And yes, landscaping happens to be one of the more common fronts for these groups.

This is just one tip that those with pre-existing conditions can use …

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7 top medical comments, May 17th, 2009

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

1. Anonymous on whether IV sedation is overused:
I think it depends on the patient and on the procedure. For my colonoscopy, I did prefer the sedation. It wasn’t something that I cared to remember.

But I’ve also had a core needle biopsy of an abdominal tumor. The tumor was right …

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AMA: Curbing the rise in health care costs is key to health-system reform

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

by J. James Rohack, M.D.

In an unprecedented endeavor aimed at achieving health-care reform this year, the American Medical Association (AMA) stood with President Obama and other key health-care stakeholders Monday to announce efforts to “bend the spending curve” on health care. U.S. health-care …

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10 health reform posts you may have missed

With entries dating back to 2004, here are 10 classic blog posts on health care reform:

1. Convincing doctors to accept a public health care plan option

2. Why health reform is going to be difficult, and the trouble with saying no to American patients

3. Should a public plan option be part of any health reform initiative?

4. The Obama health …

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Physician payment reform by capitation, will it work this time?

Paying physicians via capitation was soundly rejected by patients when it was tried in the HMO era a decade ago.

Massachusetts is trying again. According to a state commission, they recommend “replacing fee-for-service with a system that would use a single payment to cover most of a person’s care for an entire year.”

The last time this was tried, patients rebelled as it was perceived that there …

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Physicians for a National Health Program doctors arrested, and why is PNHP resorting to criminal activity to push their agenda?

A few zealous single-payer advocates, Physicians for a National Health Program included, were arrested this past week for disrupting Senate hearings.

Pictured here is psychiatrist Dr. Carol Paris, who was among the doctors arrested.

I’m not going to rehash the single-payer debate in this post, but I wonder whether resorting to criminal activity is really the best way to push your agenda.

From this corner, …

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Convincing doctors to accept a public health care plan option

There’s no question that the possible inclusion of a public plan is one of the most contentious issues that will be debated as health reform moves forward.

As I wrote previously, I’m somewhat indifferent about the option, but, feel strongly that doctors need to maintain the ability to opt out of the plan, and stress that reimbursements need to be competitive with those of private insurers.

Well, …

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Covering a virtual colonoscopy, or not, will test the cost-cutting will of Medicare

Medicare is in the midst of deciding whether to cover virtual colonoscopies.

I wrote two prior pieces on their pending decision::

Should Medicare cover a virtual colonoscopy?

Medicare will not cover virtual colonoscopies, gastroenterologists breathe a sigh of relief

In February, after reviewing the evidence, a federal agency simply said, “The evidence is inadequate.”

Predictably, the move created instant dissent, mainly from CT-scan …

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Ten top medical blog posts, April 2009

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

1. How do I prevent and treat swine flu, and, is a pandemic imminent?

2. The Craigslist Killer is a Boston University medical student

3. Is the nursing shortage overblown?

4. Most hospitalists are good, but some, like these ones, aren’t

5. Read more…

Medicare now requires physician essays for hospice care, as if pre-authorizations weren’t bad enough

Medicare is considering throwing more bureaucracy our way.

As MedPage Today reports, because Medicare was “concerned about a rising number of hospice patients who survive longer than six months,” they are now requiring physicians to write a narrative to “describe the clinical evidence supporting a life expectancy of six months or less.”

Even worse, this comes on top of a 1.1 percent cut in reimbursements to hospice …

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Patients still trust their doctors, and how that can influence health reform

I’ve always maintained that patients will make or break health reform plans.

And with no shortage of advocacy groups wanting a seat at the health reform table, the one that connects best with the public will have the most influence.

Doctors, despite being under continual criticism from progressive and health policy circles, still have the confidence of most patients.

According to a recent poll, despite acknowledging …

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A major obstacle impeding universal coverage in the United States

What’s unique to the United States that’s rare in the rest of the developed world?

According to respected economist Uwe Reinhardt, Americans want to have their cake and eat it too. This is why universal coverage is such a contentious issue.

Dr. Reinhardt explains the principle of social solidarity, which means that “health care should be financed by individuals on the basis of their ability to …

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Why health reform is going to be difficult, and the trouble with saying no to American patients

How do we control health spending?

Most strategies boil down to eventually restricting care, for instance, not paying for treatments that haven’t been shown to work on a macroeconomic level. That may make sense when you’re talking numbers and statistics, but there will be real lives at stake when reform takes hold.

Economist Arnold Kling understands what must be done, but imagines a scenario where his …

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What if the economy was treated like a sick patient?

Physician-writer Rahul Parikh’s take on the economy is an entertaining one.

What if the economy was the patient, and how is it reacting to interventions meant to improve its prognosis?

“Shortly after the New Year, the doctors had a long discussion,” Dr. Parikh writes. “Some argued that that a Prescription for a broad-spectrum stimulus was called for. Others felt that a more careful approach, targeting …

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Is the nursing shortage overblown?

We’ve been hearing for years that nurses are in short supply.

But the economy has put a damper on that notion. Contrary to that popular belief, nurses looking for a job are having a hard time finding work. The recession has forced nurses close to retirement to keep on working, and part-timers looking for more work.

At one hospital near Washington DC, there were precisely …

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Rationing health care by waiting times, or by cost

How do Americans ration health care?

It’s by cost, as well as the number of uninsured.

Ezra Klein actually has a pretty balanced take on health care rationing issue. He says that what’s happening Stateside is equally as dismal as the waiting times both in Canada and the UK, calling each system opposite ends of “awful extremes.”

The ACP’s Bob Doherty picks up on that, …

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Why hospitalized Medicare patients get re-admitted so frequently

Hospital re-admissions are hitting Medicare patients particularly hard.

Otherwise known as “bouncebacks,” MedPage Today reports on a recent NEJM study showing that, during a 15-month period, 20 percent of hospitalized Medicare patients were re-admitted with 30 days of discharge.

When you consider how few outpatient doctors accept Medicare, compounded by the appointment shortage that many primary care physicians face, it’s no wonder that these elderly patients who …

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9 patients, 2,678 ED visits, $3 million dollars

Apparently, 9 patients in Texas, the majority of whom had mental health issues, visited the emergency department nearly 3,000 times during the past 6 years.

Many of those visits were due to non-emergency causes, and it is speculated that these patients’ mental health history played a role, as this physician comments, “They have a variety of complaints, [and] a lot of anxiety manifests as chest pain.”

The proposed …

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