RoS: Review of Systems

Emma Sandoe, a PhD student in Health Policy Political Analysis at Harvard University, joins us for a discussion of the Affordable Care Act. Prior to starting her PhD program, Emma spent six years in Washington, DC working on the passage and implementation of the ACA. She served as the spokesperson for Medicaid and HealthCare.gov at the Centers for Medicare & Medicaid Services and worked on ACA coordination at the HHS Budget Office. We start with an overview of the ACA and then review key players in the repeal and replace efforts thus far (5:25); the recent CBO report and the possibility of an insurance premium death spiral (15:00); the likelihood of Trump’s ability to keep his promise to retain the popular provisions of the ACA and what a replacement law might look like (18:00); the ACA’s flaws and some historic context for them (24:12); and give some well-hedged predictions for the coming weeks (32:05). We discuss a report released last week by the Congressional Budget Office projecting what might happen if the ACA is repealed without a replacement, and two articles from healthcare reporter Sarah Kliff looking at potential ACA replacement plans and a story about discontent with the ACA among beneficiaries. Here is a helpful article from New York Times reporter Margot Sanger-Katz looking at what President Trump’s executive order against the ACA might mean. You can find the resources for getting involved Emma mentioned here. Follow us and tweet us your thoughts @RoSpodcast and check out our facebook page at www.facebook.com/reviewofsystems. Or, you can email us at contact@rospod.org. We’d love to hear from you. And thanks for listening.

David Rosenthal, Thomas Kim, and Audrey Provenzano discuss the recent manuscript published in Annals of Internal Medicine by Sinsky and colleagues, Allocation of Physician Time in Ambulatory Practice: A Time and Motion Study in 4 Specialties. Have you ever wondered how much time you spend each month fighting with technology or filling out VNA forms? Well, Christine Sinsky and her colleagues studied this and have some answers for us…all of which raise more fascinating questions about how we practice medicine. Tweet us your thoughts @rospodcast, and send us feedback at contact@rospod.org!

On our premier show, Dr. David Levine, a general internist and research fellow in the Division of General Internal Medicine and Primary Care at Brigham and Women’s Hospital and Harvard Medical School talks about his research looking at home hospitalization. Instead of admitting patients to the floors from the ED, he admits them back home. He also reflects on some of his other research and interests in the quality of outpatient care, digital health technology, and novel methods of care delivery. Check out an article about David’s research in the Boston Globe, a video about his home hospital work, and one of his other publications that we talk about in the show, comparing doctors to symptom checking software. We also reference Bruce Leff, a leader of the home hospital movement in the US; Community Servings, an organization in the Boston area dedicated to bringing wholesome food to the chronically ill; and Iora Health, an innovative healthcare delivery organization.

Welcome to Review of Systems, your podcast for discussion of primary care innovation, payment reform, health care policy, and more. Our mission is to produce a weekly show that will engage clinicians, administrators, policy makers and public health officials in a conversation about how we can make primary care better for our patients. The show is produced and hosted by Audrey Provenzano, an internist in the Boston area, with co-hosts Thomas Kim, a family practice physician in Houston, and David Rosenthal, an internist in Connecticut. Our first show is coming next week! Stay tuned!