The world of health care today is much different than the one I became involved in as a physician over 35 years ago. But why should that surprise me? The world in general is so dramatically changed from that which I knew then, it would seem reasonable and totally understandable that we’ve had to make dramatic changes in how we work with the population in maintaining health. Or have we? …
Embrace the explosion of the new technologies
When DrRich decided to become an electrophysiologist over 30 years ago, it was because he wanted to help figure out how to prevent sudden death. Sudden death from cardiac arrhythmias is estimated to kill over 300,000 Americans each year, and at the time, some of the more recent victims of sudden death had been DrRich’s friends or loved ones. Because cardiac arrhythmias – even the lethal ones – can virtually …
Why sudden death is good public policy
Another luminary-rich panel has been formed to make recommendations about how physician and other healthcare services should be valued and paid for.
The Society for General Internal Medicine launched the National Commission on Physician Payment Reform with funding from prominent healthcare foundations. The 13 commissioners represent a mix of perspectives: a former surgeon/senator, community physicians, academics, two healthcare mega-corporations, a think tank, a state regulator, …
Hostage to a payment method that puts the interests of patients last
The American Board of Internal Medicine (ABIM) and nine other professional medical societies announced that doctors should perform 45 tests and procedures less often than currently done because there is no good medical evidence that they add any value. Specifically, a xray or other imaging for low back pain in an otherwise healthy individual or an EKG as part of a routine physical, just add a lot of unnecessary cost …
Who’s responsible for bending the health care cost curve?
Physicians from all corners of the country will be receiving refund checks by mid-April totaling nearly $200 million. The checks are not a tax season windfall courtesy of the IRS. The payments resulted from a record-breaking settlement that concluded a historic court challenge led by the American Medical Association against UnitedHealth Group.
Under the terms of this landmark settlement, UnitedHealth agreed …
AMA: Physicians’ day in court has a lasting legacy
I had a chance to “moonlight” in the internal medicine “drop-in” clinic at the Kaiser Medical Center in San Francisco while I was finishing my residency and endocrinology fellowship at UCSF. I was superbly trained in in-patient care and there was no IV or PA line that I couldn’t put in with my eyes closed. I was comfortable taking care of really sick people and thrived on complex, acute cases. I knew …
Fixing health care includes reforming medical education
March 29, 2012
Calhoun Lecture Series
Strom Thurmond Institute, Clemson University
Thank you for the invitation to speak tonight. I’m very humbled to stand before you. And what a delight to speak to people who are neither bleeding, intoxicated nor asking for Percocet! And in a setting where no one will burst through the back door on a stretcher!
As you know, I’m an emergency physician …
The future of medicine for aspiring young doctors
The following column was published on April 11, 2012 in CNN.
When you visit the doctor, chances are you are given a prescription for a drug or an order for an X-ray or lab test. Before you leave, it’s important to ask whether your doctor’s recommendations are truly necessary.
Even though much of what physicians do is meant to help patients, sometimes it’s not always the case. Drugs may have harmful side …
Discussing whether tests actually help patients or cause more harm
Physicians have historically been fairly well compensated for their efforts and thus have enjoyed many of the comforts of modern life. Most would agree this is the result of years of hard work, perseverance, intellect and dedication. In general these are also traits along with professional integrity, which raised physicians to a position of relative prominence and trust within our society. But in recent years that social position and economic …
Does contracting with third party payers compromise ethics?
“You see, Dr. Oz was right, you’re ordering way too many tests for me,” a patient told me today after seeing news reports of today’s press conference in Washington DC by the Choosing Wisely campaign. This campaign, according to news reports (WSJ, PBS, ABC, NBC, NPR, AAFP, and others), points the finger directly at doctors for ordering “worthless” and unnecessary tests (that’s why the press, like patient advocates, love this story, …
A primary care doctor takes issue with Choosing Wisely
Let me tell you about a possible paradigm-changing idea in the seemingly hopeless matter of controlling runaway healthcare costs—a topic that has far-reaching implications, not just for healthcare, but for our nation’s economy and vitality.
Organizations of doctors have decided to embrace common sense in the practice of Medicine.
Led by the American Board of Internal Medicine Foundation and joined by many other medical societies, the Choosing Wisely movement aims to …
Choosing Wisely is the health reform we need
The pressures mounting on most institutions as the years trudge by are mounting. They are mired in mountains of regulations, the need to implement millions of dollars of IT “improvements,” streamline their most productive service lines, strip down their front-line staff to dangerous levels … and all this while their reimbursements are being crushed.
Consider that a profitable hospital currently operates on a 1% margin.
Consider that the hospital is considered the most costly …
Why your local hospital may not be relevant in the future
The next time I receive medical care, I want to know how much it will cost before I agree that it will be done — and that includes no matter who pays the bill.
And, doctor, I want you to know and I want you to care how much what you prescribe is going to cost me or somebody.
You say it is beyond your control to know? I say, insist.
Rise up, …
Why we need an economic informed consent
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Recently I had the privilege of travelling to Vancouver, British Columbia to attend the inaugural BC Forum of the Canadian Coalition for Global Health Research. We had a wonderful host in the Department of Global Health of Simon Fraser University (and especially from Drs. Craig Jones & Vic Neufield). It was a challenging and pivotal conference for me.
That is not what I want to share now. The conference started with …
If you have a brain and work in healthcare, you know chances are good that David Houle and Jonathan Fleece’s prediction that “one third of hospitals will close by 2020” is on the money. Until a recent marriage and move took me to St. Louis, my job was to sell a Texas hospital system’s plans for the future to major donors; and throughout my five-year tenure, the looming and pervasive …
My philanthropic advice to America’s healthcare supporters
Have you ever owned a dog? If so, did you ever take him to the vet? I’m sure that even if you don’t own a pet, you understand the gist of the question, but now I’d like to ask it again in a different way. Before taking your animal to the doggie doctor, do you ask the little guy which vet he wants to see, or what treatment he wants …
Why American health care is inching closer to veterinary clinic status
More chronic illnesses, more diseases of old age, consumers demanding more quality and safety, physicians no longer in typical private practice, and high deductible health care polices are each about to cause major changes in the practice of medicine and how it is delivered to patients. Will this come about smoothly or, more likely, with some serious hand wringing?
Health care delivery will change substantially in the coming years. This is …
Disruptive changes are coming to the delivery system
A recent survey by Deloitte of physicians opinions on health care reform has drawn some very differing conclusions from partisan commentators.
The 501 physicians answered a number of questions, the most notable of which included a dichotomous question on whether the Affordable Care Act was “A good start” or “A step in the wrong direction.” The question was split 44% to 44%. All respect for Mr. Pollack and Dr. Murthy writing …
Will physicians ever support the Affordable Care Act?
Medicare needs to cut costs. It has chosen methods to cut costs that will damage the basic health care services needed by most Medicare patients. And instead of calling this cost cutting, it uses terms such as “shared savings.” Even worse, the “shared savings” will result in even less health spending in United States locations that already have lowest health spending. Innovative designs are not the problem. The problem is …
The basic health needs of most Medicare patients left behind by design
Up until now, I hadn’t considered to write an article on healthcare reform simply because of the divisiveness and the complexity of the issue. But after listening to the Supreme Court session and the arguments made on both sides, I can’t help but comment on one popular argument that continuously resurfaces. Yes, it’s the infamous “broccoli argument.”
In short, the argument states that if government were given the power to force individuals to …
What does broccoli have to do with health reform?
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