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Doctors receive no training on coding, which makes them prone to fraud

Physician

March 16, 2011

How much attention do you pay to your Evaluation and Management (E&M) Coding practices?

E&M codes represent the type, setting, and complexity of services provided and the patient status, such as new or established. Providers are responsible for ensuring that the codes they submit accurately reflect the services they provide.

According to the Office of the Inspector General (OIG), Medicare paid $25 …

Health costs need to be addressed by doctors, patients, and lawyers

Kevin Pho, MD

KevinMD

March 15, 2011

It’s no secret that our health system encourages doctors to order too many tests. Compounded with the widespread belief that more tests equates to better medicine, the reasons why health costs are spiraling out of control aren’t a secret.

In a perspective piece from the New England Journal of Medicine, physician Sean Palfrey notes our dire situation:

Recent advances …

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Health costs need to be addressed by doctors, patients, and lawyers

Do Not Resuscitate and the need for a central line

Ralph Gordon, MD

Physician

March 15, 2011

Just the other day I was called to see a patient coming up to the Intensive Care Unit with a diagnosis of pneumonia. Upon my arrival the patient is “hanging in there” with the blood pressure in the 60’ and 70’s systolic.

This is a no-brainer situation – the patient is in sepsis and septic shock.

Early intravenous antibiotics and aggressive resuscitation is what this gentleman needs right now. Per the ER …

Why this medical student found primary care awesome, and boring

Suchita Shah

Physician

March 15, 2011

I recently finished another 5-week clinical rotation. This one was primary care (outpatient internal medicine +/- family medicine).

First a few words about primary care as a field: I found it to be both awesome and boring.

It was awesome because I was the “doctor.” I had essentially full responsibility for my each patient. From calling him in from the …

Why this patient recommends her family physician

WarmSocks

Patient

March 15, 2011

“Do you know a good doctor?” is a question tossed around in conversation sometimes. If the person is reasonably nice/intelligent, I’m happy to hand out my doctor’s name and phone number.

Recently, I referred more friends to my all-time favorite doctor. Instead of just taking his name and phone number, the couple wanted to know why I like him. That’s a fair enough …

How to prevent suicide in physicians

Kevin

Physician

March 15, 2011

by Zakari Tata, MD

Many articles have been written on physician suicides. Yet nothing practical has been implemented. The problem is probably much larger than reported, as families will try to avoid publicity where possible.

In medicine, just as in the rest of society, people diagnosed with depression are wrongly labeled as weak, and discrimination, especially the subtle passive …

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How to prevent suicide in physicians

Alternative medicine problems patients need to know about

Alex Lickerman, MD

Medications

March 14, 2011

Americans spend an astounding 34 billion dollars on alternative medicine annually. Given that so many of us put our faith in alternative care, I wanted to clear up some common misconceptions about it to help people make wiser choices when and if they turn to it.

What is alternative medicine?

In general, alternative medicine is used to describe practices outside the bounds of conventional medicine. …

ASA addresses drug shortages to ensure patient safety

Kevin

Medications

March 14, 2011

A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.

by Arnold J. Berry, MD, MPH

Drug shortages continue to impact patients across the nation. Over the past year, anesthesiologists have been faced with the challenge of finding alternatives for several unique drugs needed to safely provide anesthesia for patients having surgical, diagnostic or therapeutic procedures.

Anesthesiologists have …

How to help autistic or delayed children behave and learn

dr_som, MD

Conditions and Diseases

March 14, 2011

Here are ways doctors can help autistic or delayed children behave and learn.

I certainly do not mean to trivialize the behavior issues that erupt as typical children develop, but the problems of atypical kids are more difficult and less likely to be fully addressed by general pediatricians and society at large.

1. Understand the ABCs of behavior. Antecedent = What happened immediately before the behavior? Behavior = A description of the …

TMA: Vaccines, autism, and Andrew Wakefield’s wake

Kevin

Conditions and Diseases

March 14, 2011

by Steve Levine

The sad story of the fraud Dr. Andrew Wakefield perpetrated on the world’s autism community lies at the intersection of my personal and professional lives. Could these latest revelations be the final chapter?

