ACO regulations and related federal issuances hit the street, after several months of waiting -- from CMS, OIG, FTC, DOJ and IRS.They cover the waterfront, ranging from the central regulation defining the structure and workings of the ACO, to limited Stark self-referral ban and anti-kickback statute waivers in the fraud and abuse arena, to new frameworks for antitrust analysis, to rules governing joint ventures involving taxable and tax-exempt ...
April 2011
All Stories
Screen your sleep lab when evaluating your insomnia
Insomnia plagues me. In that, I’m no different from millions of other Americans. But I am different in that I sought supposed experts to help me deal with this situation. My experience proved to be a nightmare.First, I believed my sleeplessness due to the fact I feel “on,” all the time, doing too many things in the space of 24 hours. ...
Preventing disease saves the crippling costs of tertiary care
When I was a family medicine intern, I met a diabetic patient in the hospital who had stopped seeing his regular doctor after he lost his job and his health insurance.His untreated diabetes made his feet go numb. He stepped on a nail and didn't realize it until he noticed ...
Google affects how clinicians and the public collect diagnostic information
My Google Reader accidentally picked up an intriguing abstract that examined a research study of resources that medical students use in solving diagnostic cases.The abstract was picked up because it contained the word “exercise” that is one of my PubMed filter queries. Although we often think that most diagnostic decision-making occurs from learned information stored in physician’s brains, information resources can ...
Could alternative medicine practitioners take the lead in health policy?
Recently, I attended a conference on integrative medicine. It was a lovely conference and I learned a lot: about Chinese therapies used for cancer, about osteopathic manipulation, and about the growing community of doctors that respect the value of complimentary medicine practices and are working to integrate them into their general practice.I also left with a sense of dissatisfaction with what ...
Physician reputation management starts in the office
by Michael Woo-Ming, MD, MPHLet's face it. Most physicians and health care professionals are too busy. Yet as a doctor myself, I know first hand you want to do as much as you can for your patient, such as making sure prescriptions are being called in, or working in an urgent appointment.Then why do most doctors ignore what's being said about them on the internet?Recently I was chatting with a ...
Palliative care and medical interventions are not mutually exclusive
by Neha Jain, MDThink back to your first memory of death.Was it a loved one? A stranger? A pet? Were you sad, happy, or just curious?My grandmother, Nani, died unexpectedly. During the wake, my cousins and I played together in the bedroom where we had been restricted. All through that memory, there’s a strange, dark, terrible ...
Ordering tests may take food out of the mouths of our patients
by Tarcia Edmunds-JehuSitting in an exam room I am watching my patient struggling to ask a difficult question that she clearly does not want to ask.After several attempts at starting and a few half finished sentences she finally manages to mumble a request for help with obtaining food for herself and her two daughters. She is a 41-year-old woman, 32 weeks pregnant with her third ...
ASA: Anesthesiologists ensure safety of anesthesia in young children
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.by Mark A. Singleton, MD
Last month, the FDA Anesthetic and Life Support Drugs Advisory Committee met to discuss various research efforts that may indicate possible connections between neurodegeneration and exposure to anesthesia in ...
When a patient evokes an emotional reaction from a physician
When it comes to caring for the sick, it's often assumed that health professionals and their patients usually get along.But that's not always true. Sales people call some of their customers difficult. Turns out that doctors do exactly the same thing with theirs. An article in the current issue of the journal Neurology provides a catalog of difficult ...
Stop and really think about what you want from life
A friend and I made a pact today. No more hanging out halfway, it’s all or nothing. Each of us has a dream for our lives.Our respective dreams are almost the same, and they’re dreams that we’d almost cast aside or given up on. Why? Because they require so much faith, dedication, focus and endurance to pull off. Neither of us had wholeheartedly committed to the dream.I've had a small ...
If you want good pediatric care, stay away from retail clinics
They’re everywhere, all of a sudden: little medical kiosks tucked into the back of drug stores, grocery stores, and big box outlets.With names like “Minute Clinic” or “RediClinic,” they stress speedy, in-and-out service. And of course, you’re already there in the store, ready to buy whatever has been prescribed. A win-win, no?No.Everyone knows that if you’re ...
Physician characteristics that are universally appreciated
The relationship a physician has not only with their patients, but also with their patient’s families, has long been the foundation of the medical system.Over the course of time this once valued bond has had its ups and downs; however today with the internet, Obama healthcare reform, and Medicare cuts to name a few, the doctor-patient relationship finds itself in its ...
Physicians referring patients to a diagnostic facility they own
Federal law generally prohibits physicians from referring their own patients to a diagnostic facility in which they have an ownership issue - a practice called "self-referral" - unless the facility is located in their own practice.This exemption exists to allow patients with access to a laboratory test, x-ray, or other imaging test at the same time and place as when patients are seeing their physician for an office visit. Less ...
Federal workers worried about a shutdown should do what doctors do
I have a suggestion for all of those federal workers who were concerned about a government shutdown.
To all those who already have better insurance and better benefits than most in the private sector; for all those whose jobs pay more than equivalent private sector jobs for the same activities. Do what hospitals do. ‘Go to your jobs, and do the necessary work anyway.’It is ironic, but hardly surprising, that the ...
