Every day I receive all kinds of emails and other ads telling me about services offering me help to meet MIPS quality metrics. While they may be helpful, most doctors don’t see the need for such a program. It drives up costs in administering and time in needless metrics reporting. Yet, give us a new regulation and a whole industry is going to pop up to profit off of our …
Why MIPS is a useless mental exercise
As President Donald Trump was fighting with Congress over the shutdown and funding for a border wall, his administration implemented a new rule that could be a game changer for health care.
Now, hospitals must publicly reveal the contents of their master price lists — called “chargemasters” — online. These are the prices that most patients never notice because their insurers negotiate them down or they appear buried as line …
A new rule that could be a game changer for health care
Chip Kelly was a former coach and general manager of my beloved Philadelphia Eagles. He was a firm believer in his “system” and felt that his players were disposable and easily replaced. Because of that, he proceeded to trade away or release very talented players and replace them with less talented players. Needless to say that without the talent, the team self-destructed, the fans were angered, and it was only …
An excerpt from Recapturing Joy in Medicine,
During my year as chief resident, I was also president of the Florida Association of Family Medicine Residents. The faculty at my residency program inspired me by their excellence as clinicians and teachers. I trusted their judgment and insight, so when they encouraged …
The power of advocacy: How doctors can be empowered physicians
In the U.S., we now have an outbreak of measles where the cases number more than it has in decades. Most of the people being infected are unvaccinated, and we’ve all seen the media reports of the growing tide of anti-vaxxers. While the CDC, WHO, and pretty much every medical and scientific authority across the globe stand by the efficacy and safety of vaccines, those opposed rather rely on the …
Death threats won’t stop this doctor from advocating for vaccines
With the announcement of CVS Health HUBs, the synergy of data and business is rapidly coming to the health sector; health systems will become havens only for the severely acutely ill, the more complex, the expensive. In the same way that urgent care centers catered to low acuity, high financial margin problems that both financially supported and congested emergency departments, HealthHUBs will take similar problems away from primary …
How pharmacy-based primary care takes the low-hanging fruit
Language matters. The use of the word “provider” may seem innocuous, but it is significant both for patients and physicians.
For patients, it has been perhaps the most pronounced step — if not leap — away from transparency. (Who is who? Nurse, doctor, chiropractor, podiatrist, psychologist? Doesn’t matter — everyone is a “provider.”)
For physicians, the ramifications have been two-fold. One on hand, the use of the word is a demotion by …
Language matters: the not-so-innocuous provider effect
Like many primary care physicians in this health care marketplace, I found myself operating on a hamster wheel of volume care, seeing more and more patients and spending less and less time with them. The pressure on my practice, my patients and my staff was unsustainable. With new regulations and declining reimbursements, there was no way to provide the levels of support and service that are so important, especially to …
Putting patients first by letting patients go
A guest column by the American College of Physicians, exclusive to KevinMD.com.
When talking with patients – particularly those with multiple, complicated medical issues – it often doesn’t take very long to hear about their increasingly suboptimal and sometimes harrowing interactions with our health care system.
Examples include inpatient experiences in which care is provided by …
In our health system, who “owns” patients?
For a hospital that had once labored to break even, Wheeling Hospital displayed abnormally deep pockets when recruiting doctors.
To lure Dr. Adam Tune, an anesthesiologist from nearby Pittsburgh who specialized in pain management, the Catholic hospital built a clinic for him to run on its campus in Wheeling, W.Va. It paid Tune as much as $1.2 million a year — well above the salaries of 90% of pain management physicians …
When physician pay packages become hospital kickbacks
Across the country, many doctors, nurses and other health care workers have remained silent about what is being called an epidemic of violence against them.
The violent outbursts come from patients and patients’ families. And for years, it has been considered part of the job.
When you visit the Cleveland Clinic emergency department — whether as a patient, family member or friend — a large sign directs you toward a metal detector.
An …
The epidemic of violence against health care workers
These are trying times for health care optimists. Despite all the hype surrounding breakthroughs in clinical practice and technology, American medicine is stuck in in neutral. Though the engine is revving loudly, little progress is being made.
This unfortunate truth came into clearer light last week when I was preparing lesson plans for the health care strategy course I teach at the Stanford Graduate School of Business. During the first class of …
Pay people for their kidneys? It’s time.
As calls for radical health reform grow louder, many on the right, in the center and in the health care industry are arguing that proposals like “Medicare for all” would cause economic ruin, decimating a sector that represents nearly 20% of our economy.
While exploring a presidential run, former Starbucks chief Howard Schultz called Medicare for all “not American,” adding, “What industry are we going to abolish next — …
Medicare for all will kill jobs. But it may be necessary.
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Who works for who?
How did we allow ourselves to let a system get built up around us that makes it so hard for us to take care of our patients?
Our job is to advocate for our patients, to help guide them towards their best health, to help them understand the difficult choices and to live healthy lifestyles, to give them …
How did we let insurance companies get so intimately involved with patient care?
Ten years ago it would not have been worth my time to write about measles nor yours to read about it. In the year 2000, thanks to a very effective 2-shot childhood vaccination program using a combined measles-mumps-rubella (MMR) vaccine, the U.S. was declared free of this potentially lethal disease. However, by the end of April this year, just over 700 cases have been reported by the CDC; the largest …
The rise and fall of measles vaccinations
This is a brief explanation of Medicare from a physician’s perspective, as well as my thoughts on how Congress could make adjustments that would bring us closer to universal care and provide the private market the freedom to improve health care outcomes.
Medicare is a national health insurance program that provides health insurance for Americans ages 65 and older, and those who are disabled or have specific chronic conditions. Medicare covers …
A physician suggests how to improve Medicare
Every time I hear that there is a nursing shortage in America, I feel myself cringe. There is not a shortage of nurses in America. There is a shortage of nurses who choose to work at the bedside. There is a reason, and it is called post-traumatic stress disorder.
Medically, we have learned that PTSD can occur after a single event or as a result of chronic stressors for a period …
If you live or work in Washington DC, your number one health care question is how do I (or my meal ticket people) win the next election. If you live or work in Caruthersville MO, chances are that your most pressing health care question is how do I (or my immediate family members) get a hold of some insulin this month. Theoretically speaking, in a healthy democracy, the answers to …
No politician has a realistic solution for health care
“Does my insurance cover this?”
I cannot calculate how often a patient poses this inquiry to me assuming wrongly that I have expertise in the insurance and reimbursement aspects of medicine. If I — a gastroenterologist — do not even know how much a colonoscopy costs, it is unlikely that I can speak with authority to a patient’s general insurance coverage issues.
Of course, patients assume that we physicians have an expansive …
Even the most seasoned patients are no match for the Medical Insurance Industrial Complex
I delight in learning my patients’ stories and giving them exactly what they need when I take care of them in the hospital. Who they are and what is the best approach to their problem is the primary mystery to be solved, my Sherlock Holmes moment. This is why, if somebody asks me, I will tell them that doctoring is the best job in the world. The opportunity to connect …
An experiment in removing the heart from medicine
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