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Repeal the SGR and enact a permanent solution that supports physicians

Health Policy

November 14, 2013

Congress is closer than ever to repealing Medicare’s sustainable growth rate (SGR) formula. Competing plans, with traction, are on the table. The leaders of American medicine are convening this weekend in our nation’s capital.

The Coalition of State Medical Societies — representing nearly 160,000 members in nine states — calls on Congress to act decisively, but not rashly.

Congress must act now to repeal the flawed SGR formula used to pay physicians …

Why our personal health data will become less private

Joseph Kvedar, MD

Health Technology

November 14, 2013

I have been following the news about the National Security Agency (NSA) access to our phone records with great interest. If we as a society don’t sort some of this out, we’ll see a repeat in the health sector a few years from now.

These discussions seem to pivot on issues of population-level safety vs. personal liberty, and on trust vs. suspicion re: how much of the process is driven by …

Accepting Medicaid patients may be smart business

Peter Alperin, MD

Health Policy

November 14, 2013

Recently, the New England Journal of Medicine published a perspective by Lawrence Casalino, MD titled, “Professionalism and Caring for Medicaid Patients – The 5% Commitment.”

In the piece, Casalino argues that physicians should commit a portion of their practice to the Medicaid population as a matter of professional obligation. Yet this got me thinking: if physicians don’t respond to the professionalism argument and, instead, insist on being completely market-driven actors, then how can …

The chronically ill are those who need online services the most

Jessie Gruman, PhD

Patient

November 14, 2013

Outsourcing work to cheaper workers is a common strategy of corporations. It has largely escaped the public’s notice, however, that much of this new labor force isn’t located in Southeast Asia, but is rather found here in the U.S. and is virtually free. It is we, using our laptops and smartphones to perform tasks once carried out by knowledgeable salespeople and service representatives.

This was particularly salient to me this week: …

Why the annual physical still has value

James Marroquin, MD

Physician

November 14, 2013

Ever since the days of William Osler, annual physical examinations with one’s doctor have been an accepted and expected part of health care. But recently the practice has come under some criticism. Given the dearth of studies showing that physicals lower the risk of death and hospitalization, some experts and organizations state that the annual physical should be abandoned.

I appreciate the effort here to question tradition and to consider if …

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Why the annual physical still has value

Video review of surgeons: Can the logistical issues be overcome?

Skeptical Scalpel, MD

Physician

November 13, 2013

Last month, a superb study by the Michigan Bariatric Surgery Collaborative showed that the more skilled surgeons were, the better were their outcomes.

Surgeons submitted a video of their choice depicting their performance of a laparoscopic gastric bypass. Since it was self-selected, it was presumably their best work. At least 10 of their peers, blinded as to the name of the surgeon, rated skills on the video which had been edited …

ACP: Practicing high value care and overcoming patients’ concerns

Yul Ejnes, MD

Physician

November 13, 2013

A guest column by the American College of Physicians, exclusive to KevinMD.com.

In earlier columns I wrote about two initiatives to promote physicians providing the best possible care by reducing or eliminating the use of tests or treatments that have little or no value to patients. They are ACP’s High Value Care and ABIM Foundation’s Choosing Wisely. I …

The outrageous ER markup for a tetanus shot

Olivier Van Houtte

Conditions and Diseases

November 13, 2013

In March of last year I began and quickly ended a cycling career. In my first race of the weekend I placed second, and in a moment of hubris felt emboldened to reach for more.

In the second race, the very next day, I signed up for a higher category. The race was tougher, and I got stuck behind the pack, which slowed immensely around turns. In an effort to advance, …

Valuable lessons I have learned as an oncologist come from patients

Don S. Dizon, MD

Physician

November 13, 2013

Every once in a while, something unexpected occurs that shakes me to my core — where I question the point of life, ask why we even bother; when in the end, it all just ends.

This time, it happened on a Sunday morning. I woke up in a good enough mood — the sun was shining through my windows, and my cat, …

New cholesterol guidelines: The statin decision lies with patients

Kevin Pho, MD

KevinMD

November 13, 2013

The release of the new cholesterol guidelines from the ACC/AHA is big news. It represents a fundamental shift in how we prescribe statin drugs.

As with many sweeping changes, there are some good, and some controversial ideas.

I like removing non-statin cholesterol drugs from the recommendations, such as Zetia. Many haven’t been shown to save lives or decrease cardiovascular events.