As chief of communications at Texas Medical Association, I promote the …

Bullying among nurses needs to stop

Sarah Beth Cowherd, RN

Patient

March 14, 2011

I do not wish simply to use the buzz word of the hour. Nor do I wish to assert that I have all the answers.

I genuinely desire to bring to light an interesting conflict that has plagued the nursing profession for decades.

Bullying.

Why in a profession centered around the concepts of compassion, caring, and healing has a mindset of bullying permeated the culture. Even more confusing is that most often, this …

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Bullying among nurses needs to stop

Danger of multiple emergency room visits to different hospitals

Jeffrey I. Kreisberg, PhD

Patient

March 13, 2011

If you are one of the more than 100 million Americans who visit emergency rooms (ER) at least once a year, you’re not alone.

Americans, insured and not, make ample use of hospital emergency rooms. One out of every five visited an ER at least once in 2007, the latest year for which the National Center for Health Statistics …

The differences between comparative and clinical effectiveness

Kevin

Health Policy

March 13, 2011

by Peter J. Pitts

“Newspeak,” the language of Big Brother, was designed “not to extend but to diminish the range of thought.”

Some well-known examples of Newspeak are Bellyfeel (a blind, enthusiastic acceptance of an idea), Duckspeak (meaning literally to quack like a duck or to speak without thinking), Crimethink (the Newspeak word for thought crime) and Goodthink (or “political orthodoxy”).

Which brings us from the nightmare fantasy of “1984” to the health …

Achieving balance in life with cerebral palsy

Erin Breedlove

Patient

March 13, 2011

As in anyone’s life, the hardest thing to achieve in life is a balance. Whether it’s work, school, home, or play, it’s just plain tough. For those of us with challenges such as cerebral palsy, it brings a new set of challenges. Here’s why.

Task execution takes longer. Where it might take my sister thirty minutes to get herself ready and out the door in the mornings, it will take me …

Withholding liver transplants for Medicaid recipients in Arizona

Gary Levin, MD

Health Policy

March 12, 2011

Governor Brewer’s decision to withhold liver transplants for Medicaid recipients in Arizona should serve as a loud warning to the electorate regarding governmental intrusions into health care financing and health care operations.

The decision was ill advised on the basis of multiple factors. The survival rates differ from one facility to another.

What is the liver transplant survival rate and what information needs to be considered when looking at such numbers?

For example, …

Humility in medicine and our academic training environments

Ken Covinsky, MD

Medical Education

March 12, 2011

I sometimes wonder if we spend too much time talking about professionalism.

It is not that I don’t think we should promote professionalism. Of course we should. But many discussions of professionalism descend into overly academic and scholarly treatises that end up obscuring rather than clarifying the values such discussions hope to promote. It may be a mistake to overly …

Why team based primary care won’t help evidence based medicine soon

Kevin Pho, MD

KevinMD

March 11, 2011

Despite the advances in evidence-based medicine, not every patient benefits.

In a recent column from the New York Times, Pauline Chen looks at a study showing exploring the issue:

For many patients, evidence-based medicine isn’t working. Two-thirds of patients with diabetes, a disease with some of the strongest evidence-based guidelines available, continue to have trouble controlling their blood sugar levels; and only half of all …

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Why team based primary care won’t help evidence based medicine soon

Prevention of disease and monitoring of chronic diseases in a yearly physical

PalMD

Physician

March 11, 2011

When I go to the doctor for my yearly physical (OK, not quite yearly, but…) he puts me through the ringer. He asks me dozens of questions, follows up with more questions, and does a (thorough!) physical exam. Then he takes some blood, and sometimes runs some other tests. The big question is “why”? What are …

What should we expect of a physician leader today?

Stephen C. Schimpff, MD

Physician

March 11, 2011

What should we expect of a physician leader today? I believe it should be something much different than what leaders do now.

Today, a hospital physician CEO might be expected to develop new or improved clinical programs, in part by recruiting the best and the brightest, by building new wings, and by purchasing new technologies. The measure of success would be improved finances as a result of added …

Japan earthquake and tsunami first hand physician account

Kevin

Potpourri

March 11, 2011

An international ACEP member has been giving real-time updates to the ACEP Disaster Section about the developing situation in Japan. He agreed to share the information with the emergency medicine community and will try to continue to provide updates when he can.

by Dr. Takashi Nagata