MedWorm provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest medical blog items that have been tagged with 'healthcare reform'. Sat, 03 Sep 2011 01:56:39 +0100 http://www.medworm.com/index.php?rid=5158989&cid=t_139124_87_f&fid=39182&url=http%3A%2F%2Fcovertrationingblog.com%2Fpodpress_trac%2Ffeed%2F1739%2F0%2Fright-to-healthcare.mp3 Podcast: If we are ever to gain control of our healthcare spending, which is a necessity if we are going to avoid an economic catastrophe during the next couple of decades, we have to come to some agreement, as a society, on a few essential questions.  Chief among these questions is whether healthcare is something we must consider to be a right for all Americans. The question of whether healthcare is a right has become a very contentious one. One side passionately declares that of course it is a right, as healthcare is so critically important that how could it be otherwise? And the other side, with equal conviction, asserts that nothing can be a right that creates an involuntary burden on another. That is, advocates on either side of the argument maintain their respective positions as be... The Covert Rationing Blog blogs http://www.medworm.com/rss/comments.php?id=5158989 Mon, 22 Aug 2011 11:09:50 +0100 5158989 http://www.medworm.com/index.php?rid=5130748&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-pros-and-cons-of-ipab-and-why-it-shouldnt-be-repealed%2F2011.08.15 In recent weeks, several Democrats and some health reform advocates including the AMA have joined Republicans in calling for a repeal of provisions in the new health law that create the Independent Payment Advisory Board (IPAB). For these people, IPAB represents the worst aspects of the new law–an unelected, centralized planning authority empowered by government to make decisions about the peoples’ health care. Arbitrary cuts to providers, short-sighted decisions that stifle innovation and rationing of care are sure to follow, they claim. While it’s true that the rules governing IPAB are flawed and should be fixed, eliminating IPAB altogether would be a mistake. (more…) *This blog post was originally published at Pizaazz* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=5130748 Mon, 15 Aug 2011 12:00:44 +0100 5130748 http://www.medworm.com/index.php?rid=5130743&cid=t_139124_87_f&fid=39182&url=http%3A%2F%2Fcovertrationingblog.com%2Fpodpress_trac%2Ffeed%2F1714%2F0%2Fduty-to-wellness.mp3 Podcast: DrRich considers it his responsibility to point out to his readers certain truths related to modern American healthcare which may not be obvious to everyone, and which the fine people in the mainstream press choose not to mention. Be honest. If it weren’t for DrRich, would you be aware that the only reason Obamacare became the law of the land is that the private insurance companies needed it in order to have any hope of long term survival?  Would you understand that the Progressive healthcare system to which we are now legally committed inherently requires all of the following things (while loudly proclaiming the opposite): ending the classic doctor-patient relationship; preventing individuals from spending their own money on their own healthcare; killing off the practice ... The Covert Rationing Blog blogs http://www.medworm.com/rss/comments.php?id=5130743 Mon, 15 Aug 2011 11:26:01 +0100 5130743 http://www.medworm.com/index.php?rid=5077685&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Ftake-an-active-role-in-your-own-health-it-can-save-more-than-just-your-life%2F2011.07.29 Sometimes you need a published study to tell you what should be obvious in the first place. This time, researchers have discovered that: When physicians have more personalized discussions with their patients and encourage them to take a more active role in their health, both doctor and patient have more confidence that they reached a correct diagnosis and a good strategy to improve the patient’s health. Really? But wait, there’s more. (more…) *This blog post was originally published at See First Blog* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=5077685 Fri, 29 Jul 2011 18:00:07 +0100 5077685 http://www.medworm.com/index.php?rid=5028219&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Funderstanding-us-healthcare-four-books-you-dont-want-to-miss%2F2011.07.13 I have had the privilege of working at an organization which is actively improving the lives of its members and also was mentioned by the President as a model for the nation.  Over the past few years, I have also demonstrated to first year medical students what 21st century primary care should look and feel like – a fully comprehensive medical record, secure email to patients, support from specialists, and assistance from chronic conditions staff. But as my students know, there are also some suggested reading assignments.  I’m not talking about Harrison’s or other more traditional textbooks related to medical education.  If the United States is to have a viable and functioning health care system, then it will need every single physician to be engaged and involved.  I&... Better Health blogs http://www.medworm.com/rss/comments.php?id=5028219 Wed, 13 Jul 2011 20:00:00 +0100 5028219 http://www.medworm.com/index.php?rid=5029203&cid=t_139124_150_f&fid=34889&url=http%3A%2F%2Fpharmamkting.blogspot.com%2F2011%2F07%2Ftracking-public-health-trends-twitter.html (Source: Pharma Marketing Blog) Pharma Marketing Blog blogs http://www.medworm.com/rss/comments.php?id=5029203 Sat, 09 Jul 2011 14:00:00 +0100 5029203 http://www.medworm.com/index.php?rid=5008198&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fobamacare-unraveled-what-could-possibly-go-wrong%2F2011.07.07 It is hard to remember all the defects in President Obama’s Healthcare Reform Act at once. President Obama’s Healthcare Reform Act is so flawed it cannot possibly work as it was intended. It must be repealed. A serious, thoughtful, practical and common sense way to “Repair The Healthcare System” must be enacted before all the stakeholders have adjusted to President Obama’s coming changes that will create a more dysfunctional system. A reader sent me a photo of a poster hanging in his local ice cream store. It is a reminder of previous criticisms of President Obama’s Healthcare Reform Act. (more…) *This blog post was originally published at Repairing the Healthcare System* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=5008198 Thu, 07 Jul 2011 14:00:26 +0100 5008198 http://www.medworm.com/index.php?rid=4997518&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthere-are-only-four-ways-to-reduce-healthcare-spending%2F2011.07.04 Everyone agrees that national spending on healthcare is on a trajectory to bankrupt America during the lifetimes of even Old Farts like DrRich. And therefore, most folks* agree that we ought to do something to reduce our national spending on healthcare. ____ *The reason it’s only “most folks” who agree is that, apparently, some folks are still partial to the Cloward-Piven strategy, and continuing to spend on healthcare as we are doing today is the quickest and surest way to get there. ____ Unfortunately, our national “discussion” on how to achieve this reduction in healthcare spending has devolved into a spectacle of accusations and counter-accusations, vituperation, abuse, and scurrility. Accordingly, not much useful has so far been achieved. Worse, the back-and-forth contumelie... Better Health blogs http://www.medworm.com/rss/comments.php?id=4997518 Mon, 04 Jul 2011 18:00:51 +0100 4997518 http://www.medworm.com/index.php?rid=4862550&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Forganized-medicine-is-out-of-touch-with-how-practicing-physicians-feel-about-obamacare%2F2011.05.24 There is a widespread discrepancy between the opinions of organized medical group leaders in the American Medical Association (AMA), the American Academy of Family Physicians (AAFP), the American College of Physicians (ACP), and  practicing physicians.  AMA, AAFP, and ACP are part of organized medicine. These organizations supported the healthcare reform law in 2010 and continue to support the legislation. I believe they have taken this position because they want a seat at the table as implementation of the legislation moves forward. President Obama has not paid attention to them so far and there is little evidence that he will in the future. In March of 2010, Speaker of the House Nancy Pelosi famously said, “We have to pass the [health care] bill so that you can find out what is i... Better Health blogs http://www.medworm.com/rss/comments.php?id=4862550 Tue, 24 May 2011 16:00:17 +0100 4862550 http://www.medworm.com/index.php?rid=4862551&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fpregnant-female-prisoners-must-remain-in-shackles-during-c-section-procedures%2F2011.05.24 “But for the grace of God go I.” My late aunt drilled that value into my six-year old head and it has never left. An article regarding a New York politician recently caught my attention. When New York State enacted a bill to ban the shackling of pregnant prisoners, a New York State Assemblywoman objected. The article goes on to discuss the case of Jeanna M. Graves, who, in 2002 was arrested on a drug charge and began a three year sentence. Graves was pregnant with twins and while in labor, was handcuffed during her entire C. Section. How utterly ridiculous. Before a C. Section begins, a patient is usually given either an epidural or spinal anesthesia. On rare occasions, she is put to sleep with general anesthesia if the baby must be delivered emergently. On all accounts, the patient’... Better Health blogs http://www.medworm.com/rss/comments.php?id=4862551 Tue, 24 May 2011 14:00:54 +0100 4862551 http://www.medworm.com/index.php?rid=4841480&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fprogressive-counter-point-the-ipab-could-be-a-good-thing%2F2011.05.18 I shouldn’t do this. It’s madness to try to delve into the minds of conspiracy theorists and try to make sense of their ravings. But I can’t help myself; I’m drawn like a moth to the flame. It never ends well. I only wind up with a horde of trolls in the comments telling me that I’m a glib supercilious idiot and should stick to medicine or go die in a fire or something. Sometimes it’s too hard to stay away. Maybe it was the personal affront I felt in the false imputation of ill motives onto progressives. Maybe it was the gross errors in fact, sitting there ripe for the plucking. I don’t know, but I just can’t resist a rebuttal to Dr Rich at Covert Rationing, who weaves a technocratic cost control body into a paranoid web of fantasy, conclud... Better Health blogs http://www.medworm.com/rss/comments.php?id=4841480 Wed, 18 May 2011 21:00:00 +0100 4841480 http://www.medworm.com/index.php?rid=4841481&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fconservative-viewpoint-the-ipab-is-the-frightening-lynchpin-of-obamacare%2F2011.05.18 In the speech President Obama gave responding to Congressman Ryan’s budget plan (the one in which he lured Ryan to sit in the front row in order to be publicly pilloried), the President did something DrRich did not think he would do before the next election. He openly invoked, and openly embraced, the Independent Payment Advisory Board (IPAB) as the chief mechanism by which Obamacare will control the cost of American healthcare. “IPAB” might be a new term to many Americans, but DrRich pointed his readers to this entity, within a few weeks of the passage of Obamacare, as the lynchpin (and a very scary lynchpin at that) of the whole enterprise. Until President Obama’s recent “outing” of IPAB, however, this new board has been almost entirely ignored by most commentators. Since the... Better Health blogs http://www.medworm.com/rss/comments.php?id=4841481 Wed, 18 May 2011 19:00:30 +0100 4841481 http://www.medworm.com/index.php?rid=4828879&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fall-attempts-to-reduce-bureaucracy-in-the-healthcare-system-will-increase-it%2F2011.05.17 “The media is the message.” It does not matter if the policy has failed previously.  All that is important is the effectiveness of the policy’s presentation and its ability to manipulate the polls. The government’s purpose is to work for the people who elected it. It does not seem to be working that way at present. Bureaucrats create rules or regulations as they interpret the laws made by congress and the president. Regulations are controlled by the administration’s ideology. Many times the regulations in one area nullify the intended effect in another area. Regulations and bureaucracy inhibit the use of common sense in policy making for the benefit of the people. The people did not have an outlet to express their opinions or frustrations until blogging came into its own seven y... Better Health blogs http://www.medworm.com/rss/comments.php?id=4828879 Tue, 17 May 2011 12:29:19 +0100 4828879 http://www.medworm.com/index.php?rid=4820848&cid=t_139124_87_f&fid=39182&url=http%3A%2F%2Fcovertrationingblog.com%2Fpodpress_trac%2Ffeed%2F1557%2F0%2Fshadowfax.mp3 Podcast:   DrRich’s most recent post attempted to show how the creation of the Independent Payment Advisory Board (IPAB) – the panel created by Obamacare that (as President Obama himself indicates) will be primarily responsible for reducing the cost of American healthcare -  nicely illustrates the Progressive mindset. That Progressive mindset, DrRich maintained, is reflected in the degree of power and breadth of control granted to the IPAB, in the coercive process under which the IPAB was created and its powers granted, and in attempts to bind future Congresses from amending those powers. DrRich did not imagine that Progressives would like his formulation very much. But as always, DrRich offered his analysis in the hope of engaging readers – friend or foe – i... The Covert Rationing Blog blogs http://www.medworm.com/rss/comments.php?id=4820848 Thu, 12 May 2011 23:39:36 +0100 4820848 http://www.medworm.com/index.php?rid=4820952&cid=t_139124_113_f&fid=34634&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FEmrAndHipaa%2F%7E3%2FD3BF4RAkszU%2F Healthcare and health IT are plagued by conundrums. Providers long have been the ones asked to make hefty investments in EMRs and other IT systems to help remove costs from the healthcare system, but payers and plan sponsors tend to enjoy most of the financial benefits. Clinicians wish their organizations would share data with others, but those in the executive suite have been reluctant to cooperate with competitors for fear of losing revenue. And, let’s face it, medical errors can be profitable if a routine procedure turns into an expensive inpatient admission. Portions of the American Recovery and Reinvestment Act and the Patient Protection and Affordable Care Act are intended to address these problems by providing financial incentives for “meaningful use” of EMRs (incl... EMR and HIPAA blogs http://www.medworm.com/rss/comments.php?id=4820952 Thu, 12 May 2011 21:45:30 +0100 4820952 http://www.medworm.com/index.php?rid=4813286&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhy-accountable-care-organizations-acos-will-fail-to-reduce-costs%2F2011.05.11 In an ideal world ACOs should work. There is no evidence that  untested and complex organizational structure of ACOs developed by Dr. Don Berwick (head of CMS) will improve quality of care and reduce costs. ACOs are supposed to provide financial incentives to health care organizations to reduce costs and improve quality. There are too many defects in the ACOs infrastructure to improve the financial and medical outcomes. At a conceptual level, the incentive for ACOs would be to increase efficiency and avoid overuse and duplication of services, resources, and facilities. In this model, ACO members would share the savings resulting from the increased coordination of care. I have said over and over again that excessive administrative fees and ineffective management of chronic disease is the m... Better Health blogs http://www.medworm.com/rss/comments.php?id=4813286 Wed, 11 May 2011 18:00:41 +0100 4813286 http://www.medworm.com/index.php?rid=4820849&cid=t_139124_87_f&fid=39182&url=http%3A%2F%2Fcovertrationingblog.com%2Fpodpress_trac%2Ffeed%2F1541%2F0%2FIPAB.mp3 Podcast: In the speech President Obama gave responding to Congressman Ryan’s budget plan (the one in which he lured Ryan to sit in the front row in order to be publicly pilloried), the President did something DrRich did not think he would do before the next election. He openly invoked, and openly embraced, the Independent Payment Advisory Board (IPAB) as the chief mechanism by which Obamacare will control the cost of American healthcare. “IPAB” might be a new term to many Americans, but DrRich pointed his readers to this entity, within a few weeks of the passage of Obamacare, as the lynchpin (and a very scary lynchpin at that) of the whole enterprise. Until President Obama’s recent “outing” of IPAB, however, this new board has been almost entirely ignor... The Covert Rationing Blog blogs http://www.medworm.com/rss/comments.php?id=4820849 Mon, 09 May 2011 15:37:30 +0100 4820849 http://www.medworm.com/index.php?rid=4780488&cid=t_139124_150_f&fid=35777&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FPharmalot%2F%7E3%2FGuogHFPFGkk%2F Good morning, everyone, and nice to see you again. A sunny day is unfolding here on the Pharmalot corporate campus, where we hope we have solved our recent tech problems. We appreciate your patience. Meanwhile, we are brewing the usual cup of stimulation - our flavor today is Mocha Nut Fudge - and perusing the news of the world. Let us know if you hear something interesting. And, of course, have a productive and rewarding day… Pfizer Earnings Rise On Lower Costs (Associated Press) Novartis CEO Not Thrilled With Health Care Reform (Fortune) Shanghai Pharma Raises $2.2B, Investors Include Pfizer (Bloomberg News) Could Chemicals In Wine Improve Stent Performance? (Health Day) Teva To Buy Japanese Generic Drugmaker (Globes) FDA Approves Boehringer/Lilly Diabetes Drug (Pharma Times) Parex... Pharmalot blogs http://www.medworm.com/rss/comments.php?id=4780488 Tue, 03 May 2011 12:02:39 +0100 4780488 http://www.medworm.com/index.php?rid=4775388&cid=t_139124_87_f&fid=39182&url=http%3A%2F%2Fcovertrationingblog.com%2Fpodpress_trac%2Ffeed%2F1535%2F0%2Fobama-ryan-kerfuffle.mp3 