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.
Of the nation’s 3.5 trillion in annual health care spending, 90 percent is for people with chronic and mental health conditions. How long can this continue? Can health care institutes afford not to engage in the 2020 wave of preventative care health care disruption? For those riding the disruption wave, the answer is simple. CMS alone is providing more than 80 billion in reimbursements for preventive care …
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Changes are coming to health care in 2020. Are you ready?
“Listen to your patient; he is telling you the diagnosis.”
This quote from famous physician William Osler is as true today as it was 100 years ago. And yet the latest version of President Trump’s executive order on Medicare threatens what patients overwhelmingly want: a physician involved in their care.
Section 5-C of the President’s order focuses on payment parity and supervision of mid-level providers. Changes to either issue would create unintended …
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The president’s plan for payment parity goes against what patients want
The World Health Organization has designated 2020 as the Year of the Nurse and Midwife in honor of Florence Nightingale’s 200th birthday.
We owe a lot to Florence Nightingale, but what about Harriet Tubman or Mary Seacole? Nursing – and society – has been changing since the days of these nursing pioneers. It’s way past time to catch up to their timeless insights and fearless activism. We owe to all these …
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It’s the Year of the Nurse
The practice of medicine is limited by what we can control. As students, we are taught to believe in the power of science, the importance of hard work, and the momentum of technological advancement as prime determinants in our patients’ outcomes. However, as we get further along in our careers, we come to realize that many of the factors that contribute to poor health are beyond our control at …
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Why this doctor decided to run for political office
There are certain paradoxes of life that are beyond the realm of rational explanation. To me, one of such is that a country that figured out how to defy gravity and conquered the cosmos has time and time again proven to be incapable of taking care of the most basic human need, namely: a commonsense health care delivery system.
U.S. spending on health care in 2016 was estimated at about 17.2 …
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Corporate games have ruined the health care system
Would a Hippocratic Oath for health care executives make a difference? Probably not. Nonetheless, there is ample evidence that the organizational cultures of too many hospitals are not conducive to physician well-being.
In a provocative blog posted on May 2, 2019, emergency medicine physician Mark Borden indicated a Hippocratic Oath was urgently needed for administrators.
Dr. Borden wrote: “Physician employment was, and is, obviously an intrinsically flawed structure …
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Would a Hippocratic Oath for health care executives make a difference?
The standard business model around which our world revolves has no place in the “business” of human life, which is what the commercialized industry of health care has become. To be the most successful, businesses work to optimize profits by minimizing their operating costs, which include material resources and all the steps involved in distributing their product. This business model, in some form, is applied universally from the manufacturing and …
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Is health care just legal human trafficking?
At kitchen tables everywhere, ordinary Americans have been grappling with the arcane language of deductibles and co-pays as they’ve struggled to select a health insurance plan during open enrollment season.
Unfortunately, critical information that could literally spell the difference between life and death is conspicuously absent from the glossy brochures and eye-catching websites.
Which plan will arrange a consultation with top-tier oncologists if I’m diagnosed with a complex …
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The hidden benefits of your health insurance plan can save your life
The Republicans don’t yet have a health care plan less than a year before the 2020 elections.
But based upon their 2017 Obamacare repeal and replace efforts, as well as a major document recently issued by the House Republican Study Committee, what might a Republican plan look like?
First, let’s review the plan House Republicans passed in 2017 during their failed repeal and replace efforts.
House Republicans would have repealed the Medicaid expansion …
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What is the Trump health plan for 2020?
As the year winds down and must-pass year-end spending bills are completed — and with that, any chance of attaching and approving health care legislation — the special interests have won big, and consumers have lost big.
Employers, unions, and insurance companies won big with the repeal of the “Cadillac” tax on high cost-benefit plans at a cost of $200 billion over ten years as well as the repeal of the …
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How special interests won big and consumers lost big
Next in a series.
The Healthcare Incentives Framework helps show how to fix incentives in health care systems. It starts by enumerating the five jobs we expect a health care system to do for us and then identifies which parties in the health care system (providers or insurers) have a natural incentive to fulfill each of those jobs. Those incentives arise naturally, but the big challenge is shaping …
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Our optimal future U.S. health care system
Over the past 40 years, the number of U.S. hospitals declined by 12 percent, from more than 7,100 in 1975 to 6,200 in 2017, according to the latest American Hospital Association survey. And, yet, despite shuttering nearly 1,000 facilities, hospitals remain the nation’s largest source of health care spending, accounting for $1.1 trillion annually (or 33% of all national health care expenditures). Much of that money goes …
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5 improvements needed to modernize the American hospital landscape
As presidential hopefuls debate health care reform, it is becoming increasingly difficult to distinguish statements rooted in fact from fiction. According to PolitiFact, only 27% of politicians’ media statements regarding health care — whether from Democrats or Republicans — are true or mostly true. Discerning the truth in a growing state of convolution is becoming increasingly difficult. In such a medical and political quagmire, it behooves health care professionals to …
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We need physicians who advocate for patients’ best interests
One of my elderly relatives was in line at the grocery store one day and saw the person ahead of him, charging what looked like a cart full of junk food to her food assistance card. My relative was incensed: Why, should his hard-earned tax dollars be used to pay for someone’s Cheetos?
Currently, one in seven Americans receives some kind of government assistance to pay for food. The largest …
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What if people were only allowed to use food assistance dollars to buy healthy food?
There are few things in our health care system that are more unfair than surprise medical bills. Consumers think they have good coverage and are getting treatment in their health plan network only to get a huge unexpected bill in the mail because it turned out that something like the anesthesiologist at their recent surgery wasn’t covered.
How were they to know that? As you’re sitting on the gurney about to …
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Compromise vs. greed in ending surprise medical bills
Migrating to the U.S. as an international medical graduate, I was shocked by the health care culture of excess. Initially, it felt good to order a CT scan on everyone who had a fall or cardiac enzymes on anybody who had atypical chest pain. I felt powerful and light years ahead of the system I left behind, where you would have to very cautious about ordering diagnostic tests as, mostly, …
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Medicare for all advocates are in for a rude awakening
It was the middle of winter in downtown Chicago in 1995, and I was sitting across from an apologetic alcoholic holding a slimy NG tube. Mr. Smith, an emaciated man in his sixties, had been on my service for three days with acute pancreatitis, and this was the fifth nasogastric tube that had “slipped” out of his nose.
Subsequently, his morning labs were just as bad as they had been on …
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Is there a link between readmission and a hospital’s non-profit status?
Negotiating lower drug prices in America could possibly stifle pharmacological innovation. But it would reduce health care cost for most Americans — and that should be all that matters.
If the United States began to regulate drug prices, medications would become cheaper, and Americans would have more access to drugs with lower health care costs. If bills like S.99 – Medicare Drug Price Negotiation Act (MDPNA) ever passes, it would permit …
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Negotiating lower drug prices in America: The tradeoffs are worth it.
