Friday, November 30, 2007

Profiting from the coding complexity

Courses at almost $1,000 a pop are moneymakers benefiting from the byzantine coding rules.

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Colostomy gone wrong

A malpractice suit alleging a botched colostomy reversal that led to "passing gas and liquid stool from the penis."

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MedBlog Power 8

11/26/2007 - 12/06/2007
Next revision: 12/06/2007



(Key: Rank, Blog name, Last week's rank, Post of note)

1) The Happy Hospitalist (2), In The Eyes of Medicare, You are a 99223

2) Health Beat (3), Health Care Reform: What Do Americans Want? (Or Think They Want?)

3) The Physician Executive (4), The Avandia Mess

4) Surgeonsblog (-), Off Center

5) WhiteCoat Rants (7), More ED Patients, Less ED Specialists

6) Jay Parkinson (1), Solving the malpractice crisis with Zocor.

7) retired doc's thoughts (-), The pathophysiology of primary care dwindles

8) Radiology Picture of the Day (-), Lost Guide Wire

The MedBlog Power 8 is a list of medical blogs that have had an exceptional week of blogging, based purely on my subjective measures. Factors I consider are how provocative the posts are, the amount of discussion it generates, and posting frequency.

The list is revised mid-week and will be published every 1-2 days on Kevin, M.D. If you want me to consider your exceptional week of blogging, you can contact me.

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Coding complexity redux

Sometimes you need a math degree to analyze RVU values.

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JCAHO hoop of the week

"Sometimes I wish stupidity were painful."

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Residents

Two approaches, with markedly different results.

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Medical school admissions

Some common-sense talk.

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Unsavory specialists

"Don't refer to them in the future" isn't really good advice for a PCP.

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"Standard of care changes every few years"

Precisely the problem with government regulation, which is slow to keep up.

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Extra time

Time spent on the patient outside the office visit is common, and often not compensated.

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PDAs for physicians

PDAs are going out of style. My Dell Axim broke a year ago, and I have yet to replace it.

Clinical Cases with a couple of suggestions to replace your PDA.

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Hand wipes and alcohol abuse

Temptation of alcohol in the hospital?
The alcohol in infection-control hand wipes used in hospitals and nursing homes may entice alcoholics or be a risk for confused patients, researchers here found.

In a search of a toxicology database for poison-control reports related to children and adults exposed to alcohol hand wipes after their use became widespread, 66% were thought to result from intentional abuse

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MedPage Today



I would like to thank MedPage Today for their continuing sponsorship at Kevin, M.D.

MedPage Today is the only medical news service for physicians that links consumer medical news and the professional medical analysis needed by clinicians.

Key to this site is their partnership with the University of Pennsylvania School of Medicine, where faculty review breaking news articles. With their Teaching Briefs, MedPage offers a reliable, physician-reviewed, source where both doctors and patients can digest breaking medical news. For those interested in the "bottom-line", Action Points introduce each article, emphasizing the take-home message.



Physicians and other healthcare professionals can accrue CME simply by reading the news. Articles are accompanied by a CME Post-Test, where AMA PRA Category 1 Credits can be obtained, without a fee.



Read more about MedPage Today.

Sponsorship opportunities continue to be available. This can be via a Standard Blogad or a customized package. Please visit the advertising information page for further details.

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Thursday, November 29, 2007

The Doctor Anonymous Show



Tune in for the latest edition of The Doctor Anonymous Show, live tonight at 10pm EST. Kerri Morrone from Six Until Me will be interviewed.

Update 10:03PM -
Listen LIVE now, and don't forget to visit the chatroom.

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Daniel Carlat goes counter-detailing

"Dr. Drug Rep" is going on a mission to give evidence-based drug talks to physician offices:
I received many helpful suggestions for how to part with my "dirty thirty." I've decided that the most logical solution is to donate time to "counter-detailing," which is essentially the opposite of giving drug talks. Pioneered as "academic detailing" by Jerry Avorn at Harvard Medical School, counter-detailing involves visiting doctor's offices and teaching about evidence-based medicine.
Admirable. However, I seriously think it will be hard for him to find an audience without the free lunch.

Update:
I extended an offer for him to come to Nashua, NH to give my practice one of his talks, and he graciously accepted. I'll keep you posted as to how it goes.

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"10 Things Your Primary-Care Physician Won't Tell You"

I was interviewed for this article in SmartMoney Magazine, which is now online:
Interest is so low that the number of primary-care internal medicine residency positions dropped by more than 50% in the past decade. "We're not really getting the best and brightest in primary care," says Kevin Pho, a Nashua, N.H., physician who writes the blog Kevin, MD. "And that's where they're needed." . . .

. . . According to one study, the income of primary-care doctors, adjusted for inflation, actually fell by 10% between 1995 and 2003. "Students are not dummies," says Pho. "They graduate with $130,000 in debt; why should they go into primary care?"