Podcast: When Congressman Ryan released the House Republican budget plan a few weeks ago, he made it clear that he believed his proposal would engender a vigorous reaction from the Progressive leadership of our government. He further expressed the hope that such a reaction would at last engage both sides in a real debate about how to reduce our crushing federal deficit, which is growing fast enough to promise societal disintegration within a generation or two. So when President Obama subsequently announced that he was giving a speech that would articulate a meaningful response to the Ryan proposal, and invited Congressman Ryan and some of his Republican confederates to attend, the Republicans respectfully showed up and sat in their designated front row seats, expecting, they said, to hear... The Covert Rationing Blog blogs http://www.medworm.com/rss/comments.php?id=4775388 Mon, 02 May 2011 10:05:11 +0100 4775388 http://www.medworm.com/index.php?rid=4789384&cid=t_139124_113_f&fid=34634&url=http%3A%2F%2Fwww.emrandhipaa.com%2Femr-and-hipaa%2F2011%2F04%2F26%2Ftell-me-something-i-dont-know-with-jonathan-bush-from-athenahealth%2F When I got the request at HIMSS 11 to be able to sit down and talk with Jonathan Bush, CEO of AthenaHealth, I knew that I had to take it. Him and I had a very interesting conversation and he’s a fascinating individual since you never know what he might say next. On that note, I decided that I better get Jonathan Bush on video at HIMSS. In fact, I think it might have been the only video I did at HIMSS. Although, once I saw how easy it was to upload this video from my phone, I might have to do more EMR related videos on the future. Although, I’ll probably need to hold it the other way. Now to the video. The basic idea of “Tell Me Something I Don’t Know” comes from the Sunday show that Chris Matthew’s does. In the segment, the people try and tell you someth... EMR and HIPAA blogs http://www.medworm.com/rss/comments.php?id=4789384 Tue, 26 Apr 2011 19:03:25 +0100 4789384 http://www.medworm.com/index.php?rid=4742647&cid=t_139124_150_f&fid=34889&url=http%3A%2F%2Fpharmamkting.blogspot.com%2F2011%2F04%2Frepublicans-favor-government-health.html Results from the latest New York Times/CBS News poll conducted April 15-20 with 1,224 adults nationwide indicate that only 25% of Republicans think providing health care coverage to the poor is the responsibility of the federal government, whereas TWICE as many (55%) believe the federal government should provide health care coverage to the elderly. Meanwhile, 73% of Democrats, favor federal health care coverage for the poor. If only there was an American Association of Poor People (AAPP)! (Source: Pharma Marketing Blog) Pharma Marketing Blog blogs http://www.medworm.com/rss/comments.php?id=4742647 Fri, 22 Apr 2011 11:42:00 +0100 4742647 http://www.medworm.com/index.php?rid=4747723&cid=t_139124_113_f&fid=34634&url=http%3A%2F%2Fwww.emrandhipaa.com%2Fneil%2F2011%2F04%2F21%2Fmore-unrealistic-expectations-from-the-public-this-time-involving-cds%2F Yet again, someone needs to educate the general public about healthcare in general and health IT in particular. HealthLeaders last week asked the question, “Does Decision Support Make Docs Look Dumb?” The story, apparently based on a 2007 study (not 2008, as HealthLeaders reported) in the journal Medical Decision Making, says: “Most clinicians would agree that evidence-based decision support tools have the potential to improve clinical quality. But patients’ perception of the tools—and the physicians who use them—might be yet another barrier to their adoption. The problem is twofold: Some patients are skeptical of docs who need a computer to help them make a diagnosis. And some physicians don’t want to be seen as being too reliant on technology.” We’ve... EMR and HIPAA blogs http://www.medworm.com/rss/comments.php?id=4747723 Thu, 21 Apr 2011 20:05:53 +0100 4747723 http://www.medworm.com/index.php?rid=4734095&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwill-our-healthcare-system-end-up-looking-like-an-apple-or-android-product%2F2011.04.21 The future direction of American health care is unclear.  Certainly the cost trend as it exists is unsustainable with health care costs being a major concern of the private sector, the government, and individuals.  How does the nation manage costs while ensuring high quality medical care, access, and service?  Proposals include increasing competition among insurers, providers, and hospitals to drive down prices or giving more financial responsibility to patients via higher deductibles and co-pays with the belief that they will demand price transparency, shop around for the best price, and as a result slow health care costs. What if both ideas are wrong? While it is possible these plans might work, I cannot help but notice the similarities in the challenges for patients in navigating the... Better Health blogs http://www.medworm.com/rss/comments.php?id=4734095 Thu, 21 Apr 2011 17:00:00 +0100 4734095 http://www.medworm.com/index.php?rid=4734103&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fare-paul-ryans-medicare-budget-cuts-going-to-harm-the-elderly%2F2011.04.20 For some time now, numerous loved ones and dear friends have been advising and occasionally urging DrRich that, perhaps, it has become a bit inappropriate, and even unseemly, for him to continue in his longtime position as President and sole member of Future Old Farts of America (FOFA). For a not unsubstantial interval DrRich ignored this advice, feigning incipient deafness. But finally, after some focused study of that which these days returns his gaze in the mirror, and reluctantly concluding that maybe his loved ones have a point (and not wishing to seem Cranky), DrRich has reluctantly decided to resign from (and therefore disband) FOFA. DrRich is pleased to announce that he has accepted a new position as President and sole member of Glorious Old Farts of America (GOFA). And it is in th... Better Health blogs http://www.medworm.com/rss/comments.php?id=4734103 Wed, 20 Apr 2011 14:00:32 +0100 4734103 http://www.medworm.com/index.php?rid=4709205&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fkudos-to-acog-a-moral-victory-for-pregnant-women%2F2011.04.13 This post is written as a follow-up to The Hijacking of Pregnant Women. It is said that sometimes you have to rock the boat in order to shift the course of progress. Well today pregnant women have reason to celebrate. The winds of change are apparent. Bowing under pressure, K-V Pharmaceutical Company reduced the price of Makena from $1500 to $690. Makena is the trade name for hydroxyprogesterone caproate or 17OHP. It is a drug recently approved by the Federal Drug Administration (FDA) to reduce premature deliveries before 37 weeks if it is given before 21 weeks gestation.  It has been used for years as an off-label drug and costs approximately $10 to $20 to make by compound pharmacists. When the FDA gave K-V an exclusive right to manufacture the drug, their integrity flew out the window.... Better Health blogs http://www.medworm.com/rss/comments.php?id=4709205 Wed, 13 Apr 2011 17:00:38 +0100 4709205 http://www.medworm.com/index.php?rid=4704653&cid=t_139124_87_f&fid=39182&url=http%3A%2F%2Fcovertrationingblog.com%2Fpodpress_trac%2Ffeed%2F1515%2F0%2Fkilling-the-elderly.mp3 Podcast: For some time now, numerous loved ones and dear friends have been advising and occasionally urging DrRich that, perhaps, it has become a bit inappropriate, and even unseemly, for him to continue in his longtime position as President and sole member of Future Old Farts of America (FOFA). For a not unsubstantial interval DrRich ignored this advice, feigning incipient deafness. But finally, after some focused study of that which these days returns his gaze in the mirror, and reluctantly concluding that maybe his loved ones have a point (and not wishing to seem Cranky), DrRich has reluctantly decided to resign from (and therefore disband) FOFA. DrRich is pleased to announce that he has accepted a new position as President and sole member of Glorious Old Farts of America (GOFA). And i... The Covert Rationing Blog blogs http://www.medworm.com/rss/comments.php?id=4704653 Mon, 11 Apr 2011 14:09:32 +0100 4704653 http://www.medworm.com/index.php?rid=4684317&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-republican-healthcare-plan-the-good-the-bad-and-the-ugly%2F2011.04.07 I am all for any proposal that will improve heath care in America. Improvement means controlling costs, covering all Americans so no one has to worry about going bankrupt to pay for health care. Improvement means access to quality care without having to worry about losing your job, which means losing your coverage. Improvement means a system where all incentives are aligned to prevent disease, rather than using expensive technologies and hospitals to treat disease after the fact. Any proposal that gets us there has my vote. In the GOP “Path to Prosperity” budget for 2012, they propose a few things that are good and a few big things that are bad…really really bad. First the good. Capping the medical malpractice lawsuits for “pain and suffering” would be a huge ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4684317 Thu, 07 Apr 2011 12:00:00 +0100 4684317 http://www.medworm.com/index.php?rid=4684319&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fsurgeons-criticize-medical-tourism-you-cant-sue-if-things-go-awry%2F2011.04.06 In an earlier post, DrRich offered several potential strategies for doctors and patients to consider should healthcare reformers ultimately succeed in their efforts to make it illegal for Americans to seek medical care outside the auspices of Obamacare. To those readers who persist in thinking that DrRich is particularly paranoid in worrying about such a thing, he refers you to his prior work carefully documenting the efforts the Central Authority has already made in limiting the prerogatives of individual Americans within the healthcare system, and reminds you that in any society where social justice is the overriding concern, individual prerogatives such as these must be criminalized. Indeed, whether individuals will retain the right to spend their own money on their own healthcare is ul... Better Health blogs http://www.medworm.com/rss/comments.php?id=4684319 Wed, 06 Apr 2011 20:00:54 +0100 4684319 http://www.medworm.com/index.php?rid=4664175&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fcounter-point-happy-birthday-health-reform%2F2011.04.01 Who would have thought when we first looked upon you a year ago, barely formed, still somewhat embryonic, that you would have grown so much in just a year, and created so much, well, trouble? Yes, I’m talking about you, health reform. After all, aren’t you the reason for the sea change in Washington? Aren’t you behind several pending appeals that will get to the Supreme Court? Aren’t you the reason that the country is going to hell in a handbasket? But wait. Let’s look at some other major milestones of the past year. – You sent $250 checks to Medicare beneficiaries to help cover the “donut hole” in their drug coverage. – You created special insurance pools designed to provide health care NOW to people with preexisting conditions who can... Better Health blogs http://www.medworm.com/rss/comments.php?id=4664175 Fri, 01 Apr 2011 14:00:00 +0100 4664175 http://www.medworm.com/index.php?rid=4615097&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fobama-is-not-reforming-healthcare-the-right-way%2F2011.03.20 Last year’s “Doctor Fix” was passed the last week congress was in session in 2010. This was after the medical profession was held in suspense for 9 months. The “Doctor Fix” was supposedly the result of President Obama making a deal with the AMA for the AMA’s support. He was going to pass a real “Doctor Fix” in 2011 by repairing the defective sustainable growth rate formula (SGR). Nothing has been done about this by President Obama in 2011. The cumulative physician reimbursement reduction of 25% was suspended until January 2012. Physicians face a 29.5% Medicare Pay Cut in January 2012. Four and one half percent was added to last year’s cumulative physicians reimbursement reduction. The reduction was calculated into the CBO’s cost score for President Obama’s Healthcar... Better Health blogs http://www.medworm.com/rss/comments.php?id=4615097 Sun, 20 Mar 2011 20:00:41 +0100 4615097 http://www.medworm.com/index.php?rid=4560276&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fmedical-ethics-and-the-r-word%2F2011.03.07 [Recently] a short article in the New York Times, New Kidney Transplant Policy Would Favor Younger Patients, [drew] my attention to a very basic problem in medical ethics: Rationing. According to the Washington Post coverage, the proposal comes from the United Network for Organ Sharing, a Richmond-based private non-profit group the federal government contracts for allocation of donated organs. From the Times piece: Under the proposal, patients and kidneys would each be graded, and the healthiest and youngest 20 percent of patients and kidneys would be segregated into a separate pool so that the best kidneys would be given to patients with the longest life expectancies. This all follows [the recent] front-page business story on the monetary value of life. I have to admit, I’m glad to s... Better Health blogs http://www.medworm.com/rss/comments.php?id=4560276 Mon, 07 Mar 2011 19:00:35 +0100 4560276 http://www.medworm.com/index.php?rid=4560277&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fhealthcare-reform-continues-as-judge-relents%2F2011.03.07 A federal judge who’d ruled healthcare reform was unconstitutional and that his decision as a federal judge was the equivalent of an injunction has relented. Healthcare reform can continue in the states, pending appellate and Supreme Court review. “The sooner this issue is finally decided by the Supreme Court, the better off the entire nation will be,” wrote federal judge Roger E. Vinson, who’d decided that the healthcare reform act’s mandate that people buy insurance or face penalties overextended Congress’ powers under the commerce clause of the constitution. One reason for granting a stay, despite his previous clear intent that healthcare reform cease, includes his statement (on page 18) that: “Can (or should) I enjoin and halt implementation of... Better Health blogs http://www.medworm.com/rss/comments.php?id=4560277 Mon, 07 Mar 2011 17:00:00 +0100 4560277 http://www.medworm.com/index.php?rid=4549754&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fmedicaid-will-the-cost-of-expanding-eligibility-be-overwhelming%2F2011.03.04 Medicaid has been front and center this week as President Obama addressed the National Governors Association, and several governors testified before the House Energy and Commerce Committee. Obama told the governors that he supports the Wyden-Brown bill, which would accelerate the availability of waivers under the Affordable Care Act (ACA), so that states would not have to first create health insurance exchanges under the law, and then have the right to dismantle them and replace them with other mechanisms to achieve coverage goals of the law without additional cost to the federales. (See Wyden-Brown fact sheet.) The sponsors’ home states, Oregon and Massachusetts would otherwise have to dismantle parts of their own health reform efforts in order to align with the federal mandates... Better Health blogs http://www.medworm.com/rss/comments.php?id=4549754 Fri, 04 Mar 2011 14:00:45 +0100 4549754 http://www.medworm.com/index.php?rid=4540564&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fit%25e2%2580%2599s-time-to-tango-impatient-with-progress-on-patient-physician-partnership%2F2011.03.02 The other day I came across this photo of a couple clasping each other in a dramatic tango on the cover of an old medical journal – a special issue from 1999 that was focused entirely on doctor-patient partnership. The tone and subjects of the articles, letters and editorials were identical to those written today on the topic: “It’s time for the paternalism of the relationship between doctors and patients to be transformed into a partnership;” “There are benefits to this change and dangers to maintaining the status quo;” “Some doctors and patients resist the change and some embrace it: Why?” Two questions struck me as I impatiently scanned the articles from 12 years ago: First, why are these articles about doctor-patient partnership still so relevant? And second, why ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4540564 Wed, 02 Mar 2011 22:00:43 +0100 4540564 http://www.medworm.com/index.php?rid=4532209&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fa-third-place-in-healthcare-what-we-can-learn-from-starbucks%2F2011.02.28 Media reports on misdiagnosis continue to mount. A recent study on patients with Alzheimer’s found that half had been misdiagnosed. Half. Another headline blared “4 out of 10 patients being misdiagnosed.” The article encouraged patients to “see another doctor” if they are worried about their diagnosis. You know what it makes me think about? Starbucks. Why? Because the way Starbucks revolutionized coffee drinking shows a way forward for healthcare. Starbucks realized that since our lives focus on two places — home and work — most of us don’t have a “third place” to go. A place where we can be free of everyday distractions and take care of ourselves. Starbucks set out to create that “third place” by making its shops comfortable, inviting places. It works... Better Health blogs http://www.medworm.com/rss/comments.php?id=4532209 Mon, 28 Feb 2011 23:00:22 +0100 4532209 http://www.medworm.com/index.php?rid=4532210&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Ffree-drug-samples-or-hospital-hotels-the-greater-evil%2F2011.02.28 Many folks criticize pharmaceutical companies for providing physicians’ offices with free drug samples. They claim that this giveaway harms consumers because drug companies must raise their prices to cover the costs of these freebies. Of course, this is undeniable. Any business expense, such as payroll or advertising, has to be covered and is expectedly borne by the consumer. If a company chooses not to advertise, outsources manufacturing to a country with cheaper labor, offers limited benefits