Tag Archives: advanced practice providers

Health Policy Updates: October 29 2016

The federal government recently confirmed that health insurance premiums on the Obamacare exchanges will be, as previously warned, getting significantly more expensive next year. There is a lot of variation, with prices going up by a lot more in some states and actually declining in others, but the overall average increase is going to be about 22%.

Sarah Kliff at Vox.com explains what this means:

“In either case, these numbers are bad news for Obamacare — we just don’t know how bad, exactly, the news is at this point.”

The NYTimes offers a summary as well:

“Most people are unaffected by the rate increases because they get their insurance through an employer or are covered through government programs like Medicare, Medicaid or the Department of Veterans Affairs.”
Continue reading Health Policy Updates: October 29 2016

Health Policy Updates: July 10 2016

I’ve written before in this space about “advanced practice providers,” how they offer a opportunity to expand access to health care while holding down costs, and how physician groups have generally been opposed to allowing them to do so. This recent policy proposal by Politico outlines the issue and offers a few concrete changes to allow APPs to expand their scope of practice and better serve patients:

“CMS and where relevant private payers should authorize advanced practice registered nurses to perform admission assessments, as well as certification of patients for home health care services and for admission to hospice and skilled nursing facilities. PAs should also have a broader role in these areas, particularly home health. To encourage more primary care providers to take part in Medicaid, state Medicaid programs should raise reimbursement for NPs to match primary care physicians.” Continue reading Health Policy Updates: July 10 2016

Health Policy Updates: June 25 2016

A new study published in JAMA Internal Medicine this week had some surprising findings relating to gifts to physicians from pharmaceutical companies. The authors asked whether physicians who received a free meal from a drug company were more likely to prescribe expensive, brand-name medications produced by that company. The answer – surprisingly or not – was “yes.” And, it remained “yes” even for single meals less that $20 in value (though the association tended to be higher for more and/or more expensive meals). This study has obvious implications regarding the ethics of physician-industry financial relationships.

The differences persisted after controlling for prescribing volume and potential confounders such as physician specialty, practice setting, and demographic characteristics. Furthermore, the relationship was dose dependent, with additional meals and costlier meals associated with greater increases in prescribing of the promoted drug. Our findings were consistent across 4 brand-name drugs, including rosuvastatin…” Continue reading Health Policy Updates: June 25 2016

Health Policy Updates: March 28 2015

First a little bit of self-promotion this week: on Thursday April 2nd I will be lecturing at the Internal Medicine residency’s daily noon conference. The presentation will basically be a summary of high health care costs in the USA, why it is a problem, and what the causes are. I hope to leave some time for questions, so everyone should have a chance to learn a lot!

Continue reading Health Policy Updates: March 28 2015

Health Policy Updates: August 16 2014

Avik Roy, of the conservative Manhattan Institute, has just released a new health care reform plan, with the general goal of using the best parts of the ACA to move forward, rather than sticking with the “repeal and replace” mantra:


“…the Plan uses a reformed version of the ACA’s health insurance exchanges as the basis for far-reaching entitlement reform. The Plan would repeal many of the ACA’s cost-increasing insurance mandates, including the individual mandate. But it would preserve the ACA’s guarantee that every American can purchase coverage regardless of preexisting conditions. And it would utilize the concept of using federal premium support subsidies, on a means-tested basis, to defray the cost of private health coverage.”

And responses to the plan here:


Roy hopes his proposal, by embracing many of the goals of the left and right, could be the basis of a grand health care compromise. But it could also have the opposite effect. Because it adopts many elements of Obamacare, it would likely be untouchable for most Republicans.”

Uh-oh. There is evidence that the new pay-for-performance experiment being tried by the ACA is not resulting in the anticipated cost savings.


The aim of the penalty and reward system was to encourage all hospitals to improve the care they deliver. That might not have happened.”


And, a similar pay-for-performance program in England seems to have failed in its objectives.


“…the reduction in mortality among patients with these conditions was greater in the control hospitals (those not participating in the program) than in the hospitals that were participating in the program


A review of direct-to-consumer health screening companies (you know, those people doing coronary calcium scores in shopping malls and spooking people into thinking that they are at immediate risk for MI) and the resulting conflicts of interest with health care providers:


Although medical professionals attempt to detect subclinical disease early and improve morbidity and mortality for their patient populations, hospitals also benefit financially when new patients enroll to see their physicians and have follow-up tests and treatments ordered, leading to increased financial reimbursement.


Can clinics based out of Wal-Mart stores help to hold down health care costs?


In-store primary clinicsversions of which you can already find at CVS, Target, and Walgreensare one way to meet that need. These clinics rely more heavily on nurse practitioners and other non-physicians to deliver care. This is why they can ramp up quickly and address the growing need for services. This is also why the clinics can provide care for less money. “