“Thank God you’re still here, Doc! It looks like they already laid off half the pharmacy department! The line is out the door!”
“Don’t worry, Mr. Golati! It’s just a regular day at the VA!” I replied.
October 1st at the VA Hospital was like every other day in most ways. It was still hard to find a parking space in the far-too-small lot. The hallways still bustled with white coats, smiling vets, …
A day at the VA during the shutdown
As deliberations over how to make healthcare more cost-effective continue to play out in forums across the country — from the U.S. Congress to state governments to health systems and hospitals — it strikes me that we are paying insufficient attention to what should be an obvious consideration – the cost of supplies.
Supplies run the gamut — from operating tables, artificial knees, intravenous solutions, and wound dressings to bed linens, …
To cut hospital costs, look at the supply chain
Due to ever increasing health care costs, stakeholders in the health care system rely heavily upon front-line workers to assist in containing costs to help make health care more affordable. Since nursing is the largest sector of front-line workers, the field has an opportunity to greatly impact cost containment. Currently, there are 2.7 million nurses in the workforce, with an expected growth rate of 26% over the next decade; however, …
How nurses can help contain health care costs
I recently saw an article about Vanderbilt University Medical Center’s nursing staff.
The administration there came up with the brilliant idea of cutting back on the housekeeping staff and making nurses do some of the cleaning, though it’s not specified how much. Nurses would be expected to take out the trash and linens, and mop up spot cleans on the floors, among other things.
They …
Nurses are too afraid to speak up in their organizations and be vocal
The anticipated and dreaded letter from my health insurance company arrived yesterday.
Dear Member:
We are writing to let you know about some important changes to your individual health insurance coverage … Your health insurance plan will no longer be available after December 31, 2013.
We very much want to continue serving you and so have selected a new ACA-compliant Regence plan for you. Your new plan has more benefits and a different …
What Obamacare means to my family
Healthcare markets are complex and confusing places. But one fact is simple and straightforward: all else equal, hospitals and emergency departments are a lot more expensive than outpatient clinics. Which makes it all the more bewildering that so many low income patients prefer hospitals over primary care clinics.
Bewildering until now. Shreya Kangovi and colleagues at the University of Pennsylvania interviewed low income patients and discovered some fascinating reasons why they aren’t …
Don’t blame low income patients for seeking care from hospitals
A recent post observed that the “highly charged scope-of-practice” fight between the medical and nursing professions has resulted in social media hate speech — too often, from physicians directed at other physicians. “Like bees to nectar, a post on the topic is sure to draw dozens of anonymous, hate-filled comments” write the authors. They propose the following “principles for civil discourse” which I believe should apply more broadly to all social media …
Renewing the dialogue between the medical and nursing professions
The Centers for Medicare and Medicaid (CMS) sets the rates all physicians get paid and insurance companies base their rates on the same formula. So who creates the formula? Well, it’s the doctors, silly! Or at least some of the doctors. Here’s how it works.
A 31-member committee formed by the American Medical Association is made up of representatives from the various specialty societies. This Relative Value Update Committee (RUC) meets …
The relative value of how physicians are paid needs to change
Medical science is making such remarkable progress that soon none of us will be well.
-Aldous Huxley
The recently completed conference, “Preventing Over Diagnosis,” was easily the most important meeting I ever attended. Sponsored by the British Medical Journal, Consumer’s Reports, and Dartmouth and Bond Universities, the goal was to identify the excesses in medical care and to figure out how to correct them.
The evidence is compelling that we in the developed countries …
Defeating overtesting: Right sometimes does bring might
Soon, millions of uninsured Americans will be able to enroll in qualified private health insurance plans offered through their state marketplaces, with federal dollars to help them afford it. The state marketplaces, created by the Affordable Care Act (Obamacare) will begin enrolling eligible people on October 1, and eligible persons will have until March 31 to sign up. The coverage and subsidies for those who sign up will start on …
How physicians can fight obstructivism over Obamacare
The main purpose of health reform, said the president at a recent press conference, was to provide health insurance to people at affordable rates. He meant the nub of Obamacare — the state shopping exchanges with their smorgasbord of insurance policies — would give coverage to millions of Americans who did not have insurance.
