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.
Recently, I was lucky to be invited to a New England Healthcare Institute discussion entitled “From Evidence to Practice: Making CER Findings Work for Providers and Patients” in Washington, DC.
How to disseminate and implement Comparative Effectiveness Research (CER) so that patient care is really improved was the first topic tackled by the expert panel and the moderator, Clifford Goodman of The Lewin Group.
The target audiences for CER findings include: patients, …
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Comparative effectiveness research (CER) in patient care
One of the big complaints about the recently enacted health care reform law is that it does little to control costs. There is some truth to that because the major focus is on increasing access to insurance. And yet there is reason for optimism on a couple of fronts:
- First, with many of the access issues settled, stakeholders can focus directly on cost matters rather than cost-shifting and finger pointing
- Second, health …
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Medicare needs to take the lead for health care cost control
by Charles W. Patterson, MD
Is it possible that some do not understand that to promote Healthcare Savings Accounts is the most effective thing we could do to preserve traditional medical practice? In a true doctor-patient relationship only doctors and patients discuss the options agree to the treatments and handle the money. No third party touches any of these.
If everyone had a HSA it would be just like the good old …
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Can HSAs restore the doctor patient relationship?
The Wall Street Journal reported that overall medical use fell as patients had fewer doctor office visits, lab testing, and maintenance medications possibly due to the recession or as a result of consumer driven healthcare in the way of higher deductibles and copays.
This is very worrisome. Certainly patients should have some financial responsibility for their care, but skimping on care will only result in Americans not becoming healthier, but sicker. …
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Patients will skip care with higher deductibles and copays
For years, physicians have argued that the specter of annual cuts in Medicare will cause many of them to leave the program, or at the very least, to limit how many new Medicare patients they will accept in their practices. Yet, for the most part, measures of seniors’ access show that the vast majority enjoy good access to care.
For instance, in May of this year, the Medicare Payment Advisory Commission …
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Will Medicare really lose physicians because of the SGR?
Since 1997 the number of US medical students choosing to go into primary care has decreased by more than 50%.
It seems that sources as diverse as the Obama Administration and the Wall Street Journal think that we should find a way to encourage medical students to choose primary care specialties in order to allow Americans to have the best and most cost effective care. This is very problematic when primary …
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Pay specialists less to save primary care
by Joyce Frieden
An estimated 30 million women will be helped by the new health reform law over the next 10 years, according to a report from The Commonwealth Fund.
“While women are just as likely as men to be uninsured, they are more likely [than men] to have trouble buying coverage on the individual market,” Karen Davis, PhD, president of the fund, said in a teleconference announcing the report’s release. “This …
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How healthcare reform affects women
Gordon Gekko is wrong. Greed is not good. Not when it comes to health care providers.
The socioeconomic study of what motivates people is a fascinating field of study, not the least of which is because of how counter-intuitive it is. For example, it seems normal to assume that the more someone is rewarded for their efforts, the more effort they will put forth toward those rewards.
These rewards (increasing salary, bonuses, …
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Greed is not good when it comes to doctors, patients and medicine
You’ve probably had the experience of going to see a primary care physician and wondering about the many aspects of that visit that just didn’t make sense.
Why is it so important for me to arrive on time when, in reality, I won’t be called back until half an hour (or more) later? What’s the point of waiting for another 20 minutes in a chilly examining room for the doctor …
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The way we practice primary care doesn’t make sense
by James Gaulte, MD
A recent publication in the publication Health Affairs has evoked comments and some concern from advocates of comparative effectiveness research and admirers of the Dartmouth Atlas.
A survey of “consumers” found a level of skepticism that is alarming to those folks who are in the business of claiming to know what aspects of medical care should be offered.
The idea that more care and more costly care gives inferior …
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Sometimes more expensive care is better treatment
Everybody knows politics is a balancing act. One must balance promises against reality.
For example, how does government keep Medicare intact for seniors while cutting $500 billion out of Medicare when government has no track record of cutting entitlement spending?
And how one do it without losing the vote of seniors, who hold the key to the balance of power?
The Obama administration and the Democrats hope to keep power by winning the …
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How seniors will accept cuts in Medicare from health reform
If we really want to find out how to damn near perfectly manage any medical problem as efficiently and cost-effectively as possible, we should be studying how doctors manage the medical problems of the cash-paying doctors they see in their own practice.
Read part one here.
My visit with Dr. Grubman was fairly simple. We discussed allergy shots and how they could possibly help significantly with my dust allergy. Since I always …
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Paying cash to doctors affects the treatment plan
Are healthy people patients? Sometimes I wonder.
If you’re healthy, you rarely see a doctor. If you go for a “routine” checkup every five years, you just aren’t very affected by the system. You might not even know what the system is. Your health insurance premium is deducted from your paycheck, so you never really see that money — not the way you would if you had to write a check in that …
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Can patients demand changes in the healthcare system?
by Edison Wong, MD
With the recent proposal to repeal the so-called Massachusetts “gift ban” (more appropriately referred to as the “interaction ban”), I asked myself who stands to gain the most from such bans?
Is it the consumers or patients? Is it the physicians or their practices? Is it the federal or state governments? Nope. Sadly, it is the insurers who gain the most, at the expense of patients.
The …
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The Massachusetts gift ban benefits health insurance companies
The decade ahead is one likely to be full of turbulence. How everything will shake out is anybody’s guess.
But we can be sure that technology advancements will slow for no one. The rate of medical technology advancement now is very fast and the speed will only accelerate. One big problem is that technology advances so fast that there is no time for a purchase – say new CT scanner or …
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America has a disease industry, not a health care system
This is a perfect example of why Medicaid is not the same as Medicare:
Having counted on Washington for money that may not be delivered, at least 30 states will have to close larger-than-anticipated shortfalls in the coming fiscal year unless Congress passes a six-month extension of increased federal spending on Medicaid.
Governors and state lawmakers, already facing some of the toughest budgets since the Great Depression, said the repercussions would …
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Why Medicaid would be better off as a federal program, like Medicare
The topic of balance billing has arisen once again, this time in this post by Movin’ Meat about the new health care insurance bill and emergency medicine.
Without further explanation, “balance billing” is generally thought of as a bad thing; a way for rich doctors to squeeze even more ill-gotten gains from their poor beleaguered patients. And that’s without even realizing what it is. …
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Understanding balance billing, a primer for patients
Although a majority of Americans probably couldn’t give you an accurate description of the differences between fascism, socialism, and communism, they have no trouble applying–and often interchanging–those labels to any effort by government to reform health care.
And, based on their efforts, one might conclude that the defining characteristic of any government involvement in health care is rationing. As if we don’t already ration, but will as soon as the government …
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Health care needs public acceptance of evidence based medicine
