In the past few years, the small rural community where I practice has seen five primary care physicians close their practice. This phenomenon is not an anomaly.
Why do doctors close their practices? There are many reasons. Doctors can be broken down into demographics like everyone else.
Baby Boomers
Most of my boomer patients are not retiring right now. In fact, they are financially hurting and looking for work, or for a second …
According to this piece from CNN Money, some are: “Doctors list shrinking insurance reimbursements, changing regulations, rising business and drug costs among the factors preventing them from keeping their practices afloat. But some experts counter that doctors’ lack of business acumen is also to blame.”
That’s all entirely true.
Pressure on reimbursement, combined with a lack of …
About six weeks ago, while in clinic, I developed pain in my stomach — specifically, in my right upper quadrant, just below the ribs. I had experienced this a few times before, but this time it seemed more persistent than usual. Following the rule that physicians make the worst patients, I kept working through it until my nurse told me I looked poorly, and made me see my own primary …
During my first week on a pediatric outpatient clinic as a third year medical student, I spent an average of 140 minutes caring for each patient. Looking back at that first week, the amount of time I spent with each patient ranged from a “brief” 79-minute visit to one whopper 188-minute visit where I reviewed several journals in the workroom and sought two attending physician opinions to be completely sure. …
Dear United States House of Representatives and Senate:
I really hope that you enjoy your Christmas break going back home to your families. While you’re home, I really hope that you will hear from those constituents who will be affected by the 27.4 percent Medicare physician pay reduction that is schedule to take effect January 1st. I really hope that the American Academy of Family Physicians, the American Medical Association, …
Do healthier employees lead to increased productivity? Several progressive companies believe so and have committed to providing employees with programs to help engage them in a healthier lifestyle.
As part of the incentives to lead a healthier lifestyle some employers have instituted a penalty and reward system tied to the companies’ benefits. For example, smokers may incur a significant surcharge to the cost of their …
I met with my staff yesterday to discuss the effect of a 27% cut in Medicare reimbursement on our patients and our office. I had a really lousy day, explaining to my elders what would happen if Congress fails to act. One of my patients aptly pointed out that Congress has not acted responsibly in the last 20 years and that it would take a miracle for them to get their …
Quality indicators are used to measure the quality of health care delivered to patients. Quality indicators are used extensively in the VA health system, and efforts are underway in Medicare to tie reimbursement levels to performance on quality indicators.
The motivations for using quality indicators are guided by the best of intentions. There are many problems with the quality of health care in the US, and quality indicators aim to improve …
There has been so much change in medicine, physicians are leaving primary care, and new ideas are being bantered about such as patient centered medical homes (PCMH) and accountable care organizations (ACO), in an attempt to try to address the problem. To add to this strain, is the knowledge that medicine is going to have to be ready to absorb thousands of additional patients in the near future …
While attending the Institute for Healthcare Improvement Annual Forum recently, my friend, Jared Conley, and I had the good fortune of finding ourselves standing a table away from Don Berwick in a relatively empty conference room. As MD/PhD in Health Policy students, we were interested in asking him a question about ACOs, so we approached him and introduced ourselves, hastily adding, “We know you’re busy, so we just have …
In the era of accountable care, you’ll notice that many hospitals and health systems are already driving towards more collaborative workflow. The integrated delivery network (IDN) is changing significantly, and for the better. But in high-acuity care areas, like the emergency department (ED), the challenge of treating patients more holistically in what is already a fast-paced environment is concerning for physicians evaluating the pay-for-performance model.
Sonia struggled to express herself through broken English. Her lively facial expressions and exuberance betrayed by her inability to string the words together fluently. One hand gesticulated widely while the other rested gently on the elderly woman’s hair.
She somehow managed to coo quietly in her companions ear, calming her, as she continued the conversation with me. Sonia’s eyes opened and closed in an exaggerated blinking manner as she questioned me …
Last month, physicians from all states and specialties came together for the American Medical Association’s (AMA) semi-annual policy-making meeting to adopt new policies that will impact the future of medicine. Of the new policies, some of the many noteworthy topics include national drug shortages, health insurance exchanges, private contracting and the …
As we approach the end of what has been another roller-coaster year for our country, it seems an appropriate time for an “annual checkup” on healthcare reform in the U.S.
Like many of my colleagues, I have followed the implementation of the monumental Patient Protection and Affordable Care Act (ACA) with great interest, mild trepidation, and a small measure of optimism.
It’s hard to believe that almost two years have flown …
As of March 2010, there were an estimated 11.2 million undocumented immigrants in the United States. Currently, three in ten immigrants are undocumented, while only one in seven of the uninsured is an undocumented immigrant. As there exists no consensus on immigration reform, undocumented individuals will gradually become a larger share of the uninsured population due to exclusion from all programs of the Affordable Care Act.
What if we had considered the following items within health care reform?
What if physicians were able to practice medicine with reduced fear of malpractice litigation? Some estimates believe the cost of defensive medicine approaches 30%.
What if patients were to be offered a different process for conflict resolution before litigation, one that is partially driven by greed? What if this process provided a remedy which met all our future financial and …
If you have read Michael Lewis’ book, The Blind Side, or seen the popular movie based on it, you know that the title refers to the fact that quarterbacks, who are typically right-handed, can’t see when a 300-pound opponent is charging at them from the left side. Not being able to see the full picture puts the quarterback directly in harm’s way and makes it harder for his team to …
Fortunately, the 27% reduction in Medicare payments to physicians that is set to take place in a matter of weeks unless congress acts is getting some press. Fox News published a piece recently, as did the Washington Post. Writer Merrill Goozner breaks things down nicely in his article, “Is There a Doctor Fix in the House … and Senate?”
However, one thing that seems to be getting confused in all the …
Are 
