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.
For years, physicians have argued that the specter of annual cuts in Medicare will cause many of them to leave the program, or at the very least, to limit how many new Medicare patients they will accept in their practices. Yet, for the most part, measures of seniors’ access show that the vast majority enjoy good access to care.
For instance, in May of this year, the Medicare Payment Advisory Commission …
Read more…
Will Medicare really lose physicians because of the SGR?
Since 1997 the number of US medical students choosing to go into primary care has decreased by more than 50%.
It seems that sources as diverse as the Obama Administration and the Wall Street Journal think that we should find a way to encourage medical students to choose primary care specialties in order to allow Americans to have the best and most cost effective care. This is very problematic when primary …
Read more…
Pay specialists less to save primary care
by Joyce Frieden
An estimated 30 million women will be helped by the new health reform law over the next 10 years, according to a report from The Commonwealth Fund.
“While women are just as likely as men to be uninsured, they are more likely [than men] to have trouble buying coverage on the individual market,” Karen Davis, PhD, president of the fund, said in a teleconference announcing the report’s release. “This …
Read more…
How healthcare reform affects women
Gordon Gekko is wrong. Greed is not good. Not when it comes to health care providers.
The socioeconomic study of what motivates people is a fascinating field of study, not the least of which is because of how counter-intuitive it is. For example, it seems normal to assume that the more someone is rewarded for their efforts, the more effort they will put forth toward those rewards.
These rewards (increasing salary, bonuses, …
Read more…
Greed is not good when it comes to doctors, patients and medicine
Everybody knows politics is a balancing act. One must balance promises against reality.
For example, how does government keep Medicare intact for seniors while cutting $500 billion out of Medicare when government has no track record of cutting entitlement spending?
And how one do it without losing the vote of seniors, who hold the key to the balance of power?
The Obama administration and the Democrats hope to keep power by winning the …
Read more…
How seniors will accept cuts in Medicare from health reform
Are healthy people patients? Sometimes I wonder.
If you’re healthy, you rarely see a doctor. If you go for a “routine” checkup every five years, you just aren’t very affected by the system. You might not even know what the system is. Your health insurance premium is deducted from your paycheck, so you never really see that money — not the way you would if you had to write a check in that …
Read more…
Can patients demand changes in the healthcare system?
The decade ahead is one likely to be full of turbulence. How everything will shake out is anybody’s guess.
But we can be sure that technology advancements will slow for no one. The rate of medical technology advancement now is very fast and the speed will only accelerate. One big problem is that technology advances so fast that there is no time for a purchase – say new CT scanner or …
Read more…
America has a disease industry, not a health care system
This is a perfect example of why Medicaid is not the same as Medicare:
Having counted on Washington for money that may not be delivered, at least 30 states will have to close larger-than-anticipated shortfalls in the coming fiscal year unless Congress passes a six-month extension of increased federal spending on Medicaid.
Governors and state lawmakers, already facing some of the toughest budgets since the Great Depression, said the repercussions would …
Read more…
Why Medicaid would be better off as a federal program, like Medicare
The topic of balance billing has arisen once again, this time in this post by Movin’ Meat about the new health care insurance bill and emergency medicine.
Without further explanation, “balance billing” is generally thought of as a bad thing; a way for rich doctors to squeeze even more ill-gotten gains from their poor beleaguered patients. And that’s without even realizing what it is. …
Read more…
Understanding balance billing, a primer for patients
Although a majority of Americans probably couldn’t give you an accurate description of the differences between fascism, socialism, and communism, they have no trouble applying–and often interchanging–those labels to any effort by government to reform health care.
And, based on their efforts, one might conclude that the defining characteristic of any government involvement in health care is rationing. As if we don’t already ration, but will as soon as the government …
Read more…
Health care needs public acceptance of evidence based medicine
by Craig A. Umscheid, MD, MSCE
In its 2010 comparison, the Commonwealth Fund has rendered the verdict yet again: the United States leaves other nations in the dust when it comes to healthcare costs — and yet provides its residents with the worst outcomes overall. In the study, the U.S. underperformed on virtually every front in comparison to Australia, Canada, Germany, Netherlands, New Zealand, and the United Kingdom.
The …
Read more…
The value of comparative effectiveness reviews is locally based
My suggestion last year that Massachusetts move away from the “free market” approach it uses to set hospital reimbursement rates was not well received by the hospital world.
But, this year, as people notice that their rates are being set by insurance companies in an unaccountable and unreviewable fashion, more and more are saying, “Well, maybe. What would it look like?”
There is a range of options. Let me lay out …
Read more…
How Massachusetts can set hospital payment rates
Our grandparents used to tell us, “if it ain’t broke, don’t fix it”.
Management gurus, in their race to the finish line have turned this sentiment on its head by telling us that, if it ain’t broke now, it will be soon, and if you do not fix it before it breaks, you will be behind the competition. This sentiment drives the annual corporate reorganization at every corporation that I or …
Read more…
What libraries and community centers have to do with health care
by Charles Smith, MD
Everybody seems to be dissatisfied with the current model of primary care.
Concierge and retainer practices are all the rage, but they serve too few patients. While some highly integrated systems (Mayo Clinic, maybe Kaiser Permanente) may be thriving, they are difficult to replicate. Most primary care physicians are demoralized by a system that overburdens them with administrative hassles and liability while providing insufficient revenue to improve …
Read more…
A new primary care payment model with health savings accounts
The Association of American Medical Colleges predicts that by 2025, the US health system will have 46,000 fewer primary care physicians than it needs.
If the prediction proves correct and we fail to develop effective mitigation strategies, the manpower shortage will create quite a mess. Ironically, the health reform law signed by President Obama in March will exacerbate the problem by increasing demand for services provided by primary care physicians.
The American …
Read more…
Why general internists are quitting clinical medicine
Early in paralytic poliomyelitis, the patient exhibits weakness; hyperesthesia; muscular pain, frequently quite severe; antalgic (reflexive) immobilization (spasm) of involved muscles; and normal or accentuated tendon reflexes.
This phase is rapidly followed by loss of motor function, which is usually asymmetric and noncontiguous: one or both legs in 60 percent of the cases; one or both arms in 25 percent. Involvement of the diaphragm and intercostal muscles reduces ventilatory capacity. Cranial …
Read more…
Poliomyelitis doesn’t make the health reform cut
by Cole Petrochko
The nation’s free clinics provide medical service to 1.8 million patients annually — more than half of those clinics operate without government funding and serve patients who are almost all uninsured — according to the first census of free clinics in 40 years.
Responses to a national mail survey by 764 free clinics in the U.S., reported in the June issue of the Archives of Internal Medicine, revealed that …
Read more…
Free clinics need more government funding
The individual mandate is the single most controversial feature of the Patient Protection and Affordable Care Act (PPACA). Everyone who can afford coverage—unless an undocumented immigrant or exempted on religious grounds—is required to have it or pay a penalty of $695 or 2.5 percent of income.
The rationale is straightforward: without a mandate, many people would wait until they needed care before buying insurance, driving up premiums for those with ongoing …
Read more…
The individual mandate and the impending Supreme Court challenge
by Shelly Towns
Many people have the mistaken idea that “socialized healthcare” means that medicine and care will now be free for everyone, but in all actuality, nothing could be further from the truth.
The new healthcare bill represents one of the largest, most sweeping domestic policy changes in a generation, and aims to provide an estimated $940 billion in healthcare to over 32 million uninsured Americans (and that’s only for the …
Read more…
Healthcare reform: Who’s getting stuck with the bill?
