KevinMD.com

Health care reform passes the House in a historic vote

Kevin

March 22, 2010Mar 22, 20102

Originally published in MedPage Today After a year-long struggle and often-raucous partisan debate, the House of Representatives passed an historic health care reform package late Sunday night. The vote on the last of the two bills in the package was…

Originally published in MedPage Today

After a year-long struggle and often-raucous partisan debate, the House of Representatives passed an historic health care reform package late Sunday night.

The vote on the last of the two bills in the package was 220-211. All 178 Republicans, along with 33 Democrats, voted against the measure. The margin was similar on the other measure; both …

Drugs and prescribing

Industry relationships with physicians are coming under fire

March 21, 2010Mar 21, 2010

Originally published in MedPage Today by Kristina Fiore, MedPage Today Staff Writer Earlier this year, Harvard's Partners Healthcare put a cap on payments its physicians can receive for serving on corporate boards at $5,000 a day. Although the cap primarily…

Originally published in MedPage Today

by Kristina Fiore, MedPage Today Staff Writer

Earlier this year, Harvard’s Partners Healthcare put a cap on payments its physicians can receive for serving on corporate boards at $5,000 a day.

Although the cap primarily affects top researchers and executives, it is by far the stiffest limit imposed by any academic medical center, and drives deeper the …

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Healthcare reform is an achievement but isn’t perfect

Robert Wachter, MD

March 21, 2010Mar 21, 201010

Heading into the final weekend of Mr. Toad’s Wild Ride, who could have guessed that in a year that brought us Death Panels, Pickup Trucks, “You Lie”, The Cornhusker Compromise, Bart Stupak (boy, that must have been a tough name to grow up with), and the Senate Parliamentarian-as-Rock-Star, we would be on the cusp of passing a perfectly …

Flood insurance by the government, but no public option

March 20, 2010Mar 20, 201011

Originally published in MedPage Today by John Gever This meditation was evoked by the prospect that my basement could be filled with E. coli-laden mud next week. I live within a few yards of Wheeling Creek, a tributary of the…

Originally published in MedPage Today

by John Gever

This meditation was evoked by the prospect that my basement could be filled with E. coli-laden mud next week.

I live within a few yards of Wheeling Creek, a tributary of the Ohio River that drains about 250 square miles of northern West Virginia and southwestern Pennsylvania. This week has brought temperatures near 70 degrees, …

Atrial fibrillation as experienced by an electrophysiologist

John Mandrola, MD

March 20, 2010Mar 20, 2010

Middle age introduces itself in many ways; one is atrial fibrillation. Youth, vigor and a medically-problem free life was seemingly right there in the recent past. A rhythm doctor often hears this suddenness of onset described as “Doc, yesterday, I was fine.” As is always the case for a first episode of an arrhythmia, yesterday, you were fine, but today is indeed a new day.

It happened during a bike ride. …

Physician voices

Professionalism matters in correctional health care

Jeffrey Knuppel, MD

March 19, 2010Mar 19, 20106

As correctional health care professionals, there may be times when we are tempted to conduct ourselves in a less than professional manner simply because we can. We may be able to get away with speaking to our patients rudely, using…

As correctional health care professionals, there may be times when we are tempted to conduct ourselves in a less than professional manner simply because we can.

We may be able to get away with speaking to our patients rudely, using profanity profusely, or wearing inappropriate clothing. After all, we work in jails and prisons. This culture is far from prim and proper. And, our patients are inmates. Many may tolerate misbehavior …

Medicare rates and capping payments to hospitals

Paul Levy

March 19, 2010Mar 19, 201015

If there is anything about economics that has been proven over and over, it is that price controls do not work. The unintended consequences are usually worse than the problem that led to the solution in the first place. Massachusetts…

Massachusetts legislators, feeling the frustration of higher insurance premiums, are now considering a bill to limit doctor and hospital reimbursement payments to 110% of Medicare rates, or perhaps some other percentage …

Coronary angiography is being overused

Coronary angiography is being overused

March 19, 2010Mar 19, 2010

Originally published in MedPage Today by Kristina Fiore, MedPage Today Staff Writer For patients without known heart disease, the diagnostic yield of coronary angiography appears to be low, researchers found. Only about 38% of those referred to the cath lab…

Originally published in MedPage Today

by Kristina Fiore, MedPage Today Staff Writer

For patients without known heart disease, the diagnostic yield of coronary angiography appears to be low, researchers found.

Only about 38% of those referred to the cath lab for the elective procedure had obstructive coronary artery disease, Manesh R. Patel, MD, of Duke University, and colleagues reported online in the New England …

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Business model woes traps doctors and impedes health care

Susan Giurleo, PhD

March 18, 2010Mar 18, 201055

If you are a physician, therapist or any other helping professional whose business model relies on third party manged care reimbursement you are engaged in the world's worst business model. Let me start with a story to set the stage.…

If you are a physician, therapist or any other helping professional whose business model relies on third party manged care reimbursement you are engaged in the world’s worst business model.

