Mental health patients and their families already pay a hefty price with the stigma of mental illness and the emotional roller coaster they often face dealing with symptoms. But insufficient mental health resources across the United States also means that they must pay a financial price as well in the form of lost productivity, out-of-pocket costs for treatment and sometimes periods of unemployment. A recent USA Today special report estimates that benefits ...

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There are over 16,000,000 American children (21.8%) who live in official poverty and double that number who are just poor. This is not happening in an obscure country, in a continent far away. It is happening right here, across the street from you. For those enjoying a good episode of Duck Dynasty, these are not children of illegal immigrants, and the vast majority is white kids. Over 44,000,000 American children (more ...

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Conflicting state versus federal incentives confuse doctors I get paid by Medicaid to see patients. How much? Exactly $52.28 if it is an easy patient issue, like a cold, and $78.54 for a harder one, like a kidney stone. Who decides when the issue is easy and when it is hard? I do. But I have to follow some complex rules when deciding whether to bill a 99213 ...

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Opening my mail today, there are multiple letters from multiple insurance companies, reportedly communicating valuable information to me about my panel of patients that they cover. One of the envelopes holds two single sheets of paper, one of which contains a listing of my panel of patients and the providers they have been referred to over the past quarter. The second sheet, mysteriously, contains only a single line: This page intentionally left ...

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The California ballot initiative: Protecting patients or letting in a Trojan horse?A guest column by the American College of Physicians, exclusive to KevinMD.com. Physicians in California are mobilizing to oppose an initiative on the November ballot that will raise the cap on non-economic damages in medical malpractice cases. The current cap of $250,000 is part of California’s Medical Injury Compensation Reform Act, or MICRA. Adopted in ...

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It may not be long before a hospital will be the least likely place to find a doctor. Pressures are mounting to replace physicians with computers, guidelines, nurse practitioners and even pharmacists. The assault on the patient-doctor relationship continues to mount. Centers for Medicare & Medicaid Services recently made a final ruling that finds the regulation requiring a doctor sit on the governing board of a hospital to be “unnecessary, obsolete, ...

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The U.S. spends nearly $3 trillion a year on health care, significantly more than any other nation. In fact, America’s annual health care spending is greater than the total gross domestic product (GDP) of every other country except China, Germany and Japan. Yet our measurable health outcomes -- from infant mortality to life expectancy -- aren’t any better than nations spending much less. I’ve written about this paradox before, pointing to a few ...

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We all want the advantage.  We put our kids in special preschools so they have the advantage.  We work 100 hours a week so our kids can do 8 activities and get the advantage. Tall people have an advantage, we’re told.  Poor people are “disadvantaged.” Well folks, there are a whole bunch of senior citizens in Massachusetts who are about to get disadvantaged starting September 1. UnitedHealthcare (UHC) will be
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Taking a page from firefighting to fix health care In firefighting, pump physics is one of the most critical things an engine company officer must understand.  How do we "get the wet stuff on the red stuff" in sufficient quantity without sacrificing penetrating power? The inverse ratio between volume and pressure (as the water pressure increases, volume decreases) has befuddled many a rookie lieutenant. The same, I think, is now true ...

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In the forty years since I started medical school, I have worked in socialized medicine, student health, a cash-only practice and a traditional fee for service small group practice. The bulk of my experience has been in a government-sponsored rural health clinic, working for an underserved, underinsured rural population. Today, I will make a couple of concrete suggestions, borrowing from all the places I have worked and from the latest trends ...

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