Tag: "doctors"

Naturopaths Beat Real Doctors in Online Reviews

If it quacks like a duck……

A study of more than 28,000 online reviews of doctors suggests that American healthcare consumers are fondest of naturopaths, audiologists, oncologists and osteopathic physicians among healthcare specialists, and are least satisfied with care given by psychiatrists, dermatologists, orthopedists and family-medicine doctors.

Ironically, the analysis indicates that generally as a doctor’s level of education and training increases, patient satisfaction actually decreases. (Vanguard Communcations)

Maybe people have a higher bar of expectations for physicians than naturopaths? I hope that is what this survey is telling us.

Is Patient Scheduling Software Valuable to Doctors?

I am a huge fan of entrepreneurs who want to make medical care more productive and consumer friendly. I wish all of them the best of success. Unfortunately, I am concerned that one of the trends attracting venture capital is chasing a shrinking market. That trend is patient-scheduling software in physicians’ offices.

I was at an angel investor pitch off in Arlington, Virginia, yesterday where one such firm was seeking investors. Two great incubator/accelerators, StartUp Health in New York and Rock Health in San Francisco (and, now, New York) have invested in Arsenal Health, inventor of Smart Scheduling.

Firms like this promise algorithms that use data to predict cancellations and no-shows. I suppose this is the flipside of ZocDoc, the remarkably successful business that doctors use to find new patients to fill appointments that have been cancelled.

These are all great ideas. I am just not sure they make sense in the future environment, where there will be surplus of patients and a shortage of doctors. A few years from now, when the U.S. has Canadian-style waiting lists to see specialists, why would a physician invest in technology to manage cancellations and no-shows?

Such technology would be very valuable where there is a surplus of doctors competing for a limited number of patients. But I don’t think anyone anticipates that for U.S. health care. I hope I am wrong.

Republicans Reach for Redemption on Medicare “Doc Fix”

Politico reports that Congressional Republicans might be having second thoughts about the extremely flawed, so-called Medicare “doc fix” legislation that they sent to President Obama a few days ago. One of those flaws was that the spending in the bill was not offset by cuts to other federal spending – which is why almost every Democrat in Congress voted for it too.

Well, they appear to be getting the message that NCPA has been sending them since March 25:

…… one GOP source said negotiators had resolved a sticking point over how to offset a recently enacted bipartisan Medicare overhaul that was not entirely paid for. The source said the agreement is likely to offset the overhaul, often called the “doc fix,” starting next year.

Better late than never. How they will get President Obama to sign any bill that offsets spending that was already committed by his signature on March 15 is unclear. (All they had to do in the original bill was remove two short sentences that exempted the spending from the so-called PAYGO scorecards. Had they done so, they would not have to worry about it today.)

Barack Obama Has the Last Word on the Medicare “Doc Fix”

I thought that I had given the last word on the flawed Medicare “doc fix” last Monday. Nope: That honor goes to President Obama. During the three week period the secretly negotiated “doc fix” legislation was being rushed through Congress (“rushed” because the Senate was in recess for most of it), I wrote an article suggesting Republicans who voted for it might be casting their first vote for Obamacare. Well, don’t take my word for it. Now that he’s signed the bill, President Obama has hosted a fabulous garden party for the politicians who voted for it. Yahoo has the whole story, including a photo of Speaker Boehner planting a bipartisan kiss on the cheek of Minority Leader Pelosi. One of my charges was that the law increased federal control of the practice of medicine.

Here’s what the President had to say about that:

“I shouldn’t say this with John Boehner here, but that’s one way that this legislation builds on the Affordable Care Act,” Obama said, adding, “But let’s put that aside for a second.”

“Doc Fix”: The War of All Against All Begins!

The U.S. Senate passed H.R. 2, the so-called Medicare “doc fix,” 92-8 last night.  By the time you read this, President Obama will likely already have signed it. He’s eager to do so, because it locks in Obamacare’s vision of the relationship between physicians and the state.

This was a seriously flawed bill, as NCPA has discussed exhaustively (here and here). Now, doctors and patients will have to get used to a new reality where the federal government and beltway lobbyists’ priorities are more deeply embedded in physicians’ offices than ever.

Billy Wynne at the Health Affairs blog has a very good, dispassionate response to the bill’s passage. Wynne starts by describing the Merit-Based Incentive Payment System (MIPS):

Who’s To Blame For Doctors’ Cash Flow Crisis?

