Michael Flanagan
Michael Flanagan

Uncertainty regarding health insurance exchanges is not going away. Changing enrollment deadlines and newly insured populations have brought challenges to payers and providers. Success will require staying competitive on price, network quality, and access.

Paul E. Terry, PhD

One of the more audacious promises of the accountable care organization (ACO) movement is the idea that providers of medical services can play a larger role in improving a population’s health. It stems from a notion that health care financing reforms will move the focus of providers from “the tyranny of the office visit” to activities where success will be judged according to improvement in clinical metrics whether a patient visits the office or not. It’s the right vision from a health promotion advocate’s vantage point because it may serve as a preamble to an era where medical and public health practices and public policies truly intersect. Dartmouth’s Jack Wennberg famously observed predictable provider-centric small-area variation in the use of clinical procedures while the Centers for Disease Control and many other public health observers have long shown that ZIP codes have more to do with health than do medical codes. Can the next generation of health reforms reconcile the tension between these loosely related truths?

Steven R. Peskin, MD, MBA, FACP

The title of this post might also read "Don't Mess with Mother Nature"

We have seen remarkable improvements in human health as a direct result of the science that has brought us our antibiotic age with significant reductions in infant mortality, deaths due to bacterial pneumonia, and other serious infections that sometimes led to systemic infection and death.

Fast forward to today, when we may obtain with a prescription many of these powerful germ killers for $4 at WalMart and Target and drug and grocery store chains. Some retailers even give away a prescribed course of antibiotics as a loss leader to entice the customer to enter that store.

The liberal (excessive, really) use of antibiotics in the United States and much of the rest of the world is having profound unintended negative consequences.

Steven R. Peskin, MD, MBA, FACP

Three days of a severe headache that would not respond to the ibuprofen, naproxen, or acetaminophen. "I never get headaches" is what I said multiple times to my wife and to colleagues. The morning of day three, a rash started to appear on my forehead, in the left eyebrow, in the scalp, with swelling around the left eye and swollen lymph nodes at the angle of the jaw on the left. My wife mentioned "shingles". Poor early diagnosis on my part, and, I said "Oh !*#%! that is what I have".

Paul E. Terry, PhD

Recently a Minnesota school was evacuated after 10 students got sick during choir practice. A carbon monoxide leak was the presumed cause, given the similarity of student’s symptoms and the rapid spread of complaints. Thirty students in all were taken to the hospital and the school was closed for the day. Tests proved negative, recovery was quick, and the Minnesota Department of Health (MDH) now reports that the likely cause was psychogenic illness.


The state spokesman said that when people in a group become ill at the same time with subjective complaints, “It is no less real.”


It seems that when an affliction — real or imagined — hits, it can spread quickly among some people. According to one of the more recent CBS News Poll, 61% of Americans disapprove of how the ACA rollout is being handled. Nevertheless more Americans are in favor of fixing the law (48%) or keeping it as is (7%) than repealing the ACA altogether (43%). More telling perhaps, according to several opinion polls about the ACA since 2010, is the stability of opinions concerning Americans’ support for or opposition to the law.


Only time will tell whether the latest ACA anguish from the chorus will fade without treatment, but one thing seems increasingly obvious: Debates about the ACA are distracting from the inertia needed for additional reforms if we are serious about reducing health care costs and improving the health of the nation.

Steven R. Peskin, MD, MBA, FACP

"Welcome to Moe's"  is the warm and friendly greeting of the staff at one of my favorite cantinas — Moe's Southwest Grill, where a rice bowl and iced tea set me back just $9 and change. But for one woman who underwent Mohs surgery for a very minor lesion that may not have required the Mohs procedure and the subsequent plastic surgery repair, her bill for the day was over $25,000, as reported in a January 18, 2014 New York Times article titled "Patients' Costs Skyrocket; Specialists' Incomes Soar".

