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Should Medicare pay for procedures that have no proven benefit?

Bob Doherty

Health Policy

September 18, 2011

“Doctors, with the consent of their patients, should be free to provide whatever care they agree is appropriate. But when the procedure arising from that judgment, however well intentioned, is not supported by evidence, the nation’s taxpayers should have no obligation to pay for it.”

So argues Dr. Rita Redberg, a cardiologist and professor of medicine at the University of California, in a provocative op-ed published in the New …

When professional courtesy could get physicians in trouble

Deniza Gertsberg, Esq

Physician

September 18, 2011

More likely than not, a physician or a dentist has at one point provided discounted or free healthcare services to some patients by waiving all or part of a fee or the copayment and/or coinsurance obligations as a “professional courtesy.” According to the Office of Inspector General’s (OIG) Compliance Program For Individual and Small Group Physician Practices guidelines, however, this practice may expose a physician to an investigation.

To be sure, not all professional courtesy discounts or free …

A PhD who’s no longer a doctor in medical school

SuFu, PhD

Medical Education

September 18, 2011

I’m a doctor. My mail comes with the Dr. prefix and my checks have Dr. on them. People introduce me as Dr. and when I go to conferences I am Dr. SuFu. However as of a couple months ago I’m no longer a doctor. With the donning of the white coat I paradoxically lost a degree and became a first name or Mr. SuFu. My name badge makes no …

False assumptions and clinical errors in modern medical practice

George Lundberg, MD and Clifton Meador, MD

Physician

September 18, 2011

Here are 22 false assumptions, practice failures, and everyday clinical errors that we believe are common in modern medical practice:

1. Lack of appreciation of the phenomenon of physician persuasion and its hidden power. The placebo effect is scientific, potent, and worthy of use.

2. Lack of understanding of the power of prevalence or pretest probability in the diagnostic process, leading to frequent false positives and “overdiagnosis” of nonexistent diseases.

3. Lack …

How your physician is like a chef

Stewart Segal, MD

Physician

September 17, 2011

I wear lots of hats. Over the years, I have developed analogies for most of the things I do and for the things I want my patients to do. Analogies help people conceptualize the complexities of medicine in a way that makes sense.

Today, I had my chef’s hat on. I was actually treating a young chef and found myself talking about food and medicine. There is a direct correlation. My …

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How your physician is like a chef

How our resuscitation efforts would be interpreted by fate

StorytellERdoc, MD

Patient

September 17, 2011

I walked up to the closed door and paused, exhaling a deep breath weighted with disappointment, trying to clear my thoughts for the conversation about to come. My clenched fist was briefly suspended, mid-air, ready to knock. Beyond the door, I could hear muffled conversation and movement.

A calm, pretty woman stood beside me. An emergency department case manager. She held a notebook and pen, ready to jot down any useful …

The shortage of general surgeons demands attention

Skeptical Scalpel, MD

Physician

September 17, 2011

There is much hand-wringing about the shortage of primary care physicians. But primary care not the only specialty with deficits. In a few years, all surgical specialties will experience significant decreases in availability. Here is what will be happening with general surgery.

Demand-side facts

The current population of the United States is about 311 million people. Estimates are that by 2020, it will rise to over 340 million.

As baby boomers age, the increase …

For doctors who suffer from burnout, the ultimate tragedy is suicide

Jan Henderson, PhD

Physician

September 17, 2011

The British medical journal The Lancet surveyed a number of studies that discuss troubling statistics on suicide and depression among American physicians. The subject is not new, but the studies attempt to provide a few new insights.

A 2004 analysis in The American Journal of Psychiatry found that male doctors were 1.41 times more likely to commit suicide than other men. The statistic for female doctors was significantly higher, …

MKSAP: 81-year-old man is evaluated for the gradual onset and progression of memory loss

mksap

Conditions and Diseases

September 17, 2011

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

An 81-year-old man is evaluated for the gradual onset and progression of memory loss over the past year. He says he has difficulty recalling the names of familiar people, has misplaced his wallet on numerous occasions, and is slower to find his car in large, crowded …

The root cause of why our health system is unsustainable

Donald H. Taylor, PhD

Health Policy

September 16, 2011

An excerpt from Balancing The Budget is a Progressive Priority.