Why patients seek a second opinion
This has been a very busy week already. I have seen many second opinons and I am always very interested in the reason why the patient initiated the second opinion.In many situations it was simply to see if I would perform the surgery. After I spent a while listening to the patient, examining them and coming up with an appropriate ...
KevinMD posts of the week, ending April 10, 2011
Here are the top posts from this past week, based on the number of times they were viewed.1. Real life example of medical school debt. Want to really understand the reality of US medical education debt?2. Why does society frown on doctors earning a reasonable living? Why then does our society, in general, have a negative perception of doctors earning a reasonable living commensurate with their education, experience ...
Talking social media and health reform with medical students
I recently concluded a trip down to Nashville, TN where I gave my talk on the health care-social media intersection at Vanderbilt University School of Medicine.
My audience normally consists of physicians and hospital staff, so talking to students was a refreshing change.I had the opportunity to have dinner the night before, and breakfast and lunch the ...
Are memory loss and mood disorders actually diabetes of the brain?
An excerpt from Feed Your Brain Lose Your Belly. by Larry McCleary, MD As diseases, memory loss and mood disorders appear to have very little in common. But could memory loss (even severe memory loss such as that which occurs in Alzheimer’s disease) and mood illnesses such as depression and bipolar disorder, actually be treated much the same ...
7 procedures that can affect the way you breathe and sleep
Millions of surgical operations are performed every year to improve your health, beauty, and even your smile, but there’s a hidden danger in some of the most common procedures that can aggravate if not actually cause obstructive sleep apnea.Sleep apnea happens when your jaws are too narrow, which constricts the internal soft tissue layer that lines your upper breathing passageways, from ...
Kevin Pho, MD
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Why more primary care doctors are referring patients to specialists
According to a recent study from the Archives of Internal Medicine, primary care physicians are referring more patients to specialists than ever...
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Should Google censor anti-vaccine claims?
One of the reasons there is such a movement against vaccines is the democratization of information, perpetuated by search engines like Google....
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Radiologists who cheat on their board exams: Who’s to blame?
In a widely circulated CNN article, many radiologists have been found to cheat on their board exams: "Doctors around the country taking an...
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Doctors: Don’t be ashamed about going bankrupt
Are doctors really going broke? According to this piece from CNN Money, some are: "Doctors list shrinking insurance reimbursements, changing regulations, rising...
Physician
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Physicians have a natural role as advocates
As physicians, we are often called upon to be advocates for our patients. Sometimes they have no other person to turn to....
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Our society expends huge sums on futile care
Mike was a runner, outdoors-man, and fitness nut. This was not so much as for health reasons as for "feeling good", but...
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I learned the value of listening to the patient
William Osler famously said (among other things): “Listen to the patient. He is telling you the diagnosis.” I was doing my obstetrical...
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Repeated experiences of shaming are not good for a young child
The little boy, who looked to be about two, darted away in a fit of giggles. His young mother, who seemed thoroughly...
Patient
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Patient engagement is the holy grail of health care
For health care professionals, patient engagement is the holy grail of health care. It is the key to patient adherence – a...
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Why do doctors delay hospice referrals?
This is a response to Deb Discenza's article requesting a one page informational sheet informing a patient about hospice or palliative care. This would...
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How touch can calm patients
So, Megen at Not Nurse Ratched wrote post recently about therapeutic presence. The following passage really caught my attention: "Question is: are...
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How I became a hospice volunteer
People often ask me how I became a hospice volunteer. For the record, nobody is more surprised than I am. You know...
Policy
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A lack of incentive for medical schools to train primary care doctors
A social media movement is happening before our eyes with action starting to take shape. The #occupyhealthcare movement has begun within to...
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What should be the stated aim of health care in America?
The triple aim of health care, as defined by the Center for Medicare and Medicaid Services (CMS) is: improving the experience of care, bettering...
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How Moneyball applies to healthcare
The storyline is familiar. An organization is challenged to achieve better results without spending more money. An executive is committed to obtaining...
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The problem of insurance gaps in cancer patients
Why are cancer organizations waiting until it starts to rain before they suggest buying an umbrella? “Join my Medicare Advantage plan and...
Tech
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Why the prognosis of patients is difficult
Many clinical decisions in older persons are dependent on life expectancy. For example, as life expectancy declines, cancer screening is likely to...
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Innovative technologies can markedly enhance safety
“To Err Is Human” is the title of the now famous book from the Institute of Medicine on patient safety published about...
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Google knows more about certain diseases than physicians ever will
Professor Gunter Dueck, is a calm and eloquent german mathematician who’s also the CTO of IBM Germany. He studied mathematics and philosophy...
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Robotics can revolutionize the delivery of medical care
Robotics has the potential to revolutionize the delivery of healthcare. It can help extend the delivery of information, expertise and clinical care...
Social Media
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The Internet is where patients go for pre-visit consultations
As a physician, technology cannot replace you, but it can make you more efficient and effective. This was the message from Richard...
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5 ways doctors can benefit from professional connections
Looking ahead to the next several months, I’ve found myself frequently wondering how many physicians will make this their year to take...
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Twitter Is my third office location
The physician’s decision to first dive into social media can be stress-inducing. Issues of time management, maintaining professionalism, and determining a return...
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The impact of social media on a physician assistant
The impact of social media on medicine could arguably be compared to the impact of the industrial revolution on the human condition....
