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.
My wife and I were invited to dinner at the home of one of my daughter’s friends. My daughter is a graduate of the International Baccalaureate program of Murphy High and her friends tend to be interesting.
This particular friend is majoring in pre-med and has parents who immigrated from Vietnam following the fall of Saigon. As is usual when one has a physician dinner guest (and perhaps when one doesn’t) …
Read more…
Our love affair with technology holds primary care back
Somewhere in the Obama Administration, there is an elitist central cabal that operates with the support of the highest organs of our central government. It conspires in windowless basement rooms to plot the gun control, mass vaccinations and the nationalization of key U.S. economic sectors like automobile and chardonnay manufacturing.
Healthcare, however, is its maximum target. Much like pieces on a chess board, and with the support of renegade organizations like …
Read more…
Can accountable care organizations lower costs and improve quality?
by James Gaulte, MD
Should medical student applicants be chosen less for their demonstrated ability to master large amounts of knowledge and solve problems and more for their social consciousness and desire to push forward with social justice?
That appears to be the suggestion of a panel of experts from the AMA in a project called the Initiative to Transform Medicine (ITM) who believe an …
Read more…
Should social justice matter when choosing medical students?
How do you judge how good a doctor is? By personal interaction? By what relatives and friends say? By whether he or she is on time when you go for your visit? By doctor rating websites on the Internet? By patient satisfaction surveys conducted by doctors themselves or rating agencies?
Or do you do it by the numbers? The federal …
Read more…
How judging doctors by the numbers may be meaningless
There is a critical gap in the supply of primary care physicians in the U.S., and it should come as no surprise that our existing primary care delivery and payment models are at the heart of the issue.
The traditional primary care model — medical care provided by a physician and a small support staff, often without benefit of health information technology (HIT) — was developed at a time when the …
Read more…
Explaining the critical gap of primary care physicians
Boston Medical Center has provided care to the underserved and Medicaid population in Boston for almost 150 years. And what’s happening to the venerable institution is gut-wrenching to read.
I trained at Boston Medical Center (BMC), completing my internal medicine residency there in 2002. A recent write-up in Boston Magazine highlights the financial trouble the hospital is going through:
Boston Medical Center is almost broke, perilously close to what …
Read more…
Boston Medical Center gets screwed by the Massachusetts government
Even as a medical student, I’m already complicit in exacerbating the problem of the high cost of health care.
It hit me one day, during my medicine rotation. We were working up a patient, and I was ordering tests with my resident. The patient had liver disease and perhaps some ascites.
He came in for another issue, and this wasn’t of primary concern to us, and we really wouldn’t have …
Read more…
How a medical student can exacerbate the high cost of health care
Today we mostly have prepaid medical care insurance with some co-pays and deductibles – both with commercial insurance and with Medicare.
In other words, our insurance covers essentially everything from basic and routine care to the catastrophic. And the insurance pays out based on units of care – a visit, a test, a procedure, a hospitalization, a prescription. This creates a system in which providers (physicians, …
Read more…
A system based on units of activity encourages more units of care
I remember this one moment back in the midst of health care reform when I was sitting in a radio studio, feeling pretty glum about the whole ordeal, and I mused aloud, “I wonder if anyone is enjoying this at all.”
For some of us, improving the health care system is more than a passing fancy. I’m a health services researcher. It’s my job. Those people on the TV pay attention …
Read more…
Wanting better health care shouldn’t be conservative or liberal
Dr. Wes, a blogging cardiologist, posted a follow-up to his recent post on e-mail correspondence between physicians and patients.
The majority of emails he receives tend to be for very simple things like checking a lab result.
Current EMRs don’t make reviewing and sharing lab values efficient. Dr. Wes writes:
[O]ur current model of the electronic medical record sending every single result to our inbasket, even though it contains …
Read more…
Physicians deserve to be compensated for time spent on email
In making the case for health care reform, inappropriate utilization of emergency rooms is frequently cited as an example of our inefficient system and an important factor behind the staggering cost of U.S. health care.
