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.

Language matters: the not-so-innocuous provider effect

Torie S. Sepah, MD

Health Policy

June 10, 2019

Language matters. The use of the word “provider” may seem innocuous, but it is significant both for patients and physicians.

For patients, it has been perhaps the most pronounced step — if not leap — away from transparency. (Who is who? Nurse, doctor, chiropractor, podiatrist, psychologist? Doesn’t matter — everyone is a “provider.”)

For physicians, the ramifications have been two-fold. One on hand, the use of the word is a demotion by …

In our health system, who “owns” patients?

Philip A. Masters, MD

Health Policy

June 7, 2019

A guest column by the American College of Physicians, exclusive to KevinMD.com.

When talking with patients – particularly those with multiple, complicated medical issues – it often doesn’t take very long to hear about their increasingly suboptimal and sometimes harrowing interactions with our health care system.

Examples include inpatient experiences in which care is provided by …

When physician pay packages become hospital kickbacks

Jordan Rau

Health Policy

June 6, 2019

For a hospital that had once labored to break even, Wheeling Hospital displayed abnormally deep pockets when recruiting doctors.

To lure Dr. Adam Tune, an anesthesiologist from nearby Pittsburgh who specialized in pain management, the Catholic hospital built a clinic for him to run on its campus in Wheeling, W.Va. It paid Tune as much as $1.2 million a year — well above the salaries of 90% of pain management physicians …

Here’s the secret to emergency department efficiency

Phillip Stephens, DHSc, PA-C

Health Policy

June 5, 2019

A gray-haired emergency medicine physician once provided the most succinct view of ED efficiency ever uttered. He said, “Sometimes they ask us to dig a ditch. Then they give us spoons with which to do the job.” Though cynical, it is the view of many. There really is only one problem and a single solution to ED efficiency. The problem is variation. The answer is scale.

Biologists understand variability best. Biologic …

School vaccine exemptions must be for medical conditions only

Shetal Shah, MD

Health Policy

June 5, 2019

No, vaccines do not cause autism.

No, vaccines do not cause cancer.

No, vaccines are not toxic.

No, getting the disease is not safer than vaccination.

Yes, they are safe. Yes, they are effective. As a pediatrician, I spend countless hours each week talking about vaccines and counseling parents about the importance of immunization. While parents may not know anyone with rubella, polio or tetanus — almost every parent knows someone who knows someone …

Nursing’s newest problem: The young eating the old

Debbie Moore-Black, RN

Health Policy

June 3, 2019

In 1976, we couldn’t wait to be nurses. Our starched white dresses with the nurse caps and stripes symbolized our graduation status as we were called one by one to receive our diploma and a rose.

We took an oath to care for the sick, to be professional, to critically think, to respect doctors and to respect patients and family members.

And to respect each other.

It was the age before computers. We …

The epidemic of violence against health care workers

Marlene Harris-Taylor

Health Policy

June 3, 2019

Across the country, many doctors, nurses and other health care workers have remained silent about what is being called an epidemic of violence against them.

The violent outbursts come from patients and patients’ families. And for years, it has been considered part of the job.

When you visit the Cleveland Clinic emergency department — whether as a patient, family member or friend — a large sign directs you toward a metal detector.

An …

Protect yourself and your standard of living as a nurse

Anne Naulty, RN

Health Policy

June 1, 2019

This article is about learning to protect yourself and your standard of living as a nurse. Now that I am considered a seasoned nurse, I have concluded that there are many essential aspects of the nursing profession that are not discussed during nursing school. It is a shame because many of these topics should be discussed so that new nurses can prepare themselves for issues that may and often occur …

Pay people for their kidneys? It’s time.

Robert Pearl, MD

Health Policy

May 31, 2019

These are trying times for health care optimists. Despite all the hype surrounding breakthroughs in clinical practice and technology, American medicine is stuck in in neutral. Though the engine is revving loudly, little progress is being made.

This unfortunate truth came into clearer light last week when I was preparing lesson plans for the health care strategy course I teach at the Stanford Graduate School of Business. During the first class of …

Medicare for all will kill jobs. But it may be necessary.

Elisabeth Rosenthal, MD

Health Policy

May 31, 2019

As calls for radical health reform grow louder, many on the right, in the center and in the health care industry are arguing that proposals like “Medicare for all” would cause economic ruin, decimating a sector that represents nearly 20% of our economy.

