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.

Doctors are focusing on lifestyle when practicing medicine

Health Policy
May 14, 2010

An interview with Elizabeth Chase, MD, obstetrician-gynecologist in Dover, New Hampshire

Elizabeth Chase, better known as Betsy, is a close and enduring college friend of my son, Spencer. She is a solid, pragmatic, hard working obstetrician-gynecologist, with two sons, and an architect husband, who spends his time caring for their children and their house in Dover, New Hampshire. She represents many of changes that occur when women become full-time physicians. The …

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Doctors are focusing on lifestyle when practicing medicine

AMA legal battle a victory for fair pay from insurers

Health Policy
May 13, 2010

A guest column by the American Medical Association, exclusive to KevinMD.com.

Physicians filing claims in $350M UnitedHealth Settlement can get help from new AMA guide

by J. James Rohack, MD

In mid-April, the first of 18 million people around the country began receiving legal notices containing details of a record-breaking settlement reached last January in a historic court challenge …

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AMA legal battle a victory for fair pay from insurers

Bartering and whether doctors should be paid with chickens

Potpourri
May 13, 2010

Generally, I find my practice works best when I get paid in dollars. They’re convenient. They can be transmitted electronically between bank accounts. Mary and Annie like them. I can spend them by swiping a credit card.

But, in a remarkable effort to win the “Let’s See How Stupid I Can Sound” award, a Nevada candidate for U.S. Senate has proposed ditching the idea of paying doctors in money, and going …

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Bartering and whether doctors should be paid with chickens

Physician assistant name change rubs doctors the wrong way

Health Policy
May 11, 2010

Much like many other news items, I came upon the one about the proposed name change for Physician Assistants quite by accident: it came to me as an e-mail notification of a new topic being discussed on one of the physician only discussion boards that I am a part of. Apparently, after 40+ years of the profession’s existence, there is a grassroots effort afoot to upgrade the name, and presumably …

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Physician assistant name change rubs doctors the wrong way

Health insurance will be reformed by a little known department

Health Policy
May 11, 2010

by Joyce Frieden

In one of those “important but little noticed” announcements that government officials are prone to put out, the Department of Health and Human Services recently let the world know – via the Federal Register — that it has created an Office of Consumer Information and Insurance Oversight to assist with implementation of the newly passed health insurance reform law.

This new office has four divisions. Here are a …

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Health insurance will be reformed by a little known department

ABIM: Quality medical care needs more than strong systems

Physician
May 10, 2010

A guest column by the American Board of Internal Medicine, exclusive to KevinMD.com.

Imagine a sub-par doctor at a vibrant health system with care delivered and coordinated by skilled teams, using robust EHRs and other vital supports for physicians and patients. Now imagine an extremely talented, knowledgeable doctor at an underfunded community clinic. This clinic has no real computer system, …

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ABIM: Quality medical care needs more than strong systems

Transparent medical pricing lowers health costs

Health Policy
May 10, 2010

My friend, the Buckeye Surgeon, has resisted reforms in medical residency training programs, that have eased some of the inhumane exhaustion on young interns and residents.

I have a different view on the subject. This issue generates spirited debate in the blogosphere and in teaching hospitals across the country.

Not all medical education reforms, however, provoke controversy. I learned recently from an Ohio medical student that they are now being taught …

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Transparent medical pricing lowers health costs

Calorie counts in health reform is significant for patients

Health Policy
May 6, 2010

Counting calories as part of health care reform—who knew? But apparently it’s there on page 455 of the health-care reform act, according to Marion Nestle, Professor of Nutrition at NYU, writing in the New England Journal of Medicine. There will now be a national effort at posting calorie counts in chain restaurants.

There are many ways to improve the overall health of Americans, but tackling obesity is surely one of the …

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Calorie counts in health reform is significant for patients

How Massachusetts controls health costs should be closely watched

Health Policy
May 5, 2010

A major criticism leveled at the health reform law is that it doesn’t do enough to control costs. Yet experience with a similar breed of health reform in Massachusetts indicates that the cost control issue will come to the fore sooner rather than later.

Recent stories have reinforced my conviction about this:

Massachusetts health plans have sued the state and stopped issuing new policies to small businesses and individuals after the …

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How Massachusetts controls health costs should be closely watched

Maternal death rates improve but hurts fund raising

Health Policy
May 5, 2010

by Mike Himowitz

When you’re advocating for a health cause, can good news be bad news?

It’s entirely possible — when science threatens fund-raising, and at the worst possible time.

Consider a study of worldwide maternal death rates by a team from the University of Washington that appeared online recently in The Lancet.