to its employees, then they can sell their product at a low price. In this hypothetical example, anemic sales may doom the company quickly. Naturally, free samples are not really free. The rest of us pay for them. While this is true, I don’t think it is evil. Unlike the U.S. government, at least... Better Health blogs http://www.medworm.com/rss/comments.php?id=4532210 Mon, 28 Feb 2011 20:00:00 +0100 4532210 http://www.medworm.com/index.php?rid=4512393&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fnew-doctor-considering-primary-care-show-me-the-money%2F2011.02.23 There are plenty of reasons why medical students aren’t choosing primary care as careers. Lack of role models. Perception of professional dissatisfaction. High burnout rate among generalist doctors. Long, uncontrollable hours. But what about salary? Until now, the wage disparity between primary care doctors and specialists has only been an assumed reason; the evidence was largely circumstantial. After all, the average medical school debt exceeds $160,000, so why not go into a specialty that pays several times more, with better hours? Thanks to Robert Centor, there’s a study published in Medscape that shows how money affects career choice among medical students. Here’s what they found: Sixty-six percent of students did not apply for a primary care residency. Of these, 30 percent woul... Better Health blogs http://www.medworm.com/rss/comments.php?id=4512393 Wed, 23 Feb 2011 18:00:09 +0100 4512393 http://www.medworm.com/index.php?rid=4498275&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Faggressive-care-when-is-it-better-for-patients%2F2011.02.19 The recurring narrative among health reformers is that hospitals that provide more care raise health costs, but don’t necessarily improve quality. This has lead to a backlash against so-called “aggressive” hospitals and doctors, with upcoming financial penalties to match. But the situation, as always, appears to be more nuanced than that. In her column in the New York Times, Dr. Pauline Chen looks at one subset of patients who actually may benefit from aggressive care: Those who suffer surgical complications. The study, found no difference in the rate of complications for aggressive and nonaggressive hospitals. But when they looked at all the patients who had complications and examined their outcomes, the researchers found that regardless of the urgency of their operations, those pat... Better Health blogs http://www.medworm.com/rss/comments.php?id=4498275 Sat, 19 Feb 2011 17:00:29 +0100 4498275 http://www.medworm.com/index.php?rid=4495204&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fovertreated-is-underread%2F2011.02.18 My daughter, Elana, home from college on winter break, offered me a book to peruse from one of her classes. She correctly suspected that her father, the MD Whistleblower, would enjoy reading a book authored by a whistleblower pro. The book, “Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer” by Shannon Brownlee should be required reading for first year medical students, who have not yet acquired views and habits that promulgate excessive medical care and treatment. For those of us already in practice, this book should be a required element of board recertification. Brownlee understands the medical system well and describes a culture of excess, conflicts of interests, absence of universal quality control mechanisms and fractured and disorganized care with no one ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4495204 Fri, 18 Feb 2011 18:00:00 +0100 4495204 http://www.medworm.com/index.php?rid=4477758&cid=t_139124_87_f&fid=39182&url=http%3A%2F%2Fcovertrationingblog.com%2Fhealthcare-reform%2Foverhauling-america%25e2%2580%2599s-healthcare-machine-a-review Some might wonder why America needs a new book on fixing our healthcare system, now that the the Patient Protection and Affordable Care Act (i.e., Obamacare) has already done that for us. Well, there are several reasons, so take your pick: 1) Obamacare might be repealed. 2) Obamacare might be found unconstitutional. 3) If Obamacare is permitted to proceed into its full glory, it shouldn’t be long before it leads to social upheaval either by: a) exploding the federal deficit far beyond even what we’re seeing today; or b) alarming a critical mass of Americans regarding the new, oppressive powers which the new law grants to the federal government. If 1 or 2, the process by which our nation will re-address healthcare reform may look much like the contentious, but deliberative, proc... The Covert Rationing Blog blogs http://www.medworm.com/rss/comments.php?id=4477758 Tue, 15 Feb 2011 11:08:12 +0100 4477758 http://www.medworm.com/index.php?rid=4464496&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fmaking-employee-health-a-fundamental-part-of-company-culture%2F2011.02.11 Dick Quinn of Quinn’s Commentary has a pithy post about why it’s hard for the government to control healthcare costs. He says: Nobody complains about the cost of healthcare, rather they complain about their insurance premiums or their payroll deductions for health benefits. He’s right about what politicians react to. The healthcare reform law is loaded with things that are meant to contain the price of coverage. But I would add two words to his post: “Nobody who votes complains about the cost of healthcare.” It’s true: The large employers who pay for much of healthcare in America complain about the cost a lot. But they are doing something about it. In my work, I have the opportunity to present at events with some of our Fortune 500 clients. (I have one this week with The Home ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4464496 Fri, 11 Feb 2011 16:00:28 +0100 4464496 http://www.medworm.com/index.php?rid=4459956&cid=t_139124_87_f&fid=39182&url=http%3A%2F%2Fcovertrationingblog.com%2Fhealthcare-reform%2Fget-perednias-new-book-for-free-on-kindle-through-feb-12-2 You can get a free Kindle edition of Douglas Perednia’s excellent new book, Overhauling America’s Healthcare Machine from now through February 12, at this link. This is an offer you should not pass up. Perednia writes the very fine Road to Hellth blog, and is a well-known author, researcher, medical practitioner, and entrepreneur.  His new book is a post-Obamacare view on what we really ought to do to reform our healthcare system in a way that will actually work, and will actually reduce costs. DrRich will be posting full a review of Overhauling America’s Healthcare Machine here next week, but he can assure you right now that it would be well worth your time to read it. (And if you’re going to read it, why not get it while it’s free?) It is comprehensive, extreme... The Covert Rationing Blog blogs http://www.medworm.com/rss/comments.php?id=4459956 Thu, 10 Feb 2011 14:31:57 +0100 4459956 http://www.medworm.com/index.php?rid=4455262&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fintegrating-major-health-systems-could-make-things-worse%2F2011.02.09 Health reformers propose the proliferation of integrated health systems, like the Mayo Clinic or Kaiser Permanente, which, according to the Dartmouth Atlas, lead to better patient care and improved cost control. To that end, accountable care organizations (ACOs) have been a major part of health reform, changing the way healthcare is delivered. Never mind that patients may not be receptive to the new model, but the creation of these large, integrated physician-hospital entities that progressive policy experts espouse comes with repercussions. Monopoly power. To prepare for the new model of healthcare delivery, physician practices have been consolidating. In many cases, they’re being bought by hospitals. Last year, I wrote how this is leading to the death of the private practice physician... Better Health blogs http://www.medworm.com/rss/comments.php?id=4455262 Wed, 09 Feb 2011 22:00:58 +0100 4455262 http://www.medworm.com/index.php?rid=4438886&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fis-the-er-really-the-best-place-to-get-primary-care-quicker%2F2011.02.05 In 1986, when Congress passed the Emergency Medical Treatment and Active Labor Act (EMTALA), hospitals and ambulance services were mandated by law to stabilize anyone needing emergency healthcare services regardless of citizenship, legal status, and/or insurance status. This was instituted at the time to prevent the prevalent practice of “dumping” — refusing to treat patients because of insufficient insurance or transferring or discharging patients on the basis of anticipating high diagnosis and treatment costs. While the implications of this law are indeed very noble in providing undifferentiated care to all patients based solely on healthcare needs and not financial status, it has unfortunately led to many patients presenting to the emergency department (ED) for primary care is... Better Health blogs http://www.medworm.com/rss/comments.php?id=4438886 Sat, 05 Feb 2011 17:00:34 +0100 4438886 http://www.medworm.com/index.php?rid=4429020&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-physician-exodus-when-doctors-leave-hospitals-behind%2F2011.02.02 My partners and I have long struggled with the lack of specialty back-up at our hospital. Semi-rural hospitals, out of the way facilities, just can’t always attract specialists. So, we’re happy to have cardiologists every night, but understand that we only have an ENT every third night. We’re thankful to have neurologists, even if they don’t admit anyone. We’re glad to have radiologists, even if they don’t read plain films after 5PM on weekdays. Still, I continue to scratch my head about why only three of seven community pediatricians take call, such that family physicians have to admit their patients. I was bumfuzzled that our neurologists were previously going to require us to use telemedicine for stroke evaluation when their offices were close by the hospital. (In the same y... Better Health blogs http://www.medworm.com/rss/comments.php?id=4429020 Wed, 02 Feb 2011 17:00:12 +0100 4429020 http://www.medworm.com/index.php?rid=4424236&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-eroding-doctor-label%2F2011.02.01 It came as a Twitter “follow” from @coldfeet65, a self-proclaimed “Nurse Practitioner Hospitalist.” I had never heard this term before. Does it mean a nurse practitioner who cares for hospitalists? Or is it a hospitalist who is a nurse practitioner? Or maybe it’s a nurse practitioner who helps hospitalists? (Honestly, I think I know which one she means, but you get my point.) Perhaps this is a prescient glimpse to healthcare of the future, where our more typical nurse and doctor labels are supplanted by more and more monikers that serve to confuse, rather than clarify, each of our roles in healthcare delivery. As specialists in cardiology, we’ve seen a similar trend with cardiology hospitalists. But we should be clear what this means to the patients and ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4424236 Tue, 01 Feb 2011 16:00:00 +0100 4424236 http://www.medworm.com/index.php?rid=4419466&cid=t_139124_158_f&fid=38949&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FAgingWithGraceCareconnection%2F%7E3%2F4K9_RXdUjt0%2Fmedicare-expert-says-healthcare-reform.html The Affordable Care Act would not keep healthcare costs down, testified David Foster, chief actuary for the Centers for Medicare & Medicaid Services, before the House Budget Committee.Foster also said that healthcare costs might actually increase if Medicare cuts to nursing homes, hospitals and home health agencies wind up being politically unpopular, the Associated Press reports. These cuts, Foster said, could push 15% of providers out of the business. Additionally, he said that the healthcare law funnels savings from Medicare to coverage for the uninsured.White House officials have disputed Foster's analysis throughout the healthcare reform process. His assessment came last week in direct response to President Obama's State of the Union address. (Source: Aging with Grace CareConnection) Aging with Grace CareConnection blogs http://www.medworm.com/rss/comments.php?id=4419466 Tue, 01 Feb 2011 01:13:00 +0100 4419466 http://www.medworm.com/index.php?rid=4411584&cid=t_139124_113_f&fid=34634&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FEmrAndHipaa%2F%7E3%2F6MVNc1ieIzM%2F The always opinionated Anthony Guerra has an article up on Information Week that describes why he thinks the Meaningful Use sky is falling. Add that to a recent comment I got on a previous post that links to a Healthcare Data Management article talking about the potential repeal of the HITECH act and it seems worthwhile to assess the state of meaningful use. I’ll start with the potential repeal of meaningful use first. We’ve known for a long time that the house was going to be going after healthcare reform once the republicans took over control of the house. In fact, we posted about the potential impacts to HITECH from the new Congress before. I personally get the feeling that not much has changed on this front. I’m going to reach out to some of the government liasons for... EMR and HIPAA blogs http://www.medworm.com/rss/comments.php?id=4411584 Fri, 28 Jan 2011 18:43:08 +0100 4411584 http://www.medworm.com/index.php?rid=4405776&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fstate-of-healthcare-in-the-union%2F2011.01.27 Short and sweet. That’s how President Obama addressed healthcare reform in his State of the Union address [Tuesday] night. In less than 700 words, he outlined how he’d improve but not retreat on what’s been enacted into law. He’s willing to work on changes, he said, naming malpractice reform and reducing onerous paperwork burdens for small businesses. But, he cautioned, “What I’m not willing to do is go back to the days when insurance companies could deny someone coverage because of a pre-existing condition.” President Obama had invited two real people to his address to highlight the law’s successes. One is a brain cancer survivor who can access health insurance through high-risk pools created by the law. The other is a small business owner w... Better Health blogs http://www.medworm.com/rss/comments.php?id=4405776 Thu, 27 Jan 2011 16:00:00 +0100 4405776 http://www.medworm.com/index.php?rid=4405953&cid=t_139124_130_f&fid=34938&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FEvidenceInMotion%2F%7E3%2F54QdTvfeV7Q%2Fstate-of-the-union-healthcare-reform-2011.html On Thursday, Jan 27, 4:30 PM Eastern, Medscape will participate in a roundtable discussion in our nation’s capital. They will be bringing you the pressing questions about healthcare reform to the White House, and they're interested in hearing from you. Visit Medscape.com to submit your question (log-in required). Here is the text of my question: "Evidence of overutilization of diagnostic imaging and specific surgeries implies that physicians and hospitals make treatment decisions based, at least partly, on financial gain. Many of these physicians are paid based on the volume of care they provide. In 2014, hospitals will begin organizing Medicare payments into fixed payment (capitated) Accountable Care Organizations (ACO) which will be directed by the same group of physicians and a... MyPhysicalTherapySpace.com blogs http://www.medworm.com/rss/comments.php?id=4405953 Wed, 26 Jan 2011 23:28:23 +0100 4405953 http://www.medworm.com/index.php?rid=4394442&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fclinical-guidelines-who-writes-them-anyway%2F2011.01.25 While DrRich is a conservative American, and has made plain the difficulties he has with the Progressive program in general and with Progressive healthcare reform in particular, at times he is forced to admit that, on occasion, the Progressive way of looking at the world has certain merits. And as DrRich contemplates a question that has been bothering him lately, a question that no doubt plagues many American physicians who (unlike DrRich) are still toiling away in the trenches, he finds that this is one such occasion. That question is: Just who are the people writing all those clinical guidelines — the  “guidelines” physicians are now expected to follow in every particular in every case, on pain of massive fines, loss of career, and/or incarceration? DrRich is quick to say that... Better Health blogs http://www.medworm.com/rss/comments.php?id=4394442 Tue, 25 Jan 2011 14:00:26 +0100 4394442 http://www.medworm.com/index.php?rid=4389182&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fbaby-boomers-2011-a-new-frontier-with-few-guideposts%2F2011.01.23 This is a guest post by Dr. John Schumann. ********** In 2011, the first wave of baby boomers will turn 65 years old. Sixty-five still has currency because that’s the age at which non-disabled Americans are eligible to be covered under the Medicare program (now itself having reached middle age). As our economy continues to recover (hopefully) from the Great Recession, the entrance of millions of Americans to the Medicare rolls over the next decade and a half will be a formidable planning challenge. Look at this chart to see how the baby boomers population has surged: So is the promise of healthcare reform (the “PPACA“), which will enlarge Medicaid by an additional 16 million Americans — about half of the projected growth in coverage for those currently uninsured.... Better Health blogs http://www.medworm.com/rss/comments.php?id=4389182 Sun, 23 Jan 2011 20:00:00 +0100 4389182 http://www.medworm.com/index.php?rid=4377570&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhos-more-pessimistic-about-healthcare-reform-physicians-or-patients%2F2011.01.20 While public opposition to healthcare reform has diminished since its passage, physician opinions are still negative, especially among specialists who see their value to the healthcare system decreasing as reform emphasizes primary care. A survey reports that 65 percent of nearly 3,000 physicians in all specialties said the quality of healthcare in the country will deteriorate in the next five years. Seventeen percent of respondents believe the quality of healthcare will stay the same and 18 percent believe it will improve. Meanwhile, 30 percent of healthcare consumers believe that the quality of healthcare will improve. Physicians cited as reasons for their pessimism personal political beliefs, anger at insurance companies and a lack