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.

Should doctors support Congress’ health reform efforts?

Health Policy
July 20, 2009

The American Medical Association recently gave unqualified support to the House health reform bill, H.R. 3200, and that is drawing the ire of some of their supporters.

To be sure, H.R. 3200 is the most left-leaning of the proposals, and there is clear ideological opposition to the so-called “public plan,” which expands the government’s role in our health care system. It’s a tremendously sensitive topic, with some expressing their outrage …

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Should doctors support Congress’ health reform efforts?

Health Care Reform: Putting Patients First, medical bloggers at Washington, DC

Health Policy
July 20, 2009

Well, that was fun.

kevinmd This past Friday, I participated in Health Care Reform: Putting Patients First, an event put together by Better Health’s Dr. Val Jones. It was an impeccably organized gathering, and provided medical bloggers a valuable opportunity to discuss health care reform. Great timing too, given the fact that two major reform bills were introduced earlier …

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Health Care Reform: Putting Patients First, medical bloggers at Washington, DC

Improve primary care access before guaranteeing universal health coverage, my address at the National Press Club

Health Policy
July 17, 2009

The following are my prepared remarks at Health Care Reform: Putting Patients First, held at the National Press Club in Washington, DC, on July 17th, 2009.

President Obama recently declared that, “We are not a nation that accepts nearly 46 million uninsured men, women, and children.” And indeed, finding a way to provide universal health coverage to every American is one of the focal points in today’s health care debate. …

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Improve primary care access before guaranteeing universal health coverage, my address at the National Press Club

ACR: Reducing medical imaging costs requires a short term investment

Health Policy
July 9, 2009

The following is a guest post from the American College of Radiology.

by James H. Thrall, M.D.

Health care reform cannot be approached with a “one size fits all” cost-cutting mentality. Reducing costs in the long term often requires an investment in the short term — particularly, in regard to medical imaging.

Medical imaging saves lives. Imaging also saves dollars through earlier disease diagnosis, less invasive medical procedures, shorter hospital stays, and …

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ACR: Reducing medical imaging costs requires a short term investment

5 top medical comments, July 5th, 2009

Health Policy
July 5, 2009

Here are some of the more interesting comments readers have left recently.

1. Rogue Medic on how Oprah should be handling medical issues:
If she is going to give medical advice, and she is giving medical advice, and she is going to focus on giving advice contrary to the guidelines of reputable medical organizations, maybe some of her viewers need to start suing her for the bad medical advice.

I am guessing …

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5 top medical comments, July 5th, 2009

Can the American Medical Association still be an influential voice in health reform?

Health Policy
June 29, 2009

The repercussions after Obama’s speech to the AMA’s delegates continue to be felt.

Not least of which are the murmurings of the other professional physician groups, who say that the AMA does not represent a majority of physicians. In this piece from pediatrician Rahul Parikh, he notes that about 30 percent of physicians are AMA members. Remaining doctors belong to groups with more liberal political leanings, including the American …

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Can the American Medical Association still be an influential voice in health reform?

ACP: Embracing a culture of cost-effective health care

Health Policy
June 25, 2009

The following is part of a series of original guest columns by the American College of Physicians.

by Steven Weinberger, MD, FACP

In his column in the June 1 issue of The New Yorker, Dr. Atul Gawande used the example of McAllen, Texas, to illustrate the widely disparate spending on health care around the country. This oft cited article captured the attention of President Obama, who reportedly has made it required …

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ACP: Embracing a culture of cost-effective health care

Reflections from the AMA: President Obama’s Speech

Health Policy
June 21, 2009

The following is part of a series of original guest columns by the American Medical Association.

by J. James Rohack, M.D.

We have a historic opportunity for health reform this year and the AMA was delighted to welcome President Obama to our Annual Meeting in Chicago earlier this week. Like the President, we are committed to health-care reform that will provide all Americans with affordable, high-quality health coverage.

I was personally honored …

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Reflections from the AMA: President Obama’s Speech

My reaction to President Obama’s speech to the AMA

Health Policy
June 15, 2009

I was seeing patients during the actual speech, so I had to rely on the transcript.

The points that interested me the most were any language pertaining to malpractice, addressing the AMA’s recent concerns about the public plan option, and reforming the physician payment system.

I think he did pretty well.

Regarding the physician payment system, he again addressed McAllen, Texas, which is fast becoming the symbol of what’s wrong with American …

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My reaction to President Obama’s speech to the AMA

Maggie Mahar: Removing the hazardous waste from healthcare

Health Policy
June 8, 2009

Most of us are now familiar with the estimates that as much as one-third of our health care dollars are squandered on ineffective, often unnecessary, unproven and overpriced products and services. But which third?

