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.
by Mike Himowitz
When you’re advocating for a health cause, can good news be bad news?
It’s entirely possible — when science threatens fund-raising, and at the worst possible time.
Consider a study of worldwide maternal death rates by a team from the University of Washington that appeared online recently in The Lancet.
The group, led by Christopher Murray, of the school’s Institute for …
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Maternal death rates improve but hurts fund raising
Jim called me late on a fall afternoon to report our mutual friend was in the local emergency room. “It looks like he had a stroke”. I immediately asked to speak to the ER doctor for the results of the CAT scan I knew would have been done. There were two metastatic tumors in the brain.
It has been over two years since my friend died. He was among the millions …
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Health reform may mean meaningful changes for physicians
by Diana E. Lee
The cost of therapy and medication for underinsured people are common barriers keeping people from getting treatment for a mental health problem.
Although there are community mental health centers that provide treatment for many people, their resources are stretched far too thin to help everyone who needs treatment on the level someone with a more serious issue may need. One of the most positive changes that will arise …
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How health care reform will affect mental health
by John Fauber
Paula Oertel’s brain tumor disappeared for nine years while she was on a drug not approved for her condition. The tumor returned when a move to a new home triggered a Medicare review — and subsequent denial of coverage for the experimental treatment.
Now Medicare officials have decided she will be allowed to go back on the drug.
“I am hoping …
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Medicare reverses a brain tumor drug decision
Health care reform continues to be a key political topic of discussion in the U.S. Physician supply and specialty training are important elements in designing an efficient system that provides the highest quality of care.
To understand where U.S. physician supply and specialty training is headed, I examined the U.S. trends from 1990 to 2007 (latest year data is available).
Physician supply has been growing during this period. In 1990, there were …
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Physician supply trends for primary care doctors and specialists
A guest column by the Texas Medical Association, exclusive to KevinMD.com.
by William H. Fleming III, MD
So we have this new health law that’s intended to provide better health care access for most Americans. Many of the reforms rely upon the sustainability and effectiveness of Medicare.
Medicare, however, is doomed to failure unless Congress fixes a fundamental problem existing within the current program — the Sustainable Growth Rate (SGR) formula. The …
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Texas Medical Association: Stop the Medicare meltdown
Contrary to popular belief, those without health insurance are not flooding emergency rooms as a consequence of being cut off from routine and preventive care. Actually, frequent visitors to the local ER are far more likely to have insurance according to a new review of 25 studies on ER use published since 1990.
Frequent users account for about 8% of ED patients but 28% of visits. Although frequent …
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Health reform won’t help the ER
Across the country, state Medicaid health insurance programs serving low-income children and families, people with disabilities, and older adults are struggling in an environment of chronic underfunding.
Consider that, nationwide, at least one child in four relies on Medicaid for health coverage. Medicaid funds healthcare services for two out of every five births and fills in gaps in Medicare coverage for the elderly and disabled.
But inadequate payments and outmoded methods of …
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Medicaid physician payment rates hurts primary care doctors
I congratulate President Obama and the Democrats on their historic health reform achievement.
Will this bill be able to win approval as it runs the parliamentary gauntlet? Is it an act of political suicide that will become manifest in November? Will it bankrupt the country because of lack of cost controls?
Regardless of where one stands, the bill is a political act of vast ambition and colossal risk.
Now may be a good …
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Health reform winners and losers, and how it affects doctors
by Joyce Frieden
Most patients who visit the emergency department (ED) four or more times a year have health insurance and a primary care physician, a review of the literature found.
“The uninsured represent only 15% of frequent users and are no more likely to be frequent users than they are to be occasional ED users (<4 visits/year),” Eduardo LaCalle, MD, MPH and Elaine Rabin, MD, of the Mount Sinai School of …
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Patients who visit the emergency department have insurance
While the health reform bill will have many effects, one of its most profound will be to unshackle the Centers for Medicare & Medicaid Services (CMS).
Under the legislation, CMS is now far freer to undertake a variety of pilot programs and demonstration projects designed to improve quality, safety and efficiency, and to convert the successful ones into policy. And, if that wasn’t enough for those who have long been praying …
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Don Berwick to lead Medicare and Medicaid
by John Fauber
For nearly a decade, Paula Oertel’s brain tumor was kept at bay by a drug that was not approved to treat her condition. Then Oertel did something she never imagined would jeopardize her health.
She moved — less than 30 miles — from one county in Wisconsin to another.
That move triggered a review of her health insurance from Medicare, which eventually led to a loss of coverage, including …
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Medicare denies a brain tumor drug after a patient moves
Obamacare faces a shaky future because of its call for an individual mandate. This mandate requires people to buy insurance or face income tax penalties, which the IRS would presumably enforce.
As I write, attorney generals in 35 states are in the process of challenging the individual mandate as unconstitutional.
The individual mandate issue is important. Kill it, and you kill Obamacare.
Why? Because the individual mandate is the political mechanism for controlling …
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The individual mandate may collapse health reform
In the Journal of the American Medical Association on May 15, 1991, in our first of many theme issues dedicated to “Caring for the uninsured and underinsured,” I wrote: “An aura of inevitability is upon us. It is no longer acceptable morally, ethically, or economically for so many of our people to be medically uninsured or seriously underinsured. We can solve this problem. We have the knowledge and the resources, …
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Medicare for all may be next for healthcare reform
by Emily P. Walker
A physician profiling method used by private insurance companies to steer patients toward lower-cost physicians isn’t reliable, researchers found.
According to a study published in the March 18 issue of the New England Journal of Medicine, 43% of physicians who are ranked as “lower cost” doctors according to a common formula used by insurance companies are not actually treating patients for any less than physicians with comparable …
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Insurance companies fail at rating physicians on cost
The health reform legislation was decidedly unpopular, with a variety of polls showing the majority disapproved of the bill.
What did the people want?
The ACP’s Bob Doherty linked to a post by Princeton’s Uwe Reinhardt, who observed 10 things that the public wants in health care reform:
1. Lets only patients and their own physicians determine how to respond clinically to a given medical condition, never an insurance clerk or, even …
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How health reform can be popular with the American public
