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.

Health care is making the classic mistake that many startups make

Praveen Suthrum

Health Policy

June 23, 2018

Before managed care became the dominant force that it is, patients and doctors had the opportunity to get to know each other well. Doctors treated multiple generations within families. This helped establish a strong bond among patients and their doctors.

While it might have intended to mean preventing expensive care, managed care began to mean organized care. Run by institutions such as health maintenance organizations.

Insurances began to decide which doctors you …

How our health system is like the Marvel supervillain Thanos

Tom Davis, MD

Health Policy

June 21, 2018

You are a child of Thanos.

“Hear me and rejoice!”

“You have had the privilege of being saved by the American College of Cardiology and the American Heart Association. (Yeah, I know we said the same thing when we prescribed low-fat diets to decrease the risk of heart disease, but you gotta give us a pass on that one.”)

“Based on our research, we have found 100,000,000 of you are ill.”

“But we can …

A bipartisan solution for Medicaid work requirements

David Velasquez

Health Policy

June 20, 2018

When I hear pundits going on about the Medicaid work requirements, I think of my father.

He has worked in the United States for twenty-four years, taking on the role of a handyman, migrant farmer, truck driver, construction roofer, dialysis patient transporter, and elder transporter. His limited English and third-grade education land him in low-paying jobs with limited hours and an oversupply of workers — resulting in frequent periods of unemployment.

For …

The National Guideline Clearinghouse will go offline. Patients will be worse off.

Kenneth Lin, MD

Health Policy

June 19, 2018

Absent a last-minute, lifesaving intervention, after 20 years of reviewing and summarizing clinical practice guidelines in a continuously updated database, the Agency for Healthcare Research and Quality’s National Guideline Clearinghouse (NGC) will go offline on July 16th. Prior to its untimely death due to budget cuts, the NGC not only served as a one-of-a-kind online resource for clinicians, researchers, and educators, but raised the bar on guideline …

Fixing primary care’s broken business model

Hans Duvefelt, MD

Health Policy

June 19, 2018

Primary care visits are never quick; we don’t give much advice over the phone or online; and we prioritize the government’s and insurance companies’ public health agenda over our own patients’ concerns.

Imagine health care as a retail customer experience for a few minutes:

Imagine you’re going to Walmart to buy a bag of dog food, a new coffee maker or to equip a small kitchen in your newly built mother-in-law apartment.

1. …

It’s always easier to judge someone’s failures from higher ground

Michael Kirsch, MD

Health Policy

June 18, 2018

We’ve all heard the excuse or explanation that “it’s society’s fault,” to explain someone’s failure. We hear expressions like this often when an individual has committed a crime or simply failed to succeed. Personal accountability is diluted as we are told that this person came from an imperfect home, had no role models or ample education.

These arguments are often wielded by those who have been favored with society’s blessings and …

A physician was fired for standing up for his beliefs

Jamie Katuna

Health Policy

June 17, 2018

Dr. Eugene Gu. He is — was — a surgical resident at Vanderbilt University. His resume exemplifies academic perfection: valedictorian in high school, undergraduate degree from Stanford, medical degree from Duke, surgical residency at Vanderbilt. He also founded his own research company. Not once throughout the span of his academic or professional career would one have any reason question his capability or competency. But several weeks ago Vanderbilt fired him, citing “performance” issues.

Why?

Because …

A physician’s take on thoughts and prayers

Earl Stewart, Jr., MD

Health Policy

June 14, 2018

They are intangible, as intangible as the space that the death of a loved one leaves behind. There is emptiness where there was once-occupied space. The past tense supersedes the present and definitely any aspect of the future tense and verse. Where they are supposed to be — in our homes, in our cars, at our kitchen tables, out to dinner with us, in our arms — there are only …

More equitable health care starts with you

Rehaan Shaffie, MD

Health Policy

June 14, 2018

I am a hospitalist at a safety-net hospital. Through my work, I have come to understand how our daily decisions — filtered through our own biases — influence how health care is implemented, and I had a personal teacher in my first year as an attending. Soon after starting my job, I met Mr. K. He was in his 40s, well-kempt, soft-spoken and had the good habit of looking people …

Don’t blame doctors for outrageous emergency department prices

Peter Ubel, MD

Health Policy

June 12, 2018

Recently I posted a piece, describing research out of Johns Hopkins, showing that when patients come to ERs — either with no insurance or insurance that is out-of-network — they often face charges that are four, six, or even ten-fold greater than what Medicare would pay for the same services.

