Specialty Care

Specialists writing on KevinMD about their practices: what private equity does when it buys a specialty group, from dermatology roll-ups to staffing companies, and whether nurse practitioners and physician assistants belong in every specialty and on what terms. Two maintained records draw on this archive: Private equity and corporate medicine: what physicians say, in their own words and Scope of practice: what physicians, nurse practitioners, and PAs say, in their own words.

Doctors receive no training on coding, which makes them prone to fraud

Michelle Mudge-Riley, DO

Physician

March 16, 2011

How much attention do you pay to your Evaluation and Management (E&M) Coding practices?

E&M codes represent the type, setting, and complexity of services provided and the patient status, such as new or established. Providers are responsible for ensuring that the codes they submit accurately reflect the services they provide.

According to the Office of the Inspector General (OIG), Medicare paid $25 …

Do Not Resuscitate and the need for a central line

Ralph Gordon, MD

Physician

March 15, 2011

Just the other day I was called to see a patient coming up to the Intensive Care Unit with a diagnosis of pneumonia. Upon my arrival the patient is “hanging in there” with the blood pressure in the 60’ and 70’s systolic.

This is a no-brainer situation – the patient is in sepsis and septic shock.

Early intravenous antibiotics and aggressive resuscitation is what this gentleman needs right now. Per the ER …

How to prevent suicide in physicians

Kevin

Physician

March 15, 2011

by Zakari Tata, MD

Many articles have been written on physician suicides. Yet nothing practical has been implemented. The problem is probably much larger than reported, as families will try to avoid publicity where possible.

In medicine, just as in the rest of society, people diagnosed with depression are wrongly labeled as weak, and discrimination, especially the subtle passive …

Read more…

How to prevent suicide in physicians

ASA addresses drug shortages to ensure patient safety

Kevin

Medications

March 14, 2011

A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.

by Arnold J. Berry, MD, MPH

Drug shortages continue to impact patients across the nation. Over the past year, anesthesiologists have been faced with the challenge of finding alternatives for several unique drugs needed to safely provide anesthesia for patients having surgical, diagnostic or therapeutic procedures.

Anesthesiologists have …

How to help autistic or delayed children behave and learn

dr_som, MD

Conditions and Diseases

March 14, 2011

Here are ways doctors can help autistic or delayed children behave and learn.

I certainly do not mean to trivialize the behavior issues that erupt as typical children develop, but the problems of atypical kids are more difficult and less likely to be fully addressed by general pediatricians and society at large.

1. Understand the ABCs of behavior. Antecedent = What happened immediately before the behavior? Behavior = A description of the …

Withholding liver transplants for Medicaid recipients in Arizona

Gary Levin, MD

Health Policy

March 12, 2011

Governor Brewer’s decision to withhold liver transplants for Medicaid recipients in Arizona should serve as a loud warning to the electorate regarding governmental intrusions into health care financing and health care operations.

The decision was ill advised on the basis of multiple factors. The survival rates differ from one facility to another.

What is the liver transplant survival rate and what information needs to be considered when looking at such numbers?

For example, …

Making sense of colorectal cancer headlines

Kevin

Conditions and Diseases

March 11, 2011

by Robert Bresalier, MD

Did you hear the one about the cancer-sniffing dogs?

Sounds crazy, right? This is just one of many recent headlines that may leave you scratching your head.

Not every study you read in the news is the final word. But recent research can provide interesting new insight on colorectal cancer — the second leading cause of cancer death in the United States.

Here’s some insight to help you make sense …

Aspects of psychiatry this doctor appreciates

Jeffrey Knuppel, MD

Physician

March 10, 2011

Working as a psychiatrist is very rewarding. It’s stressful in a unique way, and some people may look at me strangely for having an unusual job. But overall I really enjoy it. Here are some of the aspects of psychiatry that I really appreciate.

1. Being trusted. Psychiatrists meet people when they are at their most vulnerable points, and we are entrusted with extremely …

AMA push against Medicare recovery audit overreach

Cecil B. Wilson, MD

Physician

March 10, 2011

A guest column by the American Medical Association, exclusive to KevinMD.com.

