June 19th, 2011 by BobDoherty in Health Policy, Opinion
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“Doctors, with the consent of their patients, should be free to provide whatever care they agree is appropriate. But when the procedure arising from that judgment, however well intentioned, is not supported by evidence, the nation’s taxpayers should have no obligation to pay for it.”
So argues Dr. Rita Redberg, a cardiologist and professor of medicine at the University of California, in a provocative op-ed published in the New York Times. She writes that Medicare “spends a fortune each year on procedures that have no proven benefit and should not be covered” and offers the following examples:
“Medicare pays for routine screening colonoscopies in patients over 75 even though the United States Preventive Services Task Force, an independent panel of experts financed by the Department of Health and Human Services, advises against them (and against any colonoscopies for patients over 85), because it takes at least eight years to realize any benefits from the procedure.”
“The task force recommends against screening for prostate cancer in men 75 and older, and screening for cervical cancer in women 65 and older who have had a previous normal Pap smear, but Medicare spent more than Read more »
*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*
June 13th, 2011 by BobDoherty in Health Policy
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This question has to be asked, because health policy gurus are looking to the new Center for Medicare and Medicaid Innovation (“the Innovation Center”), created by the Affordable Care Act, as being the principal driver of innovative delivery system reforms to “bend the cost curve”— but skeptics wonder if it can live up to its billing.
The Innovation Center’s website says all of the right things:
“The Innovation Center has the resources and flexibility to rapidly test innovative care and payment models and encourage widespread adoption of practices that deliver better health care at lower cost.
Our Mission: better care and better health at reduced costs through improvement. The Center will accomplish these goals by being a constructive and trustworthy partner in identifying, testing, and spreading new models of care and payment. We seek to provide: Read more »
*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*
June 6th, 2011 by BobDoherty in Health Policy, Opinion
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“We can destroy ourselves by cynicism and disillusionment, just as effectively as by bombs.”
This observation, from the late, great British historian Kenneth Clark, could be a warning sign to the medical profession. Some of the more incendiary commentary in blogs, editorials, and medical publications today display the classic characteristics of cynicism, which is a profound pessimism accompanied by a deep distrust and even the disparagement of the motivations of others. Physician cynics not only direct their anger at the usual suspects – members of Congress, insurance companies, and government “bureaucrats”—but even at their own colleagues, including the leadership of their own professional societies.
Now, to be clear, I am not talking about principled disagreement and debate over the best policies or course of action, which is good and healthy. It is only when such disagreement becomes “personal”—assuming the worst motivations of others, even when you don’t personally know them—that it becomes the type of self-destructive cynicism described by Clark.
Take the cynics’ charge that the leaders of physician professional associations, including ACP, are living in “Ivory Towers” disconnected from the “real world” of practice, and that they “sold out” the rest of the medical profession by their actions. Really? Read more »
*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*
May 25th, 2011 by BobDoherty in Health Policy, Opinion
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You’d think that ensuring that there will be enough primary care doctors would not become a partisan issue. If you are a Republican congressman from Texas, or a Democratic Senator from California, you’d want your constituents to have access to a primary care doctor, right?
Apparently not: in the hyper-polarized and ideological world in which we now live, even modest steps to support primary care have been caught up in the worst kind of partisanship. The Washington Post reported recently that funding for a new expert commission authorized by the Affordable Care Act (ACA), which was to examine barriers to careers in primary care, has been blocked by Republicans:
“When the government set out to help 32 million more Americans gain health insurance, Congress and the Obama administration acknowledged that steering more people into coverage had a dark underside: If it works, it will aggravate a shortage of family doctors, internists and other kinds of primary care. So Page 519 of the sprawling 2010 law to overhaul the health-care system creates an influential commission to guide the country in matching the supply of health-care workers with the need. But in the eight months since its members were named, the commission has been unable to start any work. Read more »
*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*
May 6th, 2011 by BobDoherty in Health Policy, News
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Should the government be able to dictate to a doctor what he or she is allowed to discuss with a patient? Yes, says the National Rifle Association (NRA), which is pushing state legislation to prohibit physicians from asking patients about firearms in their homes.
An NRA-supported bill in Florida originally would have made it a criminal offense—punishable by fines and/or jail—if physicians asked a patient about firearms. The Florida Medical Association (FMA) fiercely opposed the bill as an intrusion on the physician-patient relationship. Now, a compromise has been reached between the NRA and the FMA that “allow doctors to ask questions about gun ownership, as long as the physician doesn’t ‘harass’ the patient, and doesn’t enter the information into the patient’s record without a good reason.” Violations would be policed by the state licensing board instead of being subject to criminal prosecution.
A long-standing ACP policy encourages physicians “to inform patients about the dangers of keeping firearms, particularly handguns, in the home and to advise them on ways to reduce the risk of injury.” But this issue is much bigger than guns, it is about whether the government should be allowed to tell physicians what they can and can’t say to patients. Read more »
*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*
