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Nurse Practitioners are not Doctors, They’re Better

by Kyle Fischer, MD, MPH in Advanced Practice Providers

In an era of physician shortages and insurance expansion, the American health system is struggling to keep pace with increasing demand from patients. Although the last decade [...]


Quality of Care

Continuity of Care

Health care costs

  • Source: Allen Skyy (Flickr/cc)

    Medicaid crowd out: hype or reality?

    With Medicaid expansion underway, questions about whether Medicaid coverage “crowds out” private coverage have reemerged. Critics of Medicaid expansion contend that public health insurance causes individuals to forego private coverage. A recent study published in Inquiry sought to quantify this phenomenon—specifically, to determine how many new Medicaid enrollees had private insurance at the time of Medicaid enrollment and, of those new Medicaid recipients, how many dropped their private [...]
  • Source: Kirt Edblom (Flickr/CC)

    Coverage that Doesn’t Cover It

    As a medical student living in Texas, two things are very familiar to me: having uninsured family members and being solicited by said family members for medical advice. Source: Kirt Edblom (Flickr/CC) A few weeks ago, a relative approached me at a family BBQ (also familiar to anyone living in Texas) and showed me a superficial skin infection on her inner thigh. It was red, painful, and had gnarly streaks where the infection was spreading. I advised her to head to a real doctor for antibiotic [...]
  • Source: Mishio (Flickr/CC)

    Should We Subsidize the Sick?

    The projected savings from the Affordable Care Act (ACA) are not solely from the health care exchanges: a large portion of savings stem from re-allocating medical resources towards the sickest patient populations. By improving the health of the sickest patients with high levels of health care utilization, the ACA directs savings toward other provisions such as insurance subsidies. Source: Mishio (Flickr/CC) A new study in Medical Care Research and Review collected information on patients with [...]
  • Source: Christiaan Triebert (Flickr/CC)

    Expanding ACO’s Beyond Medicare

    In 2012, the Center for Medicaid and Medicare Services (CMS) implemented a novel program in their efforts toward achieving the Triple Aim: Thirty-two organizations with experience in care coordination enrolled in the Medicare Pioneer accountable care organization program. During the first two years, Pioneer organizations were judged on 33 quality measures with a shared savings and risk payment policy. This article evaluated year one performance of Pioneer ACOs by comparing outcomes and cost for [...]
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    Happy accident lowers health care costs

    The Affordable Care Act (ACA) increased emphasis on quality reporting for doctors and hospitals in an effort to improve care and, hopefully, improve health outcomes for patients. Whether or not this will be accomplished is yet to be seen. However, Medicare’s Hospital Compare tool, implemented prior to the ACA in 2005 by the Centers for Medicare and Medicaid (CMS), has had another unanticipated effect: lowering costs. Source: (CC) A new study published in Health Affairs by public [...]
  • Source: Time Green (Flickr/CC)

    Foreshadowing Pitfalls for the Affordable Care Act

    Several countries have implemented healthcare systems that seek to attain universal health insurance through private markets. Germany, the Netherlands, and Switzerland have already embarked on this journey and can serve as guides for the United States. Source: Time Green (Flickr/CC) Some observers would say that the Affordable Care Act’s health insurance exchanges are an attempt to “Swissify” America and its health insurance marketplace. I, for one, agree. All four nations possess a [...]
  • Source: Kris Krüg (Flickr/CC)

    Primary Care is Still the Answer

    Though the patient-centered medical home has been praised as the ultimate strategy in keeping patients out of emergency departments and hospitals, so far the actual results have been mixed. A new study out of California, however, provides more positive evidence for the benefits of a continuous, longitudinal relationship with a primary care physician. Source: Kris Krüg (Flickr/CC) The Health Care Coverage Initiative in California created a provider network and defined benefits for a previously [...]
  • Source: Kevin Dooley (Flickr/CC)

    Learning Pricing from the Airline Industry

    Source: Kevin Dooley (Flickr/CC) Traveling by air during the 1950s and 1960s during the Golden Age of Flying was different from what most of us are used to today. Lavish layouts, complimentary drinks, and exorbitant ticket prices made air travel for the majority of people out of reach. Nowadays, the average person can travel around the country at a fraction of the cost by using websites that compare among discount and premium airlines. There is a great lesson in airline industry history that, [...]
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    The First Five Years of the ACA in Review

    The Affordable Care Act (ACA) turned five in March of this year and the authors of this Health Policy Report in The New England Journal of Medicine describe the milestones that the law has reached so far: Source: Since the implementation of the ACA, 30 million have gained insurance under its various provisions and protections. The number of uninsured Americans has decreased an estimated 7 to 16.4 million, with young adults, Hispanics, blacks and those with low incomes benefiting [...]
  • Source: COM SALUD Agencia de comunicación (Flickr/CC)

    Saving Primary Care, One NP at a Time

    This meta-analysis by Martinez-Gonzalez and colleagues examined the effects of task-shifting from physicians to nurse practitioners in primary care. Twenty studies included in the meta-analysis all compared nurse-led care with physician-led care in general practices, including frequency and length of consultations, amount of referrals, prescriptions, tests, investigations ordered, and costs. Source: COM SALUD Agencia de comunicación (Flickr/CC) Nurses were about 20% more likely to have return [...]

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