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 …
Checks and balances in health reform
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, …
Greed is not good when it comes to doctors, patients and medicine
by Edison Wong, MD
With the recent proposal to repeal the so-called Massachusetts “gift ban” (more appropriately referred to as the “interaction ban”), I asked myself who stands to gain the most from such bans?
Is it the consumers or patients? Is it the physicians or their practices? Is it the federal or state governments? Nope. Sadly, it is the insurers who gain the most, at the expense of patients.
The …
The Massachusetts gift ban benefits health insurance companies
by Cole Petrochko
The nation’s free clinics provide medical service to 1.8 million patients annually — more than half of those clinics operate without government funding and serve patients who are almost all uninsured — according to the first census of free clinics in 40 years.
Responses to a national mail survey by 764 free clinics in the U.S., reported in the June issue of the Archives of Internal Medicine, revealed that …
Free clinics need more government funding
Malpractice and heart catheterization have been in the news recently.
A spicy concoction for sure. An epidemiological study published in an online subsidiary of Circulation addresses the role of three major medical issues facing cardiologists today: malpractice, heart catheterization, and medical costs.
It is hard to get more controversial.
Heart catheterization, the invasive assessment of the coronary artery lumen, has always been a hot-potato topic. The “percent-normal” was the buzz word when I …
Heart catheterization worries that every cardiologist face
A video excerpt from The Vanishing Oath, a film directed by Ryan Flesher, MD.
The average physician salary in the United States is $146,000 — which is undeniably a lot of money at face value.
But it’s a lot less when you factor in the overhead costs that doctors incur. And that’s not including the medical school debt which, on average, exceeds $150,000.
This clip shows how the take home pay of …
Doctors make far less money than most people think
With healthcare reform dominating the news recently, MRI and other imaging tests have become the (misguided) targets of many critics.
Although MRI makes up only one-half of one percent of total healthcare expenditures, it is easy to demonize since the average healthcare consumer can understand imaging much easier than the diagnosis related groups (DRGs), hospital facility fees or insurance contracts that have a much greater impact on the cost of health …
Clinical judgment and when neurologists should order an MRI
What is “MRI Abuse”? This is when the health care provider orders MRIs (Magnetic Resonance Imaging) in excess or for the wrong reasons. There are many causes of MRI abusive behavior but most evolve out of a significant misunderstanding of how to properly utilize this diagnostic tool. MRI imaging has a high sensitivity to detect anatomic abnormalities, does not expose the patient to high doses of radiation like a CAT …
MRI abuse can be dangerous and expensive for patients
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 …
How the oil shortage will affect hospitals and healthcare
In reference to the seemingly “simple” name change being proposed for Physician Assistants to Physician Associates, I take great exception to the commentary offered by Dr. Zilberberg in her recent article entitled, Physician assistant name change rubs doctors the wrong way.
She states: “Physicians have been only too successful at becoming the final word in health, at the exclusion of all others.”
Physicians are the highest and most extensively trained group …
Physician assistant not associate: Reasons against a name change
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 …
Bartering and whether doctors should be paid with chickens
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 …
Internal medicine is dead, will concierge physicians thrive?
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 …
Primary care is burdened by excessive paperwork
Here are the top 10 preventive services. These items were chosen by the National Commission on Prevention Priorities, and highlight those preventive services including immunizations, screenings, preventive medications, and counseling that give “the most bang for the buck.”
For an in depth discussion of methods and results, read Am J Prev Med 2006;31(1):52–61
Discuss Daily Aspirin Use
This counseling does not mean everyone should take aspirin to prevent heart attack and stroke, but …
10 cost effective preventive medicine services
Medicare, the government insurance company for everyone over age 65 (and for the disabled), pays fees to primary care physicians that guarantee bankruptcy.
Additionally, 70 percent of hospitals in the United States lose money on Medicare patients. That’s right, for every patient over age 65, it costs the hospital more to deliver care than the government reimburses. That is why Mayo Clinic has said it will not accept Medicare payments for …
Why the Mayo Clinic is refusing to see Medicare patients
Originally published in HCPLive.com
by Ed Rabinowitz
When it comes to negotiating fees with health plans, practices and physicians have more leverage than they realize. The problem, says John Schmitt, a managed care expert with EthosPartners Healthcare Management Group, is that practices often don’t even try. “Groups negotiate an agreement with a payor and then, for whatever reason, just fi le it away. Most medical groups do not have a good, proactive …
Tips for doctors who negotiate reimbursement rates with insurance companies
by Paula Hartman Cohen
Have we overlooked the public health aspect of health care reform?
In the health care reform debate, we’ve heard and read how health care reform will or will not work, what it will or will not cost, and how it will or will not impact each one of us as individuals.
We’ve also heard from those who have great faith in our current system, and sincerely believe we should …
How health care reform can improve public health
by Jeoffry B. Gordon, MD, MPH
The public policy and current political action around changing the system overlooks two important technical fallacies:
(1) That health care is most efficiently distributed by a free market mechanism; and,
(2) That medical services are an ordinary commodity.
The commercial market model is a failing economic and public policy ideology used to rationalize and justify corporate control of the health care system to profit from the enterprise. …
Stunning news. The Boston Globe on Flea, his trial and how his blogging ultimately led from a possible victory to settlement:
As Ivy League-educated pediatrician Robert P. Lindeman sat on the stand in Suffolk Superior Court this month, defending himself in a malpractice suit involving the death of a 12-year-old patient, the opposing counsel startled him with a question.
Was Lindeman Flea?
Flea, jurors in the case …
The demise of Flea, who live-blogged his medical malpractice trial
What is defensive medicine?
Defensive medicine is the deviation from sound medical practice to avoid the threat of malpractice litigation.
According to a 2005 study in JAMA, over 90 percent of physicians surveyed admitted to practicing defensive medicine. This can range from “positive” defensive medicine, like ordering unnecessary tests, referring to consultants, or performing unneeded procedures; to “negative” defensive medicine, like avoiding high-risk patients or procedures.
Read more…
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