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’s no doubt that the health care conundrum our nation is facing is fraught with high-risk hypotheses and their unpalatable consequences. Complicating this further is the business-minded nature of many lobbyists and policy-makers influencing our government’s decisions, including President Trump’s. This is particularly timely given the recent executive orders Mr. Trump has unilaterally implemented that both sides of the aisle are concerned about. As a physician with a top priority …
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Eliminate the middlemen of private insurance companies
The tide is finally rising under the idea of health care for all in America. It is no longer possible to tar this simple and ubiquitously implemented idea as a bid to “take away our freedom” or “destroy the free market.” Hearteningly, the debate is shifting towards the harder questions of when, and how.
One popular idea is to expand Medicare to cover all Americans — essentially turning the government into …
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This is the one thing will make Medicare for all possible
In 1729, a prescient Jonathan Swift wrote an essay that has a place in the health care debates of 2017. “A modest proposal for preventing the children of poor people from being a burthen to their parents or country, and for making them beneficial to the publick” reads almost like the title of a modern academic manuscript. Then, as now, it was important to look past the title before re-tweeting, …
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A modest proposal in response to eliminating the individual mandate
The Office of the Surgeon General existed since 1871 when Dr. John Woodworth was appointed the first supervising surgeon of the national hospital system. In the previous year, the Marine Hospital was reorganized into the national hospital system. On January 4, 1889, Congress formally recognized the new personnel system as the Commissioned Corps. The Corps was established along military lines and initially consisted of only physicians. They …
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Paging the surgeon general: America needs you
From the CMS website, October 30, 2017, “Today, Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma discussed the agency’s efforts to streamline quality measures, reduce regulatory burden, and promote innovation … We need to move from fee-for-service to a system that pays for value and quality — but how we define value and quality today is a problem. We all know it: Clinicians and hospitals have to report …
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If Medicare wants value, it should cancel MACRA
A friend recently asked me, “Where do we go from here?” The friend was referring to our impasse with health care in America. The Democrats have failed to repair the Affordable Care Act, and the Republicans have failed to repeal or replace it.
With the status quo, I can understand our health care system providing lower quality care compared to its counterpart industrialized nations. I can even tolerate lack of access to …
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3 steps to a better health care system
The Sunshine Act is part of the Patient Protection and Affordable Care Act passed in 2010. This act went into effect in August of 2013 and requires the full disclosure of any payments (or transfers of value, i.e., lunches and dinners) made to physicians from pharmaceutical and medical device manufacturers.
The spirit of the act is to have more transparency with regards to potential conflicts of interest created when physicians receive …
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Have you been reported under the Sunshine Act?
Years ago, our government had a problem with health care. Medicare and other health care costs were spiraling out of control. It was clear that the problem was rapidly advancing technology and pressure to provide that technology to everyone who was demanding it. But the government, as usual, choose a politically motivated solution.
They went after the one group involved who was the most disorganized, least clear on its desires and …
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Does the medical profession need their version of the NRA?
The United States of America is home to the free and land of the great. So many have died attempting to flee from war, dictatorships, and poverty to gain access. Once a country with such strong influence, it’s now divided by bipartisan views and gridlocked actions. As a nation, we struggle to find solutions for our poor outcomes. Why does such a great country rank so poorly in education and …
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Registered nurse for president!
It may be hard to believe, but there is a bigger problem than repealing or saving the Affordable Care Act. And that problem is: Why are we so sick to need it in the first place?
Health insurance has become the sine qua non for life in America. Without it, the Fates sever the thread of life with ease. For those escaping the scissors of death, you might be beleaguered with …
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President Trump: Stop focusing on insurance and focus on health
Every patient eventually asks the same question: “How can I find the best hospitals and doctors?”
The solution might seem easy, since we live in a world where information is readily available on the Internet. In a few clicks we can shop for goods, review consumer products, market ourselves on social media, and complete financial transactions instantly. You would think that health care, which accounts for 17 percent of the GDP, …
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Why quality reports for hospitals and doctors are interesting but flawed
Have you ever wondered why your computer often shows you ads that seem tailor-made for your interests? The answer is big data. By combing through extremely large datasets, analysts can reveal patterns in your behavior.
A particularly sensitive type of big data is medical big data. Medical big data can consist of electronic health records, insurance claims, information entered by patients into websites such as PatientsLikeMe and more. …
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Our laws don’t do enough to protect our health data
During a 15-minute recess, the elementary school students trooped from the playground toward nurse Catherin Crofton’s office — one with a bloody nose, a second with a scraped knee and a third with a headache.
Kids quickly filled a row of chairs. Staffers brought paper towels for the bleeders and tried to comfort the crying.
“We’re here for first aid, emergency, counseling,” said Crofton of the Mount Diablo Unified School District. “There …
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One nurse for 4,000 pupils isn’t the healthiest arrangement
It’s a tale of two health systems: the VA and Kaiser Permanente.
The U.S. Department of Veterans Affairs, Veterans Health Administration (VA) is a mission-driven health organization, serving our nation’s veterans. A patient population of 8.9 million, led by David Shulkin, MD. An early leader in health technology adoption. The VA has faced serious issues; however: long patient wait times (deadly long in some cases) and high physician turnover rates.
Kaiser Permanente …
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Better paid, better utilized physicians can transform the VA
I’ve discovered a new condition called “Cadillac Health Care Syndrome.” Those afflicted are relatively healthy people who have numerous diagnoses, take multiple medications and have frequent surgical procedures because they have excellent health insurance with little to no out-of-pocket expenses. Risk factors include early retirement, lack of hobbies, jobs with paid sick days, excessive television watching and overuse of the Internet to investigate symptoms.
It has been widely assumed that better …
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Is too much insurance a problem?
My spry, 90-year-old patient decided she had a urinary tract infection two weeks ago. She had difficulty urinating and the constant urge to void with no fever, no chills, no back pain, no bloody urine. She was advised to come in for an appointment the same morning, but this didn’t suit her. The alternative choice was to see her urologist who made time available that same day. She decided this …
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Why Medicare cannot stay solvent: a case study
Over the past seven seasons, Game of Thrones fans have demonstrated the ability to spot an emerging threat early on — a quality more leaders in health care need to possess.
If you’ve tuned into the popular HBO series from the beginning, you likely recall Ned Stark (Lord of Winterfell) forecasting doom and gloom in the show’s opening episode, appropriately titled “Winter Is Coming.” Right then, you knew something bad was …
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What health care can learn from Game of Thrones
If we listen to the president, fixing the American health care system is too complicated. It is not actually that complicated. The number one issue is cost. Even with many millions of people unable to access care, we already spend close to twenty percent of every dollar in the U.S. on health care. If we hope to include everyone in the health care system, then we need to lower health …
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Fixing the American health care system is simple. Here’s how to do it.
