Public Health & Policy

The role of non-physician clinicians in primary care

Physician

July 22, 2011

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) …

The challenge of pre-authorization for an elective procedure

Kevin

Policy

June 27, 2011

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 …

Why the AMA is in decline, and should doctors care?

Kevin Pho, MD

KevinMD

June 20, 2011

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 …

How to minimize the costs of surgery

Christopher Chang, MD

Policy

June 5, 2011

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):

Hospital Charges …
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How to minimize the costs of surgery

Cooperation between patient and doctor is essential today in health care

Paul Dorio, MD

Physician

May 4, 2011

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 …

How an ACO will affect physicians and Medicare patients

Benjamin Geisler, MD, MPH

Policy

April 14, 2011

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 …

Physicians referring patients to a diagnostic facility they own

Bob Doherty

Policy

April 10, 2011

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 …

Why medical education needs to be more affordable

Edwin Leap, MD

Education

March 29, 2011

I was talking to a young man who is starting medical school this fall. His tuition at one of South Carolina’s newer schools will be $40,000 per year. That’s admittedly on the high end. On the low end, it runs a paltry $33,000 per year.

And this is all after college, of course. He and others like him are taking out loans to the tune of $240,000 to pay for their …

Hospitals taking over private practices

Manoj Jain, MD, MPH

Physician

March 8, 2011

A decade and a half ago, when I moved to Memphis, I proudly hung a sign outside an office I shared with another doctor. It had my name followed by an MD. I had started my own small business as a solo practitioner in medicine.

Over the years, the practice has grown. I now have several employees and my own office, with the names of several other doctors alongside mine on …

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Hospitals taking over private practices

Treatment guidelines pros and cons

David Williams

Conditions

February 17, 2011

I was puzzled by a Health Affairs article showing the public finds arguments against treatment guidelines a lot more compelling than arguments in favor. But after reading the technical appendix, which contains the full text of the survey, I think the problem is that the researchers framed the question poorly. In particular, the researchers portrayed guidelines as unrealistically rigid.

In A National Survey Reveals Public Skepticism About Research-Based Treatment …

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Treatment guidelines pros and cons

How to check your scientific paper for plagiarism

George Lundberg, MD

Education

February 8, 2011

We were taught in grammar school that plagiarism is wrong. It is stealing someone else’s property.

Imagine in high school asking your mother to buy you “Cliff Notes” so you can copy it word for word. Mother would not have liked that, and it wouldn’t have been right.

To write an essay today, you’ll probably start with a search engine. Instantly, Mr. Google delivers many intelligent commentaries on anything, probably better than …

If you’re in medicine, you’re in politics

Kevin

Education

February 7, 2011

by Nicholas J. Rohrhoff

Each generation of physicians has no choice but to take on the responsibility of learning the science of medicine – how best to care for patients. But current circumstances dictate that we must also bear the burden of developing policy that creates the best system in which to provide that care.

Creation of a 21st century American healthcare system will require engagement and …

Everything about medicine is now big business

Peter J. Weiss, MD

Policy

December 18, 2010

Medicine used to be different. Doctors couldn’t do too much for you. They didn’t get paid very much and they were focused more on helping than on managing a business.

Hospitals were community-based not-for-profit or public entities. Drugs and devices were not as sophisticated or expensive, and they weren’t marketed directly to consumers. Well Toto, we’re not in Kansas anymore.

After witnessing our “healthcare reform” process you must have seen that almost …

The cost of keeping the terminally ill alive

Richard Meyer

Physician

December 16, 2010

Last year, Medicare paid $55 billion just for doctor and hospital bills during the last two months of patients’ lives.

And it has been estimated that 20 to 30 percent of these medical expenses may have had no meaningful impact. Most of the bills are paid for by the federal government with few or no questions asked. This statistic is from a 60 Minutes story on “The Cost of Dying” and …

How a plumber charges more than a neurosurgeon

S. Irfan Ali, MD

Policy

November 30, 2010

So there was a neurosurgeon who called a plumber for a house visit.

The plumber arrived and after spending an hour bestowed the neurosurgeon a bill of $500. The surgeon was stunned; he said, “Even I don’t charge this much after a surgery.” The plumber stood up, gave him a sly look and said, “well that is why I am a plumber now; I used to be a neurosurgeon.”

I mention this …

Do posters in the hospital really help patients?

Jaan Sidorov, MD

Policy

November 21, 2010

The Disease Management Care Blog received this posting from an experienced nurse with a background in clinical and administrative medicine.

We’ve all seen them. Those vacuous workplace posters exhorting teamwork, creativity and other forms of inspiration and accomplishment. A version has begun to creep into our nation’s health care facilities. reminding everyone of the need for privacy, how infections can be spread and the importance of patient service. And if my …

Tips for questioning costs in today’s health care system

Kevin

Policy

October 14, 2010

by Joanna Fief

About two years ago in the wee hours of the morning, I found myself in a local emergency room with severe stomach pain, incessant vomiting and dehydration. It wasn’t pretty, and I was desperate for something – anything – to ease my pain and stop my vomiting.

Gratefully, within minutes of receiving an IV with medications for pain and nausea, my symptoms subsided. After a couple of blood tests …

Doctors should work weekends, and how reformers alienate physicians

Kevin Pho, MD

Policy

October 5, 2010

Peter Orszag wants doctors to work weekends.

The former director of the White House Office of Management and Budget wrote as much in this past weekend’s New York Times:

Doctors, like most people, don’t love to work weekends, and they probably don’t enjoy being evaluated against their peers. But their industry can no longer afford to protect them from the inevitable. Imagine a drugstore open only five days a week, or …

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Doctors should work weekends, and how reformers alienate physicians

Checks and balances in health reform

Richard Reece, MD

Policy

August 26, 2010

What follows are ten thoughts on checks and balances in health reform.

I am writing from Oak Ridge, Tennessee, where I am attending a high school class reunion. My son Spencer, a nationally known poet and a candidate for the Episcopal priesthood, is with me. He is checking on my past, and I am trying to provide balance so he can understand his father’s legacy.

There …

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Checks and balances in health reform

Greed is not good when it comes to doctors, patients and medicine

Chris Rangel, MD

Policy

July 31, 2010

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, …