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.
It is well known that smoking cigarettes negatively impacts health and leads to an increased risk of stroke, heart disease, lung cancer and death.
No one debates this anymore. But it wasn’t always this way, and it didn’t come easily.
In the 1940s, almost half of the population in the United States smoked, and the tobacco industry was subsequently incredibly powerful and politically active. It spent millions of …
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Fight gun violence with science
Why is U.S. health care so costly compared to other developed countries? A recently published report provides some insights.
In a study of 11 countries, Harvard researchers found that while the United States has the highest health costs relative to its GDP, its use of services is average. More specifically, the U.S. ranks lower than nearly every other country in doctors’ visits, hospitalizations, hospital days, and consultative services.
The difference is …
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America leads the world in high tech care and health care costs
Hospitals serve as the economic lifeblood of their communities. They are the second-largest source of private-sector jobs in the United States, employing 5.4 million Americans who, together, embrace a virtuous mission to heal and help others in need.
And yet, every year, more and more of them are forced to shut their doors. With soaring costs, eroding margins and mounting pressure from competing providers, the American hospital industry is on life …
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A radical proposal to save America’s hospitals
Now that the children have shouldered their muskets and taken aim — figuratively speaking, of course — against the gun lobby, maybe we can interest them in another partisan conflict that’s even more sweepingly about their survival: climate change. Not to minimize the horrific consequences of school shootings, but there are many more lives at stake from climate calamities. Threats from sea level rise, flooding, wildfires, and storms are multiplying …
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A case for climate activism: but where are the medical students?
Eye surgery is a delicate business. It involves operating within an orb the size of a large marble to remove a cataract or repair a retinal detachment.
Not only is superb eye-hand coordination a must, but also an awareness of the myriad other medical issues in the elderly population most in need of eye surgery.
Traditionally, patients undergoing cataract surgery had a preoperative medical evaluation, including blood work, chest X-ray, and EKG, …
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Why cataract surgery is more complicated than it should be
A hundred years ago, the practice of medicine was just that: the practice of professionals specially trained to alleviate suffering and heal the sick. Doctors had a fiduciary responsibility to put the needs of their patients before their own. A small town doctor might be paid for his efforts in chickens — living or cooked.
Flash forward.
Medicine is big business. Trillions of dollars are spent every year in the health care …
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Medicine could use more common sense
Medical practices with risk-adjusted contracts must sharpen their diagnosis coding. Practices that are part of accountable care organizations (ACOs) or that have risk-adjusted contracts with commercial payers have an economic incentive to accurately report the disease burden of their patients. In fee-for-service medicine, physicians are paid based on the fee schedule associated with a CPT code, and any modifier attached to that code. The diagnosis code establishes the medical necessity …
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How to do risk-adjusted diagnosis coding the right way
By their nature, fee-for-service reimbursement schemes incentivize procedures over prevention. This creates a serious moral hazard: If you keep your patient panel healthy through early interventions and exhaustive lifestyle counseling, then there are fewer profitable procedures to do. On the other hand, if you let your patients become critically ill, then you will be rewarded handsomely for all of the (now) medically necessary procedures and tests that you can perform …
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A reimbursement structure that can benefit primary care
You go to your doctor because you are suffering pain, fatigue, or some equally debilitating ailment. Your doctor examines you and is worried there may be a serious underlying medical reason for your symptoms and orders a test. But, before you can have that test done to determine the cause of your symptoms, the insurance company must agree that you need it in order for them to cover the cost …
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The health insurance industry is like a house of cards
It is wildly popular to say that the chief culprit in the U.S. health care system is the traditional fee-for-service payment system, which rewards physicians for volume but not quality, leading to high-cost, low-quality health care. It supposedly follows that the fix is a system of “value-based” payments.
Despite the popularity of these arguments, both aspects have been shown to be wrong. Studies show that the rising cost of American health …
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What is the perfect fee-for-service system?
I was behind schedule (again). My next patient was Helen, a non-compliant diabetic that hadn’t been into my office in over two years. Her blood sugars weren’t controlled at her last visit when I’d tried to impress on her the serious health problems that could develop if she didn’t take better care of herself.
Clearly, I’d failed. Maybe I’d even chased her away? No pill I prescribed would help her diabetes …
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The real cost of not having health insurance
I’ve got a confession to make. I own stock in a firearms maker.
Seems ironic that someone like myself — a physician has cared for countless victims of gun violence and someone who advocates for evidence-based policies to avert gun deaths — would not only own guns himself but also be a stockholder of a company that manufactures them.
Let me explain how this happened. When I first got out of residency, …
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Why this physician divested from a firearms maker
The NHS is robust. And part of that is due to the passion of its workforce. Since its beginning in 1948, the service has met each new challenge with vigor. But never before has it’s existence been under such threat. And with it, the safety of a nation. And there is no one more qualified to save it than those who fight on the frontline. I sat …
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Why nurses must help lead the NHS
“I’ve done this thousands of times. If you do not intubate him, he will die quickly. I’m a pro, but I don’t have all night: either decide to let me do my job, or he dies. But remember, he could die while I do the procedure as well.”
These were the words that echoed around a group of five siblings, a spouse and ten grandchildren, all lost in the chaos of …
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What Frederick Douglass can teach us about health care
First, a history lesson. Back in the mid-2000 oughts, the AAFP launched a wholly owned subsidiary called TransforMed. It was originally started to help practices implement the “new model of care” from the Future of Family Medicine Report. Soon after it was launched, the joint principles of the patient-centered medical home (PCMH) were announced, so TransforMed pivoted to help practices implement the PCMH model of care.
In …
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The tiny gains of patient-centered medical homes. Are they worth it?
All eyes are on interest rates as investors look for more signs of trouble ahead.
If their concerns over higher-than-expected inflation prove accurate, many players in the U.S. economy will suffer the burden of higher costs. But perhaps no sector would feel the strain more than health care. Higher costs would be just the start of many problems to come for providers, insurers and, eventually, patients.
Surging inflation would create a vicious …
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How inflation will affect our health system
If you get health insurance through your job, beware: you might be picking up more of the cost of your medical care than you realize. With increasing frequency, employers are directing their workers to the kind of high deductible, high out-of-pocket insurance plans that leave workers financially responsible for a surprising portion of their health care expenses.
Not long ago, having insurance coverage meant your costs were largely …
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How high-deductible plans are a bait and switch