Doctors never cease from complaining about insurers’ bureaucracy. It’s one reason why they cannot stand the repeated Medicare “doc fixes” that have occurred at least once a year for over a decade: When Congress does not increase the physician fee schedule before the previous fix runs out, they fear that Medicare contractors will slow roll their claims, creating a big cash flow problem.

(That’s one reason why the lobbyists supporting today’s fiscally irresponsible “doc fix” waited until March 19 to let us know it was coming to the House of Representatives. Last year’s fix expired on March 31. Delaying until the last minute means the lobbyists can more easily drive politicians into a panicked herd and head them off a fiscal cliff.)

The cash flows can be observed by patients, who receive physicians’ invoices and insurers’ Explanation of Benefits (EOBs). One reader went to the doctor on July 31, 2014. As shown in the graphic below, the health plan processed the claim on August 25 and mailed it to the beneficiary on August 29.

More Criticism of the Medicare “Doc Fix”

From Paul Winfree of the Heritage Foundation:

Rather than a permanent replacement to the Sustainable Growth Rate, it is much more likely that the House doc fix will be shorter term patch requiring another series of patchwork legislation just nine years from now.

From David Hogberg of the National Center for Public Policy Research:

When the Senate returns from recess this week, it will consider the “Medicare Access and CHIP Reauthorization Act” (MACR). The bill has acquired many names such as “The Doc Fix Fix” and “Budget Buster,” but a more appropriate one is “IPAB-lite.”

IPAB — the Independent Payment Advisory Board — was created as part of Obamacare to cut Medicare expenditures whenever those expenditures grew too quickly. Thankfully, IPAB’s unpopularity has thus far prevented it from getting off the ground. Unfortunately, the changes MACR makes to Medicare’s payment system seem very much along the lines of what IPAB would do.

(Readers may be forgiven for wondering when I will let go of this so-called Medicare “doc fix”. We expect a vote in the U.S. Senate tonight – but do not guarantee it!)

Chief Actuary Blows Away Make-Believe Medicare “Doc Fix”

A similar version of this Health Alert appeared at Forbes.

On March 25, the U.S. House of Representatives voted for a fiscally irresponsible so–called Medicare “doc fix” that will add $141 billion to the deficit over the next ten years, according to the Congressional Budget Office (CBO). The U.S. Senate will likely vote on the bill later today, and the same lobbyists who dragged Obamacare into the end zone in 2010 are hoping for another win. This one will be even better, because it will be bipartisan.

Nobody denies the way Medicare pays doctors today is flawed. Every year, Congress has to increase the scheduled amount of money because if it did not, fees would drop by about one fifth. Many doctors would stop seeing Medicare beneficiaries.

There are two major differences between this so-called “fix” and previous ones. The first one is real: Previous increases have been offset by cuts to other government spending, and this one is not. The second one is fiction: That this doc fix is a permanent solution to the fee problem.

That fiction was debunked last week in a report published by Medicare’s Chief Actuary.

Federal Rules Create Big Obstacles for Health Information Technology Entrepreneurs

electronic-medical-recordThis blog has long noted the painful consequences of the federal government’s intervention in health information technology (HIT).  Last February, NCPA published an Issue Brief recommending that the federal government’s ambitions in HIT be rolled back. The major problem is the government’s undue influence in Electronic Health Records (EHRs).

Last month, the Administration published the regulations for stage 3 of the Meaningful Use incentives, which both pay and fine doctors for their use of EHRs in accordance with the rules. Margalit Gur-Arie describes the new rules:

Meaningful use stage 3 is adding a host of structured and codified data elements that you will need to collect and record. To that end, you should consider updating your policies as follows:

  • Require each patient to provide an updated resume at least once a year, because you need to continuously collect and update work history, including positions held, and financial information.
  • In collaboration with your attorney, create a crosswalk based on State laws and meaningful use regulations regarding what you must ask or are barred from asking your patients. For example, in some states you are not allowed to ask about guns in the domicile, and for meaningful use you must inquire how often your patient goes to church, and whether he or she is a homosexual (regardless of your specialty). It’s a fine balance, and you don’t want to break any laws.

From Left and Right; Opposition to Flawed Medicare “Doc Fix”

The U.S. Senate will have to deal with the flawed so-called Medicare “doc fix” Wednesday at the latest, if doctors are not to suffer a significant drop in their payments from Medicare.

Voices from both right and left have discovered serious problems with the bill, and proposing solutions. Here are three examples: