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’ve just come back from my semi-annual renewal in my belief that family medicine is the foundational solution to make healthcare more affordable in America: the interim session of the Texas Academy of Family Physicians. The most important activity at these meetings is the networking: the chance to bounce ideas and experiences off colleagues from around the state.
The issue of cost came up and two colleagues in private practice told …
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The unintended cost consequences of patient centered care
Fed up with our health care delivery system? Maybe even angry? What should a person do? What can a person do?
I recently wrote a post on drivers of change in health care delivery such as the aging population, adverse lifestyle behaviors, shortages of physicians and developing consumer expectations. I planned to follow up today with what those drivers will produce as change in the delivery system. But a commentator responded …
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Take charge of your healthcare quality and costs
Imagine you’re a physician, and you have a full schedule of patients to see the day after the Supreme Court has thrown out the entire Affordable Care Act. Imagine you never liked “Obamacare” in the first place, so you are feeling pretty good about the Supreme Court decision.
Your first patient, an elderly retiree named Mrs. Jones, comes in for her annual Medicare wellness visit—one of the new Medicare preventive benefits …
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Chaos for doctors if the Affordable Care Act is struck down
When DrRich decided to become an electrophysiologist over 30 years ago, it was because he wanted to help figure out how to prevent sudden death. Sudden death from cardiac arrhythmias is estimated to kill over 300,000 Americans each year, and at the time, some of the more recent victims of sudden death had been DrRich’s friends or loved ones. Because cardiac arrhythmias – even the lethal ones – can virtually …
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Why sudden death is good public policy
The American Board of Internal Medicine (ABIM) and nine other professional medical societies announced that doctors should perform 45 tests and procedures less often than currently done because there is no good medical evidence that they add any value. Specifically, a xray or other imaging for low back pain in an otherwise healthy individual or an EKG as part of a routine physical, just add a lot of unnecessary cost …
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Who’s responsible for bending the health care cost curve?
Physicians from all corners of the country will be receiving refund checks by mid-April totaling nearly $200 million. The checks are not a tax season windfall courtesy of the IRS. The payments resulted from a record-breaking settlement that concluded a historic court challenge led by the American Medical Association against UnitedHealth Group.
Under the terms of this landmark settlement, UnitedHealth agreed …
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AMA: Physicians’ day in court has a lasting legacy
Physicians have historically been fairly well compensated for their efforts and thus have enjoyed many of the comforts of modern life. Most would agree this is the result of years of hard work, perseverance, intellect and dedication. In general these are also traits along with professional integrity, which raised physicians to a position of relative prominence and trust within our society. But in recent years that social position and economic …
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Does contracting with third party payers compromise ethics?
The pressures mounting on most institutions as the years trudge by are mounting. They are mired in mountains of regulations, the need to implement millions of dollars of IT “improvements,” streamline their most productive service lines, strip down their front-line staff to dangerous levels … and all this while their reimbursements are being crushed.
Consider that a profitable hospital currently operates on a 1% margin.
Consider that the hospital is considered the most costly …
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Why your local hospital may not be relevant in the future
The next time I receive medical care, I want to know how much it will cost before I agree that it will be done — and that includes no matter who pays the bill.
And, doctor, I want you to know and I want you to care how much what you prescribe is going to cost me or somebody.
You say it is beyond your control to know? I say, insist.
Rise up, …
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Why we need an economic informed consent
Recently I had the privilege of travelling to Vancouver, British Columbia to attend the inaugural BC Forum of the Canadian Coalition for Global Health Research. We had a wonderful host in the Department of Global Health of Simon Fraser University (and especially from Drs. Craig Jones & Vic Neufield). It was a challenging and pivotal conference for me.
That is not what I want to share now. The conference started with …
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Health comes from community
Have you ever owned a dog? If so, did you ever take him to the vet? I’m sure that even if you don’t own a pet, you understand the gist of the question, but now I’d like to ask it again in a different way. Before taking your animal to the doggie doctor, do you ask the little guy which vet he wants to see, or what treatment he wants …
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Why American health care is inching closer to veterinary clinic status
Back in 2000, a group of experts convened by the Agency for Healthcare Research and Quality (AHRQ) reported that, although substantial medical error and injury was occurring in the ambulatory setting, very little research had been done to understand the reasons why.
To address what they recognized as a serious issue, this expert panel made 11 specific recommendations that were intended to stimulate research in this area.
Fast forward to the present …
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Improving patient safety in ambulatory care
Here’s something I read recently in a blog post (The Limits of (Neuro)science at Neuroskeptic) that started me thinking: “Will science ever understand the brain? … The notion that humans are complex and hard, while nature is easy, is an illusion created (ironically) by the successes of reductionist science. Some of the biggest questions facing mankind for eons have [been] answered so well, that we don’t even …
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Is medicine a science?
More chronic illnesses, more diseases of old age, consumers demanding more quality and safety, physicians no longer in typical private practice, and high deductible health care polices are each about to cause major changes in the practice of medicine and how it is delivered to patients. Will this come about smoothly or, more likely, with some serious hand wringing?
Health care delivery will change substantially in the coming years. This is …
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Disruptive changes are coming to the delivery system
A recent survey by Deloitte of physicians opinions on health care reform has drawn some very differing conclusions from partisan commentators.
The 501 physicians answered a number of questions, the most notable of which included a dichotomous question on whether the Affordable Care Act was “A good start” or “A step in the wrong direction.” The question was split 44% to 44%. All respect for Mr. Pollack and Dr. Murthy writing …
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Will physicians ever support the Affordable Care Act?
Medicare needs to cut costs. It has chosen methods to cut costs that will damage the basic health care services needed by most Medicare patients. And instead of calling this cost cutting, it uses terms such as “shared savings.” Even worse, the “shared savings” will result in even less health spending in United States locations that already have lowest health spending. Innovative designs are not the problem. The problem is …
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The basic health needs of most Medicare patients left behind by design
Last June the American Academy of Family Physicians (AAFP) sent a letter to the AMA’s Relative Value Scale Update Committee (RUC) demanding specific changes to the ways that the RUC conducts its business. Primary care has been severely compromised by the RUC’s recommendations, and there was an implicit threat that the nation’s largest medical society would withdraw if the demands were ignored.
I co-authored a Kaiser Health News article in …
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Should family physicians leave the RUC?
Up until now, I hadn’t considered to write an article on healthcare reform simply because of the divisiveness and the complexity of the issue. But after listening to the Supreme Court session and the arguments made on both sides, I can’t help but comment on one popular argument that continuously resurfaces. Yes, it’s the infamous “broccoli argument.”
In short, the argument states that if government were given the power to force individuals to …
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What does broccoli have to do with health reform?
