Physicians writing on KevinMD about the rules they practice under: prior authorization and the algorithms now deciding it, gold card laws, scope of practice and who may practice without supervision, Medicare and Medicaid, the Affordable Care Act, drug pricing, rationing that is done and not named, and the policies that decide which patients get care. Four maintained records draw on this archive: Prior authorization: what physicians say, in their own words, Scope of practice: what physicians, nurse practitioners, and PAs say, in their own words, Race and medicine: what physicians say, in their own words, and Medical ethics: what physicians say, in their own words.
I was reading a medical home advocacy group’s upbeat approach to a recent JAMA study that had found scant benefit in the concept when, suddenly, we tumbled into Alice in Wonderland territory.
The press release from the leadership of the Patient-Centered Primary Care Collaborative (PCPCC) started out reasonably enough. The three-year study of medical practices had concluded that the patient-centered medical home (PCMH) contributed little to better quality of care, lower cost …
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Redesign the medical home to thrive in the real world
The administration has confirmed that the individual policies that were supposed to be cancelled because of Obamacare can now remain in force another two years.
For months I have been saying millions of individual health insurance policies will be cancelled by year-end — most deferred until December because of the carriers’ early renewal programs and because of President Obama’s request the policies be extended in the states that have allowed it.
The …
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Even supporters need to realize that Obamacare needs a fundamental fix
March 2nd through the 8th was National Patient Safety Awareness Week — I don’t really know what that means either. We seem to have a lot of these kinds of days and weeks — my daughters pointed out that March 4 was National Pancake Day — with resultant implications for our family meals.
But back to patient safety and National Patient Safety Awareness Week. In recognition, I thought it would be useful to …
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Patient safety and the human toll of inaction
Next in a series.
You the patient are really not the customer of the physician. Since the insurer will determine whether and how much the physician will be paid for attending to your needs, you are largely a bystander in the relationship. The doctor’s customer has become the insurer.
Our system of care is definitely not customer-focused. Doctors truly believe that they have the patient’s best interests in mind and they …
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The doctor’s customer has become the insurer
I truly enjoy the practice of medicine. The challenge, the complexity, and the constant evolution, combined with the opportunity to continually, positively, and substantially affect people’s lives should lead to an exciting career.
However, the economics of medicine as a business have sapped much of this enjoyment for everyone involved.
As the government strives to save health care dollars, the hospitals and insurance companies gear up their high priced lobbyists to guide …
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Why doctors would make good plumbers
Comcast recently announced it is merging with Time Warner, the 2nd largest cable company in the US. Together, this deal nets Comcast an estimated 57% of the cable subscriber marketplace and heralds a new oligarchy in US media and entertainment. It’s big news for Comcast, but aren’t as excited.
Why?
Because both Comcast and Time Warner have been consistently rated the worst providers of customer service in the cable industry. Now as they …
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The consolidation of health care: 5 questions to ask
A guest column by the American Medical Association, exclusive to KevinMD.com.
It’s crunch time for our nation’s physicians. After an 11-year battle, we stand closer now than ever before to repealing Medicare’s fatally-flawed sustainable growth rate (SGR) formula.
With the introduction of the SGR Repeal and Medicare Provider Payment Modernization Act of 2014 last month, Congress took a critical step toward reforming the nation’s …
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AMA: Urge Congress to repeal the SGR now
“Hey doc, I saw on an ad on the TV last night about this new asthma inhaler. Shouldn’t I give it a try?”
This type of question would occur several times a week. When I started practicing medicine it was considered unethical to advertise medical treatments. Now, we’re bombarded with enticements for tests and treatments. The inhaler the patient requested cost $264 a month — more than double what he was …
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The medical industrial complex and the surge of health costs
The Republicans have an alternative to Obamacare and they may have given the Democrats a big political gift.
The proposal was unveiled by Republican Senators Richard Burr (NC), Tom Coburn (OK), and Orrin Hatch (UT).
The Republican plan targets many of the most unpopular parts of the Affordable Care Act such as expensive mandated benefits and the resulting lack of choice, the individual mandate, the employer mandate, and age-rating disruptions.
My sense is that most …
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An analysis of the Republican alternative to Obamacare
As an internist (yes, I am a specialist, just not a subspecialist), I do no procedures. Patients pay me (albeit mostly indirectly) for my cognitive skills. But we live in a culture that seemingly rewards procedures more that pure cognition. Now I understand that procedures are not mindless. Physicians doing procedures must think prior to the procedure, during the procedure and after the procedure. But cognition without procedures seems undervalued.
The …
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Solving the physician income disparity
Next in a series.
We have a real paradox in American health care. On the one hand we have exceptionally well educated and well trained providers who are committed to our care. We are the envy of the world for our biomedical research prowess, funded largely by the National Institutes of Health and conducted across the county in universities and medical schools. The pharmaceutical and biotechnology industries continuously bring forth …
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The real paradox in American health care
You may never have heard the name of Dr. Charles R. Denham until the Justice Department alleged he took nearly $12 million in kickbacks from CareFusion Corp. to influence a national guideline for a product hospitals buy to prevent infections during surgery.
But you surely know the names the radiation-oncologist-turned-activist-and-entrepreneur rattles off as those with whom he has worked. They include organizations such as the Centers for Disease Control and Prevention, the Cleveland …
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The scandal that rocked the patient safety movement
Is anyone else frustrated with the business of medicine? I guess that’s a stupid question. But really, when you were training to become a physician, what were your goals? For me, I wanted to have a career that was meaningful, interesting, and at the same time provided a good living for myself and my family. Growing up, I was always told to strive to become a doctor or a lawyer. …
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Maybe medicine isn’t really a business after all
When you go shopping, everything has a price tag. Buying a new car is challenging, but ignoring dealership costs may result in sticker shock when you receive the first payment notice three weeks later. Few of us would ignore costs this way.
In actuality, this happens everyday in health care as we interact with medical professionals, have an examination, and are given treatment without knowing the price.
Headlines alert us how health …
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What is the price of that medical test?
8:00am Sunday: You glance over and notice an email from your boss while you’re eating breakfast and reading the paper. Ok, you think, I’ll respond later, maybe after my run.
8:10am: Ping! A text arrives. “I have a question about the project.” Ok, you think, it’s Sunday, but sure, I’ll get back to him after breakfast.
8:20am: The phone rings. It’s him. “I’ll need that slide for tomorrow’s presentation. How soon can you get it to …
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Doctors need to stop working 24/7
Medicare’s Sustainable Growth Rate (SGR) payment formula has hung like an annual albatross around the necks of physicians, Congress, and medical associations for more than a decade. Finally, we have a realistic opportunity to fling that albatross into the sea.
Three congressional committees — from both the House and the Senate, with both Democratic and Republican support — have crafted the SGR Repeal and Medicare Provider Payment Modernization Act of 2014, …
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SGR repeal: A marked improvement over the status quo
I recently asked if Obamacare was unraveling.
The Obama administration announced that they are delaying the employer mandate again.
In the announcement, they said that large employers, those with at least 100 workers, will only have to cover 70% of their otherwise eligible workforce in 2015 and 95% in 2016 and beyond.
The administration also said that employers with 50 to 100 workers will have their mandate to provide affordable health …
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Obamacare: What will the administration back off on next?
We all know that health care costs in the U.S. are too high. But why is American health care so expensive? Some experts blame the desire for profit. Russell Andrews, a neurosurgeon and author of Too Big To Succeed laments “the morphing of American medicine from a function of a humanitarian society into a revenue stream for health care profits, drug and medical device companies, hospitals, and insurance companies. In …
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Profits are not to blame for health care costs in the United States
