It has been freezing cold in much of the country for the last two months, but things have been heating up in the controversy over the implementation of ICD-10. First, a quick primer for those of you who have not been following this. Continue reading Why does ICD-10 feel so bad?
There is a lot of stuff written in the business literature about “corporate statements” and the role they can play in guiding strategic decisions. When done right, I think these foundational documents can be quite effective. Does anyone doubt that Walmart really does focus its efforts every day on its stated mission of “saving people money so they can live better”? Continue reading Physician Compact
I was talking to a colleague last week about his practice, and remarked that he was still keeping a paper medical record. Without hesitation, he made it clear that he not only liked the paper record, but he positively dreaded switching to an electronic record. He said sadly that he thought it was inevitable that he would be forced to switch, but hoped that the day would be far into the future. Continue reading How to fix EMRs
There has been a lot of understandable outrage over the troubles plaguing Healthcare.gov, the federal website for purchasing individual or family health insurance under the Affordable Care Act (aka Obamacare). Opponents of the law (Republicans), recovering from their self-inflicted wounds over the government shutdown, see this as evidence of the fundamental unworkability of the law, and of the folly of a “government solution” to a complex problem. Supporters of the law (Democrats) are terrified that the difficulty in buying insurance will dissuade the so-called “young invincibles” (healthy young people who have limited needs for health care services) from buying coverage. Continue reading Functioning Health Exchanges
The irony continues. The federal government is “shut down” but health insurance exchanges at the center of the law that provoked Republicans to hold the country hostage have been up and running, and attracting a lot of interest. Although there have been some well-publicized (and expected) technical glitches, millions of people have visited State and Federal websites to learn more about their options for purchasing health insurance.
At the same time, the New York Times reported this week that millions of other citizens, who have incomes too low to qualify for subsidized private insurance on the exchanges, will continue to be uninsured. Remember that the Affordable Care Act was designed to expand health insurance coverage in two ways: for those with the lowest incomes, states were offered new funds from the federal government to expand Medicaid, which would have covered nearly all of the new expense at the outset, and about 90% thereafter. For those with higher incomes, the exchanges were created to provide new access to private insurance and subsidies based on income. Continue reading Week Two
October 1 marks what should be an important milestone in the implementation of the Affordable Care Act (ACA), informally known as “Obamacare.” Sadly, this has been overshadowed and even threatened by irresponsible and reactionary posturing by Republican members of the US House of Representatives.
Today was supposed to be the day that a signature element of the legislation was realized – the opening of Web-based “exchanges” through which individuals without employer-provided health insurance could purchase it from private insurance companies with progressive government subsidies based on income. Together with federal funds for the expansion of Medicaid, the patch-quilt of state health insurance programs for the poor, the goal of providing affordable (get it?) insurance to nearly all citizens was to be achieved. Instead, the news is filled with talk of a government shutdown or even a default on repaying federal debt, either of which would be a completely avoidable, self-inflicted wound to our prosperity. Continue reading Opening Day
It has been a good week for celebrating doctoring. The week started with a dinner in honor of the winners of our Patients’ Choice award, and ended with our health system’s third annual “Harvest Moon” physician celebration. The latter is a social event designed to allow all of our affiliated physicians the chance to get together for an evening devoted to nothing more complicated than getting to know one another better. Continue reading Physician Celebration
I had a wonderful experience last night, hosting a dinner in honor of the recipients of our first annual Patients’ Choice Award, given to the 5 physicians with the best scores on the outpatient patient satisfaction survey. As readers of this blog know, I don’t like the term “patient satisfaction,” because it seems like such a simplistic measure and a low bar. I think that quality care and effective communication require a lot more than “satisfying” patients. Continue reading Great Night
I have been thinking more about the price of health care services. I have already shared some thoughts about this, but this time I have a more personal story to tell.
I recently had an echocardiogram. I would score the indication as “uncertain” (not clearly appropriate or inappropriate) according to professional guidelines. As a cardiologist myself, however, I would have ordered one in similar circumstances without hesitation. So I did not think the test itself was a problem — until I got the bill. Continue reading More on Prices
Few things unite physicians as much as the belief that the current malpractice tort system is seriously broken. The litany of complaints is long and familiar: many suits are without merit; the cost of malpractice defense forces settlements even when the “medicine” was good if the outcome was bad; lawyers take too big a slice of the financial pie; we are all forced to practice defensively to avoid getting sued, thereby driving up the cost of health care. Of all of these, the belief that malpractice fear drives physicians to overtest and overtreat seems nearly universally held. Even so, there has been very little evidence to support it, and efforts to quantify the impact of “defensive medicine” on health care costs have been largely speculative. Continue reading Fear of Malpractice Claims and Defensive Medicine