of accurate planning in the reform act. Other reas... Better Health blogs http://www.medworm.com/rss/comments.php?id=4377570 Thu, 20 Jan 2011 18:00:00 +0100 4377570 http://www.medworm.com/index.php?rid=4360979&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fphysician-burnout-depression-and-suicide-in-surgeons%2F2011.01.18 I wrote last year in USA Today about the impact of physician burnout. Not only do doctors suffer, but so do their patients. Burnout starts early in residency, with entering interns having a depression rate of 4 percent, similar to the general public. But after the first year of residency, that number balloons to 25 percent. Now another study adds fuel to this disturbing trend. A paper published in the Archives of General Surgery looks at the prevalence of physician burnout in surgeons: In a national survey, one in 16 surgeons reported contemplating suicide, researchers reported. An increased risk of suicidal ideation was linked to three factors: depression, burnout, and the perception of having made a recent major medical error … … But only about one in four of those who reported thi... Better Health blogs http://www.medworm.com/rss/comments.php?id=4360979 Tue, 18 Jan 2011 16:00:58 +0100 4360979 http://www.medworm.com/index.php?rid=4331015&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Frepealing-healthcare-reform-to-gain-campaign-ammunition%2F2011.01.10 Repealing healthcare reform has become a way of stockpiling ammunition for the campaign trail. The Republican-led House has scheduled a repeal of healthcare reform for Wednesday, Jan. 12, and they’d garner as allies some but not all 13 Democrats that voted against healthcare reform to begin with. The House’s quixotic vote would then promptly die in the Democrat-held Senate. But recording votes on repeal would put pressure on already vulnerable lawmakers, as well as give a quick boost to incoming ones. A Gallup poll shows 46 percent of Americans want healthcare reform to be repealed, 40 percent don’t want repeal. Unfortunately, not only can’t the law be passed, it would add $230 billion to the federal debt by 2021, according to the Congressional Budget Office. Hous... Better Health blogs http://www.medworm.com/rss/comments.php?id=4331015 Mon, 10 Jan 2011 16:00:00 +0100 4331015 http://www.medworm.com/index.php?rid=4322505&cid=t_139124_87_f&fid=39182&url=http%3A%2F%2Fcovertrationingblog.com%2Fpodpress_trac%2Ffeed%2F1221%2F0%2Fconstitutionality-briar-patch.mp3 We presented our nation with a healthcare plan that would cover almost everybody, and which would save the private insurance industry. But now, the actions of the Republican naysayers have destroyed the only mechanism that would have allowed the insurance industry to continue to function.  And now the insurance companies are falling like dominoes, and uninsured Americans will soon number over 100 million.  You and your loved ones and your neighbors face imminent death or disability from Republican neglect.  We must act, and we must act now. “I and my Democratic colleagues did not want it this way. We fought hard for our centrist, market-based plan.  But our Republican opponents and their allies in the reactionary Court leave us no choice.  My fellow Americans, as a matter of nat... The Covert Rationing Blog blogs http://www.medworm.com/rss/comments.php?id=4322505 Fri, 07 Jan 2011 12:17:47 +0100 4322505 http://www.medworm.com/index.php?rid=4304877&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-best-book-on-health-care-reform%2F2011.01.03 The best book on health care reform — or surviving it — is the “The Innovator’s Prescription: A Disruptive Solution for Health Care.” The decade worth of research spent understanding, studying, and ultimately offering solutions to make the health care system more accessible, higher quality, and affordable is clear. Unlike other books, the authors, respected Harvard Business School (HBS) professor Clayton Christensen, Jerome Grossman, a doctor who also was the Director of Health Care Delivery Policy Program at Harvard Kennedy School, and Jason Hwang, another doctor and graduate of the MBA program at HBS, avoid the traps the plague most other solutions by taking a completely different perspective by looking at other industries where products and services offere... Better Health blogs http://www.medworm.com/rss/comments.php?id=4304877 Mon, 03 Jan 2011 14:00:00 +0100 4304877 http://www.medworm.com/index.php?rid=4287416&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-twelve-days-of-healthcare-reform%2F2010.12.24 Today’s blog will be my last for 2010, as I will be taking a break to spend the Christmas and New Year’s holidays with family and friends. In keeping with a tradition I started two years ago, I again have taken the liberty of mangling a beloved holiday song, story, or rhyme to give a humorous (I hope!) perspective on current politics. In December, 2008, I adapted “Twas the Night Before Christmas” to convey President-elect Obama as being a not-so-jolly old elf besieged by lobbyists demanding stimulus gifts. Last year, I depicted the GOP as the Grinch trying to stop “ObamaCare” from coming. Today, I’ve re-written the “Twelve Days of Christmas” carol so that it is the government bestowing “gifts” (based on actual provisions of the Affordable Care Act) that the new Co... Better Health blogs http://www.medworm.com/rss/comments.php?id=4287416 Fri, 24 Dec 2010 14:00:00 +0100 4287416 http://www.medworm.com/index.php?rid=4285173&cid=t_139124_87_f&fid=34816&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FHonestMedicine%2F%7E3%2F5smNnuczGvI%2Fhmonamazon.html For over a year, I have been busy writing my book, HONEST MEDICINE: Effective, Time-Tested, Inexpensive Treatments for Life-Threatening Diseases. It has been wonderful, terrible, exhausting—and ultimately, life-changing time. And now it is published--and on Amazon.com! The idea for HONEST MEDICINE started germinating in 2002, when my husband Tim was in the hospital with a non-healing post-surgical head wound caused when his suture line wouldn't heal. His doctors performed 8 surgeries to try to get his skin to heal. Nothing worked.  Then, through a friend and colleague, Dr. Carlos Reynes, I found Silverlon, a different kind of wound-healing system. Just hours after placing Silverlon on Tim’s head, his skin started to heal. I was elated. (You may read about our experience here.)�... HONEST MEDICINE: My Dream for the Future blogs http://www.medworm.com/rss/comments.php?id=4285173 Thu, 23 Dec 2010 22:38:56 +0100 4285173 http://www.medworm.com/index.php?rid=4272289&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-musical-chairs-of-medical-speciality%2F2010.12.19 The consolidation of physician specialty practices into larger corporate healthcare systems in urban areas is creating a new challenge for today’s doctors when the music stops: There might not be a chair available. There are simply many fewer hospital systems in large urban areas than there are specialy practices, so the number of specialist positions a large healthcare system is willing to absorb might be limited. As doctors and hospital systems coalesce into as-yet-to-be-clearly-defined “accountable care organizations,” the cost of too many specialists in an organization is being carefully weighed. (more…) *This blog post was originally published at Dr. Wes* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=4272289 Sun, 19 Dec 2010 20:00:00 +0100 4272289 http://www.medworm.com/index.php?rid=4266299&cid=t_139124_158_f&fid=38949&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FAgingWithGraceCareconnection%2F%7E3%2Fxj0oTn2ufUA%2Fseniors-lose-out-with-payment-cuts-to.html The temporary fix that Congress has passed to stave off the looming 23 percent reduction in Medicare reimbursements to physicians is better than nothing - but the long-term problem remains unsolved. Lawmakers have for years kicked down the road tough choices on a critical issue - and those who stand to suffer the most should physician pay be cut are elderly Americans.Dr. Jerald Winakur has been a private practice geriatrician for 35 years. He has managed to keep his office doors open despite the edicts that have come down from Medicare year after year.He is not against all payment cuts for physicians' services. There is growing recognition among doctors that many of the services at issue - primarily technical procedures - are over-compensated. We can thank the American Medical Association ... Aging with Grace CareConnection blogs http://www.medworm.com/rss/comments.php?id=4266299 Thu, 16 Dec 2010 16:54:00 +0100 4266299 http://www.medworm.com/index.php?rid=4258866&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fjudge-rules-healthcare-reform-unconstitutional%2F2010.12.14 A federal judge in Virginia has ruled that healthcare reform is unconstitutional and expects the Obama administration to honor that ruling while it’s being appealed. But states and private companies are continuing to plan and budget for it nonetheless. The court ruled that Congress exceeded its constitutional powers in compelling Americans to buy health insurance. Judges elsewhere have ruled the law is valid or dismissed the cases on procedural grounds, while a judge in Florida will hear another case later this week. In the meantime, though, employers and healthcare companies have to continue adjusting to the reform law’s many provisions. States will continue to set up their health insurance exchanges, and they’ve already budgeted for the additional 16 million people who ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4258866 Tue, 14 Dec 2010 17:00:00 +0100 4258866 http://www.medworm.com/index.php?rid=4258869&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-illusion-of-healthcare-reform%2F2010.12.13 The greatest minds are assembled to discern the answer in healthcare reform. Powerful interest groups are aligned to design solutions to protect their turf. Rubrics, formulas, slogans and taglines get designed, spun, pitched and thrown out. The burden of finding alignment, an answer, a plan that suits everyone seems insurmountable — unless we don’t. The idea of a fit for all is an illusion. Justice and equity are seen differently. We imagine some public consensus at our own peril. But honesty has been in short supply. To paraphrase Oprah: What do we know for sure? Some people want a relationship with a trusted doctor who knows them well. They want to pick the doctor, the neighborhood and the hospital they attend. Others want immediate access and have little trust or interest in a p... Better Health blogs http://www.medworm.com/rss/comments.php?id=4258869 Mon, 13 Dec 2010 21:00:00 +0100 4258869 http://www.medworm.com/index.php?rid=4253139&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwomens-health-in-the-u-s-gets-an-f%2F2010.12.12 The Oregon Health and Science University has published its fifth report card since 2000. It grades and ranks the United States on 26 health-status indicators for women. In 2010, not one state received an overall “satisfactory” grade for women’s health, and just two states — Vermont and Massachusetts — received a “satisfactory-minus” grade. Overall, the nation is so far from meeting the goals set by the U.S. Department of Health and Human Services that it receives an overall grade of “unsatisfactory.” The national report card uses status indicators to assess women’s health: Women’s access to healthcare services (medically under-served area, no abortion provider, no health insurance and first trimester prenatal care) Wellness... Better Health blogs http://www.medworm.com/rss/comments.php?id=4253139 Sun, 12 Dec 2010 18:00:00 +0100 4253139 http://www.medworm.com/index.php?rid=4241723&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Felizabeth-edwards-champion-of-healthcare-reform%2F2010.12.08 The day Elizabeth Edwards announced that she had breast cancer, my heart sank. Finding a lump in the breast only heightens the suspicious that the prognosis may not be good and in Elizabeth’s case, it wasn’t. We all admired Elizabeth for different reasons. In my case, it was her love for healthcare reform that quickly grabbed my attention. Elizabeth advocated universal healthcare and comprehensive insurance for all Americans, not a “compromised” version based on partisanship and politics. As the years wore on, she discussed her diagnosis of incurable breast cancer with passion stating that she knew that she had access to the best possible care, but empathized with women who were not as fortunate. It is said that behind every successful man lies the power behind the throne, and we k... Better Health blogs http://www.medworm.com/rss/comments.php?id=4241723 Wed, 08 Dec 2010 16:00:14 +0100 4241723 http://www.medworm.com/index.php?rid=4233184&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fhealthcare-reform-law-state-courts-pose-a-threat%2F2010.12.06 Flush from their big win in the midterms, the Boehners are vowing to repeal and replace the Big O’s health reform law. They pose a legitimate threat, but an even larger one lies in the courts, where suits challenging the constitutionality of the law have been popping up like fireflies on a late August night. In Virginia for example, Republican-appointed Federal District Court Judge Henry Hudson has indicated that the Individual Mandate — a key provision of the law that has been challenged in a suit filed in his court by the state’s Republican Attorney General — might not pass his sniff test. Hudson said he’d rule on the matter this month. If he deems the provision to be unconstitutional, he might (it’s unlikely, but he might) enjoin the law altogether until higher courts rule o... Better Health blogs http://www.medworm.com/rss/comments.php?id=4233184 Mon, 06 Dec 2010 19:00:41 +0100 4233184 http://www.medworm.com/index.php?rid=4225661&cid=t_139124_150_f&fid=35777&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FPharmalot%2F%7E3%2FNannBzcrm6Q%2F Health care reform may eventually solve some problems, but the price of medications may not be on the list. Consequently, drug pricing is likely to remain a contentious topic for the forseeable future. Consider that prices may continue to rise, even though drugmakers are required to offer new discounts and pay a new tax, prices may well continue to rise. In the 12-month run-up to passage of The Patient Protection and Affordable Care Act, there was a 9.7 percent average price hike on widely used meds. Then there’s the steep cost of so-called specialty drugs - those bank-account draining biologics. In 1995, just eight cost more than $10,000 annually; now, there are 48. And what is really known about behind-the-scenes rebates? And so the deep thinkers at Deloitte, the consulting firm, a... Pharmalot blogs http://www.medworm.com/rss/comments.php?id=4225661 Thu, 02 Dec 2010 16:49:32 +0100 4225661 http://www.medworm.com/index.php?rid=4214114&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fhealthcare-reform-law-is-gaining-public-support%2F2010.11.29 GOP hardliners soon to be in control of the House have made repeal of the detested healthcare reform law a cornerstone of their agenda, despite the impossibility of actually being able to repeal it, politically, at least until an election or two has passed, and despite the fact that their ascent to power had more to do with the terrible economy and high unemployment than any mandate to repeal the law. It seems that, finally, there may be movement towards increased public support for the law. A new McClatchy poll shows a majority of Americans now in favor of the law: A majority of Americans want the Congress to keep the new health care law or actually expand it, despite Republican claims that they have a mandate from the people to kill it, according to a new McClatchy-Marist poll. The post... Better Health blogs http://www.medworm.com/rss/comments.php?id=4214114 Mon, 29 Nov 2010 15:00:00 +0100 4214114 http://www.medworm.com/index.php?rid=4207287&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fbiotech-and-life-sciences-grant-program-only-a-few-crumbs-to-go-around%2F2010.11.29 After assuming control of the House in the mid-term elections, Republicans vowed to eviscerate the Affordable Care Act, the health reform law signed by the “Big O” last March. Thank heavens, therefore, that the Boehners were too busy congratulating themselves to even notice those federal helicopters dumping $1 billion in cash on some needy biotech companies just as the election results were being tallied. Yep, it happened. Federal disbursements in the form of grants and tax credits were made last week, as required by a provision in the reform law known as the Qualifying Therapeutic Discovery Project Program. According to the terms of this program, biotech and life sciences companies with less than 250 employees could apply for federal funds to cover research costs they had incu... Better Health blogs http://www.medworm.com/rss/comments.php?id=4207287 Mon, 29 Nov 2010 13:00:34 +0100 4207287 http://www.medworm.com/index.php?rid=4207290&cid=t_139124_87_f&fid=39251&url=http%3A%2F%2Fwww.rethinkingpatientsafety.com%2Fmy-blog%2F2010%2F11%2Fis-iatrogenic-injury-inevitable.html Sadly, yet another study shows that many patients are harmed by their medical care, iatrogenic injury. Worse, significant effort over the past decade by leading minds in medicine, state and federal governments, professional medical associations and thousands of advocates have produced little impact. The most recent study indicates that the rate of patient harm produced by medical error remains relatively constant. These findings are consistent with what other studies have been showing in the past decade: little if any measurable progress. It is time to re-think the approach being taken to patient safety. The approach we are using has not worked, is not working, and cannot reasonably be expected to work in the future. In the coming weeks, lessons from successful attempts to reduce injuries ... Rethinking Patient Safety blogs http://www.medworm.com/rss/comments.php?id=4207290 Mon, 29 Nov 2010 00:07:12 +0100 4207290 http://www.medworm.com/index.php?rid=4200561&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhy-we-should-be-thankful-for-the-uninsured%2F2010.11.25 In what has become a tradition over the past few years, DrRich proudly reprises his annual Thanksgiving message to his beloved readers: Gathered around the Thanksgiving table, DrRich’s large extended family, carrying out a longstanding tradition, each offered in their turn one reason for being thankful on this most reflective of American holidays. DrRich listened respectfully as each of his loved ones, and each of the ones he was obligated to tolerate benignly because they had married (or in some other manner had committed to) one of his loved ones, recounted a cause for thanks. There is no need for DrRich to recite their utterances here, because they were all perfectly predictable and fairly mundane, having mostly to do with items such as maintaining good health, finding a job, being ab... Better Health blogs http://www.medworm.com/rss/comments.php?id=4200561 Thu, 25 Nov 2010 16:00:30 +0100 4200561 http://www.medworm.com/index.php?rid=4197065&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-seduction-of-primary-care%2F2010.11.24 Hey there, big, smart, good-looking doctor… Are you tired of being snubbed at all the parties? Are you tired of those mean old specialists having all of the fun? I have something for you, something that will make you smile. Just come to me and see what I have for you. Embrace me and I will take away all of the bad things in your life. I am what you dream about. I am what you want.  