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Dr. Don Berwick’s “Patient-Centered” Medicine

There’s been a bit of buzz in the health blogs over President Obama’s decision last week to use the mechanism of a recess appointment to be the director of the Centers for Medicare and Medicaid Services (CMS).

Recess appointments, for those who may not be aware, allow a President to put a nominee in place when Congress is in recess in order to have him in place without the messy process of having him approved by the Senate. True, the Senate still has to approve a recess appointment by the end of its term, or the seat goes vacant again, but it’s an excellent way to avoid having nasty confirmation fights during election years. Of course, both parties do it, and the reaction of pundits, bloggers, and politicians tend to fall strictly along partisan lines.

If you support the President, then a recess appointment is a way to get around the obstructionism of the other party. If you don’t support the President, it’s a horrific abuse of Presidential power. And so it goes. Either way, I don’t really care much about the politics of how such officials are appointed so much as who is being appointed.

The man who was appointed last week to head CMS is Donald Berwick, M.D., CEO of the Institute for Healthcare Improvement. His being placed in charge of CMS will likely have profound consequences not just for how the recent health care/insurance reform law is implemented, but for how the government applies science-based medicine to the administration of the this massive bill. Read more »

*This blog post was originally published at Science-Based Medicine*

How Will The Medicare Cut Affect You?

Once again, Congress is playing with fire by not enacting a permanent solution to the Medicare SGR (sustainable growth rate) physician payment cut problem.

Congress got itself tied up in knots trying to figure out a way to reverse a 21% cut in Medicare payments to doctors that went into effect yesterday. It ended up agreeing to legislation, which was signed into law late Thursday evening by President Obama, to restore payments to the pre-cut (2009) levels through the end of May.

The action, though, may have come a dollar short and day late. CMS has indicated that it had no choice but to tell carriers to begin processing claims with the 21% cut, starting yesterday. Read more »

*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*

What Would It Take For You To Give Up Tobacco?

I was shopping the other day for Sam’s Club food (frozen blueberries 4 pounds for $7.50). As we checked out, I scanned the price of cigarettes behind the counter. Marlboro cigarettes were selling for just under $50 a carton. At one pack per day, that’s $150 a month. For a year, that works out to $1,800.

I once calculated how much a four-pack-a-day family could have had in the bank had they not smoked for fifty years and instead invested that money at standard returns. Six million dollars they’d have to enjoy in retirement. That’s amazing. Six million dollars. And we wouldn’t be talking about a bankrupt entitlement system. Read more »

*This blog post was originally published at The Happy Hospitalist*

Healthcare Reform: The State Of The States

States are varying in their reactions to healthcare reform:

Wisconsin is creating an office of healthcare reform to develop its health insurance exchange and explain changes to constituents.

Tennessee won a court ruling to remove 100,000 from its Medicaid rolls.

— Leaders in 18 states vow to challenge the new law in court. But in Idaho, a challenger for the governor’s office proposes instead taking advantage of a federal waiver that exempts states that enact reforms that control costs and improve access better than the federal laws do. (Milwaukee Wisconsin Journal Sentinel, Kaiser Health News, Reuters, Idaho Reporter)

At the federal level, President Obama and supporters continue to try to sell the reforms to Americans while the opposition tries to figure out its next steps. “Soak the rich” might be one phrase to revive, but they’d do best to distance themselves from the tea-baggers, who have spiraled out of control. (The Hill, Los Angeles Times, USA Today)

*This blog post was originally published at ACP Internist*

Corporate Executives Astonished By Average Physician’s Income

By Stanley Feld MD, FACP, MACE

Physicians in practice work hard and have little time for political and legal trickery. They assume their leadership will look out for their interests while they take care of patients.

The problem is that physicians do not have effective leadership, explaining the difficulties practicing physicians have every day with the healthcare insurance industry, hospital administrators, the government and the threat of liability. Most physicians are caring professionals who are not looking to rip off anyone. Physicians do expect reasonable compensation commensurate with their training, level of expertise and level of responsibility.

I recently presented a physician income survey to a group of corporate executives. The executives were astonished by the level of physician income relative to their level of responsibility.

The unanimous reaction of these corporate executives was the average physician’s income was that of a low mid-level manager. It is true some practice specialties earn more but the average income of practicing physicians is not commensurate with their knowledge and responsibility. Read more »

*This blog post was originally published at Repairing the Healthcare System*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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