Medicare

It has always been financially rewarding for doctors to take care of rich patients. People with more money … well, they have more money to spend on health care. But shouldn't this more money/higher payment relationship go away in Medicare?

It doesn't, and some recent payment reforms may be making matters worse. Medicare is a federal program to reimburse medical costs in people who are disabled, have kidney failure, or are ...

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"While preparing to assist our patients in the emergency rooms and dedicated COVID-19 wards, our clinic continues to triage patient concerns, creates new care plans, and provides a necessary layer of support, reassurance, and education in a chaotic and stressful time. Like all of you, my colleagues and I look forward to resuming our normal lives as once this pandemic is ...

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One afternoon in clinic, I opened a patient’s chart for a telehealth visit. Within days of the COVID pandemic, all clinic visits had transitioned to telehealth. The young woman had sent a picture through the electronic medical record of a rash on her leg. Upon calling her, the woman explained that the rash started a month ago, wasn’t painful, and she couldn’t recall anything that caused it. On further investigation ...

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On March 6, 2020, the Centers for Medicare and Medicaid Services (CMS) provided a temporary waiver to expand telemedicine services, whose use was previously limited to specific circumstances. However, as the United States grapples with the unprecedented impact of the COVID-19 pandemic on our nation’s health care system, CMS should permanently eliminate barriers limiting the routine use of telemedicine. As clinicians, we can ...

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In 2009, when more than $35 billion was invested in expanding national electronic health record (EHR) uptake, one of many advantages touted was its value as a tool for managing population health. This promise has failed to materialize due to a chaotic rollout of non-communicating systems. Today, as we confront COVID-19, the coronavirus wreaking international havoc, the need for such a tool is exquisitely evident. How could ...

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Fixing Obamacare and adding a public option is the health care policy territory first staked out by Democratic Presidential candidate Joe Biden. Writing about Biden's plan recently on my blog, I said:

If the Democrats capture the White House, keep the House, and take over the Senate, no matter who they elect as President, this Biden health care outline, not Medicare for all, will likely be the plan Democrats ...

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Migrating to the U.S. as an international medical graduate, I was shocked by the health care culture of excess. Initially, it felt good to order a CT scan on everyone who had a fall or cardiac enzymes on anybody who had atypical chest pain. I felt powerful and light years ahead of the system I left behind, where you would have to very cautious about ordering diagnostic tests as, mostly, ...

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It was the middle of winter in downtown Chicago in 1995, and I was sitting across from an apologetic alcoholic holding a slimy NG tube. Mr. Smith, an emaciated man in his sixties, had been on my service for three days with acute pancreatitis, and this was the fifth nasogastric tube that had "slipped" out of his nose. Subsequently, his morning labs were just as bad as they had been on ...

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Over half of Medicare spending is concentrated in 10 percent of patients. With Medicare expenditures rising at an unsustainable clip, reigning in the costs of those patients is key to controlling health care spending.

So who are those patients and what expenses are they racking up?

It’s not who or what I expected. When I think of high-cost patients, I envision people with drawn-out hospital stays, or imagine people ...

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Dean Ernest had been living in a nursing home about a year when his son, John, got a call last winter asking if his father was experiencing back pain and would like a free orthotic brace. The caller said he was with Medicare. John Ernest didn’t believe him, said “no” to the brace and hung up. He didn’t give out his father’s Medicare number. And yet, not just one, but 13 braces ...

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I am going to make a prediction here. No matter who we elect in 2020, Bernie or Trump or anything in between, Medicare for all is not going to happen in America. One can run an electrifying campaign on the promise of Medicare for all, or indignantly against it, but this is pure theater on both sides. I don’t know if God can make a rock so big and heavy ...

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The Democratic debates this summer demonstrated massive confusion around Medicare for all. Does it mean Medicare for all who want it? Medicare Advantage? A "public option" on an Affordable Care Act (ACA) exchange? Democrats need to get their story straight. The confusion is understandable. Medicare for all has been an aspiration since at least the New Deal, but since 1965, when Congress ...

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The monumental shift in health care from fee-for-service or a volume-based approach to value-based care will change health care delivery for the better in the United States.  When physicians do what is necessary and avoid over-testing and procedures of limited or no value, the outcomes are best for the patient, and for the entire health care system. The Centers for Medicare and Medicaid Services have tested and continue to test models ...

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Every day I receive all kinds of emails and other ads telling me about services offering me help to meet MIPS quality metrics. While they may be helpful, most doctors don’t see the need for such a program. It drives up costs in administering and time in needless metrics reporting. Yet, give us a new regulation and a whole industry is going to pop up to profit ...

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As calls for radical health reform grow louder, many on the right, in the center and in the health care industry are arguing that proposals like “Medicare for all” would cause economic ruin, decimating a sector that represents nearly 20% of our economy. While exploring a presidential run, former Starbucks chief Howard Schultz called Medicare for all “not American,” adding, “What industry are we going to abolish next — ...

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This is a brief explanation of Medicare from a physician's perspective, as well as my thoughts on how Congress could make adjustments that would bring us closer to universal care and provide the private market the freedom to improve health care outcomes. Medicare is a national health insurance program that provides health insurance for Americans ages 65 and older, and those who are disabled or have specific chronic conditions. Medicare covers ...

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Recent polls show a majority of Americans support Medicare for all, but few seem to realize that no other system in the world operates like the current single payer proposals in Congress. Recently, I addressed the concept of single-payer health care, with Cuba's system as an example. Today I'm writing more about the ideas being discussed now in our country and how those compare to other nations ...

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Kaiser Health News told the story of a 69-year-old woman who went to a new doctor for her annual check-up, assuming it was covered by Medicare and was happy with the visit until she got a $400 bill. Most Americans believe in “annual check-ups,” at which your doctor reviews your medical history, gives you a thorough physical and orders lab tests. The actual value of such visits has been questioned, but ...

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With the 2020 election cycle already moving into high gear, we are hearing a lot about Medicare for all. But is it a serious campaign promise, a catchy bumper sticker or a viable national program? Supporters suggest it will be a panacea for our nation’s health insurance needs. Others are less sure. And some are downright opposed. So where do we go? As a starting point, there are things we can ...

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