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.
In 1998, Drs. Tervalon and Murray-Garcia created the concept of “cultural humility” as a way to transcend the prevailing but limiting concept of cultural competence in teaching medical students and trainees how to respectfully deliver health care to the increasingly diverse populations of the U.S. The cultural competence paradigm leads health care professionals to assign patient group traits or labels. On the other hand, cultural humility incorporates a lifelong commitment …
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Advancing health equity conversations through cultural humility
As a master of health administration (MHA) student completing my administrative residency in the health technology industry, I chose to dedicate my capstone project to a topic positioned at the intersection of what I had learned in graduate school and what I had learned during my residency. While administrative residencies are typically in a hospital or consulting setting, I matched with a primary-care-focused electronic health record company as the organization’s …
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Melting the iron triangle: Prioritizing health equity in dynamic, innovative health care landscapes
The 2022 Top States for Business designation has higher stakes than ever, as companies compete for top talent while balancing inflation, supply chain issues, and other ongoing pandemic side effects. However, the solution to employee recruitment and retention is not an expensive corporate relocation; it is time for a corporate wake-up call. American companies must stop or re-examine existing efforts to engage with their employees and instead meaningfully adjust …
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The great resignation can be stopped. Here’s how.
It’s hard to concisely put into words how frustrated physicians are right now. How many other professional groups out there have to fight to not have their compensation cut multiple times a year? Recently, CMS released its proposed physician fee schedule for Medicare for 2023, which reduces the conversion factor by 4.42%. This compounds upon additional cuts such as the resumption …
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CMS Medicare fee cuts: The altruism of physicians is used against them
In the unending ocean of choice and complexity of medical insurance, sailing your own ship is harder than it looks. Especially when you get a new job, age into Medicare, or turn 26 and thus can’t stay on your parent’s coverage. Every ship captain needs a helmsman—brokers are a major help for picking a health plan, but they are best used as an insurance translator rather than your personal shopper. …
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Make your health insurance broker a translator, not a shopper
About a month ago, I had just finished hospital rounds when I heard “code active threat” on the overhead intercom. Thinking it was a drill, I continued typing patient notes until I heard a more urgent: “Please barricade in place or, if able, evacuate the premises immediately.”
My heart raced as I quickly weighed my options: barricade myself alone in the physician lounge or run to the parking garage, risking the …
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Gun violence is our society’s disease
I was on service as the attending physician recently, and it struck me how closely our sickest patients in the intensive care setting mirror the political mires of our country.
Usually, when I’m on service, it’s an all-consuming matter, with little time for media and external affairs. However, this time it was different: history in the making with a Supreme Court decision that eviscerated a woman’s right to choose, to care …
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How our sickest patients mirror the political divisions of our country
I recently met with leaders of provider organizations representing a range of specialties and geographies. One of the themes that came through loud and clear was their ongoing struggle to obtain claims data from their payers. As providers continue their efforts to navigate alternative payment models (APM), their need for global claims data becomes a more pressing issue.
Why claims data is important to providers
Many providers are still in a position …
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The claims data dilemma: 4 things to consider
Last year, I witnessed the extreme consequences of untreated childhood trauma as a medical trainee rotating through multiple safety-net hospitals in Los Angeles County.
I helped care for children who arrived in our emergency departments after multiple suicide attempts due to trouble in the home. Some children confided in me about their parents’ struggle with untreated substance use or mental illness and how witnessing these conditions deeply affected them.
Other children were …
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It’s time to invest in trauma-informed ACEs interventions
Mistakes and errors are regrettable but inevitable risks of the job for any patient-facing role in health care. As nurses, we are trained to report mistakes and errors when they happen. The maintenance of transparency in this way is an important element of our profession, intended to inform improvements that will, in turn, reduce the likelihood of a recurrence of the error.
The context in which Radonda’s error occurred may be …
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Florence Nightingale. Clara Barton. Radonda Vaught?
That the United States spends the most on health care is unsurprising.
What’s questionable is paying so much for the worst health care system amongst high-income countries and being far behind many countries that could not be considered high-income by any stretch of the imagination.
Other than doing brilliantly at mammograms and seasonal flu vaccines, the U.S. is found appalling. Not just Canada and Mexico, but when the likes of Chile, Saudi …
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Corruption in health care: when the mice mind the cheese
On June 24, 2022, the Supreme Court ruled 6–3 to uphold Mississippi’s Gestational Age Act and 5–4 to overrule Roe v. Wade and Planned Parenthood v. Casey. The political temperature was already heightened because Politico released a leaked draft opinion on May 2, 2022.
The pending ruling threw the United States into an emotional pressure cooker spurred on by heavy (some would say irresponsible) news coverage and social media fervor that …
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Abortion debates need to happen, but both sides need some ground rules
There are situations where I have told a patient they had no options: a cancer recurrence not responding to any treatment, detecting no heartbeat in a 37-week pregnancy, or telling someone their family member coded and didn’t survive. The worst part of these situations wasn’t just the diagnosis but the lack of options to improve the outcome. Let’s not remove choice in situations where a patient has a chance to …
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These are the women who are being told they are not a priority
Although this is a politically charged topic in our space in medicine, this isn’t political. For many of us, it’s doing our job — taking care of a patient’s mental and physical health. Making sure they are safe and doing no harm. Living in the Midwest, I had the realization today that in the near future, I will need to refer a patient in need of some reproductive services out …
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Roe v. Wade: Share our experience and be part of the solution
This morning I had a migraine. I should have known it was coming. I now have complex migraines and was having word-finding difficulty yesterday, which is a harbinger for me. How could I have known that my soul had known before my mind had, that it had known we were about to rip away a standing protection for half of the U.S. population and dress it up as a state’s …
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Physicians and patients are now pawns in a political game
Since the mass shooting in Uvalde, TX, rapidly after that in Buffalo, NY, I have read and heard several simplistic public media pieces suggesting easy means of preventing these acts. They unanimously indicated that mass shooters (MS), especially those who are younger, can be detected before their fatal actions by their statements or writings online or on paper. If these raise concerns, they can be reported to authorities, and this …
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Treating mental illness will not stop mass shootings
Cancer patients soon will have new treatment options in Connecticut. Health care providers recently received regulatory approval for a joint venture that will allow them to open the state’s first proton therapy center.
The lifesaving technology, which uses laser beams as a safer and more effective alternative to chemotherapy, is urgently needed. So the announcement was a big deal. But what the partners failed to mention in their news release is …
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As cancer patients wait, states play favorites
The scarcity of geriatricians in the United States is a severe problem in the public health sphere due to the increased number of older adults and the lack of health care professionals who specialize in this demographic.
Approximately 7,000 geriatricians are practicing in the United States, and around half of them are full-time. Research shows that 30 percent of people 65 years old and older need care from …
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The forgotten crisis: a shortage of geriatric doctors in the U.S.