It is our cultural fear of death and inability to discuss the limits of medicine to forestall death that enables the politics of health reform to be so potent.

When I did a post-doctoral fellowship in England in the mid-1990s, a professor I met who had lived in the U.S. explained to me why he thought health policy discussions in that nation …

Free medical school may not help the future of primary care

Colin Son, MD

Physician

September 16, 2011

In an op-ed appearing in the New York Times on May 29th, Drs. Bach and Kocher lay out a plan for making primary care more attractive to medical students. They propose the following: “Under our plan, medical school tuition, which averages $38,000 per year, would be waived. Doctors choosing training in primary care, whether they plan to go on later to specialize or not, would continue to receive the …

The inability to locate price anywhere in the hospital

Eric Lespin

Patient

September 16, 2011

A torn meniscus. It did not disable but it impaired, and unpredictably. My stomach learned quickly to tighten at the sound of A.’s peculiar whimper in response to a crippling pain that would shoot through her at seemingly innocuous movements of the afflicted leg. We have health insurance of sorts, the type that will help you keep your home if tragedy strikes, but that does not shield you from the …

Primary care gets caught in the physician pay crossfire

Robert Bowman, MD

Health Policy

September 16, 2011

Major journals have slipped in another article that apparently was designed for controversy and for widespread distribution to media outlets. The New York Times rapidly picked it up. As the nation enters the final months before 29.5% fee cuts for Medicare physician services, there will be many more of these that reach the light of day – too many if this is an indication.

What is common to major journals, media …

Why the family dinner is important for your kids

Nelson Branco, MD

Patient

September 15, 2011

No pediatrician can answer the question: “What’s the most important thing I can do to keep my child healthy?” without listing three of four things. I’m no different, but right now family dinners are at the top of my list. You could argue that immunizations, car seats, bike helmets, 9-1-1, sleep, or good hand washing are just as important, and I won’t disagree. But it’s hard to overlook the overwhelming …

United States health care may need reverse innovation

Kent Bottles, MD

Health Policy

September 15, 2011

The realization that the American health care system must simultaneously decrease per-capita cost and increase quality has created the opportunity for the United States to learn from low and middle-income countries. “Reverse innovation” describes the process whereby an inexpensive innovation is used first in countries with limited infrastructure and resources and then spreads to industrialized nations like the United States.

The traditional model of innovation has involved the creation of …

Patient safety in the elderly staying at home

Steven Reznick, MD

Patient

September 15, 2011

As a geriatrician in a locale with many elderly retirees, I am frequently asked how long mom or dad (or both) can stay in their home and live safely and successfully. It is clearly a complicated issue even if the individuals involved are cognitively and mentally intact, physically capable and financially able to pay for support and help.

There is much to consider. Are the patients physically able to maneuver within …

AMA: A new opportunity to fix the SGR

Peter W. Carmel, MD

Health Policy

September 15, 2011

A guest column by the American Medical Association, exclusive to KevinMD.com.

Every year since 2001 the threat of severe physician payment cuts, imposed by Medicare’s failed sustainable growth rate formula (SGR), have jeopardized the stability of the Medicare system and compromised access to care for patients. And every year – sometimes several times a year – Congress has put in place short-term …

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AMA: A new opportunity to fix the SGR

Patients should care about physician stress and burnout

Kevin Pho, MD

KevinMD

September 15, 2011

Physicians are human, like everyone else.

And when things go wrong, like making a medical error or having a patient die, they suffer like most people would.

Pauline Chen writes about Schwartz Rounds in the New York Times, where, in a confidential environment, doctors and other health professionals can discuss challenging cases.

As Dr. Chen writes, “the discussions that ensue are …

How health reform is reshaping health care markets

Joe Flower

Health Policy

September 15, 2011

The current reorganization of health care could make it better and cheaper for everyone, harnessing real creative and competitive energies to build the “next health care” —or it could lead to local monopolies, higher prices and less real competition where it matters. The many and various moves toward accountability, competition and transparency could defeat themselves.

The theme of the reorganization is clear: new types of cooperation between physicians, hospitals and other …