The group, led by Christopher Murray, of the school’s Institute for …

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Maternal death rates improve but hurts fund raising

Health reform may mean meaningful changes for physicians

Health Policy
May 4, 2010

Jim called me late on a fall afternoon to report our mutual friend was in the local emergency room. “It looks like he had a stroke”. I immediately asked to speak to the ER doctor for the results of the CAT scan I knew would have been done. There were two metastatic tumors in the brain.

It has been over two years since my friend died. He was among the millions …

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Health reform may mean meaningful changes for physicians

Defensive medicine worsens patient care and raises costs

Physician
May 3, 2010

Health care in the United States costs too much, and it doesn’t look like that’s going to change. Recent health care reform legislation doesn’t take any meaningful steps towards reducing or controlling costs. In fact, it explicitly forbids states from trying to curtail the costs of malpractice litigation in any way that would reduce lawyers’ fees.

How does a fear of lawsuits increase costs? The most direct way is …

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Defensive medicine worsens patient care and raises costs

How health care reform will affect mental health

Health Policy
May 3, 2010

by Diana E. Lee

The cost of therapy and medication for underinsured people are common barriers keeping people from getting treatment for a mental health problem.

Although there are community mental health centers that provide treatment for many people, their resources are stretched far too thin to help everyone who needs treatment on the level someone with a more serious issue may need. One of the most positive changes that will arise …

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How health care reform will affect mental health

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Healthcare reform and the new role of hospitalists

Physician
April 30, 2010

by John Gever

With growing pressures on hospitals from the new healthcare reform law and from the stakeholder community to become more efficient and effective, administrators may find they already have the necessary expertise under their own roofs, a prominent hospitalist said.

“Some organizations with hospitalist programs need look no further than these programs to chart a course toward more effective physician-hospital integration,” wrote Robert M. Wachter, MD, of the University of …

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Healthcare reform and the new role of hospitalists

Physician supply trends for primary care doctors and specialists

Health Policy
April 30, 2010

Health care reform continues to be a key political topic of discussion in the U.S. Physician supply and specialty training are important elements in designing an efficient system that provides the highest quality of care.

To understand where U.S. physician supply and specialty training is headed, I examined the U.S. trends from 1990 to 2007 (latest year data is available).

Physician supply has been growing during this period. In 1990, there were …

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Physician supply trends for primary care doctors and specialists

Internal medicine is dead, will concierge physicians thrive?

Physician
April 29, 2010

by Steven Knope, MD

For the last several years, writers in the New England Journal of Medicine and the Journal of the American Medical Association have authored doomsday editorials about the prognosis of primary care medicine. There has been much discussion about the fact that internists and family practitioners cannot keep pace with rising overheads and falling reimbursement under the traditional third-party payment system.

Paraphrasing a recent …

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Internal medicine is dead, will concierge physicians thrive?

Primary care is burdened by excessive paperwork

Physician
April 28, 2010

by Charles R. D’Agostino, MD

We’ve all seen the headlines –- “Primary Care Physicians Becoming a Scarce Breed”, “Wait Times for Appointments Increasing”, “Primary Care in Crisis” –- and have heard the pundits pontificating on the deteriorating state of primary care.

But rarely do we hear what’s happening from physicians on the front lines, those actually seeing patients. Consequently, with direct access to the primary care trenches, replete with an overworked …

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Primary care is burdened by excessive paperwork

Primary care shortage solutions after health care reform

Physician
April 27, 2010

The new reform law which is called the Patient Protection and Affordable Care Act (PPACA) will be a huge disappointment to the millions of previously uninsured people who finally purchase insurance policies when they try to find a doctor.

Primary care physicians are already in short supply and the most popular ones have closed practices or long waits for new patients. Imagine when 2014 hits and all of those patients come …

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Primary care shortage solutions after health care reform

Texas Medical Association: Stop the Medicare meltdown

Health Policy
April 26, 2010

A guest column by the Texas Medical Association, exclusive to KevinMD.com.

by William H. Fleming III, MD

So we have this new health law that’s intended to provide better health care access for most Americans. Many of the reforms rely upon the sustainability and effectiveness of Medicare.

Medicare, however, is doomed to failure unless Congress fixes a fundamental problem existing within the current program — the Sustainable Growth Rate (SGR) formula. The …

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Texas Medical Association: Stop the Medicare meltdown

Undocumented individuals make hospital discharge difficult

Physician
April 26, 2010

Working in the hospital this month, my team has been caring for Mr. M. He was here when we started on service at the beginning of the month, and unless his planned transfer to another facility goes through, he’ll be here when we sign off to the next team at the end of the month.

Mr. M is in his fifties. He speaks Spanish. He is an undocumented immigrant from Central …

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Undocumented individuals make hospital discharge difficult

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