Let me start with a story to set the stage.

Imagine you are a bright, idealistic college student. You’re good at academics, want to make a difference in the world and have hundreds of career options in front of you.

After lots of …

Physician voices

Dance healed this physician and helped with burnout

Susan Biali Haas, MD

March 18, 2010Mar 18, 20108

Ten years ago, I was an Emergency Medicine Resident and wanted to die. Today, I’m a general practitioner in part-time practice and am in love with life. What made the difference? I signed up for a dance class. Reports on…

Reports on physician burnout list the personality traits that set us up for trouble: we’re excessively conscientious, feel overly responsible, want to please everyone, and function on an extremely high level – even …

Medicare and how a grandmother worries about its costs

March 18, 2010Mar 18, 20103

Originally published in MedPage Today by Liz O'Brien My grandmother and her hospital roommate -- aged, tiny, frail, and sporting matching bright pink hairnets. They looked like twins -- two thin shrubs in winter that had each sprouted an improbable,…

Originally published in MedPage Today

by Liz O’Brien

My grandmother and her hospital roommate — aged, tiny, frail, and sporting matching bright pink hairnets.

They looked like twins — two thin shrubs in winter that had each sprouted an improbable, big pink rose.

Although sick and scared, my grandmother had admired the pink hairnet on the lady in the next bed, so my mother …

Medical education

Match Day and how each medical school celebrates

Brian Eule

March 18, 2010Mar 18, 201012

While the debate continues to rage over the health care reform bill in Washington D.C., today at Noon Eastern time, the newest class of 15,000-plus graduating medical students will get their marching orders, beginning their lives working in medicine. It’s…

It’s called Match Day and each year, on the third Thursday of March, the nation’s graduating medical school students gather with their classmates and wait for an envelope with their name on …

Medicare doc fix questions and answers

Medicare doc fix questions and answers

Vineet Arora, MD

March 17, 2010Mar 17, 20103

A 21% cut for Medicare physician fees is set to go into place soon. This year, fixing physician payment has been overshadowed by all the talk about health insurance reform. In fact, I remember being invited to talk about healthcare…

A 21% cut for Medicare physician fees is set to go into place soon. This year, fixing physician payment has been overshadowed by all the talk about health insurance reform.

In fact, I remember being invited to talk about healthcare reform on a panel for medical students this past fall. As part of my remarks, I mentioned the 21% pending cut in physician payment and recall the questions and …

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Patient voices

Taxing junk food may improve your health

March 17, 2010Mar 17, 201019

Originally published in MedPage Today by Kristina Fiore, MedPage Today Staff Writer Taxing junk food may help reduce obesity and improve health, researchers have found. Patients got significantly less of their energy (calories) from soda or pizza when there was…

Originally published in MedPage Today

by Kristina Fiore, MedPage Today Staff Writer

Taxing junk food may help reduce obesity and improve health, researchers have found.

Patients got significantly less of their energy (calories) from soda or pizza when there was a 10% increase in the price of either (P<0.001), Penny Gordon-Larsen, PhD, of the University of North Carolina at Chapel Hill, and colleagues …

Homebirth does not protect against serious maternal infections

Amy Tuteur, MD

March 16, 2010Mar 16, 201011

Homebirth advocates like to tout the many "advantages" of giving birth at home. High on the list is limiting exposure to hospital acquired infections, and since only your "own germs" are in your home, you are protected. Yes, you are…

Homebirth advocates like to tout the many “advantages” of giving birth at home. High on the list is limiting exposure to hospital acquired infections, and since only your “own germs” are in your home, you are protected.

Yes, you are protected from hospital acquired infections, but the most dangerous infectious agents are actually those that live inside the mother, not the ones in the hospital. Consider that for newborns both Group …

Patient voices

Patient costs when making medical decisions

Edward Pullen, MD

March 16, 2010Mar 16, 201013

At my office we provide care for a fair number of patients without medical insurance. Sometimes we are faced situations with no good options. At a patient visit, often times the diagnosis is not clear without doing some diagnostic tests…

At my office we provide care for a fair number of patients without medical insurance. Sometimes we are faced situations with no good options.

At a patient visit, often times the diagnosis is not clear without doing some diagnostic tests other than the history and physical exam. Many of these tests are ordered from sources outside the office, where I have little or no control over the cost of the test …

Health technology

EMR conversion doesn’t always help physician communication

Stuart Sutton, MD

March 16, 2010Mar 16, 20107

Our very large and very integrated health care system is plowing ahead with EMR implementation. All the offices are gradually converting from paper charts and all the hospitals have completed the process. As a member of one of the last…

As a member of one of the last offices to be converted to the EMR, I’ve had the pleasure of patients being assured that the notes were sent to me (albeit via the EMR we are not yet using). …