Academic Medical CentersConsumers & PatientsFuture of Health Care
February 21, 2018

How Safe is Medicare? What To Know About White House Budget Proposals

Health care providers may be lulled into believing that Medicare budget cuts proposed by the White House last week won’t happen. Media reports have repeatedly emphasized that the budget is simply a policy proposal. Congress alone has the authority to determine spending limits and allocate funds. But labeling this budget—and the Medicare proposals in it—as “dead on arrival” is a mistake. For one, the proposal includes efforts aimed at reducing drug prices and fighting the opioid epidemic. But these are minor political enticements, compared to the proposed Medicare cuts labeled as “Reducing Wasteful Federal Spending.” Those are the most significant ideas…
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Consumers & PatientsFuture of Health CareMedical Decision-Making
February 14, 2018

Don’t Just Check the Box: Capture the Patient’s Story to Define Meaningful Goals of Care

What does Shared Decision-Making between doctor and patient really look like? I spent four decades as a primary care physician, as well as 27 years teaching medical students and residents. Looking back on my treatment of patients, I now question whether my management was driven by what the patient wanted—or by what I wanted for the patient. Certainly, I wanted to do what was in the best interest of the patient, and I sincerely hope that our interests were often well aligned. In certain specific cases, I acted against the stated desires of the patient, a necessary call (discussed below).…
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Consumers & PatientsFuture of Health CareValue-Based Health Care
February 7, 2018

Five Lessons from Big Business on Value-Based Health Care

Last year we predicted that CMS would step back from the complex requirements of its Value-Based Health Care initiative, in favor of reducing provider burdens for quality reporting and reducing regulation, in general. While MACRA MIPS and the move toward financial risk still remain, we correctly anticipated that Medicare would focus its efforts on its own beneficiaries—and less on leading the charge for cost control in health care. We hoped that providers would seize the opportunity to take ownership of making health care work better, rather than respond to external requirements. Instead, despite several organizations that have pushed the agenda…
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Consumers & PatientsFuture of Health CareMeaningful MeasuresValue-Based Health Care
January 31, 2018

What Does #MeToo Have to Do With Value-Based Health Care?

Are we measuring the right things in Value-Based Health Care? That’s the question I am asking myself while reviewing recent efforts by CMS to create better measures of health care value, called Meaningful Measures. Given current, widespread reports of sexual abuse and my recent reading about the dismal state of elder health care, I can’t respond affirmatively. A Value-Based Health Care System should curtail rising health care costs and promote better health for individuals. But we can’t miss the forest for the trees. If we focus on the minutia of medical processes or even outcomes of moderate value, yet miss…
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