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.
As an American medical student doing an elective in Thailand, I was initially troubled when I saw how Thai patients were treated. I’m not speaking of the way Thai physicians apply medical science, mind you — they rely on UpToDate and sundry U.S. guidelines just as we do — but that was mostly where the similarities ended.
Morning rounds with the team of residents (sans attending, but apparently there was one …
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What this medical student learned from doing a rotation in Thailand
I recently took care of a woman in her 50s that came to our emergency department (ED) complaining of chest pain. The pain had started shortly before arriving in the ED but within minutes, we performed a battery of tests, treated her pain, and gave her an aspirin. Still concerned about heart disease being the cause of her pain, I observed her overnight in our EDs observation unit and completed …
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Freestanding emergency departments: The model we need to study
I am a scientist and a medical economist. I have been privileged to work beside doctors in both their caregiving role and their research role for 20 years. I have seen their challenges and tried to build products and services to help. I have deep respect for the challenge of medicine and the committed practitioners.
When I left graduate school in 1988, it was the beginning of the movement from fee …
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Health insurance must be driven by physicians. Here’s why.
Twenty years of experience and research reveal two indispensable truths about hospitals and health care organizations that can no longer be ignored: Those institutions neglecting the basic fundamentals of patient care risk jeopardizing the quality and safety of care they provide.
Nothing can have a greater short and long-term impact on the cost of delivering health care services than nurses.
The central role of the nurse in patient care
For more than 60 years, …
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When things go wrong operationally, nurses feel the pain first
The Merriam-Webster dictionary has many definitions for the term system, but the most straightforward, and arguably the most applicable to our health care conversation is “a regularly interacting or interdependent group of items forming a unified whole.” The common wisdom is that our health care system is broken, and hence, our government is vigorously attempting to fix it for us through legislation, reformation, and transformation. We usually work ourselves into …
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This is why health care is not a system
When nurses stand on the steps of our nation’s capital, it is a warning that something is seriously wrong in health care. Much like a canary in the coal mine, nurses are the barometer of the health of our hospitals, nursing homes and health care facilities.
On May 12th 2016, nurses from around the United States convened on our nation’s capital for the …
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Nurses take DC to save patient lives
Most industrialized nations have long supported the idea that access to health care is a fundamental right, and have built centrally planned systems to accomplish that goal. The result has been universal coverage that delivers excellent-quality outcomes at lower costs than the United States.
In some countries, such as England and Canada, the government controls both financing and certain aspects of health care delivery, while in others, including Australia, Sweden, and …
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Improving our health system requires a culture change. Can it happen?
With all the changes happening in health care and the increasing weight of federal mandates and requirements, it’s easy to view the Centers for Medicare & Medicaid Services (CMS) as the big, bad enemy. After all, if they just left all physicians and health care institutions on their own, everything would be OK, wouldn’t it? It’s an occasional line of thinking I’ve heard from many esteemed colleagues and also appears to be …
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Why Medicare is not the enemy
I am forced to attend one of these mandatory continuing medical education (CME) events. My malpractice insurance provider has a deal with the state medical association. To get lower rates, I have to be a member of the association and every 2 or 3 years attend a risk management training session.
I make it on time, despite the traffic.
As I walk into the lobby of this rather nice building, looking for …
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The state of health care in America: Smell the bacon
United Healthcare announced that it plans on exiting most of the Obamacare insurance plans by 2017. Not their traditional commercial insurance plans or Medicare supplements, but specifically the insurance plans offered through the state exchanges of Obamacare.
Didn’t President Obama tell Americans that if they liked their insurance plan, they would be able to keep it under Obamacare? Actually he did, at least 36 times. So what happened?
In …
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Why Obamacare is not economically realistic
I was saddened to hear that one of my favorite libertarians, the wonderful journalist John Stossel, has taken ill. True to form, however, he’s taking it in stride (he nonchalantly quipped, “seems I have lung cancer”), and I want to take this opportunity to wish him very well indeed. I enjoy his reporting and writing, and have learned a great deal from Mr. Stossel over the years.
But that doesn’t mean he’s always …
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What John Stossel gets right, and wrong, about health care
The changes to health care — not just in policy, regulation, and payment but also the tectonic shifts in how we define, evaluate, report and are paid for care — can make us all feel like we’re on a runaway train.
Alongside the runaway train are the significant improvement opportunities in health care we must somehow address — less variance, improved patient engagement, coordination of care, adherence to evidence, waste reduction …
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To make big heath care changes, think small
Having been a nurse for over 18 years, I have endured a few Nurses Week. At first, I was lured into the charm of my first Nurses Week bag. I had finally arrived: My first official nurse’s bag. I had arrived and for a full week, the folks at the hospital seemed to actually appreciate what we did for our patients. After a few mugs, key chains, beach towels and …
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Make this the Nurses Week we all want. Here’s how.
For decades and decades we have been counting the number of doctors in America. For decades and decades we have been coming up short compared to other developed nations, and some less developed ones as well. A poorly educated person may be tempted to suggest that we should “make” more doctors. After all, there is hardly a shortage of young people willing and able to undergo the rigors …
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The effects of cheap health care hacks will be felt for decades
CMS states it wants to increase pay to primary care physicians. And while we might quarrel with their strategies or with the speed of achieving the goal, few would quarrel with the goal itself. In recent years, CMS has developed HCPCS codes and adopted CPT codes, some limited to primary care and some not specialty restricted but all likely to be reported by primary care practices. Meanwhile, although payment systems …
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How to perform services that increase primary care revenue
A recent article suggested that using observation status for a hospitalized veteran was dishonorable to his years of service to our country because observation would subject him to higher out-of-pocket costs. This post created quite a lot of discussion and debate. While I agree with the author and commenters that observation is confusing to all and that there has to be a better way, the premise that observation …
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In defense of Medicare’s observation status
My dad was recently diagnosed with cancer. Overnight, he found himself faced with tough care decisions, small insurance crises, and the overwhelming bureaucracy of cancer. He was also about to become tasked with managing a daily care routine far outside the scope of his usual morning ritual.
Since his diagnosis, he has returned to the hospital twice with pneumonia. While many cancer patients become prone to bacterial infections due to a …
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Improve health care services for our most vulnerable