The fat in our health-care system is not hanging out conveniently on the edges of the steak, waiting to be trimmed. It will take a scalpel, a keen eye, and a steady hand to remove at least …

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Maggie Mahar: Removing the hazardous waste from healthcare

5 top medical comments, June 7th 2009

Health Policy
June 7, 2009

Here are some of the more interesting comments readers have left recently.

1. David Block on the ACP’s guest column, A practice model for increasing the appeal of General Internal Medicine:
Weinberger talks about the efficiency of Care. Our commentators talk about the efficiency of Consumption. Weinberger assumes the one-on-one of two individuals, known to each other, who together negotiate the terms of personhood. Medicine is “spiritus”; no wonder he became …

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5 top medical comments, June 7th 2009

Physician payment reform is the key to fixing the health care system

Health Policy
June 1, 2009

Changing the way doctors are paid is more important than the debate over the public insurance option, or the arguments over whether we should adopt a single-payer system or not.

Atul Gawande’s recent New Yorker article is a tour de force, and gets down to the core of why American health care is so expensive. I won’t bother summarizing it here – it deserves to be read in its …

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Physician payment reform is the key to fixing the health care system

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AMA: Curbing the rise in health care costs is key to health-system reform

Health Policy
May 14, 2009

The following is the first in a series of original guest columns by the American Medical Association.

by J. James Rohack, M.D.

In an unprecedented endeavor aimed at achieving health-care reform this year, the American Medical Association (AMA) stood with President Obama and other key health-care stakeholders Monday to announce efforts to “bend the spending curve” on health care. U.S. health-care …

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AMA: Curbing the rise in health care costs is key to health-system reform

Op-ed: Unbiased research for doctors is good medicine

Health Policy
March 26, 2009

The following op-ed was published on March 26th, 2009 in the USA Today.

As a primary care doctor, I am frequently faced with decisions where the choice is not always clear. Do the latest, more expensive drugs work better than the less costly, older medications? Will ordering an MRI help me treat a patient’s lower back pain? Often, the answer to these questions is, “I’m not sure.”

Because …

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Op-ed: Unbiased research for doctors is good medicine

Will patients or doctors be the biggest obstacle impeding health care reform?

Health Policy
March 10, 2009

If both patients and doctors don’t accept the changes required of their behavior, no amount of comparative effectiveness studies will cut health care spending.

Two prominent medical journalists write as much in their respective blogs.

First, the NY Times’ Tara Parker-Pope notes that patients have to realize that, yes, they should demand the best care possible. However, that means, “we will have to accept that ‘best’ …

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Will patients or doctors be the biggest obstacle impeding health care reform?

Relative value units, and how the RVU payment system doesn’t allow doctors to practice good medicine

Health Policy
March 5, 2009

For those who don’t know, every piece of work that a doctor performs is quantified and measured.

The base unit of physician work is known as the relative value unit (RVU). Most physician salaries are determined by the amount of RVUs a doctor produces in a given year, and in most cases, can range between$35 and $45 per RVU in primary care, depending on geographic location and …

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Relative value units, and how the RVU payment system doesn’t allow doctors to practice good medicine

Op-ed: More coverage requires more doctors

Health Policy
February 25, 2009

The following op-ed was published on February 25th, 2009 in The New York Times’ Room for Debate blog.

With the number of the uninsured having risen to 48 million Americans, clearly the need for reform is dire. But President Obama made no mention of who exactly will take care of these patients, even if they get insurance under a successful health reform initiative.

As a primary care physician in southern New …

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Op-ed: More coverage requires more doctors

Op-ed: Medicare’s mistake

Health Policy
January 14, 2009

The following op-ed was published on January 14th, 2009 in the USA Today.

Every patient’s worst nightmare is going to the hospital for a procedure only to have a surgical instrument left in his body, the wrong limb or organ operated on or, worse, dying from a medical mistake. These types of mistakes should never happen.

So when Medicare recently instituted a plan to deny hospital payments for …

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Op-ed: Medicare’s mistake

Why too many CT and MRI scans can hurt patients

Health Policy
December 9, 2008

This is an important article to read.

Many of the incentives today encourage doctors to order more advanced imaging scans, like CTs and MRIs. This expensive practice is invariably caused by this common scenario, as “patients who are in pain often demand scans hoping to find out what is wrong, doctors are tempted to offer scans to those patients, and then, once a scan is done, it …

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Why too many CT and MRI scans can hurt patients

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