Friday, April 25, 2014
Inquirer Daily News

POSTED: Wednesday, April 23, 2014, 6:00 AM
Filed Under: Robert I. Field

Does money buy happiness? The answer for doctors is not so clear.

In its annual survey of doctors, the website Medscape asked those in different specialties whether they would choose medicine again as a career if they had it to do over. Those most likely to say they would were among the lowest paid.  Among internists (average compensation $188,000), 68% were happy with their choice of profession, as were 67% of family practitioners ($176,000) and 63% of pediatricians ($181,000).

Those least likely to choose medicine again were among the highest paid. Only 41% of plastic surgeons ($321,000) would follow the same professional path. For orthopedists ($413,000), the percentage was 44%, and for radiologists ($340,000) it was 45%.

POSTED: Monday, April 21, 2014, 5:03 PM
Filed Under: Paula Stillman

I have had the opportunity to examine health care through the lens of a patient, provider, health system, self-insured entity, and a commercial and government supported insurer.  In order for health care reform to make sense, we need to follow its incentives and disincentives, understand who is responsible for spending the health care dollar, and follow the flow of money.  Unfortunately, in this time of transition, these are all very complex.

Obamacare presents an opportunity to expand the number of individuals with health care coverage and to begin to decrease the cost shifting of caring for the uninsured.  However, fixing health care requires that we fix the way payments are allocated and spent.

If payment is made the traditional way with a separate fee for each service provided, providers have little incentive to be efficient.  But what is the alternative?  There are several, and they all have problems of their own.

POSTED: Wednesday, April 16, 2014, 6:00 AM
Filed Under: Antoinette Kraus

With the federal public comment period ending this week on the Corbett Administration's Healthy PA proposal, Pennsylvanians delivered a loud and clear message to the Centers for Medicare and Medicaid.

Healthy PA is overly complex, overly complicated and unnecessary.  The best choice for Pennsylvania taxpayers and uninsured workers is to join all of our surrounding states by expanding Medicaid immediately.

The response has been overwhelming. People across the state have been sending emails, mail and comments with online tools to explain their opposition to Healthy Pa. Many of them are citing the proposed benefit cuts, eliminating medical assistance for people with disabilities, unaffordable premiums and delays in coverage to hundreds of thousands of uninsured workers.

POSTED: Tuesday, April 15, 2014, 11:15 AM

Michelle Lamb, a 39-year-old West Oak Lane day care teacher, made three monthly premium payments at more than three times the subsidized rate she should have been paying just to make sure she was covered. And her insurance has still been canceled three times – for nonpayment.

Her case may be an outlier.  But some people are still getting lost in the download between the government and the insurer.

Since she complained to The Inquirer, Lamb said, the insurer has promised to “straighten everything out. I’m pleased with the conversation but nothing has been done yet.”

POSTED: Friday, April 11, 2014, 6:00 AM
Filed Under: Krystyna Dereszowska

Open enrollment may have just ended, but preliminary data on health care utilization is already beginning to trickle in.  Although the numbers are bound to change with time, it appears that those who are already making use of their new marketplace coverage are sicker than average.  And that’s not bad news.

The US has consistently spent more on health care per capita than other high-income countries in return for higher infant mortality rates and shorter life expectancies.  Obamacare was passed in an attempt to halt this trend and improve the cost, access, and quality of the nation’s healthcare.  Or more concretely, to stop the healthy from getting sick, and the sick from getting sicker.

A study just released by Express Scripts—the nation’s largest pharmacy benefit management company, indicates that Obamacare may be achieving this concrete goal.  In January and February of this year, those who were newly insured through a marketplace plan bought more specialty medication than the commercially insured. Such medication tends to be more expensive because it treats chronic conditions with limited treatment options such as HIV/AIDS or Hepatitis C.  The rate of purchase of pain, depression, and seizure medication was also higher among marketplace enrollees.

