There is a broad consensus among healthcare policy wonks that the 800 pound gorilla in the healthcare cost debate is that a big chunk of the medical care we provide — some say as much as a third — does not help. It may even make things worse for patients. Aside from the ethical issue of doing things that don’t help, and may hurt, this useless and dangerous care is …
There is more to life than avoiding death
As I approach my 50th birthday, I worry about Medicare not being there for me when I become eligible. I have some inside knowledge about Medicare. My parents and in-laws are patients on Medicare. As a doctor, I am a provider for Medicare, and as a public health educator I am a consultant for a Medicare quality improvement organization.
Everyone, including the leaders of both Democratic and Republican parties, agrees that …
Fixing Medicare: Both providers and patients need skin in the game
The Surgeon had been handicapped by a burr in the plantar aspect of his left foot. All summer it had been causing discomfort on jogs, during soccer games, and,eventually, even just walking barefoot across the hardwood floors in the morning. There was something lodged in the thick skin of the strikeplate of his foot— a splinter, a piece of glass, whatever the hell— and it was really starting to cramp …
Performing surgery is not about empathy
The health care crowd is abuzz with the New York Times revelation that Medicare billing rates seem to have increased by billions of dollars in parallel with increased adoption of EHR technologies for both hospitals and ambulatory services. The culprit for this unexpected increase is the measly E&M code.
Evaluation and Management (E&M) is the portion of a medical visit where the doctor listens to your description of …
Stop penalizing doctors for effectively using EHRs
I am riled up—almost to the point of being inflamed.
I hate it when doctors get dragged through the mud. It’s a matter of pride. Doctors are my team.
The latest kerfuffle centers on how much we should charge for return patient visits. The difference here is between moderate and moderately high visits–or about $30.
When the Center for Public Integrity is investigating your profession, it’s unlikely to be good news. And it …
Doctors who manage patients in the office aren’t the problem
I want to clear up a misunderstanding often voiced in the healthcare blog universe: namely, whether health care is a right or a service. Our answer to this question will affect how we approach healthcare reform in the next Congress, so let me say plainly: health care is a civil right.
Civil rights are what we call those claims necessary to secure free and equal citizenship, secondary to basic rights. For …
Why health care is a civil right
Moving from paper death certificates to an online process called the Washington State Electronic Death Registry System, or EDRS. Sounds like a simple 21st century process that should make the process of completing a death certificate faster and easier right? Oh, the government designed the system. Oops.
I’ve been so frustrated by the unintended consequences of a new state governmental process for completing death certificates.
Beginning in early 2012 Washington state started …
Moving death certificates to the digital age: Unintended consequences
We had one of each in our house: one baby that we let cry for periods of time to self-soothe and one where I simply couldn’t bear to hear the crying in quite the same way. You’d think it would have been just the same for both of our boys, but it wasn’t. Clearly I wasn’t the same parent each time around.
There are many things that go into the equation …
There is no right way to help infants sleep through the night
I was making a mental packing list for a fall weekend at the beach: sweatshirt, jeans, sunglasses, those sandal things–you know, for walking on rocky shoreline? Kind of ugly, but useful? I could picture them clearly–the rubber soles and webbed uppers–but their name escaped me entirely. A person’s name, maybe? I started to go through the alphabet letter by letter, hoping for a clue. But it was gone. Not “wait, …
Is a lapse of memory a sign of Alzheimer’s?
Probably the hardest part of making the change from a traditional to a direct-care practice is the effect it has on relationships. I am only taking a maximum of 1000 patients (less at the start) and will be no longer accepting insurance. These changes make it impossible for me to continue in a doctor-patient relationship with most of my patients.
For some, this transition will be more hassle than anything. Some people …
Why I made the change to direct care practice
I vividly remember the first day my medical school classmates and I met our cadavers in the anatomy lab. Large body bags lay on metal tables that had been bolted to the floor. I remember the sheer size of the bags best. No doubt existed in my mind that dead human bodies indeed lay within them. And yet part of me couldn’t quite grasp that I was actually going to …
Strive to maintain our compassion for others
The debate over fee-for-service physician payment often is misunderstood to be about the technicalities and relative merits of the RUC, relative value units, P4P and the SGR. It isn’t—instead, it’s what the fee itself represents (and who decides), and what the service being provided actually is (and how it’s described).
Let me explain. Analysts across the political spectrum agree that the health care system needs to move …
Patients and doctors interpret fee for service differently
When I learned recently that I would need cataract surgery, I researched New York City hospital ratings from three well-known sponsors: US News & World Report, the federal government’s Hospital Compare and the Leapfrog Group. After writing about what I discovered, I wondered if perhaps a few measures might offer a clue or two about how to better honcho some of my care, like the one that asks hospital patients …
Having patient satisfaction data isn’t enough to choose a hospital
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My esteemed colleague Dr. Bob Centor is enamored of an interesting essay from which he quotes:”Only you can educate you—and you can’t do it by memorizing. You have to find out who you are by experience and by risk-taking, then pursue your own nature intensely. School routines are set up to discourage you from self-discovery. People who know who they are make trouble for schools.”
Personally, I found it more of …
Why medical students need to begin in the classroom
Charlotte Scott had an eye for madness—for just the right amount of madness. As a booker for The Springer Show, her job was to find—and forgive me if I’m getting too technical here—minor nut jobs, the kind of people who were just unbalanced enough to make for entertaining T.V. but not so wacky that they would pull an Uzi out on the audience.
I learned about Scott while reading Jon Ronson’s …
Help your doctor understand where you’re coming from
Although McAlester, Oklahoma, is a relatively small, rural town, it’s the largest town in southeastern Oklahoma. Well over 100,000 people come through for a number of goods and services, including health care. Growing up 30 minutes outside of town, I understood rural Oklahoma from a patient’s perspective, and I looked forward to seeing it from the provider’s perspective. During a summer rural externship, I spent three weeks shadowing Carol Gambrill, …
The rewards of family practice in a rural town
Have you ever returned home from a visit with your doctor and realized that you forgot to ask the one question that you really wanted an answer to? I certainly have. In fact during a recent visit with my doctor, I had every intention of asking her about a vague symptom that I had been experiencing in recent months. It was on the forefront of my mind, but when I …
Improve doctor visits by bringing checklists to check ups
Anyone working in the pharma industry will know it has been a tough few years. Dwindling innovation in the drug pipelines, the impact of global economic pressures and an increasing global focus on healthcare cost containment have all combined in a perfect storm for the sector often regarded as recession-proof.
As the backdrop to all this, social media has rapidly been finding its place as a powerful media in sectors selling …
Pharma needs to embrace social media
There are times when it is necessary to step up to the plate and go the extra mile on behalf of your patients. There is no job description for doing this and there is no manual that gives you instructions on what action you need to take on behalf of your patients. However, when you have the opportunity to do the right thing, at the right time and for the …
When you do the right thing, you become a better doctor
Walmart’s sheer size makes almost any of their initiatives newsworthy. That said, despite being a lightning rod for criticism on employee benefits and health care, they have introduced initiatives with far-reaching impacts. Their generic drug program began in September 2006 – more than 300 prescription drugs for $4/month or $10 for a 90-day supply – and was widely emulated, disrupting retail drug markets and generating immense social benefit. Imagine the …
Walmart’s Center of Excellence program is another innovation
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