The Medicare physician payment formula is a case-study in failed policy. Physicians have long known that it is not working. Polls show that an overwhelming 94 percent of Americans believe the massive cuts it schedules are a serious problem for seniors. Even members of Congress from both parties agree – and that is no small accomplishment – that it is …
AMA: Moving past a failed Medicare formula to focus on quality care
I am employed by a hospital, and have health insurance through my job. The coverage is comprehensive, and the cost has an employer contribution and employee contribution. I still get confused (though I have the hospital’s own plan) about what is covered and what is not. I can only imagine how hard it must be for my patients.
The prescription plan that comes with this insurance is straight forward: $40 for …
The impact of prescription drug costs on health spending
Now more than ever, the growing consensus among many is that doctors should avoid seeing pharmaceutical sales representatives, otherwise known as drug reps. A position statement from the AAMC, the head organization of all US medical schools and residency programs, recommends that all academic health centers avoid having drug reps on their campuses, hospital and clinics. Many medical institutions including the VA and Kaiser have also enacted similar policies banning …
Is there a harm to not seeing drug reps?
The medical profession has always been marked by division: town versus gown, primary care versus specialty medicine, states versus national. But the real fault line today is not defined by specialty, geography, or teaching versus practice, but by size of practice.
Physicians in smaller practices, without regard to specialty or where they are located, are embattled and defensive—and therefore are more skeptical when someone tries to peddle the need for delivery …
Is there a future for smaller physician practices after health reform?
Willful blindness of our public health officials on tobacco is still killing hundreds of thousands of Americans each year.
Here are the facts:
i) There are approximately 46 million tobacco smokers in the United States.
ii) While three-quarters say they want to quit smoking, and about one-third try to quit each year, fewer than 10% succeed.
iii) The FDA-approved smoking cessation aids simply do not work: They improve quit rates only minimally, if at …
The truth about reduced risk smokeless tobacco
Which electronic health record system should I select?
Among physicians and managers in small-group practices today, there is no more common question.
But lately, another vexing question has emerged: Whether to install EHR software on servers in your office, or subscribe to an Internet-based system maintained in “the cloud.”
What Is “the cloud”?
When EHR vendors began offering their products via the cloud, many physicians were puzzled. Some think that the cloud is simply …
Should you consider an EHR in the cloud?
Recently, as I finished up a visit with one of my patients who has migraine, she asked me the following: “My 10 year old daughter gets headaches. Is it possible that she has migraines too? I had headaches as a child and was always told it was nothing to worry about, but now I have headaches several times a month. Is there anything I can do to prevent this from …
What can be done for children with migraine headaches?
Obesity is becoming a major health issue in the United States across all age groups. It is well known that obesity is a major contributor in the occurrence of type 2 diabetes and heart conditions. Although physicians and other clinicians are often called upon to become the primary players in the prevention and treatment of chronic conditions, it is not possible for them to do so alone when it comes …
What can local groups do to prevent obesity in children and youth?
At the end of long days I often stand gazing out my window at the beautiful, timeless Rocky Mountains in Colorado Springs and am taken by their sense of permanence. I recently returned from Nampa, Idaho, where I presented hospital Grand Rounds on Accountable Care Organizations.
The parallels between the timeless mountains and the physicians I met in Nampa struck me. Strange, you say? Maybe, but I am accustomed to the …
What does an ACO mean in small town America?
It used to be simple: build a practice website, stuff it with some keywords and your online spine practice marketing is done. Those days are long gone and search optimization and social media strategies continue to explode and cause confusion among medical professionals. New Google changes have caused practice sites to disappear or plummet in search ranks. Guidance for a proper social media strategy varies wildly or is non-existent. Mobile …
New Google and Facebook changes that affect your physician website
Patient satisfaction is an important element of medical care. It was always important, but it has taken on a new significance since hospitals and physicians will be graded on their bedside manners. And, these grades count for cash. Money motivates. Who believes that a leopard can’t change its spots? Throw a leopard into the pay-for -performance arena, define spots as inferior quality, and watch what happens. We would all witness …
Finding the right model for patient satisfaction
My in-laws are in town for my daughter’s graduation. When I came home yesterday I was greeted with a big smile and vigorous handshake from my father-in-law. ”I just want to thank you,” he said, standing up from his chair, “for finding us a good doctor. The one you found for us is wonderful.”
My wife smiled at me warmly. I just earned myself big points. Yay!
Her parents and mine are …
Being on the other end of finding a good doctor
Why would anyone want to become a doctor? Seriously. Think about it, because this is a very important question for the future of healthcare in our country.
The future of medicine is somewhat unclear in this age of healthcare reform, but we do know a few things. Physician compensation is currently falling while lawsuits and malpractice premiums are rising. Doctors must see many more patients in a day to maintain their …
The reasons our future doctors are choosing medicine have changed
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I recently learned the sorry news that my childhood pediatrician has died. Not only was he my pediatrician, but he was also my father’s pediatrician. Our family became rather close to him over the years.
He came from a different generation of doctors, one that made house calls, that served in wars abroad, and that learned how to diagnose patients in the days before MRIs and CT scans. Even though I …
My pediatrician inspired me to become a physician
I could hear the morning call to prayer as I drove toward the Aramco Hospital in Dhahran, Saudi Arabia for my early morning rounds in the ICU. I was hoping that my young asthmatic on a ventilator might be ready to be weaned off and that the medications had kicked in sufficiently. My young Saudi medical student met me on the way in and said, “I think she’s doing better, …
Caring for the patient despite a vast difference in culture
There’s a push-pull happening right now in the evolution of health care and it’s all about you. The question under debate is simple: can you handle being the first to know your own test results?
Are you smart enough to read the results? And are you emotionally capable of handling the situation?
Do you need someone next to you when an over-the-counter test tells you whether or not you have a disease? Can …
Can you handle being the first to know your own test results?
I’m sweating and silently wondering how the chewing gum in my mouth has chemically changed to sand. My mouth is so dry I can barely speak. I may be silent, but thank goodness my patient is talking to me, because all his monitors and machines seem to be bleeping and bopping and malfunctioning at once.
I reach for my eyeglasses, which have become hopelessly entangled among pens, alcohol wipes, and other …
When teamwork takes more than the usual share of effort
While there is an extensive literature on how tired, overworked physicians provide lower quality medical care, one thing that has been ignored by advocates of quality improvement is that overwork financially harms hospitals as well. Just as tired physicians sometimes fail to attend to certain clinical details, they are also more likely to commit errors when writing the notes which ultimately are used during the coding process. If hospitals consider …
The influence of fatigue on claim quality
It always has broken my heart to see a person bankrupted by the costs of their healthcare. I remember my outrage when I first learned the only people who pay full price for their medical procedures are the ones paying cash. Insurance companies use their market muscle and patient volumes to negotiate discounts for their patients that have always been unavailable to the uninsured, individual healthcare consumer.
If you have been …
Hide your health insurance status and pay cash instead
“Oh, by the way” are four simple words that cause most docs to shudder. Yes, shudder. Your patient signed in for a sore throat, congestion, and cough. The nurse did her job. She’s recorded the patient’s chief complaints. She’s taken the patient’s vital signs and readied the patient to see me, the doc.
I take a history, asking questions about the problems that brought the patient to the office. I ask pertinent …
What patients think is not trivial
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