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Are hospitals really soaking the poor with high prices?

Health Policy

June 16, 2013

The Centers for Medicare and Medicaid recently released its compiled data on what over 3,000 hospitals across the country charge for 100 of the most common discharge diagnostic codes under the diagnosis related group (DRG) system, and boy did the DRG really hit the fan. Liberals, economists, and band wagoners got all upset about the enormous pricing differentials between hospitals for the same services.

For example, Twin Cities Community Hospital in …

Are ER services really the cost villains?

Trudy Lieberman

Health Policy

June 15, 2013

Maligned over the last decade as places to avoid because of the price of the care they delivered, a study by the RAND Corporation goes a long way toward improving the image of hospital emergency rooms (ERs). The ER price tag was too high for the insurance companies that paid the bills, so many of them tried to discourage ER use by designing policies with high coinsurance and copayments …

Childcare during medical training: Sometimes you just get lucky

Miranda Fielding, MD

Physician

June 15, 2013

Sometimes you just get lucky. When I was pregnant with my first child, during my radiation oncology residency, we had a guy living in the apartment over our garage, which we liked to refer to as “the carriage house.” He was a dog trainer by trade, and in his spare time he played softball in a local adult league. When we told him he had to move out, because we …

Fear is a primal emotion in medicine

Danielle Ofri, MD, PhD

Physician

June 15, 2013

An excerpt from What Doctors Feel: How Emotions Affect the Practice of Medicine. Excerpted with permission by Beacon Press.

The stat cardiac-arrest page came through on my beeper at exactly the same moment as the hospital-wide PA system announced, “Code 411, cardiac arrest, MICU.” The operator chanted the mantra over and over with studied deliberativeness, as though there …

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Fear is a primal emotion in medicine

What if doctors worked for free?

Hans Duvefelt, MD

Health Policy

June 15, 2013

Today I am going to write about how the US could save up to 10% on its healthcare bill.

The US spends more on health care than any other nation, $8,500 per person per year. Multiply that by 300 million people and try to grasp the vast sum of $2,5 trillion.

A lot of changes are taking place with the intent to save healthcare dollars. So far, many of those changes have …

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What if doctors worked for free?

A day in the life of a home care nurse practitioner

Laura Black, NP-C

Patient

June 15, 2013

As a 24-hour-a-day, seven days a week, on-call nurse practitioner serving elderly and frail patients, my work day is anything but typical. I start my day not at a hospital or clinic, but at my dining room table. There, I document patient visits from the day before, write up my notes and place an average of 10 or more calls—ranging from setting up appointments to calling my patient’s family members …

A more realistic approach to achieving accountable care

Sreedhar Potarazu, MD, MBA

Health Policy

June 15, 2013

Hospitals that are already struggling financially to stay afloat face significant challenges in the coming months and years under some of the provisions of Obamacare.

Under the Affordable Care Act’s Hospital Readmissions Reduction Program, hospitals that readmit certain patients within 30 days of discharge could face significant penalties.

The question is whether hospitals really have that much control over factors leading to readmission and whether they are really at fault.

Some readmissions are …

When can you override an advance directive?

Eric Widera, MD

Physician

June 14, 2013

An 85-year-old woman with moderate Alzheimer’s disease who enjoys walking in her nursing home’s garden with her walker has fallen and broken her hip. An advance directive signed by the patient states a preference for “comfort measures only,” and specifically states that she does not want to be transferred to the hospital. The physician believes that surgery would provide long-term pain relief and the chance to maintain some mobility.

What do …

Quality, cost, and value in health care: How to solve the puzzle

Robert Wachter, MD

Health Policy

June 14, 2013

I sometimes explain to medical students that they are entering a profession being transformed, like coal to diamonds, under the pressure of a new mandate.

“The world is going to push us, relentlessly and without mercy, to deliver the highest quality, safest, most satisfying care at the lowest cost,” I’ll say gravely, trying to get their attention.

“What exactly were you trying to do before?” some have asked, in that wonderful way …

We need an Apple Genius Bar for patients

Barbara Bronson Gray, RN

Patient

June 14, 2013

Have you ever been to a Genius Bar at an Apple store?

The last time I was there — checking out a pesky problem on my iPhone — I couldn’t help but wonder: why can’t we have something like that to deal with our common health issues?

