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.
Pharmaceutical companies and their shareholders are always looking for the next “blockbuster” drug, the label given to a drug that generates more than $1 billion of revenue per year.
Blockbuster drugs don’t necessarily have to save many (or any) lives – slick marketing more than compensates for marginal improvements in treatment efficacy — but they do need to target conditions that are common enough that millions of patients will buy them. …
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How health reform will help breastfeeding mothers
Obsession with medical technologies and machines characterizes American’s cultural expectations. We tend to think of our bodies as perpetual motion machines, to be preserved in perpetuity.
If the face of our machines sag, we lift it up. If our pipes clog, we roto-rooter or stent them. If impurities gum up our machinery, we filter them out. If our joints give out or lock up, we replace them. If we want to …
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Machine and technology fixation is why health costs are high
Prevention is the key to both better health and lower healthcare costs over the long haul. This is where the nation — and each of us as individuals — needs to put energy and resources. In the long run, it is more important than addressing the high cost of new technologies and drugs or their inappropriate overuse.
Today, the U.S. basically has a medical care system rather than a health care …
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Prevention improves health and lowers healthcare costs
The topic of nurse practitioners in the context of primary care has been resurgent of late, most notably in this post by Maggie Mahar. Much of the conversation is dominated by assertions such as this:
…Nurse Practitioners have the needed training and that, in fact, doctors who have gone through the full medical school curriculum are over-qualified for a job that, today, is more about coordinating …
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Nurse practitioners, doctors, and the lost art of diagnosis
Spring cleaning is a tradition in many homes. The occupants open up the home to the spring air, thoroughly clean the home, and sort through the accumulated goods, getting rid of things not used for a long time and which no one wants anymore. It gives one a sense of accomplishment, makes for a more pleasant surrounding and frees up space.
Is this something that you do at your healthcare site …
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Clean your healthcare site to become more efficient
I believe in the peak oil theory.
Think about it, in a closed system nothing is infinite. Since oil is a product of millions of years of decay, unless we use it at the same rate that is it produced, we will run out. I do not have a crystal ball any more than anyone else I know, so I will not hang my hat on when, but will commit to …
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How the oil shortage will affect hospitals and healthcare
by Marianne Mattera
“I Hate [Insert Health Insurer Here]”
Not long ago I sent an e-mail with those headline words as the subject line — I have withheld the name of the insurer to protect . . . , well, myself.
A combination of circumstances has led to massive hassles costing me what is easily 100 hours of checking, rechecking, e-mailing, and phone calling over the last 3 months. …
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Paperwork results in wasted work for doctors, insurers and patients
by Ray Carlson
With so many health insurance consumers familiar with standard “PPO” or Preferred Provider Organization health plans that feature lower annual deductibles, the HSA-compatible health plan might be getting overlooked.
These same consumers who – because of the downturn in the economy and subsequent job loss – are now shopping for, or considering shopping for, a new individual or family health plan might gravitate towards a PPO that features the …
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HSA-compatible high deductible health plan advantages
A middle aged patient whom I have seen in the past for benign palpitations called today because of atypical chest pain. Although I have criticized the overuse of nuclear imaging studies, and probably order the fewest of any cardiologist in the city, there are times when they are appropriate –this was one of those occasions. Symptoms did not rise to the level of an invasive angiogram, but could not be …
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Healthcare needs to be simpler and more like real economics
by Sandeep Grewal, MD
We as doctors and patients as well as medicine as a whole have evolved over time. What used to be a simple conversation of between a doctor and a patient has turned into a melee of medical issues, legal issues, insurance and financial issues and not to mention the complicated ICD 9 and CPT code system.
Conversation between a doctor and patient in 1960s:
Patient: Sir, I am …
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Patient relationships with their doctors over time
by Joyce Frieden
A standardized claim form and a single set of submission and payment rules for all health plans could save the U.S. healthcare system $7 billion annually, a study has found.
“Although not all costs of excessive administrative complexity have been captured in our study, both real costs in billing operations and opportunity costs in physicians’ practices are significant,” Bonnie B. Blanchfield, ScD, of Massachusetts General Hospital in Boston, and …
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Standardizing claims can save billions of dollars
Cancer. The Big C. No one wants money to stand in the way of curing a patient.
But real life is messier. Many new treatments for cancer are pricey yet provide only marginal gains over existing therapies in life expectancy and/or quality of life. Forty thousand dollars for a cure is not a real dilemma for policymakers — the same spend for an extra six weeks of life is another story.
In …
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When will cost effectiveness ever be acceptable in US healthcare?
by Emily P. Walker
I was covering an FDA tobacco meeting a while back when I heard a Howard Koh, MD, assistant secretary of health at the Department of Health and Human Services (HHS) start his speech with the World Health Organization’s definition of health.
“Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or …
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Definition of health includes social well-being
Health care in the United States is struggling to redefine itself. We have been spending twice what other countries spend on health care, yet our citizens are less healthy. We now have legislation to create more or less universal insurance coverage, and we are about to embark on a technology-driven quest for quality and uniformity. At the same time, Americans are increasingly turning to alternative health care practitioners, mostly at …
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Evidence based medicine at the expense of the art of medicine
Until about 8 years ago, inspections by the Joint Commission (TJC) were predictable and fairly silly.
Hospitals were given a couple of years’ notice of the week that “The Joint” would be visiting. Everybody scurried around preparing – waxing the floors, locking up all the medications, that sort of thing. (It always struck me as the most dangerous day to be in the hospital, since nobody could find any of the …
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Joint Commission hospital inspections have improved
Whether I’m wearing my health policy hat or seeing patients in the office, one condition continues to surface as a source of concern and frustration.
Diabetes, one of the nation’s most serious and costly health burdens, now affects almost 25 million people in this country — a conservative estimate. Another million new cases are diagnosed each year.
Three years ago, the American Diabetes Association estimated the total diabetes cost in the U.S. …
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Diabetes prevention can be led by health insurance companies
Massachusetts has a problem.
In April 2007, they became the first state to require residents to have health insurance. Reportedly this has resulted in 300,000 newly insured patients and lowered the uninsured population to 5%. But of course, given the relatively poor reimbursement rates for primary care providers, especially when it comes to government insurance, the state is facing a growing shortage of primary care providers.
Without an adequate supply of primary …
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Doctors may be forced to accept Medicare rates to stay licensed
Several years ago, when my wife directed the third-year Family Medicine clinical clerkship at a highly ranked medical school, she developed a popular workshop on the cost of health care that presented students with scenarios of patients who were either uninsured or underinsured and challenged them to provide cost-conscious health care by selecting medications and tests that were clinically appropriate and financially affordable.
Many students remarked that it was the only …
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How doctors can reduce unnecessary tests and treatments
