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.

Providing Medicare to everybody increases continuity of coverage

Health Policy
October 31, 2010

At a recent staff meeting, a colleague mentioned her client was at an “awkward age”.

I thought she was referring to a teenager, but she quickly clarified herself. She was referring to the age before someone is old enough for Medicare at sixty five, an awkward time indeed.  Many people between the ages of fifty to sixty four find that relatively minor health problems make health insurance unaffordable. For those with …

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Providing Medicare to everybody increases continuity of coverage

Deceptive marketing is widespread in health care

Health Policy
October 29, 2010

Recently, reports about deceptive marketing and other questionable practices used by the growing for-profit higher education industry in the US appeared in the news.  For example, per Bloomberg:

Recruiters at U.S. for-profit colleges lied to entice students and encouraged them to commit fraud to qualify for aid, a report by the Government Accountability Office found.

Recruiters at all 15 colleges studied by the GAO, Congress’s investigational arm, misled potential students about the …

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Deceptive marketing is widespread in health care

Comparative effectiveness research needs to be taught to doctors and patients

Physician
October 28, 2010

Oncology is the area where the health care cost conundrum is coming into sharpest focus. Theoretically, who wouldn’t spend whatever it takes to cure a life-threatening disease? And yet practically the costs of new treatments are so high, and the improvements usually modest enough, that when it comes right down to it costs are becoming a real issue for patients and doctors.

An interesting article in the Journal of Clinical Oncology …

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Comparative effectiveness research needs to be taught to doctors and patients

Unintended consequences from healthcare reform

Health Policy
October 27, 2010

In early October, the New York Times published two articles that addressed a pervasive problem from slightly different perspectives. Boiled down to its essence, the problem is the unintended consequences of some provisions of the new healthcare reform legislation.

In his well crafted article, entitled “Health Care’s Uneven Road to a New Era,” David Leonhardt explored the impact caused by the introduction of new regulations into a “status quo” system.

So-called “mini-med” …

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Unintended consequences from healthcare reform

Specialist and primary care pay per hour

KevinMD
October 26, 2010

Authors of a recent study from the Archives of Internal Medicine are unlikely to endear themselves to specialists.

As reported by Reuters, and provocatively titled, Do specialist doctors make too much money?, the study gives a per-hour breakdown of how much doctors make.

I think this is a good approach, since annual salary figures do not account for the number of hours doctors work — and in the case of primary …

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Specialist and primary care pay per hour

Will the accountable care organization (ACO) be a durable part of reform?

Health Policy
October 25, 2010

Magic bullets come and go in the world of health policy, but the accountable care organization (ACO) is likely to be a durable reform. Except for group practices like Geisinger, Harvard Vanguard, Kaiser Permanente, systems like the VA, and local communities in which independent practitioners have established cooperative collaborations, health care has been grotesquely uncoordinated in the U.S. ACOs speak to that structural lesion.

Title III of the Patient Protection and …

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Will the accountable care organization (ACO) be a durable part of reform?

Why the Florida Medical Association (FMA) is angry with the AMA

Health Policy
October 24, 2010

At an Orlando meeting recently, Florida Medical Association (FMA) members fumed that their parent, the AMA, isn’t adequately representing Florida’s private practice doctors. After talk of secession and forming a new group, they settled for writing a stern letter urging the AMA to straighten up.

The FMA dustup began with a resolution written by Douglas Stevens MD, a Fort Myers cosmetic surgeon – you can’t make this stuff up – complaining …

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Why the Florida Medical Association (FMA) is angry with the AMA

How can doctors successfully engage their patients?

Physician
October 21, 2010

by Thomas Goetz

Enough about patients: What is a doctor to do?

In the past few months, since The Decision Tree book came out, I’ve had the privilege to talk with many doctors about the opportunity and challenge of engaging patients in their own health. Some physicians, not surprisingly, have been suspicious, and even hostile to the idea that patients have a …

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How can doctors successfully engage their patients?

How the Affordable Care Act helps Medicare

Health Policy
October 19, 2010

One of the more effective criticisms of the health reform law (Affordable Care Act, or ACA) is that it hurts Medicare. It also is wrong.

Effective, in that it has been widely reported that seniors are more likely to express negative views of the ACA than other age groups. (Although the Kaiser Family Foundation’s Drew Altman, citing the group’s most recent tracking polls, writes that seniors’ opposition to …

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How the Affordable Care Act helps Medicare

Doctors working in an ambulatory care clinic

Physician
October 18, 2010

It would be difficult today to be connected to medicine as either a provider or a consumer and not be aware of the existence of free-standing ambulatory care centers.