Also, removing LDL targets can simplify …

How to teach your child colors

Natasha Burgert, MD

Conditions and Diseases

November 13, 2013

“I’m so frustrated, Dr. Natasha. My 2-year-old son knows his letters and can count to 10, but he does not seem to know any colors. He just calls everything ‘blue’. Do you think he could be colorblind?”

Parents often come to my office with the concern that their child is unable to correctly identify colors, even when these children have an impressive …

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How to teach your child colors

3 reasons to be against Obamacare

Margalit Gur-Arie

Health Policy

November 12, 2013

If you are a staunch conservative who believes that free markets should solve health care, or that poor people should work harder and have more skin in the game, or that governments should stick to building armies, you don’t need to read this post, unless of course you enjoy being aggravated by liberals.

If you are one of the talking heads posing as a progressive, while repeating the slogans of Obamacare …

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3 reasons to be against Obamacare

A meeting with Kathleen Sebelius about Obamacare

Manoj Jain, MD, MPH

Health Policy

November 12, 2013

Recently, I was among a dozen people who sat privately to talk about the Affordable Care Act (ACA), aka Obamacare, with the embattled Health and Human Services Secretary, Kathleen Sebelius. Dressed in a light green blazer, sitting alongside Memphis Mayor AC Wharton and Congressman Steve Cohen, who had nudged her to visit Memphis, Secretary Sebelius listened to our feedback and shared her insights.

First and foremost, addressing the issue of the …

Are all decisions sensitive to preferences?

Zackary Berger, MD, PhD

Physician

November 12, 2013

At the International Conference on Communication in Healthcare, which I just returned from, there was a discussion continuously coursing beneath the surface and bubbling up every once in a while. If we, acolytes of shared decision making, whether patients or providers, want to encourage decision making that has the person involved at the center, recognizing their preferences and values, does the kind of decision in question have anything to do …

Does acupuncture help pregnancy rates in IVF?

Jennifer Gunter, MD

Conditions and Diseases

November 12, 2013

Acupuncture has become, for many women, an accepted part of their infertility journey. Several studies, including a meta-analysis of 24 studies published in the journal Fertility Sterility in 2012, indicated higher pregnancy rates among women who had undergone acupuncture as part of their treatment protocol compared with women who had no acupuncture or a sham procedure. Any improvement in outcomes is welcome considering the emotional and financial drain of each cycle.

However, there …

3 words that define a philosophy of care

Rob Lamberts, MD

Physician

November 12, 2013

To what end?

Those three words have become something of a mantra, a mission, a philosophy of care.

To what end do I prescribe a medication?
To what end do I make a diagnosis?
To what end do I order tests?
To what end am I documenting?
To what end is there a patient record?
To what end do I send a person to a specialist?
To what end do patients need to come to see me in …
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3 words that define a philosophy of care

Physician burnout: Don’t blame the patient

Carolyn Thomas

Patient

November 12, 2013

My daughter loves her career as a probation officer. She is very good at what she does, and finds the work both challenging and rewarding. Yet her client case load includes some of the most unsavory of individuals, found guilty by the courts of child abuse, domestic violence, sexual assault or worse, many of them living with added complexities like addictions or mental health issues. She’s been insulted and screamed at by …

Use awareness intervention to improve physician behavior

Paul Levy

Physician

November 11, 2013

Here’s a familiar story in America’s hospitals. An “old fashioned” surgeon decides that the protocols and procedures put in place by the medical executive committee or other governing body don’t apply to him. “I’ve done it this way for 30 years, and it works fine. I’m the busiest surgeon here, and no one is going to tell me how to do my job.”

People in the risk management field will advise …

Analyzing the bipartisan plan to repeal the SGR

Bob Doherty

Health Policy

November 11, 2013

Recently, the chairs and ranking members of the Senate Finance and House Ways and Means committees released a bipartisan, bicameral plan to repeal the Medicare SGR and reform physician payments. And this time, it looks like the effort could actually succeed: never before has there been agreement between the House and Senate, Republicans and Democrats, on a plan to repeal the SGR, never mind on what they would replace it …

Is it too soon to declare the Affordable Care Act a failure?

Naomi Freundlich

Health Policy

November 11, 2013

It is hardly an understatement to characterize the health insurance exchange rollout as a big disappointment. A botched website poses a serious problem and threatens to dampen enthusiasm for the new law — especially among the coveted “young invulnerables” who need to sign up for coverage to keep premiums affordable for all. In the short term, the website troubles put the Obama administration firmly back on the defensive, scrambling to …

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