The Centers for Medicare and Medicaid Services (CMS) has pushed back the April 1 deadline for states to implement their Medicaid recovery audit contractor (RAC) programs until an unspecified time later this year. The implementation delay was welcomed by the American Medical Association (AMA) and other national physician organizations who have vocally urged CMS to improve its proposed Medicaid RAC …

Taking Chantix to help smokers quit may be worth the risk

Michael Aaronson, MD

Medications

March 10, 2011

I decided to dedicate a medical blog on smoking cessation after realizing that too many people in Douglas County (Omaha, Nebraska) smoke. Did you know that despite a smoking ban in restaurants and bars, 18.3% of people in Nebraska are smokers? That’s one in five people. And this number contributes to Omaha’s health ranking of 142 out of 182 cities in …

Gout is a common cause for episodic joint pain and swelling

Dr. Irwin Lim

Conditions and Diseases

March 10, 2011

For Christmas Eve dinner, our family congregated at Café Opera, in the Intercontinental Hotel for a scrumptious seafood buffet. Going to a buffet is a little bit evil, as you know that you’re about to commit the sin of gluttony.

I usually tell my patients who suffer with gout to avoid buffets. That 3rd mountain of prawns may precipitate an acute episode of gout. Christmas party season is a dangerous time.

Overindulgence …

What is a difficult patient, and how doctors may be responsible

Kevin Pho, MD

KevinMD

March 9, 2011

What, exactly, is a difficult patient?

Doctors can tell many tales of what they term as a difficult encounter. Just as many patients can recall doctors whom they would say are difficult to work with as well.

According to a study from the Journal of General Internal Medicine, here’s a definition:

Patients deemed difficult included those with more than five symptoms, severe symptoms or an underlying mental disorder or were less functional. These …

Your laser facial rejuvenation questions answered

Anthony Youn, MD

Conditions and Diseases

March 9, 2011

Laser facial rejuvenation is one of the most popular but most confusing treatments today.

What’s the difference between a lunchtime laser and a fractionated laser? An ablative or a nonablative laser? If many plastic surgeons are confused by the plethora of lasers available, how can the average consumer or patient know what laser is best for removing their wrinkles and tightening their skin?

Lasers work by focusing energy on a certain color of the …

ABIM: Maintenance of Certification (MOC) exams assess clinical judgment

Christine K. Cassel, MD

Medical Education

March 9, 2011

A guest column by the American Board of Internal Medicine, exclusive to KevinMD.com.

KevinMD.com recently posted a blog noting that Watson, the IBM super computer who successfully beat two contestants on Jeopardy, would eventually make board certification exams obsolete. He argues that exams that rely on “memory-based curriculum” focused on recall of facts will become unnecessary. I agree. Recall …

Treatment-resistant depression is a myth

Steve Balt, MD

Conditions and Diseases

March 9, 2011

Treatment-resistant depression is one of those clinical terms that has always been a bit unsettling to me.

Maybe I’m a pessimist, but when I hear this phrase, it reminds me that despite all the time, energy, and expense we have invested in understanding this all-too-common disease, we still have a long way to go. Perhaps more troubling, the phrase also suggests an air of resignation or abandonment: “We’ve tried everything, but …

Are doctors ordering too many tests, or practicing a new standard?

Kevin Pho, MD

KevinMD

March 8, 2011

Are medical students and new doctors overly reliant on tests and technology to make diagnoses?

That’s an interesting thought I had when reading the latest TIME.com piece from emergency physicians Jesse M. Pines and Dr. Zachary F. Meisel.

In their article, they give reasons why doctors order too many tests.

Of course, they cite defensive purposes, saying, “once a doctor has presented an …

Asking a doctor for their opinion on another physician

Doctor D, MD

Physician

March 8, 2011

If one of your patients asked your opinion of another doctor whom you know to be incompetent what would you tell your patient?

Incompetence in a physician is a scary thing! Doctors deal with problems of life and death and try to heal you with dangerous tools. A doc that isn’t competent can be seriously dangerous.

But how do you know who’s on their game and who’s falling down on the job? …

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 …

Read more…

Hospitals taking over private practices

EMR, a patient’s perspective

Ann Silberman

Patient

March 8, 2011

My oncologist’s office implemented a new EMR system when I was in the middle of chemo. Once the nurses learned the system, I saw no difference in the care I got from them.

Not quite so with the doctor. My experience with him changed dramatically.

Before EMR I would enter the exam room and sit on a chair, play Angry Birds on my iPhone and wait. My doctor would walk in, make …

Read more…

EMR, a patient’s perspective

Successfully appeal an insurance company reviewer decision

Nicholas Fogelson, MD

Physician

March 7, 2011

Coverage requests get rejected when the requested service does not fit within an insurance company’s initial guidelines for approval.

This happens for a number of reasons, but usually it comes down to poor documentation or inappropriate care, or in some cases care that is appropriate but can’t be supported in the literature. When a denial occurs, the physician or patient has several opportunities to appeal this decision. The first appeal is …

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