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.
The metallic mix of freshly spilled blood and sterile instruments engulfed his nostrils as he shifted uncomfortably in the cracked, worn, brown leather chair where so many others had sat before him. He tried not to sweat as the faceless, gray clinician coaxed the long needle deeper into his fleshy neck and watched as a rogue drop of crimson escaped and marred the otherwise pristine tile floor beneath him. He …
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Why the physician shortage in the VA is a sign of things to come
One of my most memorable experiences was more than a decade ago while working for a level one trauma center on the East Coast. I was sitting in a hospital break room during one of my breaks as an inventory coordinator when a nurse walked in. I simply asked how her day was going, and she fell into the chair next to me crying.
Surprised by her reaction, I asked, “What’s …
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Reduce nurse burnout by treating nurses as well as we treat patients
Consumers spend 16 times as long choosing a computer as they do selecting a health plan for themselves and their family. And it should not be a big surprise.
For decades, nearly all insurance companies offered similar choices of in-network physicians and hospitals. And as a result, plans differed only minimally in clinical quality, access and service. And even when clinical outcomes varied, consumers had no easy way to access comparative data.
So …
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These are the reasons why health insurers have to change
A recent study of health care organizations showed that most are not prepared to deliver standardized longitudinal care across multiple provider systems. Shared care plans will be the centerpiece of coordinated care delivery, incentivized by the move from fee-for-service to value-based care. In 2015, Medicare unveiled its plan to transition to quality-based payments via the Merit-Based Incentive Payment System (MIPS), which will sunset and subsume earlier quality-encouraging programs, and …
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How we can move to value-based health care delivery
Two decades ago, I admitted a patient to the intensive care unit for a heart attack. His children were grown, and he looked forward to retirement purchasing an RV to relax and travel the country with his wife.
Invasive cardiac technology had not evolved, so he remained in the ICU on intravenous medication to control his symptoms. On the fifth hospital day, his wife brought a letter from the insurance company …
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The corporate practice of medicine is overwhelming American health care
The fact that primary care is undervalued by Medicare and other payers has been long understood to be driving the precipitous decline in the numbers of new physicians choosing primary care internal medicine or family practice, and a growing exodus of established primary care physicians.
Efforts to address this undervaluation have traditionally been to, 1) bump up the payments (relative value units) for the office visit codes traditionally billed by primary …
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7 new Medicare codes primary care doctors can use to increase payments
My friend Jeremy went to an emergency room with belly pain, and soon learned he’d been blessed with a kidney stone. The staff summoned a urologist, but none was available, so they sent him home with a pain prescription. Continuing nevertheless to writhe in agony, Jeremy phoned urologists and learned to his dismay there were only three in the region who accepted his insurance, and none at all in his …
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Fragmentation is behind health care’s biggest problems
As health care reform drives more insured patients into the system, access to care is more critical than ever. And in protecting patient access to care, fair payment is one of the most pressing issues facing emergency physicians today.
Emergency medicine providers are in a unique position when it comes to providing patient care. Unlike physicians in private practice who can screen patients to make sure they’ll be paid for care, …
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Fair payment and balance billing in the ER: What’s the solution?
Like a pro golfer swears by a certain brand of clubs or a marathon runner has a chosen make of shoes, surgeons can form strong loyalties to the tools of their craft. Preferences for these items — such as artificial hips and knees, surgical screws, stents, pacemakers and other implants — develop over time, perhaps out of habit or acquired during their training.
Of course, surgeons should have what they need to …
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Change happens best when it’s done with clinicians and not to them
Readmissions to hospital, especially within 30 days of discharge, are on the radar of all health care organizations in the United States. This is due in no small part to stiff financial penalties that are now imposed on the worst performers by the federal government.
On the surface, it may seem like a reasonable thing to penalize hospitals that don’t successfully “get their patients better enough” to avoid readmission. However, the …
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Reducing hospital readmissions: The burden shouldn’t be all on the doctors
UnitedHealthcare (UHC), the nation’s largest health insurer, will likely pull out of Obamacare in 2017. Citing high costs and huge potential losses, they warned that 2016 will probably be their last year offering health insurance through the Obamacare exchanges.
Is this another example of greedy insurance companies with fat cat CEOs gouging the system? Or are economic realities interfering with the “hope and change” of Obamacare?
UHC isn’t really selling insurance. Instead …
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Why is UnitedHealthcare thinking of bailing on Obamacare?
With fewer than 100 days until the first primaries, the leading candidates have received ample airtime to address the important issues our nation faces. But even though health care accounts for around 18 percent of our nation’s GDP and consumes close to half of the total tax revenue collected by the federal government, their silence on providing solutions to the most pressing health care challenges our nation faces continues with …
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5 health questions every presidential candidate should answer
After reading my latest post about conflicts of interest in health care, my wife suggested that I write a piece about butterflies. Something pretty, she said. Natural. Peaceful.
Since hostility is never my goal, I thought I’d give it a try.
I read for an entire evening on butterflies — their life cycle, behavior, mechanisms for protection, and how different cultures view them. All I could keep thinking about was how much my grandmother …
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How butterflies are bad omens for health care
Whenever you read a health care article, paper, book, blog post or even tweet, that substitutes the term consumers for patients, and the term providers for doctors, or physicians, you should inherently assume that the authors are advocating for something that will not benefit you or the people you care for, something that will most likely harm you financially and if you happen to be less than independently wealthy it …
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The clear and present future of consumerized health
Recently, I have discussed networks (Internet and electricity), but I would be remiss if I didn’t spend a few moments on the networks that are most likely to rob us of personal choice and increase costs: Health care networks.
Wait, didn’t President Obama promise us that the new health care law would preserve choice for us? Didn’t he promise us lower costs? Well, in spite of much good …
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Health care networks: A mistake we will pay for
The emergence of direct primary care (DPC) has the characteristics of a social movement, defined as a “purposive and collective attempt of a number of people to change individuals or societal institutions and structures.”
Moreover, the DPC movement has thus far succeeded largely because it is based on a guiding set of strongly-held principles from which its founders have not wavered. The concept of direct primary care as …
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Direct primary care is a social movement. And it faces the same challenges.