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MedBlog Power 8

11/26/2007 - 12/06/2007
Next revision: 12/06/2007



(Key: Rank, Blog name, Last week's rank, Post of note)

1) The Happy Hospitalist (2), In The Eyes of Medicare, You are a 99223

2) Health Beat (3), Health Care Reform: What Do Americans Want? (Or Think They Want?)

3) The Physician Executive (4), The Avandia Mess

4) Surgeonsblog (-), Off Center

5) WhiteCoat Rants (7), More ED Patients, Less ED Specialists

6) Jay Parkinson (1), Solving the malpractice crisis with Zocor.

7) retired doc's thoughts (-), The pathophysiology of primary care dwindles

8) Radiology Picture of the Day (-), Lost Guide Wire

The MedBlog Power 8 is a list of medical blogs that have had an exceptional week of blogging, based purely on my subjective measures. Factors I consider are how provocative the posts are, the amount of discussion it generates, and posting frequency.

The list is revised mid-week and will be published every 1-2 days on Kevin, M.D. If you want me to consider your exceptional week of blogging, you can contact me.

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Nosebite

Pretty nasty.

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How to write off a $1.2 million hospital bill

Get your story published in the WSJ.

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Grady Hospital: "The slowly-boiled frog"

If this is how the government treats a safety-net hospital, I'd hate to think what would happen if they were responsible for all our health care.

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Penalized for appropriate coding

EMRs are causing physicians to code appropriately, and resulting in higher payments. So why are doctors being penalized?

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Vicodin ES #180, 1 tab q4hrs prn pain x 4 refills

Who's comfortable writing something like this? According to The Angry Pharmacist, some physicians are.

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Thought Process

A Sid Schwab short story.

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Virtual hip replacement

Now's your chance to be a surgeon.



(via ScienceRoll)

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Job board



The latest jobs on the Kevin, M.D. Job Board:


Together with The Health Care Blog, your job post will be viewed by readers of two prominent health care blogs, with a targeted audience of physicians, nurses, health IT, and other health professionals.

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"Drug-seekers get sick, too"

Real pathology in a patient that a nurse wanted to "kick [her] out of here."

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Cut Medicare payments for doctors, you'll have fewer doctors

With physicians facing a 10% cut in Medicare reimbursement, I would like to reprint my op-ed published on August 2007 in the New Hampshire Union Leader.

Monday, Aug. 6, 2007

MEDICARE is planning to cut physician payment rates by 10 percent in 2008. These reductions will continue annually, and it is predicted that the total cuts will be about 40 percent by 2016.

The topic of physician compensation generally elicits little public sympathy. After all, the average primary care physician salary in 2006 was about $150,000. Who are we to complain about reimbursement? As you will see, however, cuts in physician Medicare payments affect everyone.

Medical practices today essentially function as small businesses. Physicians are responsible for expenses like rent, payroll, employee health insurance and malpractice insurance. These costs are expected to increase 20 percent in the next nine years. During this same time, physician Medicare payments are faced with cuts of 40 percent. Already, some practices lose money every time a Medicare patient is seen. Some may find the link between medicine and money distasteful, but the hard truth is that it is impossible to practice medicine in a business model that is headed for financial disaster.

At a time when baby boomers are approaching the age of 65, some physicians attuned to this economic reality have simply stopped accepting Medicare patients. According to a recent survey by the American Medical Association, 60 percent reported that they would have to limit the number of new Medicare patients they treat due to next year's cut. Half would reduce their staff. Fourteen percent would "completely get out of patient care." Some seniors are already faced with calling 20 to 30 providers in the desperate hope that someone will accept Medicare.

It is unlikely that the primary care shortage will improve in the near future, as Medicare reimbursement rates continue to be a primary driver of physician salary. In a report by the Center for Studying Health System Change, incomes of primary care physicians fared amongst the worst in keeping pace with inflation between 1995 and 2003, while medical specialists fared the best.

Medical students, already burdened with an average debt in excess of $100,000, are clearly gravitating towards specialties where salaries have better kept pace with inflation. The report concludes that with "the diverging income trends between these specialties and primary care, the result is likely to be an imbalance in the physician workforce and perhaps a future shortage of primary care physicians."

Some may be wondering if this is just a "Medicare problem." Should you care if you have private insurance?

Absolutely. With primary care being the backbone of every health system, patients cannot have their chronic medical issues addressed in a timely fashion with a lack of primary care access. In delaying care, chronic diseases blossom into more serious conditions that are forced to be seen in already overcrowded emergency rooms.

Hospital-based care is often the most expensive and the corresponding rise in health care costs plays a major role in the increase of health insurance premiums. Unfortunately, the government responds to rising health care costs by further reducing physician payments and the cycle continues to spiral out of control.