I am yours if you want me… Seduce: verb [trans.] attract (someone) to a belief or into a course of action that is inadvisable or foolhardy : they should not be seduced into thinking that their success ruled out the possibility of a relapse. See note at “tempt.” (From the dictionary on my Mac, which I don’t know how to cite.) If you ever go to a professional meeting for doctors, make su... Better Health blogs http://www.medworm.com/rss/comments.php?id=4197065 Wed, 24 Nov 2010 13:00:39 +0100 4197065 http://www.medworm.com/index.php?rid=4190152&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhat-kind-of-physicians-does-the-government-want-to-see%2F2010.11.22 Here’s my [recent] commentary at KevinMD.  Let me know what you think. What kind of physicians DO we want for the future? I was talking with a pre-med student recently. He had completed his very first medical school interview and was, understandably, excited. But he told me the interviewer had asked him what he thought would be the outcome of the current healthcare reform measures. I laughed to myself. After 17 years in practice, even I don’t know the outcome, though I have my suspicions. It seemed a loaded, almost unfair question. After miring students in biology, physics, chemistry and every known application-padding activity, after expecting volunteerism and activism, I’m not sure why they would expect this young man to have any earthly idea about the reform measures from hi... Better Health blogs http://www.medworm.com/rss/comments.php?id=4190152 Mon, 22 Nov 2010 17:00:20 +0100 4190152 http://www.medworm.com/index.php?rid=4190154&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fhealth-reform-compete-and-succeed-or-repeal-or-replace%2F2010.11.22 Senator Scott Brown (R-MA) thinks so. So does Senator Ron Wyden (D-OR). And Senator Bernie Sanders (I-VT). Senators Brown, Wyden and Sanders have introduced the “Empowering States to Innovate Act.” Ezra Klein blogs that the Senators may have found a way forward on health reform. “If a state can think of a plan that covers as many people, with as comprehensive insurance, at as low a cost, without adding to the deficit, the state can get the money the federal government would’ve given it for health-care reform but be freed from the individual mandate, the exchanges, the insurance requirements, the subsidy scheme and pretty much everything else in the bill,” Ezra Klein writes. “If conservative solutions are more efficient, that will be clear when their ben... Better Health blogs http://www.medworm.com/rss/comments.php?id=4190154 Mon, 22 Nov 2010 13:00:00 +0100 4190154 http://www.medworm.com/index.php?rid=4183296&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fhow-bad-the-government-is-at-selling-insurance-or-is-it%2F2010.11.19 Did you know there is actually a “public option” in the health care reform law?  It’s true — it’s called the Pre-Existing Condition Insurance Plan (PCIP), and it’s designed to cover people who who have been unable to get insurance because of a pre-existing condition. To hear the stories about how big of a problem this is in America, you’d think a product like this would be a big hit. Except it’s been a big flop. How big of a flop? Well, according to the Washington Post, they missed their sales targets by 98 percent: Government economists had projected that people turned down by private insurers would flock to the new Pre-Existing Condition Insurance Plan, with 375,000 expected to sign up this year. But as of this week, a little more than 8,000 had enrolled, officials... Better Health blogs http://www.medworm.com/rss/comments.php?id=4183296 Fri, 19 Nov 2010 17:00:49 +0100 4183296 http://www.medworm.com/index.php?rid=4175695&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fprimary-care-poverty-and-mortality-in-england-and-america%2F2010.11.17 It is an article of faith that, in Barbara Starfield’s words, adults whose regular source of care is a primary care physician rather than a specialist have lower mortality, even after accounting for differences in income, and she draws upon studies at both the county and state levels to prove it. Now a new paper in JAMA about England’s Primary Care Trusts refocuses the discussion on poverty. While Starfield’s county-level studies are often cited as evidence that more primary care physicians and fewer specialists lead to lower mortality, they actually showed virtually no differences at all. And when repeated by Ricketts, the small differences noted were not consistent throughout various regions of the U.S. On the other hand, “counties with high income-inequality experienced much hig... Better Health blogs http://www.medworm.com/rss/comments.php?id=4175695 Wed, 17 Nov 2010 17:00:23 +0100 4175695 http://www.medworm.com/index.php?rid=4167956&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fhealthcare-decision-making-and-don-berwicks-leaders-with-plans%2F2010.11.15 From a recent post of the Retired Doc’s Thoughts blog entitled “What Are the Plans Of Don Berwick’s ‘Leaders With Plans?’“: “I wonder which is worse: A medical leader recommending price controls out of ignorance of basic economics or being aware of the likely outcomes and mak[ing] that recommendation anyway?” Wow. I’m speechless. Thanks to Retired Doc for getting this out in a cogent summary. *This blog post was originally published at GruntDoc* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=4167956 Mon, 15 Nov 2010 23:00:55 +0100 4167956 http://www.medworm.com/index.php?rid=4167958&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fhappy-birthday-baby-boomers-one-more-eligible-for-medicare-every-8-seconds%2F2010.11.15 Today begins a lame duck session of Congress before it breaks for Thanksgiving. It’s the final chance to work out a temporary patch to Medicare reimbursement before a 23 percent cut takes effect Dec. 1. Doctors are going to stop taking new Medicare patients if the cuts happen. And, as one breast cancer surgeon explains, if Medicare stops paying, so to private insurers and even military health programs. Congress will meet in December, but the damage will be done. This all is happening two weeks before the baby boomers become eligible for Medicare. That populous generation starts to turn 65 beginning on Jan. 1, which means they become eligible for Medicare on Dec. 1, which, as we mentioned, is the day the 23 percent Medicare pay cut kicks in. Boomers will continue to become eligible ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4167958 Mon, 15 Nov 2010 19:00:00 +0100 4167958 http://www.medworm.com/index.php?rid=4167960&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fmedical-malpractice-reform-would-doctors-accept-the-deal%2F2010.11.15 The bipartisan debt commission appointed by President Obama recently released its recommendations on how to pare the country’s debt. Of interest to doctors is the suggestion to change the way doctors are paid. Physician lobbies have been advocating for removal of the Sustainable Growth Rate (SGR) formula — the flawed method by which Medicare, and subsequently private insurers, pays doctors. According to this method, physicians are due for a pay cut of more than 20 percent next month. According to the commission: The plan proposes eliminating the SGR in 2015 and replacing it with a “modest reduction” for physicians and other providers. The plan doesn’t elaborate on what constitutes a “modest reduction” in Medicare reimbursement. Meanwhile, the Centers for Medicare and Medicai... Better Health blogs http://www.medworm.com/rss/comments.php?id=4167960 Mon, 15 Nov 2010 15:00:26 +0100 4167960 http://www.medworm.com/index.php?rid=4151796&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-end-of-private-practice%2F2010.11.08 I didn’t need the Wall Street Journal to tell that the days of “private practice” are numbered. According to recent numbers, fewer and fewer medical practices are under the ownership of physicians. Even in my corner of the economically secure State of Texas, small practices are folding faster than beach chairs at high tide. I was driven out of private practice in 2004 by rising malpractice premiums and plummeting reimbursement. In Texas at the time the trial attorneys ran the place and medmal insurance carriers simply couldn’t keep up with the greed. Medical practices are just too expensive to run and the services that physicians provide are dangerously undervalued. You do the math. Sure it’s a complicated issue. But the end result is institutionally-employed doctors with inst... Better Health blogs http://www.medworm.com/rss/comments.php?id=4151796 Mon, 08 Nov 2010 23:00:01 +0100 4151796 http://www.medworm.com/index.php?rid=4139237&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fhealthcare-reform-and-a-divided-congress%2F2010.11.05 Republicans who had opposed healthcare reform before the election are now elected officials with a say in how the programs are funded. At federal and state levels, the program’s opponents either have a larger voice or are now in charge of implementing elements of reform. Sen. Majority Leader Harry Reid said he’d consider adjustments to healthcare reform. Frightened seniors flipped toward opposition to healthcare reform, while flipping on the issue may have saved a few Democrats. Exit polling showed 48 percent would repeal healthcare reform, 16 percent would leave it as is, and 31 percent would expand it. Now that Republicans have a larger say in the matter, take a look at their plan for healthcare in A Pledge to America, starting on page 25, and decide for yourself. (New Yor... Better Health blogs http://www.medworm.com/rss/comments.php?id=4139237 Fri, 05 Nov 2010 14:00:00 +0100 4139237 http://www.medworm.com/index.php?rid=4121849&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fnotes-from-the-connected-health-symposium-2010%2F2010.10.31 I [recently] attended the Connected Health Symposium in Boston. I enjoyed many of the sessions (sometimes wished I could have attended two simultaneously, though the livetweeting — #chs10 — helped on that front), and as usual enjoyed the hallway and exhibit floor conversations too. As is often the case at conferences these days, I had the opportunity to meet several online connections in real life for the first time.  (I will not attempt to give a comprehensive report of the symposium here. Please see the livetweeting archive and other reports to get a sense of the rest of the event.) This year’s exhibit floor included a diverse mix of distance health tools. Most striking from my perspective was the fact that most of these tools do one of two things: Enable patient-cli... Better Health blogs http://www.medworm.com/rss/comments.php?id=4121849 Sun, 31 Oct 2010 22:00:01 +0100 4121849 http://www.medworm.com/index.php?rid=4118933&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fphysician-referrals-be-daring-and-ask-for-a-special-order%2F2010.10.28 As a specialist, one of the saddest truisms about practicing medicine in the private world has always been how little one’s clinical skills determines referrals. Unfortunately, as our present healthcare climate pushes “providers” to consolidate along the lines of major hospital networks this injustice will only worsen. A decade or so ago when I started private practice it was obvious that referrals came to me because of my association with an established group. This association was essential, as one could have been the next Michael Jordan of electrophysiology, but referrals would still have gone along historic lines, to the favored group. It would have taken a Herculean effort, over years, to encroach upon such long-established referral patterns, etched over the bonds of ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4118933 Thu, 28 Oct 2010 20:00:00 +0100 4118933 http://www.medworm.com/index.php?rid=4118937&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fprimary-care-doctors-how-valued-are-they%2F2010.10.27 Authors of a recent study from the Archives of Internal Medicine are unlikely to endear themselves to specialists. As reported by Reuters, and provocatively titled, Do specialist doctors make too much money?, the study gives a per-hour breakdown of how much doctors make. I think this is a good approach, since annual salary figures do not account for the number of hours doctors work — and in the case of primary care doctors, this includes uncompensated time doing paperwork and other bureaucratic chores. Here’s what they found: … the lowest wages — amounting to $60.48 an hour — [were] paid to primary care physicians. In other broad categories of practice, surgeons took home the highest average hourly wage of $92. Internal medicine and pediatric docs earned about $85 an hour, the re... Better Health blogs http://www.medworm.com/rss/comments.php?id=4118937 Wed, 27 Oct 2010 22:00:56 +0100 4118937 http://www.medworm.com/index.php?rid=4105669&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-new-healthcare-law-so-sad-its-funny%2F2010.10.25 Thanks to Scott Hensley over at Shots, NPR’s Health Blog, for highlighting this sad but funny video on where we’re going with healthcare. Scary what happens when theory meets reality: -WesMusings of a cardiologist and cardiac electrophysiologist. *This blog post was originally published at Dr. Wes* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=4105669 Mon, 25 Oct 2010 13:00:00 +0100 4105669 http://www.medworm.com/index.php?rid=4097936&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fdoctors-hospitals-and-the-yankees%2F2010.10.23 Joe Boyd hated the Yankees. “Those damn Yankees. Why can’t we beat ‘em?” Then he got the opportunity to save his beloved Washington Senators by making a deal with the devil — giving up his soul in exchange for being transformed into “Shoeless Joe” to propel his team to win the World Series. Interesting. I think a lot of doctors are making their deal with the devil. They are looking for a small gain in comparison to a long-term of misery. True — Joe Boyd made out in the end, but that will only happen if someone from Hollywood writes our script. Here’s the problem: At the core of our problems with healthcare is the total lack of cohesive communication. Doctors have no idea what other doctors have done with a patient. Tests get ordered, medications get changed, proc... Better Health blogs http://www.medworm.com/rss/comments.php?id=4097936 Sat, 23 Oct 2010 16:00:04 +0100 4097936 http://www.medworm.com/index.php?rid=4098490&cid=t_139124_158_f&fid=38949&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FAgingWithGraceCareconnection%2F%7E3%2FiV-twYF3u98%2Fi-actually-took-9-hours-to-read.html By Martha B. Boone, MDThe following is a letter written by Dr. Martha Boone to her patients. Very enlightening...Dear Wonderful Patients,This is about the healthcare reform bill.90% of my patients ask me what I think. 