At first, the logic makes sense: emergency rooms have to treat people, so the uninsured often turn there for care, including primary care, which is very expensive to provide in an emergency room, and would be …
Read more…
Should reduced ER use be a measure of health reform?
This has to be a very difficult time for insurance companies in Massachusetts. Notwithstanding that they are non-profits, they are under a lot of scrutiny with regard to reserve margins and profitability. Much of this is unfair, but I think that is just a sign of the times. Hospitals face a similar issue, too. Doctors are certainly next in line.
But the Massachusetts insurers have an additional problem. They have been …
Read more…
A difficult time for health insurance companies in Massachusetts
As part of the new health care legislation, the government has instituted Medicare’s Physician Quality Reporting Initiative (PQRI) in an attempt to motivate health professionals to do the right thing.
According to the legislation, PQRI asks physicians to report how the care they furnish aligns with evidence-based clinical guidelines for a variety of medical conditions, such as diabetes or heart disease. In 2010, physicians who successfully report these measures will receive …
Read more…
What motivates health care workers is needed to explain health care costs
The most visible impact of Affordable Care Act is surely the expansion of health insurance coverage to 30 million uninsured Americans, but a lesser known provision in the overhaul will have far-reaching implications as well.
The provision catapults the US Preventive Services Task Force (USPSTF) from an obscure agency that produced unenforceable guidelines about screening and preventive services into one whose recommendations directly impact reimbursement.
According to the terms of the new …
Read more…
Health reform vaults the USPSTF into prominence
The individual mandate is the single most controversial feature of the Patient Protection and Affordable Care Act. Everyone who can afford coverage—unless an undocumented immigrant or exempted on religious grounds—is required to have it or pay a penalty of $695 or 2.5 percent of income.
The rationale is straightforward: without a mandate, many people would wait until they needed care before buying insurance, driving up premiums for those with ongoing coverage, …
Read more…
Patient Protection and Affordable Care Act individual mandate controversy
by James P. Davison, DO
Emergency department utilization and its impact on health care reform legislation has been a hot topic of conversation in healthcare journals and the blogosphere. It is a tenet of the currant legislation that ER visits and cost growth will go down, contributing to a decreased health cost growth curve.
Opponents state the newly insured will flock to the nation’s emergency rooms. Proponents …
Read more…
Emergency department utilization and its impact on health care reform
Health Affairs reports on a study that finds Evidence That Consumers Are Skeptical About Evidence-Based Health Care.
According to the abstract,
We found many of these consumers’ beliefs, values, and knowledge to be at odds with what policy makers prescribe as evidence-based health care. Few consumers understood terms such as “medical evidence” or “quality guidelines.” Most believed that more care meant higher-quality, better care. The gaps in …
Read more…
Patients don’t believe the evidence, blame our healthcare system
Howard Brody, a family physician, recently wrote an article in the Annals of Family Medicine discussing, “Professional Medical Organizations and Commercial Conflicts of Interest: Ethical Issues.”
The article focused on how AAFP has “recently been criticized for accepting a large corporate donation from Coca-Cola to fund patient education and materials on obesity prevention,” and how this money has been called a “conflict of interest.” To that effect, Dr. Brody defines such …
Read more…
Working with industry requires building a culture of trust
Is the pen mightier than the PC?
When it comes to prescribing, it appears so. A new report from the Center for Studying Health System Change finds that most physicians write their RX scripts by hand, despite financial incentives for physicians to adopt electronic prescribing. Even those who have e-RX systems do not always use them, and when they do, they may not to use the features that were …
Read more…
Why are most physicians writing their prescriptions by hand?
by Jeoffry B. Gordon, MD, MPH
I have always considered it to be my professional responsibility and ethical imperative to fight for my patients with the insurance companies to get approval for every test and medication that I think is medically necessary.
My batting average is close to 100% Lately, the insurance companies have been trying to draw the noose tighter and make the task of getting …
Read more…
Insurance companies affect patients with paperwork for tests
