The Obama administration on Monday announced an ambitious goal to overhaul the way doctors are paid, tying their fees more closely to the quality of care rather than the quantity.
Holy crap: They’re really doing it. Or trying to do it. Who the hell knows what they’re trying to do? Not “them,” that’s for sure.
The United States government via the Department …
The beginning of the end of Medicare as we know it
As physician burnout becomes more widespread, it’s time to think about the future. Do you have people asking you if you would be a doctor again?
Not a week goes by without me being asked by either a medical student or a practicing physician:
Do you recommend medicine to others? Or is physician burnout too rampant, too overwhelming, too all-consuming?
That’s one of those super …
Don’t let your babies grow up to be doctors
First off, this is the first time I have typed an official response to a blog post: “Dear health IT: Please understand our frustrations.” You might think, hey aren’t you a millennial, shouldn’t you be blogging non-stop? Like doing everything from my taxes to baking with my smartphone? No, not really; besides residency doesn’t make it very feasible either.
Yet, the need to respond to Dr. Leap’s blog post was …
The cumbersome EHR: It’s time to implement solutions
I recently went to Boston to see the Goya exhibit at the Boston Museum of Fine Arts and was thrilled to see one of my favorite paintings by this artist: Self Portrait with Dr. Arrias. The painting was on loan from the Minneapolis Institute of Arts — a museum I never had the …
Portraits of physicians: Finding meaning in art
You should know that medical documentation has gone awry. But you really just have no idea. If you’ve been to the hospital or to the doctor’s office even once this year, I’m willing to bet that at least a portion of your medical information is now found somewhere within an electronic medical record (EMR). An EMR is really just some mega-computer that stores your health …
The bloated state of health care today
I’m no stranger to dealing with the medical world and its billing systems. I’m a triple cancer survivor, had knee surgery in 2012 and now have ulcerative colitis. All told, I’ve had eleven surgeries and fourteen colonoscopies. Paperwork is practically my middle name.
But the last twenty-four hours have been ridiculous.
In that time, I’ve had three different encounters with healthcare billing — each absurd in its own way, and each more …
It’s time for medical practices to own their billing mistakes
How many times each week do we hear the phrase, “If you’re not completely satisfied, we’ll refund the purchase price — no questions asked.”
This is more often a marketing ploy than a true money-back guarantee. I have a sense that trying to obtain a promised refund on an item that dissatisfied us is about as easy and carefree as changing an airline ticket reservation or reaching a live human when …
Should doctors offer a money-back guarantee?
A guest column by the American College of Physicians, exclusive to KevinMD.com.
Some think that it should be repealed and replaced. Others support it but feel that it needs to be improved. A few believe that it’s OK as is. I’m not writing about Obamacare — I’m describing maintenance of certification (MOC).
I will not use up my word count …
ABIM’s internal medicine specialty board and improving MOC
Of all the radical changes affecting health care that have sent providers reeling, we are about to experience the knockout punch: the effort to change health care reimbursement from a quantity-based to a quality-based system. Of all the changes to health care, I can’t think of any other that has been based on more false assumptions. Given the fact that there is always low hanging fruit, supporters of the quality-based …
Quality-based health care is based on false assumptions
As much as I have given the “ologists” and other members of the dysfunctional U.S. health care system a hard time in previous posts, it’s only fair that I call out bad family medicine as well. I have a great example.
I recently saw patient who is relatively new to the area who had seen another family physician in my community. He is 39-year-old male, and his only significant potential health …
Here’s an example of bad primary care
Since leaving medicine, I’ve been an entrepreneur and an independent artist. They are similar pursuits, and both have taught me about the experience of living in creative rather than reactive mode.
How do you know if you’re living in reactive mode? If you define and measure yourself based on external circumstances, and you believe you really are limited by what’s happening outside yourself, you are in reactive mode. Most of our …
What doctors can learn from artists and entrepreneurs
Why is it so hard to make a dent in the huge volume of unnecessary health care? In the U.S., about 20 to 30 percent of the medical interventions American patients receive are useless and often harmful, and waste hundreds of billions of dollars each year.
Insurers have known this for decades. These days, many more doctors have begun to see the big picture, along with policy makers. But the …
Fixing overtreatment: Lone rangers need not apply
Recently, the Department of Health and Human Services (HHS) announced an ambitious goal to have 85 percent of payments made to doctors linked to clinical quality measures within the next two years. HHS believes that incentives should be weighted almost entirely toward quality of care instead of volume of care. I guess if you’re a patient, you could ask yourself the …
The wrong people are leading the charge for health care quality
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My friend, Trent, is an auto mechanic. When he was growing up, he loved to work on old cars. He rebuilt his first one when he was fourteen — and drove it for 11 years. He loved finding problems and figuring out how to fix them. He never cared about getting rich; his goal was to make a decent living doing …
If mechanics were paid like doctors
Loyal patients are the lifeblood of a medical clinic. And devoted patients are worth their weight in gold. It’s a lot easier to care for an established patient that lots of one-timers who never return. Beyond ease of workflow, the economic benefits are fabulous. A loyal patient panel will stay with you (and pay you) through sickness and in health …
7 secrets to keep loyal patients for life
Physicians are docile. We are programmed to put the greater good above our own. We train mercilessly, work tirelessly, and bend faithfully at the alter of those we have vowed to heal. This is our birthright. This is the covenant we signed in our own blood when we took our healing oath. Decry us as they will, no one becomes a …
The fight against MOC: The spark that unites physicians
When I entered the profession of being a family doctor, like many aspiring physicians, I had a more altruistic vision of what it would be like. However, the reality of that picture over the last 10-years has resulted in frustration, disappointment, and, above all, the realization that health care has changed for the worse. It has become unaffordable for the masses and institutionalized for the benefit of corporate America, not …
Family medicine doesn’t have to be a dying profession
Primary care is a messy business. Nobody has just one simple problem, and no patient has all the typical symptoms for their diagnosis. Most don’t even tell us everything that’s going on. And most don’t follow their treatment plan completely. But this may be OK, since we often change our minds about what is right or wrong in the practice of medicine.
Knowing what constitutes success in front line medicine is …
A career in primary care means you are comfortable with uncertainty
The serious diagnosis is a polite middle-aged woman with a hopeful smile sitting on the side of the bed, with her husband in the chair across from her, as you carefully tell them what it means to have ovarian cancer.
The serious diagnosis is the teenager who just found out he has lupus nephritis — without any other signs or symptoms of lupus — and that he might be on hemodialysis …
In his State of the Union address, President Obama announced a precision medicine initiative “to bring us closer to curing diseases like cancer and diabetes.” The goal of precision medicine is to more accurately identify diagnoses and treatments based on a patient’s genetic information. This information will hopefully lead to better screening, earlier diagnosis, and more personalized treatment.
But it’s hard to imagine that patients will get this kind of medical …
Precision medicine: Getting the right patient to the right doctor
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