Dr. Niran Al-Agba

Gaming the System: Pediatrics, Mammograms, and MACRA

Imagine what quality metrics the pediatric cardiac surgeon is going to track. He would do well to collect statistics on how often he images patients for appendicitis because it is likely a rare occurrence. Things are really looking up for the use of data and technology in healthcare. Costs are likely to keep rising with everyone scoring in the 99th% percentile once they figure out how to game the system. But we certainly cannot stand in the way of science or progress now can we?

Niran Al-Agba2020-05-14T03:27:54+00:00February 21, 2017|Categories: Policy, Practice|Tags: ACA, Affordable Care, MACRA, MIPS, Physician Autonomy, Transparency, Value-based Care|

Free-market Medicine: Can Independent Practices Stay Viable Using Price Transparency?

I need a light, a stethoscope, and a pen to heal and comfort human beings; the rest is basically nonessential. This Mexican physician and I fundamentally do the same thing every day; except he has no receptionist, no billing personnel, no manager, no administrator, no care coordinator, and definitely NO EMR in his emergency clinic. He documented the visit in less than 3 minutes (like I do), signed it, and handed me the top page for my records. His care was good, his skills were solid, and his decision-making sound; I would have treated any other child the same way.

Niran Al-Agba2020-05-14T03:25:58+00:00February 10, 2017|Categories: Policy, Practice|Tags: Burnout, Free Market, Independent Practice, Physician Autonomy|

Meaningful Use: A Bird’s Eye View from the Penalty Box

Welcome to the penalty box, with no term limit. Every single visit, procedure, counseling session, or medical intervention will have 2% shaved off the top. The average family physician receives about $100,000 a year in Medicare reimbursements, so a 2% penalty for 2017 will become 3% in 2018, and increase to 4% in 2019—a combined three-year total of $9,000.

Niran Al-Agba2020-05-04T01:54:53+00:00January 24, 2017|Categories: Policy, Practice|Tags: Burnout, EHR, EMR, MACRA, Meaningful Use, MIPS, Penalty|

Et Tu, Dr. Noseworthy?

Should patients fire their doctors if they suspect burnout? In a recent PBS interview, Dr. Noseworthy suggested patients should “change physicians” when faced with non-empathetic doctors suffering from burnout. His cavalier resolution (continue reading →)

Niran Al-Agba2020-05-03T23:31:15+00:00November 2, 2016|Categories: Policy, Practice|Tags: Corporate Medicine, Corporatization, Health Policy, Hospitals, Mayo|

MACRA Payment Regulations Should Be Evidence-Based

Whether applied to policymaking for individuals, large populations, or administration of health services nationwide, it is imperative regulatory decisions be anchored to empirical evidence. The official MACRA rule has now been released. (continue reading →)

Niran Al-Agba2020-05-03T23:15:25+00:00October 18, 2016|Categories: Policy, Practice|Tags: ACA, Burnout, EHR, EMR, Health Policy, MACRA, Medicare, MIPS, Physician Autonomy|

Practicing Medicine My Way.

“To say the things he truly feels; and not the words of one who kneels. The record shows I took the blows – and did it my way.” My way would involve fewer bureaucrats making significant healthcare decisions that impact the entire country and its population at large. Both patients and physicians are taking blows from those in charge of the system who know nothing about the world of primary care.

Niran Al-Agba2020-05-03T22:23:22+00:00August 29, 2016|Categories: Physician, Practice|Tags: Physician Advocacy, Physician and Media, Physician Autonomy|

My Ideal Electronic Health Record

I recently contacted her mother to inquire if she wanted her daughters’ medical chart. She said it was a gift to see her daughter through the eyes of her physician, who was there every step of the way. Medical records are more than metadata on a computer screen; they are a sacred chronicle of our enduring connection with our patients in life, and even in death. When an EMR can do that, I will be thrilled to embark on a digital journey. Until then, give me paper or give me death.

Niran Al-Agba2020-05-03T22:25:19+00:00August 26, 2016|Categories: Policy, Practice|Tags: Burnout, EHR, EMR, Physician Autonomy, Physician Suicide|

Building Better Metrics: Using Physician Outcomes

Government and insurance companies should stop wasting dollars and cents chasing visions of value, rather use common sense and give physician outcomes the attention they deserve. Healthcare will be on better footing now and into the future.

Niran Al-Agba2020-05-03T22:34:52+00:00August 12, 2016|Categories: Policy, Practice|Tags: Burnout, MACRA, Medicare, MIPS, Physician Autonomy, Physician Suicide, Value-based Care|

MACRA is to Medicine what No Child Left Behind was to Education

The No Child Left Behind (NCLB) Act is to the education system what MACRA is to healthcare. Why must we keep repeating history?

Niran Al-Agba2020-05-03T22:42:21+00:00August 2, 2016|Categories: Policy, Practice|Tags: Education, MACRA, No Child Left Behind, Physician Advocacy, Physician Autonomy|

Rural Care: A Primer For Washington Officials, Columnists and Economists.

I am not convinced time and money spent implementing new technology does anything to improve patient care; I am fairly certain, however, conversations with my patients provide considerable value.

Niran Al-Agba2020-05-03T22:59:10+00:00July 27, 2016|Categories: Policy, Practice|Tags: Corporatization, EHR, EMR, Government Medicine, MACRA, MIPS, Rural Care|