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The shocking lack of data behind the medical home

Jan Gurley, MD

Health Policy

February 25, 2014

When looking to examine patient-centered medical home data, there’s no better place to start than the 26-month evaluation of the multi-site National Demonstration Project. Begun in 2006, with results published in 2010, this federally funded project included an array of repeated cross-sectional surveys and medical record audits at baseline, 9 months, and 26 months, using patients from 36 family practices that were randomized into two groups: those practices that received …

Save mammography or save women? Supporters face a quandary.

Michael Kirsch, MD

Conditions and Diseases

February 25, 2014

Sometimes, we play a little politics on this blog. I am a student of current events and enjoy following the dysfunction and absurdities in American politics. To paraphrase the legendary former British prime minister, “never has so little been done by so many to benefit so few.”

Readers know how skeptical I am about medical dogma. When I was an intern a quarter century ago, I didn’t grasp why routine measurement …

Does the ACGME serve the needs of tomorrow’s physicians?

Wes Fisher, MD

Medical Education

February 24, 2014

“A new roadmap for improving residents’ professional skills was released Tuesday by the Accreditation Council for Graduate Medical Education (ACGME)” begins the press release.

As I dove into this announcement a bit further, I discovered the origins of this initiative outlined in this executive summary published by the ACGME on the “CLER Program:”

The Accreditation Council for Graduate Medical Education (ACGME) recognizes the public’s need for a physician workforce capable of meeting the challenges of …

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Does the ACGME serve the needs of tomorrow’s physicians?

Education on distracted driving can’t start early enough

Heidi Roman, MD

Conditions and Diseases

February 24, 2014

I gotta say, the daily commute has been feeling a bit hairy lately. Seems like I’m passing accidents more frequently. Watching a bit more weaving. I can’t be sure that it’s all related to distracted driving, but sure seems like a lot of it is. Every day I witness drivers looking down at phones at stoplights, missing the change to green. I even saw a smartphone mounted to one car’s driver side dash and the driver scrolling through websites …

Patients can’t solve health costs, even with skin in the game

Ann Robinow

Patient

February 24, 2014

Attempting to alter the health care marketplace so provider decisions are based on patient value has shaped my career for the last 20 years. Often use of the health care delivery system creates a learning opportunity for me as well as the poor, unsuspecting provider of care. A recent experience was instructive.

A close encounter with a jungle rock while mountain biking sent my husband back to our cruise ship with …

Radiologists on the new mammogram study. Who’s right?

Jennifer Gunter, MD

Conditions and Diseases

February 24, 2014

The BMJ recently published the latest results from the Canadian National Breast Screening Study (CNBSS). A brief summary of the CNBSS: Women were randomly assigned to annual mammography or breast exams and then the outcomes tracked. The results in the BMJ: mammography did not improve survival.

This is a very interesting study and when I first started working on this post I wanted to delve more into the science of …

Don’t blame doctors for going concierge

Afshine Ash Emrani, MD

Physician

February 23, 2014

Merrill Markoe’s reports that she was fired by her doctor in her article, “My Doctor, the Concierge,” which was both sarcastically entertaining and painfully true. She writes a powerful commentary on the divide caused by insurance companies between doctors and patients. She is shocked at the rapidly growing trend of an access fee to see concierge doctor and yearns for the Hippocratic Oath’s “May I long experience the joy …

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Don’t blame doctors for going concierge

We are training physicians with an eye towards the past

Jon Coleman

Medical Education

February 23, 2014

How do you ask a person to be the last person to go through an education system that is failing them? Yet we’re doing just that. Every day tens of thousands of medical student wake up to an education, and an education system, that is failing them. This is not to say that we are not producing good doctors. On the contrary, our doctors are likely the most well-educated, and …

SGR repeal: A marked improvement over the status quo

Coalition of State Medical Societies

Health Policy

February 23, 2014

Medicare’s Sustainable Growth Rate (SGR) payment formula has hung like an annual albatross around the necks of physicians, Congress, and medical associations for more than a decade. Finally, we have a realistic opportunity to fling that albatross into the sea.

Three congressional committees — from both the House and the Senate, with both Democratic and Republican support — have crafted the SGR Repeal and Medicare Provider Payment Modernization Act of 2014, …

Why private education loans need reform

Suraj Bhatt

Medical Education

February 23, 2014

Education debt nearly is a practical puzzle. For many students, this lending proves crucial and extends enormous utility. Stickiness usually surfaces only after a student graduates and his or her loans enter repayment. While debt dollars or repayment problems may differ across academic majors and college settings, students should be reasonably able to defer their education loans, regardless of lender, while enrolled in school.

