Health Policy and Public Health

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.

How a psychiatrist can write 100,000 prescriptions a year, and what that means for primary care

Matthew Mintz, MD

Physician

January 8, 2010

The Miami Herald is reporting an investigation of a psychiatrist who wrote almost 100,000 prescriptions a year. Sen. Grassley and the feds have halted payment to this Miami psychiatrist who stated that “he prescribes only what is medically necessary” and “works long hours, seeing patients for 10 minutes at a time and many of his patients need four or five medications.”

I have no personal knowledge, interaction, acquaintance with psychiatrist Dr. …

How can medical guidelines be immune from politics?

Marya Zilberberg, MD, MPH

Conditions and Diseases

January 4, 2010

The recent uproar over the new screening mammography recommendations got me thinking about a lot of stuff. One of the lessons cited by some journalists and pundits is on how potentially volatile information should be presented to the public. The USPSTF was excoriated by critics not only for what it said, but how it said it. While the objections over the former can be dismissed as ravings of loud and …

10 ways patients can save on health care costs

Richard Reece, MD

Patient

December 22, 2009

It’s beginning to look like health care consumers are going to have to take lowering health care into their own hands since no answers are coming down from above.

Here are ten tips for lowering your costs.

One, encourage your employer to offer a health savings account with a high deductible. Encourage the employer to pay half the deductible. Your premiums will be much lower, and your employer will save up to …

Would I vote for the Senate healthcare bill? Here’s where I stand on reform

Kevin

Health Policy

December 21, 2009

Now that the Senate health care bill is nearing its home stretch, some are wondering if I continue to support reform.

As a reminder, I wrote back in July that doctors should support Congress’ health care reform efforts, because, “some reform is better than none, and doctors advocating for a free market-based system shouldn’t hold out, hoping for the perfect package.”

There were deuling columns in last Friday’s New York Times, …

The medical home in health reform’s attempt to fix primary care

Kevin

Health Policy

December 19, 2009

Originally published in MedPage Today

by Kristina Fiore, MedPage Today Staff Writer

Encouraging “medical homes” to deliver care outside the emergency room should be a key aspect of healthcare reform, according to researchers, policymakers, and business leaders.

“It’s not rocket science to put a nurse practitioner near a public housing project,” said Jeffrey Brenner, MD, a physician in private practice in Camden, …

The limits of using Medicare patient data for quality outcomes

Kevin

Health Policy

December 16, 2009

Originally published in MedPage Today

by Todd Neale, MedPage Today Staff Writer

Most primary care physicians don’t see enough Medicare patients to determine statistically significant differences in cost and performance between practices, researchers found.

In fact, nearly two-thirds (65.7%) of primary care doctors worked in practices that saw too few Medicare patients to provide reliable comparisons with national benchmarks for cost and …

AMA weighs in on the Senate health reform bill

Kevin

Health Policy

December 15, 2009

The following is part of a series of original guest columns by the American Medical Association.

by J. James Rohack, M.D.

As the year winds down, health system reform continues to move forward. The Senate bill currently under debate includes a number of provisions that are consistent with the AMA’s reform priorities, some provisions we oppose and others that need to be improved to better benefit patients and physicians. As part …

How health IT can bankrupt healthcare

Kevin

Health Technology

December 8, 2009

Originally published in HCPLive.com

by Alberto Borges, MD

For those interested in health information technology, there is now an excellent, new, powerful article about this topic entitled, “Can Cleveland Clinic Be a Model for Digital Medicine?” where they discuss how this hospital system has failed to recoup their $100 million investment to date.

Here is my take on the Cleveland Clinic story, beyond the …

Read more…

How health IT can bankrupt healthcare

The inpatient, outpatient divide in patient care today

Helen Kao, MD

Physician

December 7, 2009

As the health reform debates continue, I am struck by the lack of attention to what seems to be a critical issue in poor health care delivery.

With the technologizing of medicine (and more recently the hospitalist “movement”), delivery of health care has come to be centralized around acute care hospitals. Over time, patient care has been divided into acute inpatient care and ‘ambulatory’ outpatient care. While transitions of care, hospital-at-home, …

Should medicine be efficient in the business sense?

Marya Zilberberg, MD, MPH

Health Policy

December 6, 2009

When we talk about efficiency in the business world, we are basically talking about getting as much profit as possible. This profit is wrung out of the system by reducing production costs to the maximum extent possible and by charging the top price that the market allows.