10% prefer to get their information from the media. If you want to know what has actually happened to me, my family, and some of my patients, please...read on.If you prefer to form your opinions without the input of your doctor, feel free to delete this now. There is MUCH “theory” out there about what the healthcare bill will and won’t do for Americans.I actually took the nine hours required to read it. I am VERY, VERY, worried about its content and what it will potentially do to American healthcare. Let’s talk about what has actually come to pass, so far- Read full ... Aging with Grace CareConnection blogs http://www.medworm.com/rss/comments.php?id=4098490 Sat, 23 Oct 2010 15:22:00 +0100 4098490 http://www.medworm.com/index.php?rid=4086268&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fpreventive-healthmedicinecare-lets-give-it-a-name%2F2010.10.20 It’s a scene that plays out thousands of times every day in doctors’ offices across the country — the moment the doctor shifts from addressing the concerns that brought the patient into clinic to when he or she attempts to make sure everything else is going okay. Often this happens at the end of a sick visit, after working up an upper respiratory infection or back pain. Sometimes it happens after following up a chronic medical problem such as high blood pressure or arthritis, and occasionally it happens under ideal circumstances, during an annual physical or routine wellness visit. It doesn’t necessarily happen at the end of the visit. Often it sneaks it’s way into various points in the encounter — as when the doctor places his or her stethoscope over a patient’s che... Better Health blogs http://www.medworm.com/rss/comments.php?id=4086268 Wed, 20 Oct 2010 18:00:58 +0100 4086268 http://www.medworm.com/index.php?rid=4086269&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fmedical-ethics-and-the-amish-bus-driver-rule%2F2010.10.20 Rachel Maddow, in a discussion related to the provision of abortion services, once proposed that we (society) should invoke the Amish Bus Driver Rule (ABDR) whenever medical professionals invoke their personal convictions in refusing to provide legal medical services. The ABDR goes like this: If you’re Amish, and therefore have religious convictions against internal combustion engines, then you have disqualified yourself for employment as a bus driver. (Presumably Ms. Maddow would not apply the ABDR to everyone, since it would disqualify, for instance, Al Gore from utilizing horseless carriages and other fossil-fueled contrivances.) The ABDR would do far more than merely render it okay for doctors to perform abortions and other ethically controversial (but legal) medical services. The... Better Health blogs http://www.medworm.com/rss/comments.php?id=4086269 Wed, 20 Oct 2010 16:00:58 +0100 4086269 http://www.medworm.com/index.php?rid=4077245&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fmedicare-should-it-pay-less-for-less-effective-care%2F2010.10.18 From its inception, Medicare has been agnostic about the effectiveness of different treatments when it sets payment rates. Once a treatment is found to be “reasonable and necessary,” Medicare establishes a payment rate that takes into account complexity and other “inputs” that go into delivering the service. But it is prohibited by law from varying payments based on how well an intervention works. This would change under a “dynamic pricing” approach proposed by two experts in this month’s issue of Health Affairs. The article itself is available only to Health Affairs subscribers, but the Wall Street Journal health blog has a good summary. The researchers propose that Medicare pay more for therapies with “superior” results and the same f... Better Health blogs http://www.medworm.com/rss/comments.php?id=4077245 Mon, 18 Oct 2010 13:00:00 +0100 4077245 http://www.medworm.com/index.php?rid=4060590&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhy-is-healthcare-reform-so-complicated%2F2010.10.12 A common question that I get as a practicing physician with a public health background is: “Why is healthcare reform so complicated?” I feel that the question of who’s responsible for healthcare payment is not always an easy one to answer. An example from my most recent weekend on call covering an academic pediatric endocrinology practice demonstrates this point: “Bill” is a 16-year-old African American male on state Medicaid insurance with type 1 diabetes since the age of 10.  He is followed regularly every three months by another colleague in the endocrinology clinic. Review of his last several clinic notes on the electronic medical record reveal that he has been in moderate control of his diabetes on NPH/Novolog twice-daily insulin regimen. Approximately one... Better Health blogs http://www.medworm.com/rss/comments.php?id=4060590 Tue, 12 Oct 2010 15:42:07 +0100 4060590 http://www.medworm.com/index.php?rid=4060593&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fu-s-healthcare-spending-why-so-much%2F2010.10.11 Aaron Carroll over at The Incidental Economist has been running an excellent series on healthcare spending in the U.S. and how much more we spend than the rest of the world on a per capita basis, as a percentage of GDP, and by category. It’s an excellent series and I wholly recommend it. Summary graph: Hint: the U.S. is the lavender-ish line on top. As he says, is there anything about this graph that isn’t concerning? (more…) *This blog post was originally published at Movin' Meat* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=4060593 Mon, 11 Oct 2010 20:00:00 +0100 4060593 http://www.medworm.com/index.php?rid=4040566&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fhealthcare-and-fred-flintstone%2F2010.10.06 Like most kids who grew up in the 1960s, I spent many a night watching the adventures of Fred, Wilma, Barney and Betty, the coolest cavemen ever (sorry, GEICO). It is hard to explain the appeal of the Flintstones, which [recently] celebrated the 50th anniversary of its first broadcast. Its animation was primitive, the stories campy and cliché, and it was horribly sexist — but the characters were lovable, the dialogue funny, and who couldn’t love the way it depicted “modern conveniences” (like washing machines) using only stone-age technologies (bones, stones and dino-power?) What does Fred Flintstone have to do with healthcare? Not much, really, although Fred was the victim of a medical error. According to Answers.com: “A 1966 episode had Fred can’t st... Better Health blogs http://www.medworm.com/rss/comments.php?id=4040566 Thu, 07 Oct 2010 01:00:00 +0100 4040566 http://www.medworm.com/index.php?rid=4036650&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fshould-doctors-work-weekends%2F2010.10.05 Peter Orszag wants doctors to work weekends. The former director of the White House Office of Management and Budget wrote as much in this past weekend’s New York Times: Doctors, like most people, don’t love to work weekends, and they probably don’t enjoy being evaluated against their peers. But their industry can no longer afford to protect them from the inevitable. Imagine a drugstore open only five days a week, or a television network that didn’t measure its ratings. Improving the quality of health care and reducing its cost will require that doctors make many changes — but working weekends and consenting to quality management are two clear ones. And he’s right, to a point. I’ve pointed to studies showing that mortality rises on the weekends, in part due to skeleton staffs ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4036650 Tue, 05 Oct 2010 18:00:02 +0100 4036650 http://www.medworm.com/index.php?rid=4031245&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fhealth-care-reform-plain-and-simple%2F2010.10.04 The Kaiser Family Foundation has produced an informative and entertaining short animated movie that explains the problems with the current health care system, the changes that are happening now, and the big changes coming in 2014. Narrated by newscaster Cokie Roberts (a member of Kaiser’s Board of Trustees), the nine-minute animation explains plainly how health care hadn’t worked in the past, addresses the controversies surrounding its passage, and outlines what will happen in the near future and in 2014. *This blog post was originally published at ACP Internist* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=4031245 Mon, 04 Oct 2010 13:00:00 +0100 4031245 http://www.medworm.com/index.php?rid=4027158&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-ppaca-does-it-pass-the-playground-test%2F2010.10.03 Could understanding the tacit rules which govern play on a neighborhood playground help us explain why some aspects of implementing healthcare reform are unlikely to succeed? Recent news involving McDonald’s Corporation suggests so. On the playground, there are some simple precepts — like the fact that older and stronger kids get to make up the game, and the rules. That’s understood and mostly okay. As if these leaders are considered modestly benevolent and the rules are workable, the game is good and all benefit. And all players on the playground know this basic tenet of fairness: That the rules of the game shouldn’t change in the midst of the competition, and, taking it one step further, if the rules have to be changed they weren’t very good in the first pla... Better Health blogs http://www.medworm.com/rss/comments.php?id=4027158 Sun, 03 Oct 2010 19:00:00 +0100 4027158 http://www.medworm.com/index.php?rid=4027159&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fmedicare-reimbursement-a-23-percent-cut-soon-to-come%2F2010.10.03   “It will never happen.” “They know better than to do it.” “They realize the disaster it would be if they let it pass.” That’s what I hear. I hear that the upcoming SGR adjustment, the one that will cut Medicare reimbursement by 23 percent, won’t go through. In case you missed it, the SGR is a formula coming from the Balanced Budget Act of 1997 that does automatic cuts to Medicare reimbursement. This year we witnessed a legislative game of chicken in congress, with both sides agreeing that it was a bad idea to screw physicians in a time that they are trying to fix healthcare. (more…) *This blog post was originally published at Musings of a Distractible Mind* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=4027159 Sun, 03 Oct 2010 16:00:13 +0100 4027159 http://www.medworm.com/index.php?rid=4018184&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fnew-self-referral-disclosure-protocol-now-in-effect%2F2010.09.28 The Office of Inspector General (OIG) of the U.S. Department of Health and Human Services scrapped its old self-referral voluntary disclosure program in 2009 (it dated back to 1998, and was revisited in 2008), and the Patient Protection and Affordable Care Act (PPACA) mandated that it be replaced. Just like clockwork, on the deadline for its promulgation the OIG obliged, and the new Self-Referral Disclosure Protocol is now posted and effective. The new protocol could be clearer and offer more comfort, but it doesn’t. Makes one pine for the old policy’s clarity: In the old days, voluntary disclosure bought you a discounted fine for Stark violations — not like the new protocol’s wishy-washy, maybe-we’ll-give-you-a-discount language. The new protocol also fa... Better Health blogs http://www.medworm.com/rss/comments.php?id=4018184 Tue, 28 Sep 2010 20:00:00 +0100 4018184 http://www.medworm.com/index.php?rid=4003255&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-medicare-reform-act-smoke-and-mirrors-for-patients-and-physicians%2F2010.09.27 An interesting debate occurred in the Washington Post between Michael Leavitt, former secretary of Health and Human Services and a member of the Medicare Board of Trustees from 2005 to 2009, and Dr. Don Berwick, the director of CMS. Michael Leavitt wrote a scathing article criticizing President Obama’s Medicare Reform Act calling it an illusion. Don Berwick wrote a rebuttal to Michael Leavitt’s article. Michael Leavitt starts off his article by stating: “Despite the report from Medicare’s trustees this month that the hospital insurance trust fund will not be depleted until 2029, 12 years later than was predicted just last year, Medicare is no better off than it was a year ago. “ The Medicare Trustees Report was strange. Nothing was done to change anything and all of a sudden,... Better Health blogs http://www.medworm.com/rss/comments.php?id=4003255 Mon, 27 Sep 2010 19:00:29 +0100 4003255 http://www.medworm.com/index.php?rid=4002884&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fhealth-care-not-health-performance%2F2010.09.26 The “empowered patient” movement (which I think is a good thing) strives to take the doctor out of the center of care and put the patient at its focus. The role of doctor is not to be the star of the show, the quarterback, the superhero, but the advocate and helper for the patient to accomplish their goal: Health. Many rightly attack doctor prima donnas who want the exam/operating room to be about them instead of the patient. This is health care, not health performance. They want doctors who care more about the people they treat than they do about money, praise, or status. I get it. I get the message that doctors have to adjust to this new age of patient empowerment and patient-centeredness. I get the fact that making patients wait is a bad thing, and that communication is as essentia... Better Health blogs http://www.medworm.com/rss/comments.php?id=4002884 Sun, 26 Sep 2010 15:00:36 +0100 4002884 http://www.medworm.com/index.php?rid=3998984&cid=t_139124_87_f&fid=39182&url=http%3A%2F%2Fcovertrationingblog.com%2Fhealthcare-reform%2Fthe-inevitability-of-bias-in-clinical-research DrRich has said many times that clinical science is among the least exact of the sciences, and therefore, the results of clinical research are particularly susceptible to “spinning” by various interested parties, in order to yield the kind of results they would prefer to see. Until recent times in American medicine, the parties who have been most interested in spinning clinical research have been the people who run drug companies and medical device companies (who need clinical research which supports the use of their products), and the medical specialists (who are more likely to be paid for performing medical procedures that are supported by clinical research). In writing about such data-spinning abuses, DrRich has particularly targeted his own Cardiology Guild, but only becaus... The Covert Rationing Blog blogs http://www.medworm.com/rss/comments.php?id=3998984 Thu, 23 Sep 2010 22:47:16 +0100 3998984 http://www.medworm.com/index.php?rid=3969011&cid=t_139124_87_f&fid=39182&url=http%3A%2F%2Fcovertrationingblog.com%2Fpodpress_trac%2Ffeed%2F947%2F0%2FGODpanelists.mp3 Podcast: In quainter times, medical “guidelines” merely meant a set of general principles which doctors ought to keep in mind when deciding on the most appropriate medical care for their patients. But in recent years guidelines have come to represent reasonably firm expectations for medical practitioners. And doctors who fail to closely follow guidelines may not be looked upon favorably any more by insurance companies or Medicare. Obviously, then, since the guidelines finally determine who gets what, when and how, controlling the guidelines (i.e., making sure the guidelines say what you want them to say) has become important to any interest group within the healthcare system. And nobody understands the critical importance of guidelines better than cardiologists, a group of whi... The Covert Rationing Blog blogs http://www.medworm.com/rss/comments.php?id=3969011 Tue, 14 Sep 2010 12:50:55 +0100 3969011 http://www.medworm.com/index.php?rid=3965414&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fmedical-insurance-pre-authorization-services-for-free%2F2010.09.13 The Office of Inspector General (OIG) of the U.S. Department of Health and Human Services released an advisory opinion at the end of last month okaying a hospital’s proposal to provide insurance pre-authorization services free of charge to patients and physicians. This is an issue that has long vexed folks in the imaging world. Clearly, this is a free service provided to referral sources (to the extent they are obligated by contract with third-party payors to obtain the pre-authorization before referring a patient for an MRI, for example), so why is the OIG okay with it? In their opinion, the OIG blesses the arrangement for four reasons. (more…) *This blog post was originally published at HealthBlawg :: David Harlow's Health Care Law Blog* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3965414 Mon, 13 Sep 2010 14:00:13 +0100 3965414 http://www.medworm.com/index.php?rid=3959928&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Femergency-rooms-overused-for-routine-care%2F2010.09.11 The Patient Protection and Affordable Care Act (our government’s name for healthcare reform) may make our already crowded emergency rooms swarm with more patients. A new study from Health Affairs shows that more than a quarter of patients who currently visit emergency departments in the U.S. are there for routine care and not an emergency. New complaints like stomach pain, skin rashes, fever, chest pain, cough or for a flare up of a chronic condition should not be treated in emergency rooms. They are best worked up and treated by an internist or family physician, preferably one who knows the patient. So why are these patients waiting for hours and spending up to 10 times as much money for emergency department care? (more…) *This blog post was originally published at E... Better Health blogs http://www.medworm.com/rss/comments.php?id=3959928 Sat, 11 Sep 2010 15:00:00 +0100 3959928 http://www.medworm.com/index.php?rid=3965519&cid=t_139124_113_f&fid=34634&url=http%3A%2F%2Fwww.emrandhipaa.com%2Femr-and-hipaa%2F2010%2F09%2F10%2Femr-conference-thoughts%2F I’ve been really enjoying the EMR conference yesterday and look forward to it again today. I’m a bit tired from it all, but the people at the conference have been great. It’s pretty small in numbers, but I’ve enjoyed the small intimate crowd and the smart people I’ve met. I’ve been talking to a lot of people who’ve asked if I’m going to various conferences. I’d like to go to more, but I must admit that it’s quite an expensive (financially and time) to go to a conference. I am planning to make the trek out to HIMSS 11 in Orlando and I posted the first HIMSS 11 keynote speakers on EMR and EHR. I’ve got at least a dozen new blog topics from this conference that I’ll be posting soon. So, look forward to some good stuff ove... EMR and HIPAA blogs http://www.medworm.com/rss/comments.php?id=3965519 Fri, 10 Sep 2010 07:00:30 +0100 3965519 http://www.medworm.com/index.php?rid=3954260&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fdoes-defensive-medicine-cost-less-than-doctors-think%2F2010.09.09 Nothing polarizes the heath care debate more than defensive medicine. A recent study from Health Affairs will only add more fuel to the fire. Here’s what I wrote a couple of years ago in USA Today: “When you consider that rampant testing is a major driver of escalating health care dollars, addressing defensive medicine should be a primary goal of cost containment.” Is that still true? Well, yes and no. (more…) *This blog post was originally published at KevinMD.com* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3954260 Thu, 09 Sep 2010 16:00:28 +0100 3954260 http://www.medworm.com/index.php?rid=3942789&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fabout-concierge-or-boutique-medicine%2F2010.09.07 A recent piece in The New York Times wondered if the few patients who can afford to pay for additional attention and access to their primary care doctors in a concierge medicine or boutique medicine practice might be ethical since the extra dollars are used to support the traditional primary care practice that the vast majority of patients currently receive.  