An excerpt from The Future of Health Care Delivery.
We Americans like to pride ourselves on having the best health care system in the world, but unfortunately that is not the case. We have a medical (that is, sick) care system—a system that waits until we become ill before it kicks into action—instead of a health care system focused on helping us stay healthy. We give lip service to prevention and, …
Four brutally honest declarations:
1. I can perfectly decide what is best for myself, my family, my patients, and my practice. I don’t need outside guidance telling me how to lead.
2. I decide what works best on my terms to practice the best medicine.
3. I will succeed and lead because I am focused on my goals just as much (if not more) than my patient’s goals.
4. My goal is to make …
Labor and deliveries are slowly closing across the United States: California, Pennsylvania, and Ohio. In regional areas where there have been no closures, conversations in hospital boardrooms are probably questioning whether they should be. But why? Because of health care reform, increasing medical expenditures, hospitals are making less money due to reduced reimbursement, and because of the financial margin of obstetrics. To explain the complex answer further, we need to …
Are doctors really going broke?
According to this piece from CNN Money, some are: “Doctors list shrinking insurance reimbursements, changing regulations, rising business and drug costs among the factors preventing them from keeping their practices afloat. But some experts counter that doctors’ lack of business acumen is also to blame.”
That’s all entirely true.
Pressure on reimbursement, combined with a lack of …
About six weeks ago, while in clinic, I developed pain in my stomach — specifically, in my right upper quadrant, just below the ribs. I had experienced this a few times before, but this time it seemed more persistent than usual. Following the rule that physicians make the worst patients, I kept working through it until my nurse told me I looked poorly, and made me see my own primary …
While we are talking about things that drive health care costs up, this one has bothered me since I was in practice years ago. I am a believer in competition, I think it forces us to be creative and provide better, cheaper, more efficient products and services.
But there is the mindset of leadership at play as well. Are we competing to provide better patient services to improve patient care, or …
The recent budget crisis in many state Medicaid programs has led the directors of these health care programs for the poor to cast about for ways to cut their costs, and many have landed on a ‘solution’ that puts lives at risk and undermine the financial viability of an emergency care safety net that is already severely underfunded and overwhelmed. Some 21 states use a variation of the old definition …
If you’ve ever been sick, especially with anything serious, you quickly realize that doctors, nurses and their ilk are an unusual and precious resource.
First you have to find smart people with personalities willing and able to put up with a lot of guff in the service of their fellow man. Then they have to be willing to (usually borrow, and) spend tens or hundreds of thousands of dollars for …
Someone has gone and rained the facts down on what is generally considered a feel–good story in American medicine, the dramatic increase in female doctors in America.
In response to Dr. Herbert Parde’s “The Coming Doctor Shortage” article in the Wall Street Journal, Dr. Curtis Markel pointed out that there is a difference between the raw, gross number of physicians in America, and the effective number of practicing physicians. Not only …
We hear that doctors do not like “protocol medicine” – they do not want to follow a “cookbook” when every patient is different. It is not a good understanding of the issues.
Some years ago when I worked in a branch of he National Cancer Institute and then the University of Maryland Cancer Center, we admitted many patients with acute leukemia. The treatment approach including the necessary special tests to …
When I was in medical school, we had a class on health economics taught by William Kissick. I didn’t pay as close attention as I should have (especially given what I do now). But I remember one thing he stressed. It involved the iron triangle of health care.
There are three aspects of health care systems that are essential: quality, cost, and access (thus the triangle). The problem …
There is no “right” answer to the healthcare reform issue. There are facts, opinions, myths, politics and reality, all in no particular order of magnitude. Unfortunately, thus far and likely in the future, the reform will be political and thus costly and painful and will not address the core issues involved in fixing the inherent systemic problems.
There have been many things written with regard to this topic and I …
Sometimes you just don’t want to be right. Over the past 5 years, I have seen an alarming pattern arise in my profession. Many of my patients have heard me talk about Soylent Green, an old Charleton Heston movie. The premise of the movie seems absurd. Can you imagine the government of the United States providing for all the needs of its people including healthcare, food, clothing, and even death?
David …
With sixteen million more Americans expected to gain health care coverage in the coming years as a result of the Affordable Care Act, access to actual health care providers may become more difficult. This may be especially true for patients with marginal coverage such as Medicaid.
The Kaiser Family Foundation recently explored the role of non-physician clinicians – specifically nurse practitioners (NPs) and physician assistants (PAs) …
by Grayson Wheatley, MD
It was supposed to be a routine office visit for my patient.
Unexpectedly, it turned into a real-world health economics lesson for me, the treating physician. The old adage “listen to your patients; they will always give you the answer” became exceedingly true in this case, even when it dealt with an issue beyond a medical diagnosis, such as lack of transparency …
The American Medical Association recently released its membership numbers, and they’re declining.
According to MedPage Today, the AMA “saw another steep drop in its membership in 2010 — this time losing about 12,000 members or 5% of its total membership.”
It’s been well publicized that the AMA only represents a minority percentage of physicians, depending on what you read, it’s between 20 and 30%. But it seems many physicians have little …
Surgery is expensive, there are no doubts about that. However, there are a few things a patient without insurance who desires surgery can do to minimize the costs as much as possible. Before going into cost-cutting measures, you first need to understand where the costs come from.
In rank order, the costs of surgery come from (highest to lowest):
There are many aspects to being a doctor. Just as important are the many aspects that go into being a patient. Of course, the difference is that one has been perceived as being a position of power and the other one has not. I don’t believe this distinction is useful or true in today’s world.
Patients and doctors work …
by Benjamin P. Geisler, MD, MPH
Everybody is talking about Accountable Care Organizations or ACOs these days.
The reason being that the Centers for Medicare and Medicaid Services or CMS has released the rules for shared savings between ACOs and CMS.
The complete proposed rule is 429 pages long and they’re seeking comments on it now until early June.
What is an ACO?
ACOs will take care of …
Federal law generally prohibits physicians from referring their own patients to a diagnostic facility in which they have an ownership issue – a practice called “self-referral” – unless the facility is located in their own practice.
This exemption exists to allow patients with access to a laboratory test, x-ray, or other imaging test at the same time and place as when patients are seeing their physician for an office visit. Less …
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