Whether that coverage will be affordable or comprehensive for families remains to be seen. What is crystal …
Who gets left out of Obamacare?
The Affordable Care Act (ACA), aka Obamacare, is law. And its implementation is moving along slowly, but steadily.
You have to give credit to the folks who believed in it, whether grass-roots supporters or highly placed politicians. They rammed it down the American gullet like a lead ball down the muzzle of a Hawken rifle. The problem is, once it goes off, the whole thing is going to explode.
The reasons are …
The Affordable Care Act ignores simple issues of human nature
In 2008, a couple of years before the Affordable Care Act became the law of the land, Donald M. Berwick, MD, and his colleagues at the Institute for Healthcare Improvement (IHI) introduced the Triple Aim concept and set to work on ways to (1) improve population health, (2) increase patient satisfaction and (3) reduce per capita healthcare costs.
In pursuit of these goals, IHI encouraged the exploration of a variety of …
The Triple Aim is vital to our collective health
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A guest column by the American Medical Association, exclusive to KevinMD.com.
The administrative burden of being a physician continues to fuel discontent among doctors. The unfulfilling interface with the insurance bureaucracy is a major contributor to physician dissatisfaction. But not all health insurers are equal when it comes to hassle factors imposed on physicians.
New data released by the American Medical Association (AMA) ranks …
AMA: The administrative burden of being a physician
In coming years the US could see growing shortages in the availability of primary care physicians (PCPs). With the number of individuals seeking care increasing and the current medical system continuing to incentivize physicians to specialize, the number of available PCPs will decline proportional to the population. To fill that gap, Ezra Klein and others have asserted that expanded scope of practice will allow nurse practitioners (NPs) …
The NP vs MD debate is missing the bigger picture
What follows are not complaints. These are just the facts.
Here’s a recent exchange from an enlightened physician leader, one who has yet to give up: “My colleagues are discouraged and frustrated every day, leaving the office defeated and fatigued. There are other ways to practice.”
High health care costs get most of the attention, but there’s a more important crisis coming your way.
First a review, then to the looming crisis.
When Americans travel …
Can American doctors get off the hamster wheel?
An enemy intent on ruining the U.S. economy and sabotaging our public health could do no better than burden us with our current system of health care. The crushing costs of our health expenditures almost double per person those of other developed countries, with health outcomes that fall somewhere between mediocre and lousy.
There is no single cause for our medical fiasco and no single cure — especially since all solutions …
Use the Internet to create a competitive medical marketplace
Apparently the Affordable Care Act has inspired panic among some physicians groups worthy of the fear historically reserved for deadly epidemics. From the articles I read, these groups are wringing their hands in hysteria over what to do and how to survive. One solution that has apparently gained popularity in these circles is the launching of campaigns against one of the most logical solutions, nurse practitioners.
Last fall, the medical association …
In the battle for primary care, both doctors and nurses are to blame
In the midst of the sea of change that is health reform, one thing has become increasingly clear: high utilizers of our health care system matter. A lot. Increasingly, local and national innovations have cropped up to identify the most costly patients, intervene to decrease their usage and, thus, ratchet down their cost to the system over time. To some, this approach is one of our greatest hopes of bending …
High utilizers of our health care system matter
We have now entered a world where most the obviously good ideas are already taken. Someone has already invented the chair. Someone has already invented the desk. The spaces where innovation will occur now are in the crevices of where academic disciplines come together. By using paradigms from behavioral economics, I believe physicians and public health officials can navigate this uncharted interdisciplinary terrain to solve the U.S.’s current obesity problem.
In …
A behavioral economics approach to solve obesity
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