Questions you might ask are: - What is a concierge medicine or boutique medicine practice? - Is it worth the money? - Is the care better quality? - Is it possible to get similar access and care by doctors not in a concierge or boutique medicine practice? When you think of a concierge, you think about a fancy hotel staff person who answers questions and speaks various languages, books reservations to restaurants, events, and tours (ev... Better Health blogs http://www.medworm.com/rss/comments.php?id=3942789 Tue, 07 Sep 2010 20:00:00 +0100 3942789 http://www.medworm.com/index.php?rid=3933086&cid=t_139124_87_f&fid=39182&url=http%3A%2F%2Fcovertrationingblog.com%2Fpodpress_trac%2Ffeed%2F922%2F0%2Fwearetheborg.mp3 Podcast: In a remarkable article that somehow* was accepted for publication in the Annals of Internal Medicine, the White House offered some friendly advice to American PCPs who may be wondering how Obamacare will affect them. That advice, to summarize, is: “We are the Borg. Prepare to be assimilated.” ______ * DrRich is forced to wonder whether yet another group of medical editors is auditioning for the death panels. ______ The article was written by Ezekiel Emmanuel from the White House’s Office of Management and Budget, and Nancy-Ann M. De Parle, who is Mr. Obama’s Czar of Healthcare Reform. (A third author was from the McKinsey Group.) After reminding physicians of their moral obligation to the collective, the White House authors rhapsodized about all of the wo... The Covert Rationing Blog blogs http://www.medworm.com/rss/comments.php?id=3933086 Fri, 03 Sep 2010 14:33:08 +0100 3933086 http://www.medworm.com/index.php?rid=3929235&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fpatient-bill-of-rights-what-ever-happened-to-it%2F2010.09.02 One of the more surprising twists and turns in the continuing debate over healthcare reform is that many physicians who now object to the Affordable Care Act (ACA) were just a few years back advocates for more federal regulation. In fact, in the early 2000s, more than 200 “provider” and consumer groups — including many state medical and national medical specialty societies that now oppose the ACA because of concerns about “excessive regulation” — were among the fiercest champions of federal legislation to mandate that health insurers comply with a Patient Bill of Rights. A bipartisan bill introduced by Senator John McCain (R-AZ) and the late Senator Ted Kennedy (D-MA) would have ensured that patients have the “right” to appeal insurance compa... Better Health blogs http://www.medworm.com/rss/comments.php?id=3929235 Thu, 02 Sep 2010 11:00:00 +0100 3929235 http://www.medworm.com/index.php?rid=3924904&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fprimary-care-crisis-why-the-patient-centered-medical-home-will-fail%2F2010.09.01 Everyone understands the need for a robust primary care workforce in making healthcare more affordable and accessible while keeping those in our care healthy. With the aging of America and healthcare reform, even more Americans will need primary care doctors at precisely the same time doctors are leaving the specialty in droves and medical students shun the career choice. As a practicing primary care doctor, I’ve watched with great interest the solutions for the primary care crisis. And I’ve been utterly disappointed. Patients so far don’t like the patient-centered medical home (PCMH) as noted in Dr. Pauline Chen’s New York Times column. The changes recommended won’t inspire the next generation of doctors to become internists and family doctors. (more…)... Better Health blogs http://www.medworm.com/rss/comments.php?id=3924904 Wed, 01 Sep 2010 18:00:00 +0100 3924904 http://www.medworm.com/index.php?rid=3924907&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fpracticing-primary-care-a-lesson-in-treading-water%2F2010.09.01 As a primary care physician, I am becoming painfully aware of how hard it is to be good –- I mean really good — at what we do today. I would prefer to believe that it has always been so, yet I do not believe that our predecessors in the medical profession found it nearly as difficult to excel in their time as we do now. With all of the technological and medical advances, you might ask how I could believe this to be true. Too, you might consider it pessimistic or even crazy to suggest that physicians 20, 30, or 100 years ago found it easier to practice medicine well in their time. You could counter with numerous or obvious examples such as antibiotics, pharmaceuticals, robotic surgical procedures, or even our wondrous ability to peer inside the human body without cutting it open.�... Better Health blogs http://www.medworm.com/rss/comments.php?id=3924907 Wed, 01 Sep 2010 12:00:43 +0100 3924907 http://www.medworm.com/index.php?rid=3902898&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fus-pharmaceutical-sales-the-top-10-list%2F2010.08.25 The top moneymakers for the U.S. pharmaceutical industry might surprise you. These aren’t necessarily the most prescribed medications (although some of them are), but they’re the top products in terms of sales in 2009. The revenues were in billions: 1. Lipitor - used for high cholesterol: $7.5 billion 2. Nexium - a proton pump inhibitor for GERD: $6.3 billion 3. Plavix - a blood thinner: $5.6 billion 4. Advair Diskus - used for asthma and COPD: $4.7 billion (more…) *This blog post was originally published at EverythingHealth* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3902898 Wed, 25 Aug 2010 20:00:00 +0100 3902898 http://www.medworm.com/index.php?rid=3889030&cid=t_139124_83_f&fid=34856&url=http%3A%2F%2Finsidesurgery.com%2F2010%2F08%2Fcolleges-dodge-healthcare-insurance-rules%2F A consortium of colleges are maintaining that they do not have to comply with the regulations in the Obama healthcare reform law because to do so would functionally prohibit them from being to offer the limited, low-limits packages at all. (Source: Inside Surgery) Inside Surgery blogs http://www.medworm.com/rss/comments.php?id=3889030 Sat, 21 Aug 2010 02:05:09 +0100 3889030 http://www.medworm.com/index.php?rid=3885318&cid=t_139124_87_f&fid=36050&url=http%3A%2F%2Fblisstree.com%2Flive%2F196091%2F Get Your Wallet Out: In 2011, employees may have to pay more for their healthcare expenses while large businesses make changes to conform with the healthcare reform law. (via MedPage Today) Post from: BlissTree (Source: Breastfeeding 1-2-3) Breastfeeding 1-2-3 blogs http://www.medworm.com/rss/comments.php?id=3885318 Thu, 19 Aug 2010 19:27:27 +0100 3885318 http://www.medworm.com/index.php?rid=3858153&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Ffixing-up-primary-care-is-anyone-home%2F2010.08.11 By John Henning Schumann, M.D. The Patient Protection and Affordable Care Act (aka “Health Care Reform”) signed by President Obama in March will revolutionize primary care in the United States. By 2014 tens of millions of uninsured people will “enter” the system by being granted insurance, either through expansion of the Medicaid program or through mandated purchasing of insurance via state pools or the private market. This alone will have a profound impact, straining the capacity of our already frayed system. Therefore, embedded in the law are funds to encourage growth and improvement in primary care: Incentives to encourage graduates to enter primary care fields (family medicine, internal medicine, and pediatrics) and practice in underserved areas (through scholar... Better Health blogs http://www.medworm.com/rss/comments.php?id=3858153 Thu, 12 Aug 2010 01:00:00 +0100 3858153 http://www.medworm.com/index.php?rid=3858154&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Freducing-hospital-bouncebacks-how%2F2010.08.11 In their most recent piece at Slate, emergency physicians Zachary F. Meisel and Jesse M. Pines tackle the issue of bouncebacks — that is, the re-admission of recently-discharged hospitalized patients. They bring up good some good points, and point out that until recently hospitals really didn’t have any incentive to reduce bouncebacks: …hospitals have never had a compelling reason to try to prevent bouncebacks. Hospitals are typically paid a flat sum for each inpatient stay — shorter stays equal higher profits. When patients bounce back, hospitals can charge the insurance company twice for the same patient with the same problem. Many hospitals also view bouncebacks as out of their control: If a patient boomerangs back because she doesn’t follow doctor’s orders, it’s not t... Better Health blogs http://www.medworm.com/rss/comments.php?id=3858154 Wed, 11 Aug 2010 22:00:33 +0100 3858154 http://www.medworm.com/index.php?rid=3848869&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fcovertrationingblog.com%2Fpodpress_trac%2Ffeed%2F809%2F0%2Fsaveobamacareimplications.mp3 Why Big Health Insurance Supported Obamacare, Part IV In the past few posts (in particular, here and here), DrRich has shown why the health insurance industry embraced Obamacare, and indeed, took extraordinary steps to assure that Obamacare became the law of the land. This, of course, is especially interesting in light of the common perception that Obamacare constitutes a major defeat for the greedy health insurance industry. But the fact that big health insurance gave critical support to Obamacare is far more than merely interesting. It has major implications both to supporters of Obamacare, especially the ones who hope for an eventual single-payer outcome, and to opponents of Obamacare, many of whom hope to repeal it after the 2010 mid-term elections. For the health insurance industry to... Better Health blogs http://www.medworm.com/rss/comments.php?id=3848869 Mon, 09 Aug 2010 20:00:46 +0100 3848869 http://www.medworm.com/index.php?rid=3848870&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fhealthcare-reform-will-keep-medicare-afloat%2F2010.08.09 One of the more effective criticisms of the health reform law (Affordable Care Act, or ACA) is that it hurts Medicare. It also is wrong. Effective, in that it has been widely reported that seniors are more likely to express negative views of the ACA than other age groups. (Although the Kaiser Family Foundation’s Drew Altman, citing the group’s most recent tracking polls, writes that seniors’ opposition to health reform “is at least somewhat over played.”) Effective, but wrong: The ACA actually helps Medicare in three important ways. (more…) *This blog post was originally published at The ACP Advocate Blog by Bob Doherty* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3848870 Mon, 09 Aug 2010 18:00:00 +0100 3848870 http://www.medworm.com/index.php?rid=3848872&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Ffair-pay-and-unfunded-mandates%2F2010.08.09 This is my column in [the August 3rd] Atlanta Journal Constitution: Secretary of Labor Hilda Solis recently produced an interesting public service announcement. In it, she stated that every worker deserves to be paid fairly for his or her labor (whether the worker is documented or not), and offered both a website and telephone hot-line which workers could use to report unfair payment by employers. (Incidentally, here’s the link: www.dol.gov/wecanhelp.) In the video, she stated succinctly, “You work hard, and you deserve to be paid fairly.” Those of us who practice medicine completely agree. So we might reasonably ask if this announcement also applies to physicians who are undercompensated for their work. This routinely happens when patients are covered by Medicare and Medic... Better Health blogs http://www.medworm.com/rss/comments.php?id=3848872 Mon, 09 Aug 2010 14:00:42 +0100 3848872 http://www.medworm.com/index.php?rid=3822921&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhy-patients-are-wary-of-the-primary-care-medical-home%2F2010.08.04 Say the words, “Patient-centered medical home,” and you’re bound to get a variety of opinions. On this blog alone, there are a variety of guest pieces critical of the effort, saying it does not increase patient satisfaction, nor does it save money. And that’s not good news for its advocates, who are pinning primary care’s last hopes on the model. Medical homes hit the mainstream media recently, with Pauline Chen focusing one of her recent, weekly New York Times columns to the issue. She discussed the results of a demonstration project, showing some positive results. (more…) *This blog post was originally published at KevinMD.com* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3822921 Wed, 04 Aug 2010 14:00:17 +0100 3822921 http://www.medworm.com/index.php?rid=3812975&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fdoes-healthcare-reform-involve-research-on-human-subjects%2F2010.08.02 Every time an experiment on human subjects in proposed in our hospital (or any hospital in the United States for that matter), there is an exquisitely sensitive tuning fork that exists to protect human subjects: the investigational review board or “IRB.” Any researcher who has ever brought a research proposal before an IRB knows that any hint of potential harm to a human subject that exists in a research project will kill the proposal faster than you can say “boo.” An IRB submission is required for all research projects using human subjects in accordance with the Federal Policy for the Protection of Human Rights 45 CFR 46, the Food and Drug Administration (FDA) regulations 21 CFR 50, 56 , and with the Federalwide Assurance granted by the H.H.S. Office of Human Resea... Better Health blogs http://www.medworm.com/rss/comments.php?id=3812975 Mon, 02 Aug 2010 22:00:00 +0100 3812975 http://www.medworm.com/index.php?rid=3808666&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Flife-insurance-companies-and-cancer-survivors%2F2010.08.01 I have always heard that Northwestern Mutual Life (“The Quiet Company”) was a grade-A company. And for years I have been happy to have a disability insurance policy and a term life one with them. I got those policies back in the early 1990s, and it was a good thing I did. In 1996 my health changed. I was diagnosed with leukemia. I knew I was very lucky to have insurance in place because, as many told me: “You’ll never get insurance now.” Now fast-forward 14 years, and 10 years after receiving treatment in a phase II clinical trial. I have no evidence of disease and have not had any evidence for nine years. The drug therapy I received in a trial has now been approved by the FDA and in Europe as the standard of care. People are living well with this leukemia and it is extending li... Better Health blogs http://www.medworm.com/rss/comments.php?id=3808666 Sun, 01 Aug 2010 16:00:44 +0100 3808666 http://www.medworm.com/index.php?rid=3790705&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fteam-care-in-the-patient-centered-medical-home%2F2010.07.26 “Team care” has become a rallying cry for those who think the patient-centered medical home is bad for healthcare reform. Comments on a recent blog post in the New York Times provide a good example of this. When patients get sick, as the argument goes, they want to see their doctor — not some nurse or PA who they don’t know. I agree. There are a whole bunch of things wrong with all the current focus on team care in the patient-centered medical home. (more…) *This blog post was originally published at Mind The Gap* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3790705 Mon, 26 Jul 2010 14:00:24 +0100 3790705 http://www.medworm.com/index.php?rid=3767074&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fgovernment-decisions-about-avandia-and-preventive-services%2F2010.07.19 An FDA advisory panel has voted that the diabetes drug Avandia (rosiglitazone) can remain on the market, but recommended further warnings associated with its use. The panel was divided, the New York Times reported, with 12 of 33 members saying the drug should be removed from the market, 10 voting to restrict sales and strengthen the warning label, 7 recommending only strengthening the warning label, and 3 voting for no change. One panel member abstained. (New York Times) The White House yesterday announced which preventive services would be available at no charge to patients under the new healthcare legislation. Adult patients who choose a health plan after September 23 will receive mammograms, diabetes screening, and tobacco cessation counseling, among other services, at no increased cos... Better Health blogs http://www.medworm.com/rss/comments.php?id=3767074 Mon, 19 Jul 2010 23:45:57 +0100 3767074 http://www.medworm.com/index.php?rid=3753826&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-free-stuff-of-healthcare-reform%2F2010.07.14 It happened. Guilty. I confess. Reading about Dr. Berwick’s recess appointment to lead the Centers for Medicare and Medicaid Services (CMS) induced me to watch a Fox news clip. Gosh, I feel bad about it. It felt good, though. Patients — that’s you and me — should know that CMS controls doctors, nurses and especially hospital/practice managers. They are ten times more scary than the radar patrol car on the highway. Dr. Berwick likes the British system of healthcare delivery. In Europe healthcare is free, and everyone likes free stuff. Free stuff happens all the time, doesn’t it? In Cambridge, Mass — at Harvard — free stuff for all seems a plausible tenet. There must be a lot of coffee shops and free time in Cambridge. In the real world — on Ma... Better Health blogs http://www.medworm.com/rss/comments.php?id=3753826 Wed, 14 Jul 2010 14:00:00 +0100 3753826 http://www.medworm.com/index.php?rid=3753827&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-canary-and-the-primary-care-physician%2F2010.07.14 The vexing problem with “truth” when it comes to healthcare is to understand its limits. Let’s start with two  popular notions. The first: canaries are harbingers for detecting chemical leaks. The second: primary care specialists claim higher salaries for their work will prevent their extinction. Both claims sound plausible, but then come the conditions, the nuances, the variables and empirical testing and observation — the so called threads of truth. Notion 1, The Canaries: In 1972 my brother passed through the military’s basic training and was Vietnam bound until a perfect score on a standardized test, his Phi Beta Kappa and a chemistry degree from college rerouted his destiny to a remote patch of the Utah desert. Instead of being a foot soldier, he gave back to his count... Better Health blogs http://www.medworm.com/rss/comments.php?id=3753827 Wed, 14 Jul 2010 12:00:59 +0100 3753827 http://www.medworm.com/index.php?rid=3746737&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Ffor-quality-patient-care-teamwork-in-medicine-is-critical%2F2010.07.12 From KevinMD’s medical blog, guest post by Toni Brayer, M.D., shares a story where a team approach in medicine is critical for quality patient care. Dr. Brayer writes: “Medicine is a team sport