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.

How should pharmacy benefit managers (PBMs) and pharmacies communicate with physicians?

Medications
February 2, 2010

by George Van Antwerp

In the pharmacy and pharmacy benefit manager (PBM) business, there are lots of reasons to reach out to a physician:

* Drug-drug interactions
* A chemically equivalent version of the drug prescribed is available
* A therapeutically equivalent version of the drug prescribed is available
* The prescribed drug is not covered
* A prior authorization is required
* The patient is required to try an alternative drug first (step therapy)
* The prescribed …

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How should pharmacy benefit managers (PBMs) and pharmacies communicate with physicians?

What doctors need to know about Google Android and Nexus One

Health Technology
February 2, 2010

The momentum and enthusiasm in the mobile technology world is, these days, clearly with Google.

The question for many people is whether to go with the reigning champion of the mobile device world (arguably Apple) or to take a chance on the challenger. The Nexus One, the flagship of the Android family of mobile devices, was unveiled to much fanfare in …

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What doctors need to know about Google Android and Nexus One

How the stress of caregiving can lead to stroke

Conditions and Diseases
January 31, 2010

Originally published in MedPage Today

by Michael Smith, MedPage Today North American Correspondent

The strain of caring for a disabled spouse is associated with an increased risk of stroke, researchers found.

The risk is increased for men, and especially African-American men, according to William Haley, PhD, of the University of South Florida, in Tampa, and colleagues.

On the other hand, there was no significant …

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How the stress of caregiving can lead to stroke

Should society consider purchasing and selling tissues and organs?

Conditions and Diseases
January 31, 2010

by Michael Kirsch, MD

Choose the best answer.

To stimulate organ donation, we should provide organ donors with:

* Cold, hard cash
* Upgrades to business class on any flight within the continental United States for 1 year
* College tuition discounts for up to 3 children
* Income tax relief
* First row Bruce Springsteen concert tickets
* A certificate of appreciation

There is a reason that we don’t ask families of kidnapped victims what our policy should …

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Should society consider purchasing and selling tissues and organs?

How can doctors stop drugs prescribed by other physicians that are no longer effective?

Medications
January 30, 2010

Here are two vignettes illustrating the failure of doctors to master the obvious and maybe a window onto the future struggles to control medical costs.

A 90-year old is referred for care due to “end stage dementia.” End-stage dementia is medical speak and as such does not really convey the appropriate imagery. It means a skeletal man, in a wheelchair or mostly in bed, with diapers, who has does not know …

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How can doctors stop drugs prescribed by other physicians that are no longer effective?

How to stop theft from your medical practice

Physician
January 27, 2010

Originally published in HCPLive.com

by Ed Rabinowitz

There’s a great scene in the movie The Big Chill where the main characters are having a discussion on the topic of rationalizations. One individual comments that he doesn’t know anyone who could get through the day without two or three juicy rationalizations. That may be true. But when a rationalization involves taking things from the office or workplace, and that office just happens to …

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How to stop theft from your medical practice

The National Consortium of Breast Centers (NCBC) response to the USPSTF breast cancer screening recommendations

Conditions and Diseases
January 26, 2010

I’ve been given permission to deliver the National Consortium of Breast Centers (NCBC) position statement. It does a far better job with a critique of the USPSTF Screening recommendations than I did when I shared my first thoughts. As the President for the NCBC, I want to acknowledge the work done on behalf of our organization by our Policy Chairpersons, Drs. John Bell and Barbara Rabinowitz, both of whom are …

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The National Consortium of Breast Centers (NCBC) response to the USPSTF breast cancer screening recommendations

Teaching doctors the art of negotiation

Physician
January 22, 2010

Originally posted in HCPLive.com

by Jeff Brown, MD

When I am in a civilian situation and someone asks me what I do, if I am feeling whimsical, I sometimes answer “I’m in sales.”

Think about it – almost all of our professional interchanges can be seen as: 1) trying to talk someone out of doing something, like smoking, or 2) trying to talk someone into something, like exercising. Using a broader brush, you …

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Teaching doctors the art of negotiation

Did Martha Coakley kill health reform, and what Senator Scott Brown means for healthcare

Health Policy
January 20, 2010

In case you haven’t heard, in a stunning result in yesterday’s special election in Massachusetts, Republican Scott Brown won the Senate seat previously occupied by the late Edward Kennedy.

Needless to say, pundits are going crazy analyzing the results, and its implications on health reform. I’ll leave the political commentary to them, but I’ll comment on what this means for health reform’s future.