Genius Bars are located in Apple Stores in easy-to-access shopping areas, like malls. The Genius Bars are …

A dream to help everyone find and choose better foods

David L. Katz, MD

Physician

June 14, 2013

NuVal began as, and remains, a dream of mine — a dream about helping everyone find and choose better foods, and in the process, putting pressure on the food industry to offer better foods in the first place. They’ll stop selling what we stop buying, after all.

This was a dream born initially of frustration. I have been caring for patients for over 20 years, and placing an emphasis on the …

Stop prescribing benzodiazepines for anxiety

Anonymous

Medications

June 14, 2013

As a physician in a rural health clinic, I frequently see patients who complain of anxiety. The majority of these patients are in their 20s to 40s. Some have never been evaluated by a mental health professional, and many of these patients take benzodiazepines on a chronic basis. After current review, I wonder if we as primary care physicians are good at treating anxiety, or are we contributing to drug …

It’s time for parents to stop distracted driving

Claire McCarthy, MD

Physician

June 14, 2013

As someone who has been a parent for 22 years, I know firsthand just how hard driving kids around can be. When they are little they cry, as they get older they ask a million questions and fight with their siblings, and when they get older there’s the whole issue of the radio, not to mention the chaos of friends in the car. But a study recently released suggests that when …

Finding mindfulness in unexpected places

Heidi Roman, MD

Physician

June 13, 2013

I’m not sure I’ve ever been great at being still. As a kid, I joined one activity after another. Not because my parents told me I should. I just liked it. Staying busy. But, I could concentrate. Quiet the mind. I’d sit and read for hours on end or close my eyes and listen to a cassette tape from beginning to end.

Even through busy high school and college years, a …

Americans too often lose autonomy at the end of their life

John Mandrola, MD

Physician

June 13, 2013

Perhaps it’s because I love the practice of medicine so much. Or maybe it’s because doctors (and teachers) have always been my heroes.

I’m trying to sort out why I feel so offended by Paul McHugh’s editorial in the Wall Street Journal. His sensational and paternalistic view of physician-assisted suicide can be summed up in one word—shameful.

It is true, thankfully so, that in the United States offensive speech is protected. And …

The racial disparity of cancer screening and preventive medicine

Sindhura Kodali

Conditions and Diseases

June 13, 2013

Like many other Millenials who grew up in the age of Lara Croft and Brangelina, I greeted Angelina Jolie’s announcement that she had undergone a preventative mastectomy and reconstruction last month with sadness for her loss and admiration for her heroic decision and very public disclosure. I hope her story will lead other women to undergo screening and potentially save lives, but real improvement in women’s health outcomes requires …

Second opinions: A chance to listen and teach

Lyle Fettig, MD

Physician

June 13, 2013

You drive down a busy expressway amidst thousands of other vehicles and a billboard jumps out at you. In the font of confidence, it reads, “The first step in fighting cancer should be a second opinion.”

The billboard informs you of the location of the nearest Cancer Treatment Center of America (CTCA), “only” about 130 miles from the billboard.

When …

Reflection after attending an Alcoholics Anonymous meeting

Robert Spencer, MD

Medical Education

June 13, 2013

I’m two weeks into my psychiatry clerkship, sitting quietly in the back of a crowded Alcoholics Anonymous meeting and watching a middle-aged man discuss his past struggles with alcoholism. He starts with his difficult childhood, describing his abusive father. When he was eleven years old, his parents divorced. Soon after, he resorted to alcohol as an escape from his loneliness, drinking to “fit in” and impress his friends at social gatherings. As …

First day at a family planning clinic

Sophia Lee Ryan

Medical Education

June 13, 2013

I’d prepared as much as I could: I had a huge coffee, a water and every kind of snack imaginable stuffed into my bag. In my head I carried as much information about dilation and curettage as I’d been able to absorb during a study session at Starbucks the night before.

I was a third-year medical student doing my obstetrics and gynecology clerkship, and I was about to spend a day …

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First day at a family planning clinic

The worst kind of guideline in prostate cancer screening

Kenneth Lin, MD

Conditions and Diseases

June 12, 2013

Before critiquing the American College of Physicians’ recent guidance statement on screening for prostate cancer, I will begin by saying that I generally hold the ACP’s clinical guideline development process in high regard. They often base their guidelines on comprehensive and methodologically sound reviews of the evidence produced by Evidence-Based Practice Centers.

In some cases, when several good-quality guidelines are already available, the ACP chooses not to reinvent the wheel …