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“Moving from volume to value” is health care reform’s latest mantra. Policymakers hope to replace fee-for-service systems with value-based approaches that reward improved outcomes achieved at lower cost. Ground zero in these efforts is the Medicare Physician Fee Schedule (MPFS). What payment reformers often fail to recognize is that the specific MPFS payment rates have important implications for Medicare and its beneficiaries. The relative payment levels for the thousands of service codes and the absence of payment for other activities powerfully influence how physicians spend their time — and their tendency to perform unneeded tests and procedures. The mix of services that physicians provide under a particular fee schedule can affect value at least as much as any improvements derived from rewarding physicians on the basis of quality measures — the approach Congress took in the Medicare Access and CHIP Reauthorization Act of 2015. (Robert A. Berenson and John D. Goodman, 4/7)

While I’ve used an electronic medical record for several years, Epic, the system my hospital recently adopted, makes recording stories such as the one my patient shared especially difficult. Her grief and her fatigue, which are inseparable in reality, Epic treats as different problems. That she lives alone and there’s conflict in her extended family, which are also inextricable from her symptoms, must be filed under a tab marked “Social Documentation.” (Suzanne Koven, 4/6)

An impoverished 63-year-old woman is diagnosed with squamous-cell carcinoma of the lung with extensive metastases. There is no hope for cure, but radiation and chemotherapy, which could cost more than $100,000, may extend her life for a few months. If this patient unambiguously requests treatment, her doctors may struggle with the decision but will probably provide the treatment, ignoring the cost as a matter of principle. On the other hand, a health department — or a hospital — proposes an action that would prevent many cases of lung cancer by helping smokers quit. It could be offering free nicotine-replacement therapy to every smoker or running smoking counter-advertisements on television. The organization will immediately face resistance: Can we afford that? (Thomas A. Farley, 4/7)

Health care has faded into the background of the election campaign as Donald Trump himself has become the issue on the Republican side and the debate between Hillary Clinton and Bernie Sanders over health care has shifted to other topics. Health wasn’t even listed among the “most important issues” Republican voters could select from in the exit poll of Tuesday’s Wisconsin primary. But that doesn’t mean health is a total non-factor in the primaries; it is a more salient issue for some voting groups than others. And a broad constellation of health issues, not only the Affordable Care Act, are likely to have traction in the general election, particularly among women. (Drew Altman, 4/6)

We have let Walgreens down, America, and I for one am sick about it. Not sick enough, alas, to require pills, lozenges, expectorants and other over-the-counter medications, but I feel bad. Turns out reported incidents of the flu in the United States were down 16 percent from a year ago, as tracked by IMS Health. We're also winning the cold war. (Phil Rosenthal, 4/6)

Even though US consumers spend 3 times more for hospital care than for medication, they are much angrier with pharmaceutical companies than hospitals for driving up the cost of health care. Drug companies raise this apparent inconsistency in an effort to defend their pricing practices. In so doing, however, they fail to appreciate why they’ve been targeted for so much opprobrium. Ironically, the industry’s biggest public relations problems may arise from its most effective and widely applicable innovations. (Austin Frakt, 4/6)

One way of defining a "rogue" industry is to see which ones have declared war on their customers. By that measure, pharma stands at or near the top of combining the elements that go into making a rogue: contempt for the public and the unmitigated pursuit of greed. (Daniel Hoffman, 4/6)

The career of Rick Scott, Florida's Republican governor, has long been one of the outstanding mysteries out of the nation's statehouses. He won his first race for governor in 2010, even though the hospital company he ran until forced out in 1997, Columbia/HCA had been accused of defrauding federal healthcare programs and paid $1.7 billion in fines, damages, and penalties, then the largest healthcare fraud settlement in U.S. history. He won reelection in 2014, despite amassing a politically retrograde position on healthcare issues at odds with his supposed expertise in the field. (Michael Hiltzik, 4/6)

The winter my son Nat broke our playroom window with his head was an endlessly snowy one. He was home on school break and on sensory overload — rocking too wildly on a rocking chair, too close to the bay window. A nauseating shatter, like the crack of thin ice underfoot. Miraculously, he was not hurt. (Susan Senator, 4/6)