Physicians writing on KevinMD about policy as it reaches the exam room: prior authorization and the state and federal rules now written for it, scope of practice laws state by state, the CDC opioid guideline and what forced tapers did to patients, and public health from vaccination to the pandemic. Four maintained records draw on this archive: Prior authorization: what physicians say, in their own words, Scope of practice: what physicians, nurse practitioners, and PAs say, in their own words, Opioids: what physicians and pain patients say, in their own words, and Vaccines: what physicians say, in their own words.

Physician consolidation places health reformers in an ironic dilemma

KevinMD
June 23, 2011

One of the major efforts of the Affordable Care Act is to consolidate physician groups, so they can be modeled after integrated health systems like the Minnesota’s Mayo Clinic or California’s Kaiser Permanente.

According to health reformers, these integrated systems can reduce variation in care, which improves quality, and potentially reduces costs.

There’s been a major effort to re-organize hospitals and physicians under guises of Patient Centered Medical Homes and Read more…

Physician consolidation places health reformers in an ironic dilemma

ACP: ACOs – On to the final rule

Health Policy
June 23, 2011

A guest column by the American College of Physicians, exclusive to KevinMD.com.

by John Tooker, MD, MBA, MACP

Recently, I commented on cost saving, quality, and care coordination requirements in the proposed rule that physician practices will likely need to meet to be eligible for additional Medicare payments.

The public comment period on the proposed rule for …

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ACP: ACOs – On to the final rule

2 changes to cut Federal health care expenditures

Health Policy
June 23, 2011

If we’re serious about cutting Federal health care expenditures over the long term, here are two changes that will do just that.

1. Requiring HHS to negotiate with pharma for Part D drug costs would reduce annual expenditures by over $20 billion.

As I’ve noted repeatedly(but unfortunately few in the mass media have), Part D’s perhaps the biggest deficit problem we have – the ultimate unfunded liability is now over $20 trillion. …

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2 changes to cut Federal health care expenditures

A new organization for primary care

Health Policy
June 22, 2011

Recently, the Board of the American Academy of Family Physicians (AAFP) announced that, for now, it would continue participating in the Relative Value Scale Update Committee (RUC), the secretive American Medical Association committee that, through a longstanding relationship with the Centers for Medicare and Medicaid Services (CMS), has heavily influenced physician reimbursement.

At nearly the same time, Medicare announced that it will go broke in 2024, a decade sooner …

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A new organization for primary care

5 strategic tools to solve our healthcare woes

Health Policy
June 22, 2011

It’s getting scary.

We are facing, before the end of this decade, a bifurcated future. The way things are going now—with the economy wheezing, doctors bailing, chronic disease rising fast, boomers sliding out of the Viagra years into the Depends years, reimbursements getting squeezed ever tighter, Medicaid sputtering on fumes, and 30 million or more new people soon swarming our doors with insurance cards—if we don’t pull a rabbit out …

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5 strategic tools to solve our healthcare woes

Medical practice career choices commonly become medical business failures

Physician
June 21, 2011

by Curt Graham, MD

Never in the history of medicine have doctors faced such a ruthless gauntlet of threats, financial debts, and practice restrictions than they do today.  These factors, among others just as crucial, don’t begin to tell the story about why 40% of medical doctors readily admit to intense frustration in their practices, in addition to the percentage of doctors quitting medical practice completely.

They’re not retiring.  They’re adapting.  Extended …

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Medical practice career choices commonly become medical business failures

Why the AMA is in decline, and should doctors care?

KevinMD
June 20, 2011

The American Medical Association recently released its membership numbers, and they’re declining.

According to MedPage Today, the AMA “saw another steep drop in its membership in 2010 — this time losing about 12,000 members or 5% of its total membership.”

It’s been well publicized that the AMA only represents a minority percentage of physicians, depending on what you read, it’s between 20 and 30%.  But it seems many physicians have little …

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Why the AMA is in decline, and should doctors care?

How Medicaid is under political attack

Health Policy
June 20, 2011

by Rishi Manchanda, MD, MPH

Mr. M walked into the community clinic where I work with a portable oxygen tank in tow. At 62, he’s gaunt and winded, battling a disease that is progressively scarring his lungs. Every breath is a fight. Instead of the clear flow of air, I hear the sound of velcro ripping when I place my stethoscope on his chest. In medicine, his …

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How Medicaid is under political attack

How physicians not adhering to clinical guidelines may be punished

Physician
June 18, 2011

The Justice Department decided to weigh in on the topic of clinical guidelines.

As if to underscore Dr. Rich’s assertion that “guidelines are no longer guidelines,” the Federal government has raised the prospect of fining your doctor and/or sending her to prison for the crime of not strictly following guidelines of care.

As reported by MedPage Today:

“Federal prosecutors are looking into physicians’ prescribing practices relating to implantable cardioverter defibrillators …

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How physicians not adhering to clinical guidelines may be punished

Considering a single payer model for health reform

Health Policy
June 17, 2011

The Patient Protection and Affordable Care Act is in the process of being rolled out, however many questions remain.

