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.
How are you feeling today? Do you feel a bit under the weather? Maybe you have some aches and pains, or a miserable flu, or maybe you have some chronic condition like diabetes or asthma, or some other ailment. Perhaps you could benefit from medical attention, but then again getting medical care is so darn inconvenient and expensive and time consuming, and everybody knows that our health care system is …
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Health delivery models that require a less costly skill mix
In a time of crisis is when leaders step forward. If our nation faces one crisis, then it is that of the health care system which increasingly is unaffordable and trails other industrialized countries in quality and access. If there was a time leadership was needed then it would be now. As doctors, we should be providing this leadership. No longer can we let others dictate how health care should …
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Doctors need to be the leaders of health care change
Now that states have decided what they are going to do about health insurance exchanges—those new shopping carts created by Obamacare to help consumers find health insurance who do not get it through their employers—the really tough part begins. State and federal governments need to make sure that consumers understand their health insurance choices.
You probably thought that the tough part was behind us. You see, states had a difficult decision …
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Health insurance exchanges will be hampered by choice overload
I recently spoke at the Student National Medical Association’s (SNMA) Annual Medical Education Conference in Louisville, KY. Accompanying me was former SNMA President Bryant Cameron Webb, MD, JD. We covered three main topics in our workshop: medical education, the practice of medicine, and the underserved.
Medical education
Many people believe that there is, or soon will be, a physician shortage. There are nearly 1 million physicians scattered across America representing a ratio …
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Reflections on medical education, medical practice and the underserved
In the past, neither hospitals nor practicing physicians were accustomed to being measured and judged. Aside from periodic inspections by the Joint Commission (for which they had years of notice and on which failures were rare), hospitals did not publicly report their quality data, and payment was based on volume, not performance.
Physicians endured an orgy of judgment during their formative years – in high school, college, medical school, and in …
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Public reporting improves the work of the measured and the measurer
It’s been three years since the Patient Protection and Accountable Care Act (PPACA) became law. There have been widely divergent opinions published by journalists on the impact of the law for Americans: from a rose-colored account from the New York Times, to a not-so-peachy account published at Reason.com. Few doctors have ventured into this discussion.
The need for health care cost reform
I should start by saying that I am biased. I grew up in …
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The Affordable Care Act: Spinning reform without real reform
American Medical News has an important article – Will a “silent exodus” from medicine worsen doctor shortage?
Frustrated by mounting regulation, declining pay, loss of autonomy and uncertainty about the effect of health system reform, doctors are cutting back the number of hours they work and how many patients they see.
Between 2008 and 2012, the average number of hours physicians worked fell by 5.9%, from 57 hours a week to 53, and doctors …
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How the silent exodus will worsen the doctor shortage
It was recently the Affordable Care Act’s third birthday, but you might have missed it for all of the (lack of) attention it received. Sure, there was the usual back and forth from the law’s supporters and opponents, but almost nothing that provided any new insights.
Supporters, such as the liberal New York Times editorial page, marked the ACA’s anniversary by touting the tens of millions already being helped …
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4 hard truths about Obamacare
Even stronger controls have just been set out for HIPAA. They come in the final regulations for the Omnibus Health Insurance Portability and Accountability Act, or the HIPAA rule. The new rules became effective March 26. However, medical offices and business associates have until September 23 to comply.
Mostly, the changes affect patient requests and approvals, breach reporting, and business associates. Along with that, the penalties for noncompliance have gone up. …
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The new HIPAA regulations: Do you know the rules?
People are people, whether they are identified by their career or their role in the healthcare process. So, whether you’re working with a referring physician or a patient, it’s important to consider emotions, their role in the sales process and how they drive and destroy value. One of the most valuable emotions to have in our business is loyalty. Loyalty is what providers work towards with referring physicians and what …
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Loyalty and honesty are key to improving transparency in healthcare
First I believe our health care system must be better so I’m always curious to hear how others might propose to fix it. I recently had the opportunity to listen in two conversations with businessman David Goldhill about how healthcare might be made better. Goldhill lost his father to a hospital acquired infection and witnessed multiple errors during his hospitalization which compelled him to write not only a piece in …
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Can David Goldhill fix healthcare?
We are frequently reminded by the General Accounting Office and CMS that a great proportion of Medicare health costs are incurred in the last three months of a patient’s life. Health care policy experts have tried to reduce these costs by encouraging end of life planning. Living wills, health care directives and the availability of hospice and palliative services will not put a dent in these costs because of human …
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Human nature prevents any cost savings at the end of the life
Several months ago, as I was in the last few months of my private practice, I watched the Joy Luck Club with my wife. I had seen the movie many times before, but somehow at that moment in time, when I was grieving for my practice and my profession, I began to have some startling clarity.
Specifically, I was particularly struck by this dialogue:
I tell you the story because I was raised …
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Primary care has lost its self-esteem
We recently marked the third anniversary of the passage of the Affordable Care Act by reflecting on the positive changes it has brought about and by mulling over the multifaceted challenges that stymie our efforts to build more accessibility, equity, quality, safety, and cost-effectiveness into one of the most complex healthcare systems in the world.
Reining in healthcare costs, a central element in the reforms we seek, is inextricably linked to …
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Are we ready to creatively destroy medicine?
A dark wind is beginning to blow through the tortured landscape of health care in America. At the confluence of the corporate cold front with the warm front of technology innovation, a storm is brewing. A storm that may grow into gentle and much needed rain showers, or the grandest tornado ever experienced by mankind, and unlike the wondrous works of nature, the path taken here is completely within our …
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Does our health system really need doctors?
In 2006, Governor Mitt Romney signed Chapter 58 of the Acts of 2006 entitled “An Act Providing Access to Affordable, Quality, Accountable Health Care.” It has been described by many names, including Massachusetts Healthcare Reform (MHR), Romneycare, or simply, as the template for the Affordable Care Act. The goal of the act was straightforward: to ensure near-universal access to health insurance for citizens of the Commonwealth of …
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Our healthcare system is far more resilient than we think
