Health Policy and Public Health

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.

What should we expect of a physician leader today?

Stephen C. Schimpff, MD

Physician

March 11, 2011

What should we expect of a physician leader today? I believe it should be something much different than what leaders do now.

Today, a hospital physician CEO might be expected to develop new or improved clinical programs, in part by recruiting the best and the brightest, by building new wings, and by purchasing new technologies. The measure of success would be improved finances as a result of added …

Challenge the constitutionality of EMTALA

Lucy Hornstein, MD

Health Policy

March 11, 2011

Here is a letter to the editor in a recent Philadelphia Inquirer:

… In 1986, Congress passed and President Ronald Reagan signed the Emergency Medical Treatment and Active Labor law, which requires hospitals to admit all who arrive at the emergency room and treat them without regard for their ability to pay.

In essence, we had federally mandated national health care – signed …

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Challenge the constitutionality of EMTALA

Hospitals taking over private practices

Manoj Jain, MD, MPH

Physician

March 8, 2011

A decade and a half ago, when I moved to Memphis, I proudly hung a sign outside an office I shared with another doctor. It had my name followed by an MD. I had started my own small business as a solo practitioner in medicine.

Over the years, the practice has grown. I now have several employees and my own office, with the names of several other doctors alongside mine on …

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Hospitals taking over private practices

Primary care physicians are rebelling against the system

Robert Centor, MD

Physician

March 6, 2011

I believe primary care docs are rebelling against the system. The system has made primary care physicians suffer emotionally and financially. The system has taken the greatest form of medical care – that consisting of continuity, comprehensiveness, complexity and completeness – and denigrated it.

Now I talk about “the system” in an anthropomorphic sense, but “the system” is virtual. “The system” has no conscious, it is not deliberate, rather it represents …

Free health screening: A service to our community’s health

Steven Reznick, MD

Patient

March 4, 2011

Last weekend I had the privilege of supervising University of Miami Miller School of Medicine students at a free public health screening in Pompano Beach, Florida. The screening was sponsored by the medical school, with the assistance of community leaders, and held in a local public school. The program organization, recruitment of student and faculty volunteers and management of the program was undertaken and implemented by the students. It is …

Repeal of reform won’t fix our health system

Brad Wright, PhD

Health Policy

March 4, 2011

The system we had before health reform became law was simply not working. I think we can all agree on that. A significant number of people oppose “Obamacare.” I can understand that. But repeal doesn’t really solve the problem. Sure, if you think that health reform has or will actually make our system worse than it was before, it seems prudent to undo the legislation, but that brings us back …

Proton beam therapy and the medical arms race

Paul Levy

Physician

March 2, 2011

Proton beam therapy is an effective modality for killing certain types of cancer cells. New England and the Northeast are fortunate to have a proton beam machine at Massachusetts General Hospital, where it has been in use for some time effectively treating patients. This is a valuable resource, serving the entire region and beyond.

But what happens when everyone wants one? Well, we see the medical arms race at work again.

These …

Requests for OTC prescriptions for a FSA burdens primary care

Matthew Mintz, MD

Health Policy

February 27, 2011

As reported by MSNBC, the federal government will no longer allow flexible spending accounts (FSAs) to be used for over the counter medications, without a prescription. FSAs, which are offered by many employers, allow you to use tax free dollars for medical expenses that aren’t covered by your insurance. FSAs are a great idea and can be used for things like eye glasses, dentistry, or even …

Understand the medical economics of a primary care practice

Maggie Kozel, MD

Physician

February 26, 2011

If we are going to make rational decisions about health care reform, it helps to understand the medical economics of a primary care practice.

I was ten years out of medical school by the time I joined Narragansett Bay Pediatrics, a group practice in southern Rhode Island, and I was earning a salary of $48,000 for my “part-time” position. I worked in the office 24 hours per week, and covered nights …

How medical loss ratios impact mini-med policies

Roger Collier

Health Policy

February 23, 2011

It’s amazing how much trouble a couple of hundred inexpensive health insurance policies can cause.