Their usual habitat is along a suburban commercial strip, and their presence is generally announced by a well-lit sign displaying a hyphenated medical name, corporate-logo style. The ambulatory care center, known to much of the public as the “walk-in clinic,” is less …

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Doctors working in an ambulatory care clinic

Is healthcare is a right? A balanced opinion

Health Policy
October 15, 2010

Chris Mathews had Ron Paul on his show, Hardball, earlier this year to discuss Social Security and the new health care bill.

Mr. Mathews pointed out that people get old and no longer have an adequate income source to take care of their basic needs, and pointed to this as a reason to force working Americans to save for our retirement through a government program as a sort of …

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Is healthcare is a right? A balanced opinion

Tips for questioning costs in today’s health care system

Health Policy
October 14, 2010

by Joanna Fief

About two years ago in the wee hours of the morning, I found myself in a local emergency room with severe stomach pain, incessant vomiting and dehydration.  It wasn’t pretty, and I was desperate for something – anything – to ease my pain and stop my vomiting.

Gratefully, within minutes of receiving an IV with medications for pain and nausea, my symptoms subsided.  After a couple of blood tests …

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Tips for questioning costs in today’s health care system

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Selecting health insurance requires free choice for individuals

Health Policy
October 13, 2010

by William Bayer

Buying health insurance across state lines and health savings accounts are good – but they do not resolve the core issue.

The core issue is that the employer is making the main choice for the employees, leaving them essentially with a choice between small, medium or large. That may satisfy the most important needs, but it does not encourage competition because the …

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Selecting health insurance requires free choice for individuals

Making health care better, faster, and cheaper with collective innovations

Health Policy
October 12, 2010

The country seems to have shifted in less than 18 months from a slogan of “Yes We Can!” to “Oh, well…” and a shrug, then back to “Cool! I think. What was that, really?”

Hopes for a true rebirth of health care turned into the Year of Screaming Inanely, then took that long slide from what we might hope for to what we might settle for. Yet suddenly it seems like …

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Making health care better, faster, and cheaper with collective innovations

Quality programs have social and medical consequences

Health Policy
October 9, 2010

Like it or not, “garbage in, garbage out” is the rule rather than the exception for the vast majority of bureaucratically dictated “quality control” programs that we’re ever likely to launch.  There are three primary reasons for this.

First and foremost, there’s Goodhart’s Law:

“Originally, an economic theory stating that if a particular definition of the money supply were to be used as the basis for monetary policy, the stability …

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Quality programs have social and medical consequences

Why doctors should care about Regional Extension Centers (RECs)

Health Policy
October 8, 2010

Over the past year, states across the country have begun to develop Regional Extension Centers (RECs) to help support the broad electronic health record (EHR) initiative passed as part of the economic stimulus package in 2009.

Why should physicians care? With benefit of a little background information, the answer is pretty clear.

The evidence suggests — and it is generally believed — that adoption of EHRs by physicians and other healthcare providers …

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Why doctors should care about Regional Extension Centers (RECs)

How to foster a cycle of excellence in medicine

Physician
October 8, 2010

“What does it take to be good at something in which failure is so easy, so effortless?” asks Atul Gawande in his book, Better.  For medical students who will soon have responsibility over people’s lives, it’s a daunting question.  It draws out our fears of messing up and making mistakes.  Of getting a lower grade than our peers on a Structure Function exam.  Of answering a question incorrectly and embarrassing …

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How to foster a cycle of excellence in medicine

Doctors should work weekends, and how reformers alienate physicians

Health Policy
October 5, 2010

Peter Orszag wants doctors to work weekends.

The former director of the White House Office of Management and Budget wrote as much in this past weekend’s New York Times:

Doctors, like most people, don’t love to work weekends, and they probably don’t enjoy being evaluated against their peers. But their industry can no longer afford to protect them from the inevitable. Imagine a drugstore open only five days a week, or …

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Doctors should work weekends, and how reformers alienate physicians

6 points every physician should consider about Medicare ACOs

Health Policy
October 5, 2010

by Asa Lockhart, MD

Doctors, that age-old business advice still applies: Take your time and read carefully, and evaluate what it might mean to your patients and your practice, before you sign a contract.

Specifically, the Patient Protection and Affordable Care Act (PPACA) paves the way for Medicare shared savings accountable care organizations (ACOs).

Conceptually, this type of ACO is a collaboration of physicians and health care providers …

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6 points every physician should consider about Medicare ACOs

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