In the article, the Times journalist Elizabeth Rosenthal notes:

"Use of the surgery has skyrocketed in the United States — over 400 percent in a little over a decade — to the point that last summer Medicare put it at the top of its “potentially misvalued” list of overused or overpriced procedures. Even the American Academy of Dermatology agrees that the surgery is sometimes used inappropriately"

In this instance, the patient, a professor at the University of Central Arkansas, pushed back on the $25,000-plus charges, and, after months of wrangling, Baptist Health Medical Center reduced the bill to around $5,000, with the largest component of the reduction being the plastic surgeon's fee -- from $14,407 to $1,375 (Still a nice paycheck for what was likely less than an hour of time!).

The patient subsequently went to a dermatologist at the University of Arkansas who said that she likely did not need "such an extensive procedure." The patient's final comment in the article: "It was like, "Take your purse out, we're robbing you'"

Welcome to Mohs!

Steven R. Peskin, MD, MBA, FACP, is associate clinical professor of medicine at the University of Medicine and Dentistry of New Jersey – Robert Wood Johnson Medical School, and is governor of the American College of Physicians, New Jersey South.

Steven R. Peskin, MD, MBA, FACP

The memory tape of the golden oldie from Lovin' Spoonful was playing in my head before watching Dr. Eric Topol’s interview with Dr. Paul Offit about his recently published book, Do You Believe in Magic? The Sense and Nonsense of Alternative Medicine

The book tackles with rigor and vigor the lack of evidence for assertions and testimonials made by celebrity physicians, politicians, and stars of the small and big screen regarding the benefits for megadoses of vitamins, various nutraceuticals, and misuse of FDA-approved drugs, such as prolonged IV antibiotics for chronic Lyme Disease. Indeed, some of these may actually harm the person.

To me, the most fascinating part of this debunking of pseudo-science is the power of the placebo. Offit acknowledges the ability of the human being to heal itself. Through the connection of mind and body and conscious or unconscious thought affecting neurobiological or neurohormonal up or down regulation, we have remarkable abilities to positively or negatively impact our immune system, our perception of pain, blood circulation, digestion, and other vital functions that may profoundly help or harm our health and well being.

Just as the vaccines stimulate an immune response that prepares the body to defend itself from a viral or bacterial attack, we have the ability to autoregulate in other ways to heal ourselves. Not magic, but magical!

Steven R. Peskin, MD, MBA, FACP, is associate clinical professor of medicine at the University of Medicine and Dentistry of New Jersey – Robert Wood Johnson Medical School, and is governor of the American College of Physicians, New Jersey South.

Paul E. Terry, PhD

January 1, 2014 marks the most monumental day in the history of American health policy. The individual insurance mandate, the sunsetting of underwriting as we know it, and the planned obsolescence of the term “pre-existing conditions” in insurance all presage a fundamentally different era for access to health care. Of the 5.7% of those in the individual market, .6% will not be eligible for financial help if they want to continue buying in the individual market. In exchange, starting today, up to 47 million nonelderly uninsured will be eligible for new and/or more affordable health insurance. The good news is that there is no turning back from this miracle arrival. The bad news is there is no starting over either. The stork delivered it with warts and all.

Jessica Cherian, PharmD, RPh
Jessica Cherian, PharmD, RPh

Nowadays, every turn of a newspaper page, click of a media page on the Internet, or flip to a news channel brings us to an update, or more likely a criticism, of the public exchanges. With all of the attention on this side of the exchanges, we might be forgetting about the private exchange.   The private exchange serves as a channel for individuals and employers to purchase health insurance that is separate from the newly opened public exchanges developed under the Patient Protection and Affordable Care Act.

 The biggest difference between the two stems from the fact that government subsidies aren’t available to those choosing to purchase health insurance from the private exchange. This explains why much of the news regarding private exchanges focuses on the group market, as employers that choose to participate in a private exchange provide employees with an subsidy to be used toward the purchase of health insurance, a method also known as defined contribution.

Paul E. Terry, PhD

The recent Health and Productivity Conference sponsored by the National Business Group on Health (NBGH) signaled the arrival of what social scientists have long held as vital to the success of wellness: a balance between personal and organizational engagement in health.

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