A Physician Fallow Program To Improve Quality, Safety and Costs

David C. Kibbe and Brian Klepper First published 6/22/11 on the Health Affairs Blog

Copyright ©2011 Health Affairs by Project HOPE – The People-to-People Health Foundation, Inc.

In a recent New York Times op-ed, Rita Redberg MD, a cardiologist and Chief Editor of Archives of Internal Medicine, described the American health system’s penchant for delivering high volumes of “procedures and devices [to] patients who get no benefit and incur risks from them.” The culprit, of course, is fee-for-service reimbursement, used by Medicare, Medicaid and commercial health plans for the past 50 years, which encourages physicians to order more products and services, independent of appropriateness, with few checks and balances. Dr. Redberg notes the estimate by Medicare’s Chief Actuary that as much as 30 percent of Medicare’s expenditures — up to $150 billion/year, or about 9.4 percent of this year’s US budget deficit of $1.6 trillion — provides no value at all to patients. A 2008 PricewaterCoopers study put the waste estimate at nearly 55 percent of total national health care expenditures, a figure that, in 2011, would translate to almost $1.5 trillion, or just a shade under this year’s deficit. Continue reading “A Physician Fallow Program To Improve Quality, Safety and Costs”

Health Care Reform Needs A Wael Ghonim

By now, everyone has seen the young Google executive, Wael Ghonim – credited with starting the Egyptian revolution via Facebook – proclaiming his willingness to die for the cause.  I predict he will not only become an Egyptian national hero, but that one day he will be nominated for the Nobel Peace Prize.

But, where, oh where, is the Wael Ghonim of health care?  Who is out there that will proclaim that they will fight to the death (or even fight to a bit of discomfort) for the cause of health reform.  I don’t know anyone – right, left or center- that, when speaking honestly and in private, will say that the US health delivery “system” is working for the American people – you remember those folks, the ones we hear about so often during hotly contested political campaigns.

Continue reading “Health Care Reform Needs A Wael Ghonim”

Quit The RUC


Originally published 1/21/11 on Kaiser Health News

Recently, a Wall Street Journal expose and a New York Times column by Princeton economist Uwe Reinhardt detailed how vast health care resources are steered by the American Medical Association’s Relative Value Scale Update Committee — or RUC, a secretive, 29 person, specialist-dominated panel. Since 1991, the RUC has been the main, if unofficial, adviser on Medicare physician reimbursement – how specific procedures should be valued – to what is now called the Centers for Medicare & Medicaid Services. Many Medicaid and commercial health plans follow Medicare’s lead on payment, so the RUC’s influence is sweeping.

Continue reading “Quit The RUC”

Bad Medicine: How The AMA Undermined Primary Care in America

Brian Klepper

Originally published 12/13/07 on The Health Care Blog

On Tuesday’s Wall Street Journal website, Dr. Benjamin Brewer describes physicians’ reactions to the 10.1% cut in Medicare physician payments that will take effect January 1. He argues that the onus will fall, once again, disproportionately on primary care physicians, who are already losing the struggle to keep their heads above water.

Continue reading “Bad Medicine: How The AMA Undermined Primary Care in America”