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Doctors and hospitals are cheated during rate negotiations

Health Policy

March 29, 2012

Have you ever been in a negotiation with a health plan for a network participation contract and had the impression that the plan knew all the rates that you had agreed to in confidential negotiations with other health plans? Allow me to reassure you: you are not being paranoid. It is quite likely that the plan you are negotiating with knows exactly what rates and terms you have agreed to …

Building on the success of coordinated care

Stephan Deutsch, MD

Health Policy

March 28, 2012

With all the debate about how to best implement coordinated care that benefits patients while being feasible for providers and economical for the government, it’s ironic that little attention has been given to a decades-old managed care model that does all this.

But as Medicaid reform progresses in New York and elsewhere, that may be about to change.

The program is called PACE, or the Program of All-inclusive Care for the Elderly, …

The space between being a good doctor and a conscientious citizen

Eijean Wu, MD

Physician

March 28, 2012

As an OB/GYN resident, I tried to reconcile quality and cost of care every day. This is the story of one patient who cost the system a lot of money, but I don’t know to this day if it was too much.

Cheryl (name changed) had HIV, a history of cervical cancer, and 3 kids. At age 35, she had been cured from cervical cancer after surgery and radiation therapy. However, …

Sexuality in youth with special needs

Kitty O'Hare, MD

Physician

March 28, 2012

Recently there was a lovely story in the New York Times about a young couple struggling to navigate the complexities of a romantic relationship. Both in their early 20’s, dating is a relatively new experience for them. She likes physical affection; he prefers sitting alone on the couch. She wants a pet; he is allergic. They are learning to negotiate the small things while clinging to their common affection for …

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Sexuality in youth with special needs

Conservatives should love the Affordable Care Act

Kevin Pho, MD

KevinMD

March 28, 2012

And progressives should want health reform to fail.

No, you read that right.

Counter-intuitive? Let me explain. As the fate of the Affordable Care Act hangs in the balance in the Supreme Court, both progressive and conservative pundits have been working overtime to discern the future of health reform.

The traditional thinking is that progressives direly want health reform to move forward, and …

Robotic surgery shouldn’t be universally dismissed

Linda A. Kiley, MD

Physician

March 28, 2012

A response to Why isn’t everyone excited about robotic assisted surgery? by Kelly Wright.

Yes, it’s cool. The surgical robot is every gamer-cum-surgeon’s dream.

However, I, too, was a skeptic regarding incorporating robotic surgery into my practice. I have been practicing minimally-invasive surgery for over 20 years, including residency. I became convinced of the value of minimally invasive surgery after observing patients postoperatively. I have laparoscopically repaired an obturator nerve transection, …

Honesty is the basis of communicating with patients

Kevin R. Campbell, MD

Physician

March 27, 2012

I recently came across two articles in the press concerning doctor-patient relationships and communication. I began to reflect on what makes communication between doctor and patient most successful and many questions surfaced.

In the New York Times, a new study published in Annals of Internal Medicine was referenced. In this study, the way in which doctors communicate non-verbally was examined. Non-verbal communication was often discordant to the message being relayed, particularly …

How to say no to inappropriate antibiotic requests

Dike Drummond, MD

Physician

March 27, 2012

Studies, medical societies and position papers are unanimous in their condemnation of inappropriate antibiotic prescriptions for an uncomplicated URI … but not a single voice tells us how to do that.

Let me give you a three part structure you can use in your patient conversations in the future – and some exact words to try out. This structure is adapted from the Parenting literature, another role where boundaries and inappropriate …

A good thing we have mommy

Jordan Grumet, MD

Physician

March 27, 2012

I cradled my son’s miniature body in my hands. Only moments old, he looked up with large glassy eyes. He was so alert, so perfect. I carried him over to the bedside. The obstetrician worked on the afterbirth as my wife waited patiently to hold her child.

At the time, it hadn’t sunken in yet how much our solitary lives were changing. The nurses swept the baby away for routine testing …

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A good thing we have mommy

Insurers will plunder until patients demand value for their money

Stewart Segal, MD

Medications

March 27, 2012

Welcome to my day from hell. It is 2 p.m. and I’ve just logged my fifth prior authorization denial of the day. In simpler terms, five patients will either change their medications or pay for them out of pocket. Personally, I’m sick of this crap.