In essence, what turned into a 95% likelihood …

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Did Martha Coakley kill health reform, and what Senator Scott Brown means for healthcare

Tips for doctors who negotiate reimbursement rates with insurance companies

Physician
January 19, 2010

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 file it away. Most medical groups do not have a good, proactive methodology …

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Tips for doctors who negotiate reimbursement rates with insurance companies

Good doctors sometimes may make patients unhappy

Physician
January 18, 2010

Most of us went into medicine because, in addition to being good students, we wanted to help people. How many oceans of ink and forests of paper have been used explaining that point to admissions committees we’ll never know. Suffice it to say, it felt very good when our professors wrote us glowing letters of recommendation. Of course, we were also saying, “I want to feel good about helping people. …

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Good doctors sometimes may make patients unhappy

How a doctor’s office can affect patient trust

Patient
January 17, 2010

Originally published in MedPage Today

by Marianne Mattera

Trust is an essential element in the doctor-patient relationship.

You’re well aware of how important it is that you can trust the history the patient gives you. You know the problems that can arise in planning and managing care if you’re working with only part of the story. And you probably even feel a twinge …

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How a doctor’s office can affect patient trust

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How psychiatrists may be giving their patients too many drugs

Medications
January 16, 2010

Originally published in MedPage Today

by John Gever, MedPage Today Senior Editor

Psychiatrists who prescribe drugs for their patients today usually give more than one at a time, often with little scientific basis, researchers said.

About 60% of patients with psychiatrist office visits leading to a drug prescription received at least two medications in 2005-2006, according to government survey data analyzed by Ramin …

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How psychiatrists may be giving their patients too many drugs

Do neuroenhancement pills really improve attention, memory, or cognition?

Medications
January 15, 2010

Originally published in HCPLive.com

by Victor G. Dostrow, MD

The Internet is filled with reports of remarkable cognitive enhancement with various nostrums.

Many are not regulated, and the pages are typically associated with glowing testimonials and a link to sign up for uninterrupted (and uninterruptible) delivery of the miracle substance. More to the point of this post, other blogs, reports, and forum comments opine as to notable benefits of taking prescription medications marketed …

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Do neuroenhancement pills really improve attention, memory, or cognition?

What doctors should expect with health care reform

Health Policy
January 14, 2010

What should health care providers be doing in anticipation of the likely passage of an historic health reform bill?

There are at least three possibilities: (1) Lament the passing of the good old days and oppose it; (2) Insist that it isn’t good enough because it is lacking some key provision (tort reform; SGR replacement; robust public option); or (3) Embrace it, because incrementalism works, and prepare for what’s coming down …

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What doctors should expect with health care reform

The American College of Cardiology (ACC) sues Medicare over physician rate cuts

Health Policy
January 11, 2010

Originally published in MedPage Today

by Kristina Fiore, MedPage Today Staff Writer

The American College of Cardiology (ACC) has filed suit against U.S. Department of Health and Human Services Secretary Kathleen Sebelius charging that the 2010 Medicare Physician Fee Schedule was adopted unlawfully.

The complaint seeks an injunction that will prevent the cuts — which the association claims used a flawed survey for …

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The American College of Cardiology (ACC) sues Medicare over physician rate cuts

Cardiologists discuss how far myocardial infarction management has come

Medications
January 10, 2010

Originally published in MedPage Today

by Peggy Peck, MedPage Today Executive Editor

“What we did for patients with acute MI was place them in a cool, dark place. Give them morphine for pain and lidocaine to prevent arrhythmias and hope for the best.”

The speaker is Steven Nissen, MD, director of Cardiovascular Medicine at the Cleveland Clinic. He is describing standard care 25 …

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Cardiologists discuss how far myocardial infarction management has come

Is erectile dysfunction associated with restless leg syndrome?

Conditions and Diseases
January 9, 2010

Originally published in MedPage Today

by Charles Bankhead, MedPage Today Staff Writer

Men with restless leg syndrome (RLS) had a significantly increased risk of erectile dysfunction compared with men who did not have the neurologic disorder, data from a large cohort study showed.

The likelihood of erectile dysfunction increased with the frequency of restless leg episodes, reaching an adjusted risk apex about …

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Is erectile dysfunction associated with restless leg syndrome?

How a psychiatrist can write 100,000 prescriptions a year, and what that means for primary care

Physician
January 8, 2010

The Miami Herald is reporting an investigation of a psychiatrist who wrote almost 100,000 prescriptions a year. Sen. Grassley and the feds have halted payment to this Miami psychiatrist who stated that “he prescribes only what is medically necessary” and “works long hours, seeing patients for 10 minutes at a time and many of his patients need four or five medications.”

I have no personal knowledge, interaction, acquaintance with psychiatrist Dr. …

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How a psychiatrist can write 100,000 prescriptions a year, and what that means for primary care

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