When borrowing for education, students often draw …

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Why private education loans need reform

Huddling in the medical home: Sounds good on paper

Fred N. Pelzman, MD

Physician

February 23, 2014

“Just start work half an hour earlier.”

This is what the head of the care coordination committee for our patient-centered medical home executive committee work group recommended when we talked about our struggle getting the team together for early-morning pre-clinic huddles.

She suggested that if we started our usual practice morning at 8 o’clock we should just have everybody come in at 7:30 to load the dashboards for the morning session …

Medicare should cover infusion services at patients’ homes

Emma Singh, MD

Physician

February 23, 2014

As I explained his options, my patient’s initial shock turned to disbelief. I told the 84-year-old man that Medicare would pay for treatment of his urinary tract infection if he received infusion therapy at a nursing home, but it would not be covered if he opted to receive the therapy at his own home.

We calculated that the four weeks of therapy at a skilled nursing facility would cost Medicare about …

What’s the difference between speech and voice?

James P. Thomas, MD

Conditions and Diseases

February 22, 2014

Mr. Heim Stillear, at 70-years-old, seems older and less intelligent to his family, since he was hospitalized for a stroke about two months ago. They come to the appointment with him and help him into the exam chair. When I ask Heim what is going on with him, the long pause before his strained answer begins makes his family uncomfortable.

His daughter interjects, “We are having a very difficult time understanding …

A pediatrician’s survival story: Remembering the children

Natasha Raja, MD

Physician

February 22, 2014

I have just turned on my computer. It is midnight. I should be trying to sleep right now.

My 5-year-old is sick and I am on call for the next few nights. Fortunately, my daughter should get better in a day or two. She needs Tylenol for her fever, mama’s love and time to kick this virus. But as I sat in bed holding her and waiting for her fever to break, …

Letting go can be the hardest thing in the world

Rob Brandt, MD

Physician

February 22, 2014

Several years ago I took care of an elderly woman in the ER. She came in with a chief complaint of chest pain. She came in via ambulance and by the time she got to the trauma bay she said she was feeling a little bit better. She didn’t know she was about to die, usually people who are about to die look much worse.

She looked good, all things considered. …

How to talk with parents about vaccines

Andrew Cronyn, MD

Physician

February 22, 2014

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Walking parents through the decision to vaccinate their children is a conversation. The vast majority of the time it is an easy conversation. Sometimes it is difficult.

If the conversation goes like this, then we, as doctors aren’t doing our jobs:

Pediatrician: “Are you going to vaccinate your child?”

Parent: “No.”

Pediatrician: “Get out of my office.”

The medical community has lost a lot of ground …

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How to talk with parents about vaccines

How can the physician workforce be diversified?

Lyndonna Marrast, MD and Danny McCormick, MD, MPH

Physician

February 22, 2014

The Affordable Care Act (ACA) will increase insurance coverage for the poor, uninsured and minorities, but will it improve access to care and population health? The answer depends critically on whether or not physicians are available to care for the newly insured. Many health policy experts fear there may not be.

While the ACA contains some modest pay increases for doctors willing to see patients with Medicaid (the means-tested joint federal-state …

MKSAP: 32-year-old woman with chronic fatigue syndrome

mksap

Conditions and Diseases

February 22, 2014

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 32-year-old woman is evaluated following a diagnosis of chronic fatigue syndrome. She has a several-year history of chronic disabling fatigue, unrefreshing sleep, muscle and joint pain, and headache.

A comprehensive evaluation has not identified any other medical condition, and a screen for depression is normal. Her only medications are multiple vitamins and …

Are physicians ready for the e-patient movement?

Don S. Dizon, MD

Physician

February 21, 2014

I gave a talk recently to a group of my peers about addressing the needs of patients after a diagnosis of cancer, emphasizing points where transitions occur — from treatment, to end of therapy, surveillance, recurrence, and extending all the way up to the end of life — and how important it is to consider the entire journey of a person …

Obamacare: What will the administration back off on next?

Robert Laszewski

Health Policy

February 21, 2014

I recently asked if Obamacare was unraveling.

The Obama administration announced that they are delaying the employer mandate again.

In the announcement, they said that large employers, those with at least 100 workers, will only have to cover 70% of their otherwise eligible workforce in 2015 and 95% in 2016 and beyond.

The administration also said that employers with 50 to 100 workers will have their mandate to provide affordable health …