You will hear physicians rallying against the Medicare fee reductions in the coming year. Think about how this affects you. Contact your government representative and do your part to break this vicious cycle.

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"I don't do any medmal"

A qualifying statement by a lawyer receiving treatment in the ER.

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Disappointed in normal

Angry ER patients after being told that nothing is wrong.

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The RUC conspiracy

The proceduralists dominate the RUC committee, and have formed an alliance, thus is slowly killing off primary care:
In a self-serving game of "you scratch my back," the proceduralists support the inflated work values of one another's new procedures, and as the values float higher and higher over time, and as the number of procedures grows, the value of office-based or cognitive services diminishes in relation. And as there is only one pie to split up, the slice of the pie that goes to primary care shrinks and shrinks

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Wrong-side neurosurgery

I'm sure that Rhode Island Hospital is not liking this national publicity.

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CT scans and cancer

A NEJM study estimates that 2 percent of all cancers in the next 20 to 30 years may be attributable to CT scans.

The price of overtesting and defensive medicine has just gone up.

More testing does not always equate to better medicine.

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Insidermedicine



I would like to thank Insidermedicine for their continuing sponsorship at Kevin, M.D.

Insidermedicine (www.insidermedicine.com) is a physician-led news organization that allows you to keep on top of the latest medical information by watching unique videos that are created each and every weekday by Insidermedicine's team of medical experts. Their goal is to reach patients, medical doctors and students around the world to ensure that each is receiving a daily 'evidence based' health and medical update.

Given their wide and diverse audience, Insidermedicine offers health and medical content that is unique for their viewers. Here is a sample of some of their regular programs, which are also available in Chinese and Spanish.

Their videos are highly recommended, and I am excited to include them as a regular feature of this blog.

Sponsorship opportunities continue to be available. This can be via a Standard Blogad or a customized package. Please visit the advertising information page for further details.

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Wednesday, November 28, 2007

One of the most influential men under 45

The TB-lawyer Andrew Speaker?
. . . he represents more than just media-fed paranoia: Just like that kid a few towns away who supposedly came down with a staph infection, Speaker embodies the Great Contagion that always lurks a few coughs away, threatening a country’s increasingly fragile sense of security.

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MedBlog Power 8

11/26/2007 - 12/06/2007
Next revision: 12/06/2007



(Key: Rank, Blog name, Last week's rank, Post of note)

1) The Happy Hospitalist (2), In The Eyes of Medicare, You are a 99223

2) Health Beat (3), Health Care Reform: What Do Americans Want? (Or Think They Want?)

3) The Physician Executive (4), The Avandia Mess

4) Surgeonsblog (-), Off Center

5) WhiteCoat Rants (7), More ED Patients, Less ED Specialists

6) Jay Parkinson (1), Solving the malpractice crisis with Zocor.

7) retired doc's thoughts (-), The pathophysiology of primary care dwindles

8) Radiology Picture of the Day (-), Lost Guide Wire

The MedBlog Power 8 is a list of medical blogs that have had an exceptional week of blogging, based purely on my subjective measures. Factors I consider are how provocative the posts are, the amount of discussion it generates, and posting frequency.

The list is revised mid-week and will be published every 1-2 days on Kevin, M.D. If you want me to consider your exceptional week of blogging, you can contact me.

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US News and hospital collusion?

Dr. Wes wonders whether some of the big shot hospitals are in bed with the US News and World Report:
But what's funny is that the Big Boy winners are now in bed with US News and World Report - providing content for their issue about all kinds of diseases that they (alone, I'm sure) have mastered.

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CT scans and lung cancer screening

Notice how mainstream media discounts studies that say there is no survival benefit? Bravo to Merrill Goozner who sees the folly of ordering CT scans to screen for lung cancer before the proper evidence is available.

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Ripping the NY Times a new one

Taking apart the recent NYT editorial on rising health care costs. The public is starting to realize that this means saying "no" to patients - something that has been rejected venomously during the managed care era:
. . . one suspects that the editors who put their thumbprints on this piece may have been divided on whether we really want to rein in health care spending. On the one hand, that might be best for the nation—not to mention for the many middle-class Americans who cannot afford health care today. But on the other hand, does this mean that a New York Times editor might not get an MRI for his unspecified back pain when he wants one—just because the guidelines (and his doctor) say he doesn’t need one?

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The shadowy RUC

Responsible for corrupting the physician reimbursement system?

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Dr. Drug Rep flak

Daniel Carlat is taking heat for his controversial expose being a drug company speaker. (via Health Care Renewal)

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Patient transfers

Inefficiency leads to headache and frustration for this ER physician.

