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.

The crippling health effects of another government shutdown

Alani Gregory, MD

Health Policy

February 12, 2019

At midnight on February 15th, if Republicans and Democrats don’t come to an agreement about border security funding, the American people will be facing the possibility of a third government shutdown since President Trump took office. The most recent government shutdown — the longest in history at 35 days — left nearly 800,000 Americans furloughed or working without pay. Federal benefits that millions of Americans depend on, such as …

My battle against the nurse’s cap

Debbie Moore-Black, RN

Health Policy

February 10, 2019

Florence Nightingale was among the first nurses who started wearing a nurse’s cap.

The cap was derived by nuns and represented those caring for the sick. Hair was neatly tightened into a bun and covered by the cap.
Back then becoming a nurse was typically seen as a female profession, but men were allowed to become nurses too. In 1930, only one percent of RNs nationwide were male.

Growing up in the 1950s …

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My battle against the nurse’s cap

The true cost of being uninsured in America

Michael Weiss, MD

Health Policy

February 8, 2019

In a New York Post article dated January 23, 2019, the author states how Americans without health care insurance hit 13.7 percent. This 2.8 percent increase means an additional seven-million Americans lack health coverage as noted by the Gallup survey period.

This is not far behind the 18 percent recorded just before the Obamacare mandate in 2014.

Everyone is blamed in this article except the culprits. Do you think for one moment …

Imagine viewing health care from space

Praveen Suthrum

Health Policy

February 1, 2019

Instead of driving on the highway, let’s imagine you drove upwards from wherever you are. You’ll reach space in about an hour.

On your way up, you’ll begin to see everything differently. Cities, roads, and trees slowly blur out to make way for a new kind of reality. Converging. Diverging. Both at the same time.

What appears dissimilar on the ground (trees and shrubs) will appear similar (green). What unites on the …

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Imagine viewing health care from space

Quality is more than documentation designed to meet billing and data metrics

Austin Cannon, MD

Health Policy

February 1, 2019

As I walk into the well-upholstered elevator lobby of the hospital and make my way toward the stairs for another night of covering the ICU, I am again inundated with plaques, advertisements and a six-foot-tall cardboard cutout depicting an executive in a suit reminding us that this hospital is among the best in the nation in providing “value.” As I was previously made aware during a resident education session sandwiched …

Are clinically integrated networks a cure for checkbox medicine?

Jaan Sidorov, MD

Health Policy

January 28, 2019

Years ago, I was contacted by a health plan about an elderly nursing home patient who had not been screened for osteoporosis. While brittle bones are a big problem in skilled nursing settings, the real problem for this health plan was its low HEDIS score for “osteoporosis testing and management.” Because of the underlying financial stakes and the marketing advantages that …

Get ready for health care disruption

Praveen Suthrum

Health Policy

January 27, 2019

Just like you, I’m trying to make sense of the world around me. But there are no templates for the bridge that health care’s building for its future.

All we can do is listen to weak signals and amplify them.

Recently (and finally), CVS bought Aetna for $69 billion. I spoke to someone intimately familiar with the deal. He called it “vertical stacking” — to expand what CVS customers can get — …

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Get ready for health care disruption

Let’s insure our kids instead of building a wall

Sonali Saluja, MD, MPH

Health Policy

January 22, 2019

President Trump wants $5 billion for his border wall — right now — and another $7 billion (or maybe $13 billion) later on to finish the project. What else could we do with that kind of money? Here’s an idea: with $12 billion we could cover ALL 3.9 million American children who are uninsured today, and still have a couple billion left over. Put another way: …

#ThisIsOurLane: Can the movement to end gun violence succeed without addressing racism?

Brian H. Williams, MD

Health Policy

January 20, 2019

The movement fueling #ThisIsOurLane may fail Black Americans who endure a significant burden of gun violence. Responding to a tweet from the National Rifle Association (NRA) demanding we “stay in [our] lane” the medical community rose to the challenge. A new hashtag gained traction, thousands signed an open letter, and many shared graphic photos and stories from treating victims of gun violence.

While laudable in its medical unity, as an African-American …

Why doesn’t the allied health field play a larger role in the care of patients?

Rob Arnold, MS

Health Policy

January 19, 2019

The Association of Schools of Allied Health Professionals defines the allied health sector as “professionals that are involved with the delivery of health or related services pertaining to the identification, evaluation, and prevention of diseases and disorders; dietary and nutrition services; rehabilitation and health systems management, among others. Allied health professionals, to name a few, including dental hygienists, diagnostic medical sonographers, dietitians, medical technologists, occupational therapists, physical therapists, radiographers, respiratory …

Take ownership of our broken health care system now

John Corsino, DPT

Health Policy

January 18, 2019

In health care, we enjoy a unique opportunity to create special relationships with our work. Few enter these professions for practical reasons, and fewer still survive rigorous training without genuine belief in what they might accomplish. And cliched though they may be, the many mission statements which purport the “art of caring” do convey something real.

