Health Policy

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.

“Take it or leave it” is not negotiation but coercion

Paul Pender, MD

Health Policy

November 23, 2021

“Take it or leave it” is not negotiation but coercion.

Physicians have been subject to this tactic for much too long. As an ophthalmologist in clinical practice for nearly four decades, I experienced too often what a recent author on KevinMD described as a one-sided arrangement with a health insurance company. “Here is the fee schedule. Here is the document to sign.” End of story.

If you object to the terms of …

How to address the mental health fallout of climate change

Rishab Chawla

Health Policy

November 22, 2021

An existential crisis

On August 9, the 2021 Intergovernmental Panel on Climate Change (IPCC) Sixth Assessment Report made public what many had feared. Global temperature warming to 1.5 C is all but inevitable by 2040 — even by the most optimistic scenarios — unless radically drastic steps are taken to end the use of fossil fuels.

Severe weather events such as California wildfires and Atlantic hurricanes of the past …

Open enrollment: It’s time to leave your insurance plan behind

Andy Schoonover

Health Policy

November 20, 2021

Research shows inadequate health insurance accounts for nearly 67 percent of all bankruptcies. This statistic is staggering, and illustrates a difficult reality for the many American families navigating today’s insurance market.

Not only can medical debt become a heavy burden – it can impact every facet of an individual’s life; compromising financial stability and potentially even exacerbating underlying medical conditions, creating complications due to the stress it causes. …

The climate crisis as viewed by an emergency physician

Elizabeth M. Barreras-Rivest, MD

Health Policy

November 14, 2021

I remember the cacophony of tiny chirps outside of my childhood home made by frogs that lived in the ice grass. I remember this sound in particular because of the beauty in their voice and because in what seemed like the blink of an eye, they stopped. They were gone. It was only decades later that I learned about the devastating losses that frog populations have faced around the world …

Direct primary care is an answer to volume-based insurance reimbursement models

Troy A. Burns, MD

Health Policy

November 10, 2021

An excerpt from Medical Answers Now!: How Direct Primary Care Guarantees Fast Access to Your Doctor.

Health care costs are out of control and volume-based insurance reimbursement models are felt to be contributing to the problem. Medicare and most major private medical insurance carriers have begun testing and transitioning to reimbursement models that pay for health care services based on the …

It is time for the Supreme Court to help stem gun deaths

David Galinsky, MD

Health Policy

October 29, 2021

Every morning when I turn on the local Philadelphia TV news to hear the weather report, I also hear about the shootings that have occurred. This morning I heard that a 66-year-old man was shot while driving past his old high school. A fight had broken out between teenagers, a gun was pulled, and he was shot in the head.

The reporters sound concerned, sad, and even outraged. I thought that …

The blueprint for a Gold Medal Health Care System

Jeffrey Fraser, MD

Health Policy

October 29, 2021

An excerpt from Blueprint for a Gold Medal Health Care System.

We do not currently have a Gold Medal Health Care System. There may be more than one way to build one, but this book is about my vision of a Gold Medal system, and I will henceforth refer to my version as the Gold Medal System, or simply …

Why private equity is a dangerous employer

Kara Grant

Health Policy

October 25, 2021

About 4 months after emergency medicine physician Jessica (a pseudonym used out of fear of retaliation from her employer) joined a Michigan hospital in 2014, the department’s staffing group was bought out by TeamHealth, a staffing firm backed by the private-equity behemoth Blackstone.

Ever since Emergency Medicine Specialists (EMS) — which touts itself as one of the oldest emergency physician groups in Michigan — was acquired by TeamHealth, “it’s been …

The success of Australian firearms regulation: What it could mean for children

Christopher Johnson, MD

Health Policy

October 24, 2021

An article in the New England Journal of Medicine in 2018 noted the sad milestone that firearms were causing 15% of all deaths in children and adolescents. Somewhat encouraging, a later study showed states with stricter firearm laws correlated with lower numbers of firearm deaths in children. The relationship was quite linear, as you can see below. The authors had specific criteria for weak vs. strong gun laws: if …

Systemic racism and Indigenous deaths in health care

Benjamin Brookwell

Health Policy

October 23, 2021

Ni cta ni akohikon: That hurts me.

Carol pe ntamici: Carol, come see me.

Ni taci sa micta mackikikatakoiin: They are overdosing me on drugs.

Wipatc tca: Do it quickly.

Those were the chilling words of Joyce Echaquan, broadcasting live from Facebook on September 28, 2020 at 10:27 am (English translation provided).

