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.
by Lucas Restrepo, MD
There is only one fundamental problem with American medicine: its progressive commercialization.
Every other problem derives from it centrifugally. Medicine, wrote William Osler, is “a calling, not a business.” Patients are not clients, nor physicians businessmen. People do not spend over a decade studying medicine ―living years in poverty or overburdened with debt― merely hoping to get rich. While it is perfectly …
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Progressive commercialization of American medicine
Medicine used to be different. Doctors couldn’t do too much for you. They didn’t get paid very much and they were focused more on helping than on managing a business.
Hospitals were community-based not-for-profit or public entities. Drugs and devices were not as sophisticated or expensive, and they weren’t marketed directly to consumers. Well Toto, we’re not in Kansas anymore.
After witnessing our “healthcare reform” process you must have seen that almost …
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Everything about medicine is now big business
Comparative effectiveness research (CER) is suddenly a hot topic at all the health care conferences.
How come? Everybody agrees that we have to decrease per-capita cost and increase quality. Why? Government programs like Medicare and Medicaid foot more than 50% of our nation’s health bill, and if everything stays the same these programs will go belly up (bankrupt) in 8 years. Big problem.
Health and Human Services (HHS) has defined comparative effectiveness …
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Comparative effectiveness research (CER) needs honest discussion
Last year, Medicare paid $55 billion just for doctor and hospital bills during the last two months of patients’ lives.
And it has been estimated that 20 to 30 percent of these medical expenses may have had no meaningful impact. Most of the bills are paid for by the federal government with few or no questions asked. This statistic is from a 60 Minutes story on “The Cost of Dying” and …
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The cost of keeping the terminally ill alive
Early last year, I wrote that conservatives should have been happy with health reform.
Maybe they just didn’t realize it yet, because they’re rejoicing after yesterday’s news of a federal judge ruling the individual mandate unconstitutional.
But by supporting repeal, conservatives should be careful what they wish for.
The fact is, the Affordable Care Act is a moderate piece of legislation. There’s no public option. It leaves private insurers intact. There is …
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Health reform repeal should make conservatives nervous
Call it the McVictim syndrome. Too many pundits, public health experts and politicians are working overtime to find scapegoats for America’s obesity epidemic.
In his latest book, former FDA Commissioner David A. Kessler argues that modern food is addictive. In it, he recounts how he was once helpless to stop himself from eating a cookie. In a paper in this month’s Journal …
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Obesity patients are not victims
by Kevin Fickenscher, MD
In the great healthcare alphabet soup, it’s easy to lose sight of the differences between proposed solutions for making healthcare more efficient and effective.
Rather than tackling payment reform in isolation of care delivery, Accountable Care Organizations (ACOs) and Medical Homes offer a consolidated approach to both issues. While the models are still developing, various pilot programs are being implemented around the …
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Accountable care organization (ACO) and medical home differences
Imagine that an innovative health plan – aware that half or more of health care cost is waste and that physician costs to obtain the identical outcome can vary by as much as eight fold – hopes to sweep market share by producing better quality health care for a dramatically lower cost.
So it begins to evaluate its vast data stores. It’s goal is to identify the specialists, outpatient services and …
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Physicians need to compare themselves with their peers
When I first stared hearing about the Patient-Centered Medical Home (PCMH) concept, I perceived it to be a euphemism.
For whatever reason, the concept of primary care or family medicine hasn’t resonated with politicians, corporate benefits managers, or the general public. To me “medical home” was just a warm fuzzy term that at least gave an unknowing listener a sense of the benefits of a strong relationship with a competent primary …
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The secret to better healthcare is the primary care physician’s brain
by Steve Sanders, DO
“What am I going to do now Doc?” asked Mike, a down on his luck, 29 year–old recently unemployed truck driver, as he handed me his hospital bill.
Mike was seen at our local emergency department on a Friday evening with complaints of indigestion. Earlier that day he and his wife Susan celebrated their second anniversary by splitting a store bought pepperoni pizza. …
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$11,000 hospital bill from the emergency department
From its inception, Medicare has been agnostic about the effectiveness of different treatments when it sets payment rates. Once a treatment is found to be “reasonable and necessary,” Medicare establishes a payment rate that takes into account complexity and other “inputs” that go into delivering the service. But it is prohibited by law from varying payments based on how well an intervention works.
This would change under a “dynamic pricing” approach …
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Medicare rates will be influenced by comparative effectiveness
by Ray Carlson
As we all know, this past March Congress passed and the President signed The Affordable Care Act. One component of the new legislation was the creation of a program called the Pre-Existing Condition Insurance Plan (PCIP). This is a federally funded high risk pool for state residents who – having been denied individual insurance coverage within the past 12 months for a pre-existing condition – would now, theoretically, …
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Why the Pre-Existing Condition Insurance Plan (PCIP) fails
We’re learning a lot from Massachusetts’ experiment in universal coverage – and some of the lessons are rather enlightening.
According to Bestwire, Lora Pellegrini, president of the Massachusetts Association of Health Plans, said something along the lines of “That’s the problem with the new U.S. health care reform law … it offers millions of uninsured Americans access to health insurance but doesn’t address underlying medical costs, which are contributing to costly …
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Learning from the Massachusetts experiment in universal coverage
They are coming in fast under the radar, out of peripheral vision, in the magician’s other hand—and they will change everything. New ideas, surprising networks, stealth business models that may change health care profoundly, are bubbling up in pilot programs, experiments and full-on corporate transformations. There is something here that does not yet have a name, that no one is yet calling a movement, that no one is yet seeing …
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Integration and virtual accountable care organizations in health reform
So there was a neurosurgeon who called a plumber for a house visit.
The plumber arrived and after spending an hour bestowed the neurosurgeon a bill of $500. The surgeon was stunned; he said, “Even I don’t charge this much after a surgery.” The plumber stood up, gave him a sly look and said, “well that is why I am a plumber now; I used to be a neurosurgeon.”
I mention this …
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How a plumber charges more than a neurosurgeon
When I was in training as a resident and a fellow, I remember taking only a couple of sick days over the entire 6-year period.
And I had to stay home because I could not stop praying to the porcelain Goddess during a bout of a particularly nasty flu, despite a vaccination. I actually took pride in my health record, and attributed it directly to being rather sickly as a child. …
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Why comparing healthcare access to food is a false analogy
The Dartmouth Atlas of Health is once again throwing a harsh spotlight on McAllen, Texas.
This time the Mexican border town has the highest rate of leg amputations in the nation, a new report released recently showed. McAllen’s rate was ten times the rate of Provo, Utah, which had the lowest rate of leg amputations among the Medicare eligible population. The national average was one-third of McAllen’s rate.
McAllen became notorious earlier …
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Diabetes and leg amputations in McAllen, Texas
As I have written before, the Teaching Health Center is seen as a way to move education into the community (using Community Health Centers as a training resource) and out of the Academic Health Center.
Currently, 20 million Americans receive care in a CHC. They serve Americans who are unable to obtain access through more traditional means, either because of location (the community will not support traditional healthcare) or socioeconomic …
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Will primary care be saved by the community health center?
