I am a little fish in a big sea. And so are most of us. Or we are used to be. For better or worse, the era of private practice, outpatient medicine as we know it, is ending.
And faster than we thought. The choice now: downsize or supersize. No longer can a doctor operate a private practice as a solo practitioner or in a small group practice. We are getting …
Doctors are forced to choose between really small or super big
As the new year starts, I’m eager for a fresh start and working on improving myself both physically and emotionally. I’m also eager for the NFL playoffs and seeing how my favorite team, the New England Patriots, fares under the leadership of Coach Bill Belichick and quarterback Tom Brady. Doctors and health care can learn much from their examples.
Over the past decade, the New England Patriots have been dominant …
What health care can learn from the New England Patriots
Health care is in crisis. Reimbursements from insurance companies continue to dwindle, while the expenses of running an office continue to rise. Looming cuts in Medicare are only weeks away, and many physicians may stop taking Medicare. If these cuts go into affect, it is possible that primary care physicians could lose up to 50% of their salary. Just recently CNN reported that some doctors are going bankrupt.
How …
A concierge or boutique label is discredits retainer medicine
“The moral test of government is how it treats those who are in the dawn of life, the children; those who are at the twilight of life, the aged; and those in the shadows of life, the sick, the needy, and the handicapped.”
We all know that health care in America is too expensive and yet ineffective, falling consistently at the bottom of the rankings of industrialized nations when it comes …
Addressing the needs of the disadvantaged in our health system
About six weeks ago, while in clinic, I developed pain in my stomach — specifically, in my right upper quadrant, just below the ribs. I had experienced this a few times before, but this time it seemed more persistent than usual. Following the rule that physicians make the worst patients, I kept working through it until my nurse told me I looked poorly, and made me see my own primary …
Our healthcare system is unfair and unbalanced
Dear United States House of Representatives and Senate:
I really hope that you enjoy your Christmas break going back home to your families. While you’re home, I really hope that you will hear from those constituents who will be affected by the 27.4 percent Medicare physician pay reduction that is schedule to take effect January 1st. I really hope that the American Academy of Family Physicians, the American Medical Association, …
The patient reality of a Medicare payment cut
How do companies curb health care costs?
Do healthier employees lead to increased productivity? Several progressive companies believe so and have committed to providing employees with programs to help engage them in a healthier lifestyle.
As part of the incentives to lead a healthier lifestyle some employers have instituted a penalty and reward system tied to the companies’ benefits. For example, smokers may incur a significant surcharge to the cost of their …
How companies try to curb health care costs
I met with my staff yesterday to discuss the effect of a 27% cut in Medicare reimbursement on our patients and our office. I had a really lousy day, explaining to my elders what would happen if Congress fails to act. One of my patients aptly pointed out that Congress has not acted responsibly in the last 20 years and that it would take a miracle for them to get their …
Dropping out of Medicare will break my heart
Matthew Mintz, MD recently shared how primary care doctors are set to lose more than half of their salary. It’s well documented how primary care has faced a number of challenges with half of primary care physicians saying they’d leave medicine if they could as was mentioned in an earlier piece. There’s talk of a “doc fix” as physicians believe the debt ceiling deal is …
The primary care doc fix is in
While attending the Institute for Healthcare Improvement Annual Forum recently, my friend, Jared Conley, and I had the good fortune of finding ourselves standing a table away from Don Berwick in a relatively empty conference room. As MD/PhD in Health Policy students, we were interested in asking him a question about ACOs, so we approached him and introduced ourselves, hastily adding, “We know you’re busy, so we just have …
A medical student meets Donald Berwick
In the era of accountable care, you’ll notice that many hospitals and health systems are already driving towards more collaborative workflow. The integrated delivery network (IDN) is changing significantly, and for the better. But in high-acuity care areas, like the emergency department (ED), the challenge of treating patients more holistically in what is already a fast-paced environment is concerning for physicians evaluating the pay-for-performance model.
In today’s ED, patients may …
The emergency department in an ACO world
A guest column by the American Medical Association, exclusive to KevinMD.com.
Last month, physicians from all states and specialties came together for the American Medical Association’s (AMA) semi-annual policy-making meeting to adopt new policies that will impact the future of medicine. Of the new policies, some of the many noteworthy topics include national drug shortages, health insurance exchanges, private contracting and the …
AMA: New policies that will impact the future of medicine
As we approach the end of what has been another roller-coaster year for our country, it seems an appropriate time for an “annual checkup” on healthcare reform in the U.S.
Like many of my colleagues, I have followed the implementation of the monumental Patient Protection and Affordable Care Act (ACA) with great interest, mild trepidation, and a small measure of optimism.
It’s hard to believe that almost two years have flown …
An annual checkup on the Affordable Care Act
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As of March 2010, there were an estimated 11.2 million undocumented immigrants in the United States. Currently, three in ten immigrants are undocumented, while only one in seven of the uninsured is an undocumented immigrant. As there exists no consensus on immigration reform, undocumented individuals will gradually become a larger share of the uninsured population due to exclusion from all programs of the Affordable Care Act.
This study utilized data …
Undocumented individuals will become a larger share of the uninsured
What if we had considered the following items within health care reform?
What if physicians were able to practice medicine with reduced fear of malpractice litigation? Some estimates believe the cost of defensive medicine approaches 30%.
What if patients were to be offered a different process for conflict resolution before litigation, one that is partially driven by greed? What if this process provided a remedy which met all our future financial and …
Health reform that offers relief from fear and greed
If you have read Michael Lewis’ book, The Blind Side, or seen the popular movie based on it, you know that the title refers to the fact that quarterbacks, who are typically right-handed, can’t see when a 300-pound opponent is charging at them from the left side. Not being able to see the full picture puts the quarterback directly in harm’s way and makes it harder for his team to …
A prescription to address healthcare’s blind side
Fortunately, the 27% reduction in Medicare payments to physicians that is set to take place in a matter of weeks unless congress acts is getting some press. Fox News published a piece recently, as did the Washington Post. Writer Merrill Goozner breaks things down nicely in his article, “Is There a Doctor Fix in the House … and Senate?”
However, one thing that seems to be getting confused in all the …
Primary care doctors are set to lose more than half of their salary
My colleagues who advocate improvement to our healthcare often say, “It’s a non-issue. We all benefit from better care.” Yet the political vehicle that’s to drive the reform has stirred emotions and controversy at almost every turn, leaving us baffled. Why wouldn’t anyone want better coverage, lower cost, and more evidence-based treatments? These targeted goals improve healthcare, which is why they poll well. When asked for a general impression of the …
Government and insurance companies should have little say in death
The last four days have provided a sharp glimpse into the future that awaits those of us in the health care profession, physicians in particular. Over the last few years physicians have been burdened with mountains of paperwork, most of which contributes little to patient care, but does take time away that could be better utilized caring for our patients. However, the last four days have demonstrated that the administrative …
Rigid regulation can become detrimental to patient care
Imagine what health care in the United States could look like if we devised a system that was based on sound medical practice and proven cost effectiveness. What if we put our brains, energies and passion behind designing the smartest health care system possible?
That was the question that kept poking through my train of thought as I read a study that appeared in the most recent issue of Pediatrics, the …
A disconnect between medical resources and health care delivery
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