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.
Healthcare costs keep rising. Your insurance premiums go up, your deductible and co-pays go up, pharmacy benefits go down. Despite the high cost you get little time with your physician, insurance statements are complex beyond belief and “customer service” seems to be a foreign concept. To combat high costs we are often told that rationing will be necessary. Is that true?
Why are costs so high in this very dysfunctional healthcare …
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Is rationing necessary to reduce health care costs?
Stranded capital is a new term, a derivation of the term stranded costs that emerged from the deregulation of electric companies. It refers to “the existing investments in infrastructure for the incumbent utility which may become redundant in a competitive environment.” Many academic medical centers are weighing the importance of meeting current demand while considering the risk that, in a future competitive environment, dramatic declines could occur in the need …
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Do we have too many hospital beds?
I was recently honored to attend a discussion at the White House, convened by Health and Human Services Secretary Kathleen Sebelius. It was one of those rare “clear my schedule immediately” invitations; I thank my patients and family for allowing me to take this last minute trip.
Physician leaders from around the country were invited to the White House for a dialogue with lead government health officials (specifically administrators from the …
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Our health problems will remain, despite how the Supreme Court rules
There is enormous waste in American healthcare delivery. One estimate is anywhere from 20% to nearly 50% of total expenditures are frankly unnecessary. What is this waste? Is it real? Could it be eliminated or at least reduced? How difficult would such a reduction be to achieve? And what would be the unintended consequences?
Donald Berwick, the former administrator for the Centers for Medicare and Medicaid Services, along with Andrew Hackbarth …
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Reduce health costs by reducing waste
The Medicare physician payment formula is a case-study in failed policy. Physicians have long known that it is not working. Polls show that an overwhelming 94 percent of Americans believe the massive cuts it schedules are a serious problem for seniors. Even members of Congress from both parties agree – and that is no small accomplishment – that it is …
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AMA: Moving past a failed Medicare formula to focus on quality care
The medical profession has always been marked by division: town versus gown, primary care versus specialty medicine, states versus national. But the real fault line today is not defined by specialty, geography, or teaching versus practice, but by size of practice.
Physicians in smaller practices, without regard to specialty or where they are located, are embattled and defensive—and therefore are more skeptical when someone tries to peddle the need for delivery …
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Is there a future for smaller physician practices after health reform?
At the end of long days I often stand gazing out my window at the beautiful, timeless Rocky Mountains in Colorado Springs and am taken by their sense of permanence. I recently returned from Nampa, Idaho, where I presented hospital Grand Rounds on Accountable Care Organizations.
The parallels between the timeless mountains and the physicians I met in Nampa struck me. Strange, you say? Maybe, but I am accustomed to the …
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What does an ACO mean in small town America?
While there is an extensive literature on how tired, overworked physicians provide lower quality medical care, one thing that has been ignored by advocates of quality improvement is that overwork financially harms hospitals as well. Just as tired physicians sometimes fail to attend to certain clinical details, they are also more likely to commit errors when writing the notes which ultimately are used during the coding process. If hospitals consider …
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The influence of fatigue on claim quality
I share this post here to point out the discrepancy in physicians’ average salaries based on their specialties. In particular, I would like to highlight that the three lowest-paid specialties are the three primary care specialties: pediatrics, family medicine, and general internal medicine.
This post is not written to argue that physicians must be paid more. I would submit that if …
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We must redesign our health care payment systems to value primary care
Are you a frustrated patient because you get little time with your physician each visit? Are you a frustrated physician who would like to spend more time but can’t make it work financially? Here are some developing approaches.
Reimbursement rates for primary care visits are low, so primary care physicians (PCPs) need to see many patients to cover office expenses. There are many ways that PCPs are using to escape the …
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Primary care does not need to be expensive
I love it when I see Medicaid patients on my schedule for the day. Working at a community health center, our doors are open to all people, regardless of their ability to pay. It’s hard to run a medical office when you get $20 for a visit, which is what our uninsured patients pay. So when a patient has Medicaid we know we’ll get paid a decent reimbursement for that …
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Isn’t caring for your child worth as much as caring for your parents?
FACT: Four determinants of health account for 40% of all deaths in the U.S. – smoking, unhealthy diet, physical inactivity, and alcohol use.
FACT: A mere 3% of Americans do all of the relatively “simple” things they should to stay healthy – i.e., exercise for 20 minutes 3 times a week, don’t smoke, eat fruits and vegetables regularly, wear seat belts regularly, and remain at their appropriate BMI.
FACT: According to the …
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A population health approach to wellness
Many physicians, including myself, have the misconception that the indigent patient is more likely to be litigious than those patients with greater financial resources. A well-organized study that was reported in Clinical Orthopeaedics and Related Research reported that socioeconomically disadvantaged patients tend to sue physicians less often than their more affluent patients.
Dr. Ramon Jimenez and his colleagues at the Monterey Orthopaedic and Sports Medicine Institute and his team demonstrated that patients …
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Are the poor more likely to sue their doctors?
Recently I was sent this commentary on the issue of health care costs. It seemed like a pretty good summary of the problem to me, though it didn’t delve into solutions or the current controversy about the Affordable Health Care Act. In our country, we’ve built up a huge medical-industrial system that can do lots of good but at a huge cost. It seems that we are on the brink of a …
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Our medical-industrial system is long overdue for a real shakeup
Recently, I had a wonderful opportunity to cruise the Mediterranean and visit some fascinating cities. The land excursions were mind-expanding but quite physical. The rugged terrain and steep hills were not difficult to walk upon because I was in good shape and healthy.
But, what if I wasn’t? Questions raced through my mind such as:
What if I got sick onboard the ship?
What if I got injured?
What type of doctor signs on …
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What American medicine can learn from a cruise ship clinic
Malpractice lawsuits are a necessary evil in our society. At times, they are frivolous, often resulting from a patient’s or family’s anger at a result that was not what they had hoped. Some are actually designed just to try to get a financial settlement. When doctors are sued for malpractice, it is a searing process, isolating and painful. I have known several excellent doctors who have given up established practices …
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The scope of the standard of care in medicine has changed
America has this paradox of excellent biomedical science, innovative drug manufacturers and entrepreneurial device developers along with outstanding providers but at the same time has a dysfunctional care delivery system. A new vision is needed.
Vision is a leadership concept that presents an idea, garners support and then develops the coalitions to bring it to fruition. America needs to envision what its care delivery system should be and then determine, as …
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What should America’s health care vision be?
“It was the best of times, it was the worst of times …”
So begins a story called A Tale of Two Cities by Charles Dickens. Its about the differing responses of two different nations to the revolutionary events and social upheaval of 1775. I’m going to tell a tale of three hospitals. You’ll see why soon.
Today, in 2012, health care systems around the world, including the United States, are launching …
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Hospitals around the world aim to remain relevant to patients
The nation’s “safety net” hospitals are designed to ensure that uninsured, lower income and indigent populations receive adequate medical care – a noble and necessary function within the U.S. healthcare system. No one dedicated to the field of care giving can deny the importance of providing appropriate medical care for this population. The safety net is literally a lifeline for many in need.
But for all of the vital and positive …
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Repairing the tear in health care’s safety net with social media