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Documentation

How the patient is excluded from the reasons why we document:
We doctors, in order to make our living, have been turned into Medicare lemmings and I believe it brings incredible loss of productivity by deferring time, money and resources from patient care to patient documentation:

To appease the lawyers. It didn't happen. You're at fault
To appease the insurance companies. It didn't happen. You wont get paid
To appease the government. It didn't happen. Your quality is poor.

Guess who's missing from that population of people.

The patient.

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Comparing the airline industry to the medical profession

It's more similar than you think:
Flying low cost only carriers is like going to a clinic. You'll get to your location, or get your care, but it won't be pleasant. Flying business class or first class is like going to a concierge medical office or a medi-spa. Not only will you get to the location, you'll have a great experience on the way. Flying coach on a major carrier is like going to the typical doctor. It used to be nothing fancy, nothing great, but pleasant enough. Now it is horrible. As the airlines get squeezed, and as the doctors get squeezed, and as we the consumers let everyone know that we care only about cost, the experience is becoming less and less tolerable.

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Grady Hospital and race

Is race playing a role in the demise of this much-needed public hospital?
Gradually over the years, Grady came to be controlled by prominent African-American activists and business players. The state and counties continue to fund an incompetent, inefficient, insufferable and impossible health system because the alternative is likely to be construed through the lens of American race politics.

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The patient interview and accuracy

When reading medical records, consider the source of the information you read.

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Dr. WhiteCoat, one tough SOB

Taking care of a toothache himself:
I had a toothache while working one time which ended up being the beginning of a sinus infection. Every time I opened my mouth, my whole upper gumline throbbed. It was giving me a rocking headache. I couldn’t think straight. I sprayed lidocaine on my gums with no relief and eventually stuck a needle in my gumline and did a nerve block on myself because the pain hurt so much.

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iMedExchange



I would like to thank iMedExchange for their continuing Premium Sponsorship at Kevin M.D.

iMedExchange is a new online physician community. Currently in Beta, they are working with a team of physician advisors who provide guidance and insight through the iMedExchange Advisor Network.

"Physicians today are highly challenged, and we need help managing our personal lives, practices and patients. iMedExchange gives me access to a community of physicians that can be my greatest resource. I joined the iMedExchange Advisor Network (iAN), and became one of the many physician investors in order to be a part of this powerful solution for physicians."
- R. Maoud, M.D. (Internist, iAN Member, Physician Investor)

iMedExchange is looking for physicians to serve as advisors by giving feedback on new features, ideas, and community value. The time commitment is 10 minutes per week, from your own computer. In return for their time, advisors earn 100 stock options per month. Please join the community, and become an advisor, by visiting www.iMedExchange.com.

Sponsorship opportunities continue to be available. This can be via a Standard Blogad or a customized package. Please visit the advertising information page for further details.

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Tuesday, November 27, 2007

MedBlog Power 8

11/26/2007 - 12/06/2007
Next revision: 12/06/2007



(Key: Rank, Blog name, Last week's rank, Post of note)

1) The Happy Hospitalist (2), In The Eyes of Medicare, You are a 99223

2) Health Beat (3), Health Care Reform: What Do Americans Want? (Or Think They Want?)

3) The Physician Executive (4), The Avandia Mess

4) Surgeonsblog (-), Off Center

5) WhiteCoat Rants (7), More ED Patients, Less ED Specialists

6) Jay Parkinson (1), Solving the malpractice crisis with Zocor.

7) retired doc's thoughts (-), The pathophysiology of primary care dwindles

8) Radiology Picture of the Day (-), Lost Guide Wire

The MedBlog Power 8 is a list of medical blogs that have had an exceptional week of blogging, based purely on my subjective measures. Factors I consider are how provocative the posts are, the amount of discussion it generates, and posting frequency.

The list is revised mid-week and will be published every 1-2 days on Kevin, M.D. If you want me to consider your exceptional week of blogging, you can contact me.

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Do Americans really want health care reform?

The polls say yes, but do they really understand what's involved? The "more medicine is better medicine" mentality would have to be the first to go:
The polls show that many Americans like what they have; if there is excess in our system, they embrace it. They find comfort in the idea that, when they consider their medical options, they have a long list of choices, including the newest and the most expensive drugs, devices, tests and procedures. Most subscribe to the American creed that newer is almost always better. And, as the latest ABC News/ Kaiser Family Foundation/ USA Today poll shows, only 30 percent of those surveyed see unnecessary treatments as a problem in our system, while just 28 percent say that the “increased use of expensive new drugs, treatments and medical technology” is driving rising costs, “even though,” the pollsters note, “this is the factor most often named by experts.”

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Insidermedicine: In the Clinic - Central Retinal Vein Occlusion

In the Clinic Tip - Dr. Sanjay Sharma, MD, Examines a Central Retinal Vein Occlusion

Thanks to Insidermedicine for their continuing sponsorship at Kevin, M.D.