POSTED: Wednesday, April 9, 2014, 6:59 PM
Filed Under: Robert I. Field

Medicare paid a Florida ophthalmologist $26 million in 2012. It paid a Florida cardiologist $23 million. Dozens of other doctors received more than $4 million. And hundreds received well over $1 million.

These are among the more starling revelations contained in a trove of data on physician payments that the Medicare program released yesterday. (To access the data directly, click here.)  It was no secret that some doctors make a lot of money. But that much money, and entirely at taxpayer expense? That took many by surprise.

What is not a surprise is the distribution of Medicare payments to doctors. The highest earners were almost all specialists. An analysis by the New York Times found that all but a few of the doctors in the highest-paid 2% practiced in specialties and only a small portion in primary care. 

POSTED: Friday, April 4, 2014, 6:00 AM
Filed Under: Krystyna Dereszowska
The federal health-care website. (AP Photo/Jon Elswick, File)

The Obama administration announced that 7.1 million Americans obtained individual health insurance coverage through the marketplace exchanges by the March 31st deadline.  However, if you missed the deadline, you are not out of luck.  You still have four options for getting coverage in 2014.

You can still apply for a policy if one of the following applies to you:

1. You tried to get insurance through an exchange but couldn’t complete the application

POSTED: Monday, March 31, 2014, 6:00 AM
Filed Under: Krystyna Dereszowska

There has been no shortage of opposition against the nomination of Dr. Vivek Murthy for Surgeon General, a Harvard and Yale educated physician who trained at one of the nation’s best hospitals.  Often referred to as “America’s Top Doc,” the Surgeon General leads the U.S. Public Health Service Commissioned Corps.  Notably absent from that job description is the power to pass or enforce legislation and regulation. 

And yet, Dr. Murthy has drawn the ire of the National Rifle Association because of his support for gun control.  Support that he expressed in 2012 in a single tweet.  With his confirmation process stalled, the White House is considering its options.  However, it’s important to highlight that this smear campaign against Dr. Murthy is disturbingly off target. 

1)    We should expect doctors to oppose gun violence and promote gun control

About this blog

The Field Clinic reports and analyzes health care laws, government policies, and political trends that are transforming the care we receive and the way we pay for it. Read more about our panel of bloggers here.

This blog is produced in partnership with Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health-policy research and communication organization not affiliated with Kaiser Permanente. Portions of this blog may also be found on and in the Inquirer's Sunday Health Section.

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Robert I. Field, Ph.D., J.D., M.P.H. Professor, School of Law & Drexel School of Public Health
Jeffrey Brenner, MD Founder of the Camden Coalition of Healthcare Providers, Medical Director of the Urban Health Institute at Cooper University Healthcare
Andy Carter President & CEO, The Hospital & Healthsystem Assoc. of Pa.
Robert B. Doherty Senior Vice President of Governmental Affairs & Public Policy American College of Physicians
Neil I. Goldfarb President & CEO of the Greater Philadelphia Business Coalition on Health
David Grande, MD, MPA Assistant Professor of Medicine at the University of Pennsylvania
Tine Hansen-Turton Chief Strategy Officer of Public Health Management Corporation
Drew A. Harris, DPM, MPH Director of Health Policy Program at the Jefferson School of Population Health
Antoinette Kraus Director of the Pennsylvania Health Access Network
Laval Miller-Wilson Executive Director of the Pennsylvania Health Law Project
David B. Nash, MD, MBA Founding Dean of the Jefferson School of Population Health
Howard J. Peterson, MHA Managing Partner of TRG Healthcare, a national healthcare consulting firm
Donald Schwarz, MD, MPH Deputy Mayor for Health & Opportunity and Health Commissioner for the City of Philadelphia
Paula L. Stillman, MD, MBA Healthcare consultant with special expertise in population health and disease management
Elizabeth A. W. Williams Senior Vice President & Chief Communications Officer for Independence Blue Cross
Krystyna Dereszowska A third-year law student concentrating in health at Drexel
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