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.
U.S. health care spending is maddeningly high. As in fifty percent higher than what other wealthy countries spend, with no evidence we’re getting any bang for all those additional health care bucks.
In 2014, the state of Maryland took direct aim at this profitless profligacy, enacting a bold (dare I say European?) approach: It gave hospitals fixed budgets to cover the costs not only of inpatient hospital care, but also outpatient care …
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If you build a budget, hospitals will adapt
As the Democratic candidates for president continue to beat up each other on how best to achieve universal coverage (Medicare for all, a public option, closing the ACA’s coverage gaps), health care journalists keep wondering when President Trump will release his long-promised “phenomenal” plan to position the GOP as “the party of health care” for the 2020 election.
Skepticism is warranted over when or even if …
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Don’t underestimate the appeal of a Trump “health plan”
The bootleg medications were smuggled across the border and sold to mostly Latino immigrants in public spaces throughout Los Angeles — at swap meets, parks, beauty salons and makeshift stands outside mom-and-pop grocery stores.
The drugs were cheap, and the customers — mostly from Mexico and Central America — did not need prescriptions to buy them. Some of the products featured brand names and colorful packaging that immigrants knew well from …
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Black market pharmaceuticals target immigrants
EMTALA is born
The machine beeps alarmingly as it breathes for your child. The various numbers on the monitor are foreign to you, but you know something isn’t right because the nurse briskly walks away from the stretcher to grab the doctor, who then orders more medication and makes adjustments to the machine. The beeping stops, and the anxiety eases from the staff.
The official in business clothes — standing next to …
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An important health care safety net is at risk
A recent article in Modern Healthcare describes how private equity firms are starting to snatch up specialist physician groups that promise rich revenues, such as orthopedists, dermatologists, and ophthalmologists.
Naturally, this is about adding value, not adding to bank accounts. Because whether it’s physicians or hospitals, health insurers or drug companies, no one in health care ever does anything except in the best interest of patients.
The Modern Healthcare …
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Your bone fracture, my cash flow: the consequences of private equity in health care
With August recess at a close, Congress has yet to find a solution to end balance (or “surprise”) billing, where patients are charged the remainder of their medical bill for out-of-network (OON) expenses not reimbursed by their health plan. About the only compromise for-profit health insurers, hospitals, and physician groups can agree on is that patients should be taken out of the middle, but they can’t agree on how.
Physician groups …
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Let’s end surprise billing without a Trojan Horse
As a pharmacy technician, I watched countless individuals speak with a pharmacist about how different drug therapies work, and what they should know before taking any pharmaceuticals.
But I also have a hearing loss, and as a patient myself, I am struck by how confusing it is for consumers to find the right treatment.
Hearing loss is a medical condition that affects nearly one-third of adults between 65 and 75, and half …
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Should the government regulate hearing aids as consumer electronic products?
The Democratic debates this summer demonstrated massive confusion around Medicare for all. Does it mean Medicare for all who want it? Medicare Advantage? A “public option” on an Affordable Care Act (ACA) exchange?
Democrats need to get their story straight.
The confusion is understandable. Medicare for all has been an aspiration since at least the New Deal, but since 1965, when Congress …
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Clearing up the confusion surrounding Medicare for all
As proposals to ban surprise medical bills move through Congress and state legislatures with rare bipartisan support, physician groups have emerged as the loudest opponents.
Often led by doctors with the veneer of noble concern for patients, physician-staffing firms — third-party companies that employ doctors and assign them out to health care facilities — have opposed efforts to limit the practice known as balance billing. They claim such bans would rob …
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The infiltration of venture capital and private equity in the surprise medical bills debate
Gravel crunched beneath our feet as my co-residents, and I walked alongside one another. Our laughter filled the air as the shadow of our large white camper van stretched behind us, looming farther and farther away. We had escaped the warmth of a vehicle that had been our home all week; it was cold, and we were underdressed, not uncommon in Iceland. Surrounded by sea, the wind blew furiously, unforgivingly, …
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Discovering resolve: a trainee’s thoughts on advocacy and the crisis at the border
How do you react when presented with your quality data?
In my experience, physicians generally respond by:
- Ignoring the metrics
- Arguing about why the metrics are wrong
- Saying the metrics are stupid
A lot of doctors refuse to participate in the process of developing, reviewing and refining quality metrics. Although this has the definite advantage of feeling like you’re sticking it to “the man,” it feeds an unhelpful cycle that eventually hurts …
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Should doctors take more responsibility for quality metrics?
As voters fume about the high cost of health care, politicians have been targeting two well-deserved villains: pharmaceutical companies, whose prices have risen more than inflation, and insurers, who pay their executives millions in salaries while raising premiums and deductibles.
Although the Democratic presidential candidates have devoted copious airtime to debating health care, many of the country’s leading health policy experts have wondered why they have given a total pass …
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How hospitals drive up health costs
For over a decade, Washington, DC has been busy with fixing health care. For over a decade, the same government bureaucracy, the same advocacy (read lobbying) organizations, the same expert think tanks, the same academic centers, the same business associations, with the same people hopping around from one entity to the next, have been generating and applying the same “innovative solutions” differentiated solely by their aggrandizing names. The result? Health …
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The insanely brazen effort to remake medicine into a consumer industry
The recent Philadelphia-, El Paso- and Dayton-area shootings brought all my memories back. As a pediatric pulmonary and critical care physician, I have been here so many times before.
At 11:12 a.m. on a Wednesday last September, as I sat in my office enjoying a sunny day in the Midwest, I received a two-word text from my 15-year old high school junior: “I’m OK.”
“What happened?” I asked. “Active shooter at Greenway …
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Use pediatric research to solve the threat of gun violence
We all expect hospitals to be open and operating when we need them, but extreme weather events like hurricanes are a strain on resources and pose significant challenges for hospitals.
Closing a hospital is an extreme action, but several hospitals in Florida, Georgia and South Carolina did just that before the arrival of Hurricane Irma in 2017.
With more than 300 hospitals and a higher share of older adults than any other state, …
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How hospitals prepare for hurricanes
Why does e-cigarette maker Juul advertise its product on TV when cigarette ads are banned? The short answer: Because it can.
For nearly 50 years, cigarette advertising has been banned from TV and radio. But electronic cigarettes — those battery-operated devices that often resemble oversized USB flash drives with flavored nicotine “pods” that clip in on the end — aren’t addressed in the law.
Since launching its product in …
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Why can e-cigarettes advertise on TV?
