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.
Lena Wright’s best friend was hunched over like a character from a French novel, with spinal bones so thin they would fracture with a fit of sneezing. Determined to avoid that fate, Wright (a pseudonym) asked her primary care doctor to test her for osteoporosis with a DEXA scan, also known as dual energy x-ray absorption. The scan would send two x-ray beams through her bones, one high-energy and the …
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Reducing health costs: Patients aren’t going to take the lead
It is possible that in a few months from now, only Nate Silver’s prediction models will stand between Donald Trump and the White House. I will leave it to future anthropologists to write about the significance of that moment. For now, the question, “What will President Trump be doing when he is not building a wall?” has assumed salience.
This is relatively easy to answer when it comes to health policy. …
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A physician’s health policy advice to Donald Trump
What is happening in medicine? How will these changes affect our patients? How will they affect how we deliver health care? These seem to be the questions asked most often amongst physicians across the country. I do not profess to have a crystal ball nor can I state with any certainty what the profession we chose to dedicate our lives to will look like in the near future. However, there …
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Physicians need to get involved or risk irrelevance
American businesses hold a solution to one of the most fundamental flaws of American health care: misalignment of incentives. We live in a nation where profit-seeking behavior can be more alluring than high-quality patient care. To date, major health care reform efforts have paid little attention to the business community’s potential to address this issue.
Status quo
Currently, the status quo is such that health insurance companies and health care providers act …
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How employers can lead the way for health reform
Health care is often really costly. And with increasing frequency, a significant chunk of those costs is being passed on to patients in the form of high deductibles, copays, or other out-of-pocket expenses. As a result, millions of Americans struggle to pay medical bills each year.
What’s a poor patient to do?
For starters: They can talk to their doctors about these costs. According to a study my colleagues and …
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Talk to your doctor about health costs. It can save you money.
Currently, in American health care, experts are wringing their hands in confusion. I mean, people have insurance, right? And yet, health care is still expensive and dang it, people just keep going to the ER. Visits are climbing everywhere, and I can speak from personal experience when I say that we’re tasked with more and more complex and multi-varied duties in the emergency departments of the 21st century.
I’m not a …
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The “go to the ER” mentality of American medicine
The observation versus inpatient distinction is rightly getting more media and public attention with each passing month. In a nutshell, for anyone reading who is not familiar with what this is all about, it’s essentially a way of categorizing people when they get admitted to hospital.
You are either deemed an inpatient (basically a more complex case) or an observation (a less serious case). The individual reasons and checkboxes that have …
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When debating inpatient vs. observation, remember this history lesson
The United States far outspends peer countries on health care. When American politicians complain about these high health care costs, they often vilify pharmaceutical and insurance companies for profiting at the expense of the general public. As I wrote earlier, such vilification is misguided, pushing too much of the blame on individual actors rather than on the system that incentivizes individuals to act those ways.
So what it is …
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Who do presidential candidates blame for high health costs?
Last year, several scandals unfolded involving the Veterans Health Administration. Close to home, the Fort Collins VA hospital falsified its wait times for clinic appointments. To meet the VA goal of clinic appointments within 14 days, the hospital instructed its clerks to “cook the books,” falsifying appointment records to give the illusion that the vets were being seen in a timely manner.
Farther away in Phoenix, the local VA hospital had …
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Wait lists at the VA may be a sign of things to come
Just as the U.S. health care system is about to make performance measurement a central feature of … well, just about everything doctors do … some prominent and highly influential physicians are asking for a pause and reassessment.
Writing for the New York Times, Dr. Bob Watcher argues that, “Two of our most vital industries, health care, and education, have become increasingly subjected to metrics and measurements. Of course, …
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Explaining the physician anxiety behind performance measures
I’ve been following Marissa Mayer’s tenure for nearly four years at Yahoo. Not just because I was initially tapped to lead athenahealth’s integration of another mature advertising-driven mobile company — Epocrates — but because Yahoo, with its complexity and technology legacies, and highly competitive, fast-paced market environment, reminds me of many of the country’s largest health care delivery systems.
Both are facing significant headwinds to stay relevant in their respective industries …
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What health care leaders can learn from Yahoo’s failure
The title of Noam Scheiber’s January 9, 2016 New York Times piece on hospitalists, “Doctors Unionize to Resist the Medical Machine,” skirts the bigger issue for doctors, which has less to do with contracts, salaries and labor relations, and much more to do with the question, “Is health care just another business, and if so, can physicians be managed that way?”
I’m a silverback hospitalist, and when I started …
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Am I a health care business metric or a physician?
The American health care system is set up to care for a certain subset of the population — sick people — people with chronic disease, acute illness, acute injury, and complex disorders like cancer or metabolic issues.
The problem is, this set up doesn’t create market incentives to care for the well effectively, or to identify those at risk for disease and efficiently and reliably intervene, at scale.
To reconcile this cognitive dissonance …
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It’s time to free doctors from their boxes
Part of a series.
Primary care needs to change. That change will need the concerted efforts of patients, doctors, and other constituents. Many are cynical and believe that no worthwhile change can ever occur; others are simply resigned. But optimism can be realistic with intense advocacy and simply taking the initiative to make change. This may surprise you, but change will only happen when patients along with doctors become …
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Patients and physicians must advocate for a transformed primary care system
All hopes were abandoned. In theory, it was supposed to jump start medical care and provide access to the uninsured. It was the promise of a new day. Every American would have access to good, quality (I really have learned to hate that word), affordable medical care.
I’ll never forget that day. It was raining hard, and my clothes were soaked through. The air felt particularly raw against my skin. The …
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Can our health system really go downhill any further?
Supply chains and other service industries, like telecom, worry about “the last mile” — the final step in delivering a product or service to customers. Like other industries, health care must connect most meaningfully to the patient, and the nurse is almost always part of (if not the sole manager of) that last mile. The analogy of the last mile defines a deeply rooted issue about nursing’s criticality (and that …
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Nurses are essential to better and cheaper health care
Health care in America is fracturing right down the middle, and doctors are going to have to figure out if or how long they can straddle the divide between what patients want and what the government and corporate America want them to have.
Up until this point, the momentum has been with the payers, Medicare, and the insurance industry. But the more heavy-handed they become, the more inevitable the public backlash …
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The straight face test of our health care system