But to even for the naïve, spending enough time around health care produces a certain …

Addressing gender violence in medicine

Kelsey Priest, MPH and Caroline King, MPH

Health Policy

January 16, 2019

In medical school, we learn about Broca’s area, the region of the brain that when injured prevents a person from translating their thoughts into spoken word. When this area is damaged, from a stroke or traumatic injury, the person can hear a partner declare their love or a child cry, but are unable to vocalize a response. Silenced by their injury, their voice is trapped.

In a similar way, as medical …

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Addressing gender violence in medicine

What’s wrong with crisis pregnancy centers?

Nickey Jafari, MD

Health Policy

January 16, 2019

Perhaps you have already heard of crisis pregnancy centers (CPCs). I see highway billboards for them on most of my long drives throughout the rural midwest. Recently, I received an email from a student interest group offering medical students to tour them. That inspired me to write this because, as health care professionals, we have a lot of privilege and responsibility and are hopefully trained to respect facts and evaluate …

Why is Medicaid reimbursement below sustainability?

Niran S. Al-Agba, MD

Health Policy

January 15, 2019

Recently, a child was on a waitlist for five months to get into my practice. For this article, I will call him Tiny Tim.

Tiny Tim, now five years old, has a skin condition known as eczema or atopic dermatitis. When we first met, virtuously every area of his body was covered with wounds from constant scratching. Skin that breaks easily and heals poorly can give bacteria access to other parts …

Despite progress in cancer care, cost and equity challenges still must be addressed

David M. Aboulafia, MD

Health Policy

January 7, 2019

As a physician who has spent his career taking care of people with HIV/AIDS, cancer and various blood disorders, this is an amazing time to be working in these overlapping fields of medicine.

I began my training when roughly half the people diagnosed with HIV were destined to develop cancer, and nearly everyone died shortly after they progressed to AIDS. In resource-rich countries today, HIV care is often as simple as …

An approach to prior authorization insurance denials

Debraj Mukherjee, MD and Chaim B. Colen, MD

Health Policy

January 6, 2019

Patient access to care is a high priority for all neurosurgeons. Unfortunately, many of our practices are thwarted in these efforts from unwarranted insurance denials. Know, you are not alone. Take this common scenario:

When Ms. Mary Smith (not the patient’s real name) started her new job several years ago, she purchased the premium insurance policy that her company provided. Recently, she developed severe neck and left arm pain. Imaging of …

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An approach to prior authorization insurance denials

We need to change the way we talk about climate change

Jacob A. Fox

Health Policy

January 6, 2019

There was a point in my life when the words “climate change” would recall pictures of polar bears marooned on precarious chunks of ice, bobbing aimlessly in some foreign landscape of tundra and sea. While tragic, the environmental drama playing out at such extreme latitudes always felt like an abstraction, particularly to a kid growing up in temperate Colorado.

Today, however, as I study medicine and the environmental factors that influence …

Stop shoving metrics down nurses’ throats

Sarah E. Jorgensen, RN

Health Policy

January 5, 2019

One time, I applied for an emergency department (ED) nurse manager position. I thought I had the job locked up until I was asked during the interview how I would “enforce metrics.”

“Enforce.”

My holistic, qualitative research-based response to this authoritarian-style question was: “I’ll find more organic ways to achieve your metrics without shoving numbers down their throats.”

I didn’t get the job. Someone told me I wasn’t “MBA enough.”

Yet, I stand by …

It’s time to study firearm morbidity and mortality as we do any other public health issue

Charles Nozicka, DO

Health Policy

January 4, 2019

Among modern industrialized nations, only the United States endures the current public health epidemic of firearm-assisted injury and death. In 2017, nearly 40,000 people were shot to death in the U.S., while proponents of the Second Amendment continue to protect it at all costs — fighting even common sense measures such as limiting access to felons and the mentally ill. On both sides of this debate, opinions are lobbed as …

Is this cost-saving Medicare proposal doomed?

Martha Rosenberg

Health Policy

January 3, 2019

The Trump administration has proposed that insurance plans providing drug coverage to Medicare beneficiaries will no longer be forced to cover six hitherto “protected” drug classes. The classes — which include drugs for psychiatric conditions, cancer and immune diseases –– are among the priciest of all drugs and account for as much as 33 percent of total outpatient drug spending under Part D of Medicare.

Under the proposal, …

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