While exploring a presidential run, former Starbucks chief Howard Schultz called Medicare for all “not American,” adding, “What industry are we going to abolish next — …

Patient experience scores are being dragged down by process problems

Trisha Swift, DNP, RN

Health Policy

May 29, 2019

Which statement fits your organization the best?

Option A: Our organizational strategies, incentives, goals, and mantras are driven by patient experience.

Option B: Our organizational strategies, incentives, goals, and mantras are driven by quality and safety.

It may be hard to say an organization can be one without the other since, after all, experience is a byproduct of quality. The two are so interrelated that there is often a cloud of confusion regarding …

It’s time for physicians to be less “productive”

Anonymous

Health Policy

May 25, 2019

Physician compensation in most employed positions is based on how much a physician “produces.” I work as a psychiatrist, and this amounts to how many patients you see per hour. The more patients you see, the more “productive” you are, the more money you generate, the more valued you are by your organization and the more RVUs you churn out for a larger paycheck. But, in human terms, what exactly …

A physician suggests how to improve Medicare

Niran S. Al-Agba, MD

Health Policy

May 23, 2019

This is a brief explanation of Medicare from a physician’s perspective, as well as my thoughts on how Congress could make adjustments that would bring us closer to universal care and provide the private market the freedom to improve health care outcomes.

Medicare is a national health insurance program that provides health insurance for Americans ages 65 and older, and those who are disabled or have specific chronic conditions. Medicare covers …

How PTSD is hurting nursing

Anne Naulty, RN

Health Policy

May 22, 2019

Every time I hear that there is a nursing shortage in America, I feel myself cringe. There is not a shortage of nurses in America. There is a shortage of nurses who choose to work at the bedside. There is a reason, and it is called post-traumatic stress disorder.

Medically, we have learned that PTSD can occur after a single event or as a result of chronic stressors for a period …

Read more…

How PTSD is hurting nursing

No politician has a realistic solution for health care

Margalit Gur-Arie

Health Policy

May 19, 2019

If you live or work in Washington DC, your number one health care question is how do I (or my meal ticket people) win the next election. If you live or work in Caruthersville MO, chances are that your most pressing health care question is how do I (or my immediate family members) get a hold of some insulin this month. Theoretically speaking, in a healthy democracy, the answers to …

Private equity in gastroenterology: Is it the future?

Praveen Suthrum

Health Policy

May 18, 2019

An excerpt from Private Equity in Gastroenterology: Navigating the Next Wave.

A long time ago, gastroenterologists ran solo or small group practices. Despite the myriad challenges of running a medical business, doctors enjoyed the independence that private practices offered.

But over the years, everything got too complicated. From insurance reimbursements to …

The problem with burning health insurance down

Margalit Gur-Arie

Health Policy

May 16, 2019

Let’s burn health insurance down. Greedy corporate bastards should burn. Big Pharma and big hospitals should probably burn too. You know who else is really, really, bad? Wall Street. Let’s burn the banks. And let’s burn Big Tech and the entire Silicon Valley cartel. Let’s also burn Big Agribusiness that’s making us fat and sick. And let’s burn the Oil companies that are destroying the planet, and let’s burn the …

What’s wrong with health care, and do we have the will to change?

Davis Liu, MD

Health Policy

May 16, 2019

Our health care system is in crisis and needs significant change. So, I was excited to read Dr. Lisa Rosenbaum’s great February 2019 three-part series in the New England Journal of Medicine and accompanied round table about teamwork in health care. Rosenbaum kicks off each piece with a story: How the Brigham’s and Women’s Hospital’s “shock team,” doctors of different specialties, worked seamlessly in a “remarkable …

Our broken health system is your fault

Anonymous

Health Policy

May 15, 2019

“I don’t know what happened” is probably one of the most common phrases any parent hears. Last weekend, while wrapping my son’s bleeding head in gauze from our first aid kit, this was the best explanation my daughter could muster as to why her two-year-old brother was screaming, holding tightly to a blood-covered plastic ice cream cone. In the end, it was a complete accident (he hit his head on …

Read more…

Our broken health system is your fault

Nurses are striking. Where are the physicians?

Michael Pappas, MD

Health Policy

May 11, 2019

The U.S. health care “system” is completely and utterly broken. According to the World Health Organization (WHO), the U.S. system ranks 37th in the world, all while spending dramatically more on health care than other wealthy countries. Tens of millions remain without any health insurance coverage. For many, medical bills can mean economic ruin — some surveys show that up to Read more…

Nurses are striking. Where are the physicians?

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