Some of the ways in which the US companies have increased their efficiencies over the last 30 years are, 1) by moving manufacturing to …

Specialists should staff the patient centered medical homes, not primary care doctors

Kevin

Health Policy

December 3, 2009

Originally published in HCPLive.com

by Alan Berkenwald, MD

The approaching fire storm over the “patient-centered medical home” model reminds me of the destructive powers seen before in HMOs. Once seemingly destined to revolutionize organized medicine, the HMO model nearly destroyed it.

We can learn from past failures. We need to promote best-practice models and make physicians accountable for their actions, both physiologically and …

How the mammogram and Pap smear debates ignore the uninsured

Jeoffry B. Gordon, MD, MPH

Conditions and Diseases

November 24, 2009

by Jeoffry B.Gordon, MD, MPH

The recent recommendation of the US Preventive Services Task Force against routine screening mammograms for healthy, low risk women under the age of fifty has demonstrated our broad consensus about the value of breast cancer screening. The discussions about new guidance from the American Academy of Obstetrics and Gynecology on when to start and how often to do PAP smears illuminate the impact, effectiveness and support …

The health reform politics of mammograms and breast cancer screening

Kevin

Conditions and Diseases

November 24, 2009

Originally published in MedPage Today

by Emily P. Walker, MedPage Today Washington Correspondent

The emotional debate over a federal panel’s proposal to end routine mammograms for women in their 40s has reignited controversy over a contentious healthcare reform issue: comparative effectiveness research.

Healthcare reform opponents say the new mammogram guidelines by the U.S. Preventive Services Task Force (USPSTF) make their point: If …

Discharged from the hospital without answers; the death of Jane Q. Patient

Dan Walter

Patient

November 20, 2009

We found out that her real name was Cindy Chapman, and that she died alone and afraid.

Cindy was a paralegal, an activist and a fighter of lost causes who lived in Worcester, Massachusetts. She was part of an online community called RATEMDs, where she had many soul mates. Her posts on health care were funny and cynical and wise. Her screen name was Jane Q. Patient.

My wife, Pam, was especially …

Why health reformers should be worried about the breast cancer screening backlash

Kevin

Conditions and Diseases

November 19, 2009

What if a non-partisan, authoritative entity wrote a robust, evidence-based guideline, but nobody followed it?

That is precisely what’s happening with the USPSTF’s recent revision of their breast cancer screening recommendations. The change most find problematic is their recommendation that women younger than 50 not undergo any breast cancer screening, such as with a mammogram.

Here are their reasons explaining why:

The harms resulting from screening for breast cancer include psychological harms, …

Read more…

Why health reformers should be worried about the breast cancer screening backlash

Senate health reform plan analysis

Kevin

Health Policy

November 19, 2009

Originally published in MedPage Today

by Emily P. Walker, MedPage Today Washington Correspondent

After weeks of closed-door meetings, the Senate leaders released their $849 billion healthcare reform bill on Wednesday evening, paving the way for a procedural floor vote soon.

The bill, combining versions approved by the Finance Committee and the Senate Health, Education, Labor and Pensions (HELP) Committee, would create a …

Read more…

Senate health reform plan analysis

AMA’s democracy in action at this defining moment in the history of medicine

Kevin

Health Policy

November 13, 2009

The following is part of a series of original guest columns by the American Medical Association.

by J. James Rohack, M.D.

Delegates Vote to Continue AMA’s Commitment to Reform, Medicare Vote Pending in U.S. House of Representatives

Twice a year, physicians come together for an exhibit of democracy at its best through the AMA House …

Will the abortion restriction survive the Senate health reform bill?

Kevin

Health Policy

November 11, 2009

Originally published in MedPage Today

by Emily P. Walker, MedPage Today Washington Correspondent

After a controversial amendment to restrict abortion was approved as part of the House healthcare bill over the weekend, senators are grappling with the abortion language in their legislation.

Senate Majority Leader Harry Reid (D-Nev.), who personally opposes abortion, said the issue was being negotiated.

“I expect the bill that …

How should doctors discuss healthcare reform with patients?

Kevin

Health Policy

November 10, 2009

Originally published in HCPLive.com

Physicians are increasingly bringing their views on healthcare reform into the examination room. Others are distributing flyers or taping up signs in the office. Given that healthcare reform has become such a contentious subject in the United States, it is not surprising that conflicts have arisen between physicians and patients who hold different views.

The St. Petersburg Times …

Doctors and patients need to learn to live with health insurance companies

Kevin

Health Policy

November 10, 2009

by Marie Cooper

Consider two patients with the same managed care plan.

One has multiple sclerosis and receives an infusion of Tysabri every month. It needs pre-certification. The requirements are black and white. The patient qualifies if they have relapsing/remitting MS and have failed other therapies. The drug costs $2,000, the infusion center is another $1,000. The infusion center is a contracted provider that has …

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