Will it guarantee universal coverage? Will it stand up to the many court challenges? The private insurance industry will receive an estimated 400 billion in taxpayer money to subsidize the purchase of these plans. Is this the best way to spend our money?

Many of us in the health field remain skeptical …

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Considering a single payer model for health reform

Narrative medicine means more effective healthcare

Patient
June 16, 2011

As undergraduate premedical students, we learned about narrative medicine by chance in a New York Times article titled “Learning to Listen.”

After exploring the research of Dr. Rita Charon, we were both drawn to the new field and what it had to offer us as future medical professionals. The Times article explains, “Through literature, [Dr. Charon] learned how stories are built and told, and translated that …

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Narrative medicine means more effective healthcare

Should academic physicians have the final word on acceptable practice?

Physician
June 15, 2011

The New York Times recently published an opinion editorial entitled “Squandering Medicare’s Money“in which Dr. Rita Redberg, professor of cardiology at UCSF, proposes that much of Medicare’s financial deficit could be reduced if the government did not spend “a fortune each year on procedures that have no proven benefit.”

To support her contention, Redberg cites several studies which indicate that many routinely performed tests and treatments …

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Should academic physicians have the final word on acceptable practice?

Insurance companies cutting corners puts patients at risk

Physician
June 14, 2011

My patient, whom I’ll call Jane, had a neurologic disorder that prevented her from emptying her bladder properly.

She required a permanent urinary foley catheter to help her urinate. Jane landed back at the hospital with yet another urinary tract infection – her third in one month. She had pus draining from her catheter and was infected with a multi-drug resistant strain of the bacteria Proteus. Our lab ran tests (sensitivities) …

Read more…

Insurance companies cutting corners puts patients at risk

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Letting the states decide healthcare reform

Health Policy
June 13, 2011

by Terry O’Keefe

The State of Vermont just passed the nation’s first single-payer universal healthcare system. While there are still some bureaucratic hurdles to cross, Vermont will soon install the kind of system that healthcare progressives have been drooling about for decades.

And whether you think that puts Vermont on the high road to healthcare nirvana, or the low road to socialized medicine, I think we …

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Letting the states decide healthcare reform

Why doctors shouldn’t have to choose between medicine and family

KevinMD
June 12, 2011

For the past few Sundays, the New York Times has published provocative op-eds involving physicians.

The first tackled physician bullying.  Next was the cost of medical education.  And, most recently, the phenomenon of part-time, mostly female, physicians.

This is obviously a live-wire topic, sure to generate passionate commentary.

In the piece, anesthesiologist Karen S. Sibert goes over ramifications of part-time physicians.  …

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Why doctors shouldn’t have to choose between medicine and family

Should doctors be blamed for bad decisions by patients?

Patient
June 9, 2011

The Disease Management Care Blog attended a professional hockey game recently and it must say it was quite the spectacle.

While the athleticism on the ice was quite remarkable, the real wonderment involved the hometown fans. Questionable referee calls prompted thousands of all ages to chant phrases that the DMCB has not recently read in any medical journals, while the willingness of grown men to display, in stereo fashion, obscene gestures …

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Should doctors be blamed for bad decisions by patients?

AMA: Revisions, clarity needed before physicians form Medicare ACOs

Health Policy
June 9, 2011

A guest column by the American Medical Association, exclusive to KevinMD.com.

There is said to be an old Chinese curse: May you live in interesting times. As I wrap up my year traveling the country as President of the AMA, I can without a doubt say physicians are living – and practicing medicine – in interesting times. This can be a challenge, but does not need to be a curse.

There are …

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AMA: Revisions, clarity needed before physicians form Medicare ACOs

The growing disconnect between hospitals and post-acute providers

Physician
June 7, 2011

An interview by Curaspan Health Group with Mark Lachs, MD

Mark Lachs, MD, MPH, geriatrics physician, professor, researcher and author of the new book, Treat Me, Not My Age, says one of the hottest new areas of research is care transitions. He warns that there’s a growing disconnect between hospitals and post-acute providers.

Curaspan: …

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The growing disconnect between hospitals and post-acute providers

Do American medical specialists really make too much money?

Health Policy
June 7, 2011

Whether specialists make too much money depends on whom you ask.

Policy experts

If you ask policy experts, most of whom are progressives, they will say  “yes, of course, specialists make too much money.” Too many specialists making too much money spoil the national health care broth.

Just look at any other country, especially countries with government-run systems.

Specialists there make one-half of what our specialists bring home. Look at their total …

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Do American medical specialists really make too much money?

Why popularity based payment for doctors is not the answer

Physician
June 5, 2011

Part three of the three-part series, Let’s Pay Popular People More!

Perhaps you remember Sam, the chronic inebriate whose story I shared to discuss the pitfalls of basing doctor pay on patient satisfaction surveys.

Looking at his discharge papers, I wondered who helped Sam fill his survey out, and how much their “help” affected the results.

After all, millions upon millions of dollars are already now at stake for …

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Why popularity based payment for doctors is not the answer

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