After the post, I was inundated with angry tweets and emails, mainly from emergency medicine …

Why physicians should care about structural racism

Akshay Pendyal, MD

Health Policy

June 12, 2018

This year marks the 50th anniversary of the passage of the Fair Housing Act, which formally outlaws racial discrimination in the sale and rental of housing. The Act, passed in the wake of the assassination of Dr. Martin Luther King Jr., had, at its core, the goal of affirmatively promoting equitable and integrated housing across the United States.

Earlier this year, however, the current presidential administration announced that it would suspend an …

Identifying social determinants of health is critical to the patient interview

David Velasquez

Health Policy

June 11, 2018

After a semester of medical school, I returned home to the Antelope Valley in California, an area CNN coined, “health care’s nowhere land” because of low health insurance rates and limited provider networks that force residents to travel far for care. I wanted to help my family and neighbors by using the physical exam skills I learned during my first few months as a medical student, but …

Limiting access to guns may not be the best solution to the present crisis

John Corsino, DPT

Health Policy

June 6, 2018

Less than one year ago, on an early fall evening in Las Vegas, 59 people were killed at the outdoor Harvest music festival. A single shooter injured hundreds more, using firearms purchased through lawful channels.

There have been many mass shootings in our country, before and since, and in 2015, deaths from gun violence eclipsed for the first time deaths from motor vehicle accidents.

Not long after Las Vegas, discussion emerged in …

The caste system is thriving in medicine in the U.S.

Pramod Theetha Kariyanna, MD

Health Policy

June 4, 2018

On my morning commute as I read this NPR article, memories started flooding my brain. I could not control myself and had to write this.

My last name “Theetha Kariyanna” has its origin from a small village Theetha and added to it is my dad’s name Kariyanna (a local folk god). Back in my school days, the name was weird to my friends as the name …

The quandary of cost transparency

Ted Matthews, MBA

Health Policy

June 4, 2018

What’s the cost of the procedure? A common (and, frankly, reasonable) question from patients contemplating a surgery.

“It depends” is the honest and accurate answer — yet frustrating to provider and patient.

The reason for the ambiguity is that it’s all but impossible to tell a patient what his or her own cost will be.

Patients (again, reasonably) express frustration as to why there isn’t a set price for a given operational procedure. …

Read more…

The quandary of cost transparency

Physicians have become devalued in modern health care

Anonymous

Health Policy

June 2, 2018

I’m writing this piece because I’m finally at the point that I am truly angry. I am angry at how physicians have become devalued in modern health care. I’m angry at how systems of care have participated in this by replacing physicians with lesser trained mid-level practitioners. I’m angry at how our title “doctor” has been hijacked to allow patients to be misled or, in many cases, deceived.

It wasn’t that …

When private physician groups get acquired: Who loses?

Bimal Massand, MD, MBA

Health Policy

June 1, 2018

In the recent years, there is a growing trend in the health care industry whereby private practitioners and independent groups are being acquired by larger companies. This trend is a result of growing complexities of running a private practice and increased expectations of hospital administrators from hospital-based specialists such as anesthesiologists, radiologists and pathologists.

I will concentrate on anesthesia as it is my area of specialization, and I have some relevant …

Fixing our health care system won’t make us healthy

Christopher J. Frank, MD, PhD

Health Policy

May 31, 2018

Like all doctors, I am frustrated when I see my patients missing out on what could be years of good health. And our medical system is so dysfunctional that it’s tempting for doctors and patients to blame poor health outcomes on how we pay for medical care. But, our ridiculous payment system is a symptom, not the cause of our problems, and fixing our medical system is not going to …

Medical professionals are uniquely positioned to provide a safe space for discussion

James G. Beckner

Health Policy

May 31, 2018

Gun safety, gun rights.

On reading these words, some have immediately assumed that I’m a far-left liberal who is proposing breaking into their homes, stealing their guns and melting them down to make a statue of a kneeling, gay football player to place on the National Mall.

Still others have immediately assumed that I’m a far-right conservative speeding by in my rebel-flag-waving, coal-rolling, king cab pickup with my loaded AR-15 in the …

To fix health care, ask patients to change their understanding of how a health care system should work

Richard Young, MD

Health Policy

May 29, 2018

On a recent flight, I sat next to a woman of about 30 who was originally from France but has lived in London for a number of years for work. After exchanging the usual pleasantries, she found out I am a family physician and it became clear she wanted to give me her opinion of the British health care system. I didn’t dissuade her.

For a little background, both the U.K. …

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