and it is only when the team is humming and everyone is working together that patients can have good outcomes. Hospital errors, medication errors, poor communication between doctors and nurses are prevented by adherence to protocols that everyone follows. It takes laser focus, measuring outcomes and a great deal of hard work to ensure everyone is pulling together in a hospital. The fact that these bedside nurses take the time to work on error reduction and patient safety is really amazing. Have you seen how hard nurses work? My hat is off to these dedicated caregivers.” Dr. Brayer is exactly ... Better Health blogs http://www.medworm.com/rss/comments.php?id=3746737 Mon, 12 Jul 2010 23:00:31 +0100 3746737 http://www.medworm.com/index.php?rid=3733087&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fdespite-medicare-primary-care-doctors-were-paid-more-in-2009%2F2010.07.07 The Senate has further tweaked its doc fix legislation to restore the extension to six months (from June 1 through Nov. 30) and the pay raise to 2.2 percent, reports a Senate Finance Committee Republican advisor. In Northern Michigan, the doc fix can’t come soon enough, as yet more physicians contemplate not accepting any more Medicare patients. The legislation continues to see revisions in the Senate, following the U.S. House refusal to consider the doc fix as a stand-alone bill. (TwitDoc, WWTV/WWUP-TV News) But primary care physicians saw a 2.8 percent median compensation increase in 2009, according to a Medical Group Management Association survey. MGMA attributed the rise to employers’ and payers’ increased commitment to primary care, but noted threats to Medicare payments s... Better Health blogs http://www.medworm.com/rss/comments.php?id=3733087 Wed, 07 Jul 2010 14:00:00 +0100 3733087 http://www.medworm.com/index.php?rid=3726597&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-new-us-healthcare-bill-whos-paying-for-it%2F2010.07.05 Ever wondered who’s paying for the U.S. healthcare bill? My new favorite blog just published an infographic describing this issue in detail (click on the image for the original larger version): *This blog post was originally published at ScienceRoll* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3726597 Mon, 05 Jul 2010 18:00:36 +0100 3726597 http://www.medworm.com/index.php?rid=3726599&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fhealthcare-road-rage%2F2010.07.05 Road and construction projects have stopped all over town, thanks to concerns about future healthcare benefits. From ChicagoBreakingNews.com: Construction companies and labor unions are divided over healthcare packages. The unions seek a 15 percent annual benefits increase over three years, while contractors have countered with a 1 percent annual increase. -WesMusings of a cardiologist and cardiac electrophysiologist. *This blog post was originally published at Dr. Wes* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3726599 Mon, 05 Jul 2010 12:00:00 +0100 3726599 http://www.medworm.com/index.php?rid=3723358&cid=t_139124_112_f&fid=34799&url=http%3A%2F%2Fmwwak.blogspot.com%2F2010%2F07%2Ffamily-practice-is-dying-and-its-not.html This is going to be controversial. I don't want to hurt anybody's feelings, but I do think that this is an issue that should be discussed.Ok. Time for everybody to face reality. Family medicine as a "specialty" is dying. It's nobody's fault, but it's time to close the residencies and to redirect the medical students into other fields.I didn't always think this way. I trained with some really amazing family practice docs because my ob/gyn residency also offered a family practice 1 year "c/s fellowship" so that family medicine docs could get cesarean section privileges. However, what I've seen in the last almost 1 year as an attending at a hospital with a large number of fp docs with both ob and c/s privileges has changed my mind about the entire existence of family practice. Most of these d... Midwife with a Knife blogs http://www.medworm.com/rss/comments.php?id=3723358 Sun, 04 Jul 2010 04:35:00 +0100 3723358 http://www.medworm.com/index.php?rid=3718364&cid=t_139124_87_f&fid=36050&url=http%3A%2F%2Fblisstree.com%2Flive%2Fgovernment-healthcare-site-launches%2F Today a new government site launched, Healthcare.gov, aiming to inform the public about what their best (and cheapest) options for insurance are, and what changes will take place under the new healthcare bill. Sounds like a good idea to us. It might piss off insurance companies, but it seems like a step in the right direction for the American public. Not only does it make information more accessible, but you can even follow the site on Twitter @HealthCareGov for up-to-date information about insurance and health care. We doubt their tweets will make you LOL as much as some Twitter buds, but they’ll probably help save you money and get better health care. Post from: BlissTree Government Healthcare Site Launches (Source: Breastfeeding 1-2-3) Breastfeeding 1-2-3 blogs http://www.medworm.com/rss/comments.php?id=3718364 Thu, 01 Jul 2010 22:36:22 +0100 3718364 http://www.medworm.com/index.php?rid=3706674&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhoop-de-do-to-the-medicare-physician-pay-cut-problem%2F2010.06.28 After months of dithering, delaying, denying, and defaulting on a decision, Congress ended up…doing as little as possible to address the Medicare physician pay cut problem. Thursday night the House of Representatives acceded to the Senate’s bill to provide physicians with a 2.2 percent update retroactive to June 1. This respite, though, lasts only through the end of November, when physicians and patients will again face another double-digit cut. And if the past is prologue, a lame-duck Congress then will wait until the very last minute to enact another short-term patch, or worse yet, allow the cut to go into effect on December 1 and then pass some kind of retroactive adjustment. You know that the situation has gotten ridiculously bad when the President says this about the bill he ... Better Health blogs http://www.medworm.com/rss/comments.php?id=3706674 Mon, 28 Jun 2010 18:00:00 +0100 3706674 http://www.medworm.com/index.php?rid=3706675&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fsgr-tired-of-congress-hitting-the-6-month-snooze-button%2F2010.06.28 I have not a single thing I want to write about today. I am weary of the obvious topic: the “passage” of the 6-month extension on the SGR, but do feel I need to comment. I am tired of this. I am tired of being jerked around by congress. I am tired of congress hitting the 6-month snooze button and somehow feeling that they are doing something good. This is procrastination, not a solution. Reassurances that something will be done are starting to be irrelevant. The problem is becoming the frustration, anger, and exhaustion that congress is thrusting upon doctors and patients, not the pay cut itself. The idea of no longer having to deal with the passive-aggressive tactics of congress is becoming increasingly appealing –- and if it’s this way for me, I’m sure it’s the s... Better Health blogs http://www.medworm.com/rss/comments.php?id=3706675 Mon, 28 Jun 2010 16:00:17 +0100 3706675 http://www.medworm.com/index.php?rid=3707000&cid=t_139124_150_f&fid=38374&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FePharmaSummit%2F%7E3%2FZTO0uuU60WQ%2Fepharma-summit-healthcare.html ePharma Summit 2010 took place this past February in Philadelphia. If you were unable to make it, we will no be presenting a weekly video series featuring all of the sessions from our event. This week we will continue with presentation from Susan Dentzer, Editor in Chief, Health Affairs presenting "The Healthcare Overhaul—Evaluating What It, All Means for the Industry."Click here to watch the video. The video is under the "video" portion of the interactive player on the ePharma Summit webpage. (Source: ePharma Summit) ePharma Summit blogs http://www.medworm.com/rss/comments.php?id=3707000 Mon, 28 Jun 2010 13:00:00 +0100 3707000 http://www.medworm.com/index.php?rid=3690837&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fphysician-burnout-when-being-a-doctor-makes-you-sick%2F2010.06.23 Do doctors take care of themselves? Sometimes patients may better follow the advice of physicians who aren’t obese and don’t smoke. That was a question asked in a post last year, entitled “When fat doctors talk to obese patients.” According to studies, as reported in the Wall Street Journal, it’s a mixed bag: Physicians as a group are leaner, fitter and live longer than average Americans. Male physicians keep their cholesterol and blood pressure lower. Women doctors are more likely to use hormone-replacement therapy than their patients. Doctors are also less likely to have their own primary care physician—and more apt to abuse prescription drugs. Clearly there’s room for improvement. (more…) *This blog post was originally published at KevinMD.com* ... Better Health blogs http://www.medworm.com/rss/comments.php?id=3690837 Wed, 23 Jun 2010 20:00:31 +0100 3690837 http://www.medworm.com/index.php?rid=3683621&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fno-go-on-a-doc-fix%2F2010.06.21 The Senate has rejected the so-called “doc fix.” This means that doctors taking Medicare patients will now get 21 percent less pay for their work. How’s that getting involved in politics working out for you guys? Not so good. But there’s a larger issue here. Why do we keep trying to control healthcare costs by just mandating that less money be spent? It’s failed for decades. But like a losing gambler convinced that if he just keeps doubling down he’ll finally come out ahead, people keep trying. For example, the New York Times reported on a study of the impact of pay cuts to doctors for Medicare patients with lung cancer. (more…) *This blog post was originally published at See First Blog* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3683621 Mon, 21 Jun 2010 14:00:47 +0100 3683621 http://www.medworm.com/index.php?rid=3683622&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fhealthcare-reform-digging-out-of-the-sgr-hole%2F2010.06.21 Friday, the Senate — in a rare stroke of bipartisanship — voted by unanimous consent to reverse the 21 percent SGR cut and provide positive updates of 2.2 percent through November 2010. The legislation is fully paid for by offsets in other spending programs. Unfortunately, though, the cut remains in effect and claims are being processed at reduced rates, because the House of Representatives has recessed for the weekend and won’t be back until Tuesday. At that time, I expect that the House will pass the Senate’s six-month reprieve and Medicare will make doctors “whole” for the period of time that the cut was in effect. Not that any of this is a cause for celebration. In the meantime, claims still are being paid at reduced rates, creating havoc for physicians... Better Health blogs http://www.medworm.com/rss/comments.php?id=3683622 Mon, 21 Jun 2010 12:00:00 +0100 3683622 http://www.medworm.com/index.php?rid=3665970&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fa-man-is-not-equal-to-the-sum-of-his-medical-problems%2F2010.06.16 I believe that those controlling the purse strings are steering modern medicine towards the practice of seeing patients more as the sum of their medical problems than as individual people. Patients have become streams of data as opposed to real human lives. Consider the dynamics of a family: a wife may worry about her husband while their child adores a father she instinctively knows to be irreplaceable. Modern medicine, however, may only see a diabetic with hypertension and a cholesterol-level running too high. The computers programmed for those advocating the power of data to revolutionize medicine would boil this man down to his “meaningful” essence….numbers, for the above imaginary man: 250.00, 401.0, and 272.0. (more…) (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3665970 Wed, 16 Jun 2010 12:00:43 +0100 3665970 http://www.medworm.com/index.php?rid=3662672&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fless-is-more-in-medicine-why-patients-arent-buying-it%2F2010.06.14 In a recent article, the editors of the Archives of Internal Medicine make the case that too much unneeded care is being delivered in physician’s offices these days. According to the authors, “patient expectations” are a leading cause of this costly problem. Their solution? Get physicians to share with patients the “evidence” for why their requests are crazy, wrong, ill-informed or just plain stupid. But getting patients to buy into the “less is more” argument is a daunting task as most physicians already know. The problem is complicated by the fact that patients have a lot good reasons for not buying it. (more…) *This blog post was originally published at Mind The Gap* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3662672 Mon, 14 Jun 2010 20:00:18 +0100 3662672 http://www.medworm.com/index.php?rid=3658953&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fdoc-fix-vote-awaits-reimbursement-cut-to-take-effect%2F2010.06.14 Senators visited their districts Friday and again today, so the earliest they could vote on the doc fix is tomorrow (6/15) — the day the 21.3 percent reimbursement cut takes effect. Slowing down the process are the numerous amendments. For example, the duration of the fix is still being negotiated. And there are amendments such as redefining what makes up a rural health district. In California, some rural areas are seeing urban levels of patient demand, but giving more money to these counties is being seen as a kickback akin to others that were proposed during healthcare reform. (Part B News, The Hill) *This blog post was originally published at ACP Internist* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3658953 Mon, 14 Jun 2010 12:00:00 +0100 3658953 http://www.medworm.com/index.php?rid=3644763&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-medical-home-in-ontario-the-poor-left-behind-again%2F2010.06.09 In a recent blog posting, I described Group Health’s medical home for 8,000 patients. It proved to be a boon for primary care physicians, who were able to reduce the size of their patient panels, see fewer patients per day, refer more patients to specialists, and maintain or increase their incomes. Patients liked it, too. And Group Health was happy because expenditures per patient were 2 percent lower. But poor patients had trouble getting through the front door of the medical home, so based on demographic differences alone, expenditures should have been lower by 10 percent or more. Nonetheless, they declared victory. Now news filters south from Ontario’s eight-year experiment with medical homes for 8,000,000 patients, and the news is similar. Participation is skewed to healthier an... Better Health blogs http://www.medworm.com/rss/comments.php?id=3644763 Wed, 09 Jun 2010 14:00:52 +0100 3644763 http://www.medworm.com/index.php?rid=3644764&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fmusings-from-a-member-of-the-medical-class-of-2010%2F2010.06.09 As a medical student in his last year, I can attest that my classmates and I would like nothing less than a crystal ball. Always a daunting time in a future physician’s career path, the direction we point ourselves as we launch out of medical school this year seems as arbitrary as ever. As we examine the rolling seas of medicine and try to determine our individual paths, there seem to be more clouds than blue skies, and certainly more shadows than light. This may or may not be a feeling many prospective physicians feel, but for the class of 2010 it comes as a tough pill to swallow. In a profession at the heart of a national policy debate and with a storied history to examine, it’s extremely disconcerting to be faced with so many question marks. (more…) (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3644764 Wed, 09 Jun 2010 12:00:36 +0100 3644764 http://www.medworm.com/index.php?rid=3625500&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fprimary-care-doctors-and-the-medicare-boycott%2F2010.06.02 I saw this interesting article linked to from a blog about angry doctors dropping out of Medicare in Texas. As one who shares the universal annoyance at congress’ failure to fix the SGR for more than 30 days at a time, I was kind of cheered by this. That’s what it will take to get the system fixed – a grassroots, full-scale rejection of the system! Good for them. And the opening lines of the article were encouraging: Texas doctors are opting out of Medicare at alarming rates, frustrated by reimbursement cuts they say make participation in government-funded care of seniors unaffordable. An “alarming” rate. Wow. Cool. So how many is that, anyway? More than 300 doctors have dropped the program in the last two years, including 50 in the first three months of... Better Health blogs http://www.medworm.com/rss/comments.php?id=3625500 Wed, 02 Jun 2010 22:00:00 +0100 3625500 http://www.medworm.com/index.php?rid=3621684&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fmedicare-cut-effective-today-who-should-doctors-be-angry-at%2F2010.06.01 Instead of blogging (again) about Congress’s failure to stop the 21% Medicare SGR cut, which went into effect today, I could just re-run my April 16 post. I wrote then: “It is the failure of both political parties, over many years, to honestly deal with the SGR, including the cost of getting rid of it, which has resulted in the current ongoing SGR farce. And yet members of Congress wonder why the public holds them in such low regard.” Blogging in DB’s Medicare Rants, Dr. Bob Centor captures the outrage felt by most physicians: “I am mad. Every physician I know is mad. Patients should join us in expressing anger. Physicians cannot trust Congress if they cannot repair this absurdity.” (Bob references ACP’s statement, released on Friday; click here to... Better Health blogs http://www.medworm.com/rss/comments.php?id=3621684 Tue, 01 Jun 2010 20:00:00 +0100 3621684 http://www.medworm.com/index.php?rid=3585608&cid=t_139124_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fa-reformed-symbol-of-healthcare%2F2010.05.21 *This blog post was originally published at The Happy Hospitalist* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3585608 Fri, 21 May 2010 14:24:29 +0100 3585608