Up until recently, few people were aware of the existence of so-called mini-med policies. Marketed primarily by for-profit insurers Aetna and Cigna, they are designed to provide bare-bones coverage to employees of low-wage low-margin service companies. Unlike other approaches to affordable insurance that emphasize catastrophic coverage, mini-meds typically keep premiums affordable (some as low as $15 …

Why more primary care may not improve health care quality

Maggie Mahar

Health Policy

February 22, 2011

The emphasis on primary care as the “key” to lifting the quality of U.S. healthcare may be exaggerated according to a report by Dartmouth’s Institute for Health Policy & Clinical Practice.

“Primary care forms the bedrock of a well-functioning, effective health care system,” the researchers observe. But– and this is an important caveat- “simply increasing access to primary care, either by boosting the number of primary care physicians in an area …

ACP: High value, cost conscious care

American College of Physicians

Physician

February 22, 2011

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

by John Tooker, MD, MBA, MACP

There were two reports from the recent 2011 International Stroke Conference that got my attention.

One report noted the sharp increase in the incidence of strokes in children and young adults. The second, in the Los Angeles Times (“Mild strokes may …

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ACP: High value, cost conscious care

Change of culture in a rapidly evolving health care environment

Kent Bottles, MD

Health Policy

February 19, 2011

When a health system asked me to facilitate a Board discussion on physician alignment and integration on November 12, 2010, I was already committed to giving a keynote on the future of health care for the American Institute of CPAs in Las Vegas on November 11. Although I usually fly Delta or USAir where I have priority frequent flyer status, the only way I could get to the Board meeting …

Treatment guidelines pros and cons

David Williams

Conditions and Diseases

February 17, 2011

I was puzzled by a Health Affairs article showing the public finds arguments against treatment guidelines a lot more compelling than arguments in favor. But after reading the technical appendix, which contains the full text of the survey, I think the problem is that the researchers framed the question poorly. In particular, the researchers portrayed guidelines as unrealistically rigid.

In A National Survey Reveals Public Skepticism About Research-Based Treatment …

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Treatment guidelines pros and cons

Requiring an ultrasound and counselling before an abortion

Robert Luedecke, MD

Health Policy

February 17, 2011

A bill given emergency status by Texas Governor Rick Perry is the largest invasion of the patient-physician relationship that I am aware of. Proposed by Senator Dan Patrick (R-Houston) and supported by Lt. Gov. David Dewhurst, the bill as originally written would require physicians to perform a ultrasound and explain the physical characteristics of the fetus to anyone contemplating an abortion.

Physicians would be required to inform women about alternatives to …

Clinical guidelines in healthcare reform

Richard N. Fogoros, MD

Health Policy

February 17, 2011

While DrRich is a conservative American, and has made plain the difficulties he has with the Progressive program in general and with Progressive healthcare reform in particular, at times he is forced to admit that, on occasion, the Progressive way of looking at the world has certain merits. And as DrRich contemplates a question that has been bothering him lately, a question that no doubt plagues many American physicians who …

Insurance status when arranging follow-up from the ED

Kevin

Health Policy

February 15, 2011

by Katherine Fullerton, MD

As a pediatric emergency physician in Northern Virginia, I have the good fortune to work with an amazing staff in a busy pediatric emergency department (ED) that sees a wide range of patients with both minor and life-threatening illnesses. Of note, we have a wonderful electronic medical record (EMR) that allows us to see past visits, lab tests, and medical problems.

My last shift was an overnight …

Shared decision making to determine implantable defibrillator need

Shannon Brownlee

Physician

February 15, 2011

Implantable defibrillators are truly life saving devices that have prevented sudden death in thousands of patients. No bigger than an iPod nano, the device can sense when the heart is beating irregularly and deliver an electrical jolt that kicks it back into proper rhythm. But like so many of medicine’s miracles, defibrillators are not always used on the right patients. According to a study published recently in the …

Our health is worsening at a time when medicine has never been better

David Gratzer, MD

Health Policy

February 14, 2011

With little notice, UnitedHealth released a major paper recently considering diabetes in America.

First the bad news: a large portion of our population either has the disease or is pre-diabetic.

Now, the really bad news: diabetes and pre-diabetes rates are going to soar in the coming decade, according to the analysis, in part driven by the obesity crisis.

I’ll return back to the study in a moment, but it underscores a …