The Commonwealth Fund just published its fourth Mirror, Mirror on the Wall study comparing the U.S. health care system with other countries, and as in all previous studies, we ranked as the absolutely worst health care system in the developed world, bar none.
Yikes.
The Commonwealth Fund studied many health care domains, and we didn’t rank in first place for anything. The best we managed to do is place a lackluster third …
I have been writing a bit lately on the need for health care providers to talk with their patients about health care costs, if for no other reason than to enable patients to determine whether they can afford to pay for the healthcare that their doctors are recommending them to receive. I have been criticized for this position, on the grounds that I am rationing care from people with …
I recently read the New York Times article on the ridiculous amount that insurance company executives and hospital administrators make. So the reason that American health care is so expensive is not because doctors earn too much, or drug companies charge too much or device manufacturers are making ever more expensive devices with ever expanded indications. Except that it is all of that and more.
Hospital administrators and insurance company executives do …
The continued implementation of the Affordable Care Act (ACA) in 2014 will be as controversial as in previous years.
Here are five main areas of concern:
1. The individual mandate. By what right does the federal government “force” its citizens to buy a product they may not want? The Supreme Court upheld the mandate in 2012, but that does not end the matter. Partly — perhaps largely — because the ACA sets …
Health care reform is a reality. The ACA and its associated mandates have forever changed the landscape of medicine in the U.S. today. The Obama administration touts the goals of reform as providing affordable, cost effective, high quality care for all Americans. Certainly these are noble and lofty goals: But have we completely missed the mark?
Today, many remain uninsured and the majority that have signed up for the exchanges are simply …
Round and round and round we go yet again. The system is broken. Do something. Health care reform!
“Pay for performance” morphs into “measure (and pay) for quality.” The big problem is that no one has bothered to actually define the term, maybe because everyone assumes they know what it means — and that everyone else agrees with them. Wrong.
Quality is very much in the eye of the beholder, and …
As a future doctor, I believe that digital dialogue affords medicine a powerful responsibility to educate and engage. I believe physicians have a responsibility, as daily witnesses to the gaps and failures of public policy, to advocate for social justice and policy reform. I believe that medicine should extend beyond the proximate effects of illness and injury to address their root social etiologies.
I’ve always held these beliefs with firm conviction. …
“Do patients care about how much money their doctors make?”
This is the headline of a recently published post by Trudy Lieberman, and was written in response to the recent New Your Times’ coverage of Medicare disclosing payments to individual providers.
Now, I found the Times story fascinating on many levels, but I’ll admit it hadn’t occurred to me that the main value of this data release is that patients can …
There’s been a lot of hype about the “Ban Bossy” campaign in the news lately, and the talk is all over the map. I was thinking about it in regards to health care, especially nursing, since nurses are notoriously “bossy,” or at least referred to as such.
I can remember being a nursing student and talking with a physician about a patient during my clinicals. He told me, “You …
Next in a series.
Primary care physicians (PCPs) are becoming extinct. It’s true. Not many medical students choose primary care as their career path. Older PCPs are retiring early. Many others are closing their practices or seeking employment at the local hospital. And there has always been a shortage of primary care physicians in rural and urban poor areas. Today only 30% of all physicians practice primary care (compared to …
Next in a series.
Primary care physicians (PCPs) have too little time per patient which means too many referrals to specialists, too little time listening and thinking, no time to delve into the stress or emotional causes of many symptoms and substantial frustration by PCP and patient alike.
Previously in this continuing series on primary care, I described a patient with a straight forward if unusual symptom who was bounced …
If you learn nothing else today, I would ask you to learn that moral hazard is the cause of medical price hyperinflation.
Moral hazard is not just two words that don’t seem to go together. Moral hazard is when the person who bears the economic burden of a decision is not the decision maker. In the health care setting, moral hazard is when the third party payer (insurance/government) bears the …
The recent health care discussion in the media has centered around the implementation of the Affordable Care Act, now no longer a lengthy, inert document but rather a living, breathing manifestation of what should be a collective, unambiguous vision for the delivery of care in the United States. It is, however, anything but comprehensive in scope, and the coverage has primarily focused on crashing websites, politics, calls for resignations, and …
I first read Dr. Matthew Moeller’s piece from this past March for the first time this week after a classmate of mine passed it on to me. I’m a first-year medical student — bright-eyed but sleep-deprived, trailing the smell of the cadaver lab everywhere. I entered medicine fully aware of the long, arduous road ahead, almost exactly as Dr. Moeller described it; with many of my classmates in my …
If you had to pick a single metric to a measure a hospital, which would you choose?
Of course, you can’t boil everything about a hospital down to one, single data point. Defining quality, throughput, and other factors used to evaluate a hospital is difficult business. The Centers of Medicare & Medicaid Services (CMS) tracks dozens of core metrics related to both quality and process, both inpatients and outpatients. As a practicing …
In an earlier post, I presented some data on which kind of physicians in the United States are most and least likely to see new patients who receive Medicaid, the state/federal program to pay healthcare costs for low income people. Now a recent study lays out some reasons why many physicians are so reluctant to see such patients.
Not surprisingly, it starts with low reimbursement rates. Medicaid pays about 61% …
Providers in all parts of the health care system recognize that troublesome social conditions drive much of their work and costs. Major challenges in people’s social circumstances — layoffs, foreclosures, accidents, violence — can create horrific health care needs, many of which become chronic and carry high price tags. These extreme needs are omnipresent in the nation’s hospitals, which care for about 37 million admissions at a medical expense of …
Although you may speak of a “routine” Medicare audit, there is really no such creature. This is like saying you have a “routine IRS audit.” The fact is that there is some item you have claimed as a Medicare provider or the amount of claims Medicare has paid in a certain category that has caused you or your practice to be audited.
Having too many claims for level five CPT codes …
While the Affordable Care Act ends the era of denying people with pre-existing conditions access to health care, it allows insurance companies to charge tobacco users up to 50% more for their monthly premiums. Tobacco use for this purpose is defined as any self-reported tobacco use four or more times a week within the past six months. There are excellent intentions behind this policy — smoking is the number one …
Insurance, in its traditional form, is the wrong model for health care financing. It is the wrong commodity to be bought and sold. We don’t need health insurance, and I will tell you why. I will also tell you what we do need.
Insurance is something you buy, and then hope you never have to use. It is a hedging of your bets against bad outcomes. Term life insurance is the …
Get free updates delivered free to your inbox.
