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 the year 2018, and patients don’t always receive good care and doctors questions their career choice. How have we arrived at this tragic state of affairs? The answer is that our for-profit health care system is the principal cause — not only of poor patient care but physician burnout. Only a single-payer system, which is anchored in the idea that good health care is an inalienable right and …
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An argument in favor of single-payer health care
When I read the Washington Post article about the CDC censoring seven words last Friday night, my mind immediately jumped to the youth I take care of every day in my Baltimore clinic. It felt like a direct attack on the very patients I became a doctor to treat: the transgender young person initiating gender-affirming hormone treatment; the young woman seeking inpatient addiction treatment for the first …
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The CDC word ban: an attack on the patients I treat
Results of a study released JAMA Cardiology demonstrated that lower readmission rates among hospitalized heart failure patients, a key focus of recent Medicare value-based payment efforts, were associated with increased patient mortality. In other words, patients admitted to the hospital for heart failure are being re-admitted less frequently, but dying at higher numbers. Value-based pay, as it turns out, where monetary incentives and penalties are tied …
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How value-based pay can worsen patient outcomes
For Dr. Peter Cram, an American internist who spent most of his career practicing in Iowa City, Iowa, moving here about four years ago was almost a no-brainer.
He’s part of a small cohort of American doctors who, for personal or professional reasons, have moved north to practice in Canada’s single-payer system. Now when he sees patients, he doesn’t worry about whether they can afford treatment. He knows “everyone gets a …
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Can we implement the Canadian health system in America?
Like it or not, the Medicare Access and CHIP Reauthorization Act (MACRA) legislation will affect virtually all health care providers practicing in the U.S. Although I sympathize with Dr. Hahn’s sentiment in his article “If Medicare wants value, it should cancel MACRA,” lamenting this legislation feels like “another layer of senseless rules, data collection and more rules.”
MACRA ushers in a long-overdue value-based payment system designed to foster …
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A nurse’s reaction to MACRA haters
The Affordable Care Act, a.k.a. “Obamacare,” has roiled America since the day it was signed into law in 2010. From the start, the public was almost evenly divided between those who supported it and those who opposed it.
They still are. The November monthly tracking poll from the Kaiser Family Foundation found that 50 percent of those polled had a favorable view of the health law, while 46 …
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Why do people hate Obamacare?
In today’s health and political discussions, opioid abuse dominates the conversation despite being only part of our country’s substance use epidemic. Prenatal substance use remains an uncontrolled public health problem with high costs to women, children, and society. Part of the problem is the difficulty in measuring the extent of the problem nationwide.
Most prenatal substance use prevalence data comes from substance treatment programs and national self-report surveys, likely leading to …
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Stop criminalizing prenatal substance abuse
In a very unique study, researchers have tabulated how often family physicians provide patient care that is not covered with a CPT code. This is a little complex, for the non-physicians and even for many physicians to grasp, so I will provide a little more background first.
CPT stands for Current Procedural Terminology, which is the book written by the American Medical Association (AMA) since about 1965. This …
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How the CPT system shortchanges primary care
While on the way to a national meeting on health and public policy, I ponder on what the practice of medicine has become and whether this meeting will provide any hope for improvement. It hasn’t been clear to me that those most responsible for public health policy are listening to doctors. Politicians have been leading this charge, sometimes solo, sometimes in a group but rarely in a collaborative fashion — …
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Can technology and the art of medicine coexist?
In case you missed it: Sutter Health, the Northern California health system titan was recently sanctioned for intentionally destroying 192 boxes of material relating to its anticompetitive actions and alleged overcharges. The material, which amounted to 10 years’ worth of evidence, was initially slated to be destroyed in 2035. Sutter’s Vice President, Melissa Brendt, authorized her executive assistant, Sita Santagata, to destroy …
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Sutter Health’s antitrust case matters. Here’s why.
In a world where health care is defined by consumerism, positive health care campaigns like “Redefining Possible. The profound and unstoppable power of yes” and “Making Cancer History” have been directly targeting consumers in an effort to thrive in an increasingly competitive marketplace. Health care reform is partly responsible for the increase in hospital advertising, as customers now have a greater agency to choose where they seek care. But how …
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Are hospital ads just unregulated false hope?
“Nurse practitioner (NP) education is seriously underfunded. The profession is attempting to saddle private physicians with this cost.”
That is how “Dr. X” replied to my email asking whether he would be willing to precept a nurse practitioner student for her clinical rotation. I read through his clearly disgruntled letter and wanted to explain to him why NPs have to train “on the backs” of physicians and why funding for nursing …
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Why nurse practitioners train on the backs of physicians
Linda Radach has had six hip replacement operations since 2006, three on each side. Osteoarthritis was the reason she needed surgery in the first place, but replacing her hips in some ways only worsened her troubles.
Following two of the procedures, the implanted metal socket didn’t integrate with the bone of her own hip socket and was loose, causing excruciating pain. Most recently, the titanium metal ball in her hip corroded.
The …
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Your plumber offers a money-back guarantee. Should your doctor?