On September 26, 2020, Joyce Echaquan went to De Lanaudière Hospital in Joliette, Quebec. She was suffering from severe stomach pain. …

Expanding health care access and equity through telehealth

Gjanje L. Smith, MD, MPH, Wanneh A. Dixon, and Maria Phillips, JD

Health Policy

October 22, 2021

The COVID-19 public health emergency (PHE) has been an amplifier and catalyst for numerous issues. The pandemic has impacted health care delivery significantly, and inequities for the Black community are more apparent. Federal and state rules for telehealth compliance/reimbursement were relaxed to preserve health care access during the PHE. While we are still in the data collection and observation phase, some concepts are clear: Telehealth positively impacts health care access, …

This doctor will be running for the legislature in the future

Anonymous

Health Policy

October 20, 2021

You don’t know who I am yet, but you will in the future.

I haven’t decided yet if I will run for the House, Senate, or the U.S. Congress. If you are a health care professional, whether it be a doctor able to change medicine, nurses, respiratory technicians, dieticians, phlebotomists, patient care technicians, janitors, and food service employees, you will want to hear this.

We can donate as much money as we …

Medical debt is the enemy of everyone

Robert E. Goff, MBA

Health Policy

October 17, 2021

An excerpt from End Medical Debt: Curing America’s $1 Trillion Unpayable Healthcare Debt.

Medical debt is the mortal enemy of the patient, the physician, the hospital, the community, the state, and the nation. When we think of others’ debts, we tend to think such debts are their personal responsibility. If they’re unable to pay the debt, it’s their problem. (We make …

Read more…

Medical debt is the enemy of everyone

To “fix” health care delivery, turn to a value-based health care system

David Bernstein, MD, MBA

Health Policy

October 16, 2021

With over two-thirds of the public believing that health care should be a top policy priority, there is no debating the importance of “fixing” our health care delivery system. On one extreme of the aisle, there is a growing chorus in support for “Medicare-for-all,” a single-payer, government-funded approach estimated by two independent studies from both liberal– and conservative-leaning institutes to cost …

HIV/AIDS vaccine underscores need for better health access

Alyson O’Daniel, PhD

Health Policy

October 11, 2021

“HIV has been a blessing in my life.”

Lola was a 48-year-old woman living in Denver when I interviewed her in 2002 about her HIV-positive diagnosis. She said the diagnosis improved her life in important ways; she had received income and housing support, nutritional assistance, health insurance, medication assistance and primary and infectious disease health care based on that diagnosis.

She said her sense of life’s purpose had changed, her basic needs …

The needs of Afghan refugee children must be prioritized in evacuation and resettlement plans

Bianca Nfonoyim, MD and Rebecca Whitmire, MD, MPH

Health Policy

October 5, 2021

I smiled as the Afghan family of six approached my triage station in the Philadelphia airport. The three young boys were laughing, playful, and full of energy despite the long journey. The oldest, who looked about 10 years old, sat on a chair and immediately began describing his symptoms—sore throat and cough, most likely a viral upper respiratory tract infection. I completed my physical exam as the medical student flipped …

Is it time for a true federal COVID vaccine mandate?

Shetal Shah, MD

Health Policy

October 4, 2021

President Biden recently unveiled a series of regulations aimed to increase COVID vaccination rates. Impacting up to 100 million people, the president will require government employees, businesses with 100 or more employees, and federal contractors to be immunized.

He did not go far enough.

Like many pediatricians, I have spent hours addressing parents’ concerns about receiving a COVID vaccine for themselves or their children. Whether in a hospital, clinic, grocery store, or …

The necessity for the globalization of surgery and its barriers

Jeremy Goodwin

Health Policy

September 30, 2021

For years, the surgical practice has been an essential medicine to treat many diseases, such as benign lesions or neoplasms, deliveries, cesarean sections, infections, obstructions, bleeds, and cardiovascular diseases. In many cases, the standard of care is surgical intervention as the first-line treatment and often curative. Without surgical care, a health care system is inept at running properly.

The dilemma with surgical practice and its globalization is that it Read more…

The necessity for the globalization of surgery and its barriers

Trauma from my first anesthesia job

Patrick Flaherty, CAA

Health Policy

September 29, 2021

I still have a little mental trauma from my first anesthesia job. Well, actually, it’s really from the hospital. And it all occurred over a four-year period.

The anesthesia group was awesome. The OR staff was like family. The patients and surgeries were challenging. It was a great first job to take out of training.

Like most first jobs, I wasn’t experienced enough or confident enough to ask certain questions during the …

Read more…

Trauma from my first anesthesia job

3 ways health care leadership can get nurses back at the bedside

Juli Heitman, RN

Health Policy

September 25, 2021

The COVID-19 pandemic continues to push everyone, especially frontline health care workers, well beyond the brink. Nurses have been exposed to the most trying and difficult predicaments related to the coronavirus, and the stress has taken its toll.

During the most recent surge of cases, rural hospitals across the country have resorted to extraordinary lengths to ensure that adequate staffing is available for the patient spikes. This includes …

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