Public Policy Contributor Bradley Flansbaum writes…

I admire Don Berwick. His writings are provocative, innovative and ahead of the health policy curve, even if I do not agree with him all the time.

Enthusiastic is an understatement to describe my reaction when Obama nominated him to head CMS. Without reluctance, I assert that not as a partisan, but as a frontline doctor who genuinely cares about our healthcare system.

My bird’s-eye view of what works, and more often than not, what does not in healthcare delivery gives me an appreciation of where he wants the American system to pivot. Many docs would probably agree.

Putting aside the negative press he continues to receive, if you take the time to listen or read his opinions in their entirety, you will quickly realize the man does not resemble his op-ed descriptions. I am sure that one year ago, before the brouhaha erupted when the President nominated him, docs from red and blue states would have exited a Berwick sponsored IHI conference and not given politics, ideology, or practice approach a second thought. I mean it. It is a shame what has happened since. (more…)

Public Policy Contributor Brad Flansbaum writes…

That line came from none other than Barack Obama at the Whitehouse Correspondents dinner this year, obviously lampooning the glass as half empty, 24/7 news cycle machine. Normally, I accept the tabloid trough feed of the day, the presumed inspiration for the above laugh line, with my usual healthy sense of disdain or merriment. However, a recent slew of postings commenting on the shift in Whitehouse and HHS messaging for the promotion of the new health law preoccupied and bothered me. This type of commentary normally does not get under my skin.

I deliberated and was not sure what I found disturbing, the attacks, the methods of ACA promulgation by its architects, or whether the law itself was flawed, meaning “is it as bad as they say it is?” (more…)

Public Policy Contributor Brad Flansbaum writes…

Oft cited as a template on which to base U.S. health reform (along with the Dutch system), I have always found the Swiss model of great interest.  I read with allure an interview with Switzerland’s former health minister, Thomas Zeltner, in the latest edition of Health Affairs (firewall).  As a primer for those unfamiliar with the Swiss system, I commend this nice review written by Uwe Reinhardt from JAMA in 2004.  They transformed their system in 1996 using a highly regulated model of managed competition—with an all in approach encompassing exclusively private payers.

Frequently, reformers tout the Swiss model as an “all juice, no squeeze” affair, blemish free and a win-win for all.  The candor and honesty expressed by Dr. Zeltner is rousing and a necessary read for those interested in our reform law, its evolution, and the stumbles we might face. (more…)

Public Policy Contributor Brad Flansbaum writes…

I follow the literature on Accountable Care Organizations (ACO) because of its topical nature and its promise, as well as how it may fast track needed change in our healthcare delivery system.  I have written on this subject once before, and wish to return to it.

A Google search of ‘Accountable Care Organization’ published within the last 4 weeks returned 1.3 million hits.  In the result leads, phrases such as “promising,” “reduce costs and improve quality,” “hottest topic in reform,” abound.  Hospitalists acting as the fulcrum coordinators of inpatient care will play more than a minor role in any pilot or demo (more…)

Public Policy Contributor Brad Flansbaum writes….

After discussing the budgetary unease of our country in my last post, I wish to pick up with a brief overview concerning physician salary and workforce issues.  Because U.S. doctors train in an environment favoring subspecialty over primary care, along with the asymmetric pay coupled with that association, it is a simple to assume specialists make more because their work is more complex, they do more “stuff,” and, well, that is the way a higher power wants it.

If you spend time reading about how our remuneration system and workforce ratios evolved and why they interact like they do (beyond the RUC), you will learn (more…)

Public Policy Contributor Brad Flansbaum writes…

If there is one issue that unites physicians of virtually every stripe, it is the ongoing difficulties in resolving the SGR pay fix.  While not to appear too disingenuous, as I like my salary as much as the next physician, there is a disconnect in our midst that also speaks to the unrest on display nationwide, beyond the healthcare sphere.  As we demand our $250B, the cost of the shortfall, it is instructive to see how precarious the finances of our country are now and where that money will come from.   Below is (more…)

Public Policy Contributor Brad Flansbaum writes…

The health bill is now law.  What next for hospitalists?

Most of the chatter these days concerns access, and to a lesser extent, system reform and cost control.  In HM circles however, bundling and episode-based payments have been de rigor for 2-3 years.  Conceptually, it is rather simple to grasp what this form of payment and practice involves.  For that reason, individuals on the financial front lines have invoked these models as the next saving graces of healthcare.  I must admit, from the perspective of the overhaul stakeholders (government, employers, and insurers), I can’t blame them.  Additionally, policy wonks have (more…)

Jack Percelay writes….

No, I haven’t been in a coma unaware of what is probably the most significant change for hospitalists for the decade, it’s just that I’m (more…)

Mike Radzienda writes…

Last month I read The Commonwealth Fund Report on Global Payment Potential. If you have not read it, you should.  With unwavering certitude, the sixteen current and former healthcare system and health insurance executives interviewed for this report agreed that the global payment model for healthcare services will manifest this decade. In other words, capitation will be back and better than ever.

Regardless of what happens on the Hill this week, the real meat and potatoes of healthcare reform will come down to (more…)

Rob Bessler writes…

The theater that played out at the white house last week was disappointing. The republicans stuck to their message that the people don’t want a bill with everyone’s pork in it and the democratics pushed changed because the status quo will not work.  The issue people is the (more…)