When it comes to prescribing medication, I am very judicious in my prescribing habits. According to one of the largest insurers, my percent of generic prescriptions …

Breast feeding and the mismatch between idealism and realism

Barbara Bronson Gray, RN

Conditions and Diseases

March 26, 2012

Against the backdrop of life as it is really lived, the decision to breast-feed or bottle-feed is minuscule.

Whether or not you decide to breast-feed your baby — and for how long — is, in the scheme of things, just one decision out of a million. And ultimately, you should do what works best for you and your family.

Full disclosure here: I never wanted to breast feed. I don’t know why. …

The Affordable Care Act needs primary care to be effective

Kevin Pho, MD

KevinMD

March 26, 2012

The following column was published on March 26, 2012 in CNN.

With the Supreme Court set to hear oral arguments about the constitutionality of the President Obama’s health care law, more patients than ever have been asking for my thoughts about health reform.

I practice primary care in southern New Hampshire near the Massachusetts border, which gives me a firsthand look at how health reform has impacted my neighboring state. Despite flaws …

Reducing the need for dialysis

Allen R. Nissenson, MD

Conditions and Diseases

March 26, 2012

One pitfall of some of the incredible medical advances over the last century is that we too often forget what it was like before.

Before penicillin in the 1940s, thousands died of simple infections. Before a cure for polio in the mid-‘50s, tens of thousands were sickened, killed or disabled.

And before outpatient dialysis became widely available in 1972 – 40 years ago this year – 100,000 Americans died of kidney failure …

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Reducing the need for dialysis

Health reform is in the hands of the Supreme Court

Teeb Al-Samarrai, MD

Health Policy

March 26, 2012

I am often fascinated by the simplified dichotomies and ironies of the health care discussion. Some argue that the individual mandate infringes on individual rights yet one could argue that tying health insurance to a particular employer is in itself a violation of individual liberty. When Patrick Henry stated, “Give me Liberty or Give me Death” in protest of the Stamp Act of 1775, he helped swing the assembly (including …

3 tools to start the end of life conversation

Virginia L. Seno, PhD

Patient

March 26, 2012

Most people wish that they knew what to say and do, and how to be when approaching dying, death and grief.

Because we’re uncomfortable and unprepared for end-of-life encounters, we either stay away, say and do things that don’t help; or act in ways that are neither becoming nor helpful to the people about whom we care.

What if you did know what to say, what to do and how to be …

Health information exchanges and the problem of consent

Adrian Gropper, MD

Health Technology

March 25, 2012

Will health information exchanges provide patient access portals or not?

There are 60 or so regional health information exchanges (HIEs) in the works. They are beset with issues: technology, regulations, competing stakeholders, payment reform uncertainty, sustainability and consent. The last thing they need, it seems, is citizen clients.

It turns out that HIEs have a choice of strategies, at least in the next year or two. Now that proposed Stage 2 Meaningful …

Technology will democratize medicine

Lawrence Hofmann, MD

Health Technology

March 25, 2012

Patients are more empowered with their medical decisions, more than ever. With the Internet, they are able to research their conditions and can sometimes diagnose their conditions and treatment without having to step in the office. “Dr. Mom” can find useful information on treating their infant’s cold at 2 am.

However, when there are serious chronic conditions, patients want an expert. Patients can get information on the disease – the government, …

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Technology will democratize medicine

An America without health insurance companies

George Lundberg, MD

Health Policy

March 25, 2012

Imagine an America with no health insurance companies.

What do health insurance companies do?

They take as much money as possible from people who want health insurance coverage. They pay out as little money as possible — so-called medical loss — to settle claims from creditors for health services and products that have been delivered.

They keep as much money as possible for the incomes of their executives and other employees, and to …

MKSAP: 32-year-old man is disoriented, combative, and agitated

mksap

Conditions and Diseases

March 25, 2012

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

A 32-year-old man is brought to the emergency department after becoming disoriented, combative, and agitated earlier that day. He is accompanied by a friend, who states that the patient has a history of alcohol and drug abuse, including inhalants.

On physical examination, the patient is uncooperative and …

Improving healthcare for veterans on college campuses

David Rosenman, MD and Glenn L. Laudenslager IV, MBA

Conditions and Diseases

March 24, 2012

The healthcare needs and challenges presented by the nation’s returning veterans are complex and critical.

That’s not news to all, yet not all clinicians realize how close and relevant the issues actually are. More than half of all returning veterans are treated outside of the military healthcare system and the VA, which means community-based clinicians are on the front lines of care delivery to veterans.

Very often, this also now means that …

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