The old adage “time is money” holds true, especially in health care. Apparently the medicine time crunch spans two midnights. In October 2013, Medicare enacted a provision that changed coverage for hospitalized patients. The “two-midnight rule” states that a patient will not be covered as an inpatient unless their hospital stay is expected to cross two midnights. The end result is that many seniors are placed under observation, even if they stay ...

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Health care information technology has of course grown exponentially over the last decade, as electronic medical records (EMRs) and computerized physician order entry (CPOE) systems have become ubiquitous. It’s funny to think that not so long ago, physicians and nurses had to trawl through piles and piles of paper charts to search for the information we needed -- whether it was lab results or patients’ notes. However, the road to this ...

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I almost died today. I was driving from one clinic to another, on a busy highway in the rain, when my car hit a standing body of water and hydroplaned. I lost control of the car, spun counterclockwise across three or more lanes, and slammed into the dividing median. I remember screaming “NO!” internally right before impact. I couldn’t believe what was happening as it happened.We should all be anonymous Samaritans
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Once upon a time, I was a lifeguard.  This was the natural result of swimming fairly well, Red Cross training, and team competition.  I saw myself as a handsome, tanned guardian at the ready.  OK, I was prone to self-delusion.  When I became a doctor I carried over that image of high-perched protector on stilt chair, whistle in hand, rescue float close, ready to dive to the assistance of a ...

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The venerable University of Texas MD Anderson Cancer Center in Houston will accept patients with traditional Texas Medicaid health insurance, and some patients in Medicaid managed care plans. Memorial Hermann, another large health system in Houston, will accept traditional Medicaid patients and also those in Medicaid managed care plans. Neither institution will accept the Blue Cross Blue Shield HMO silver plan sold on the Affordable Care marketplace, according to 
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We rely on the FDA to protect public health “by assuring the safety, efficacy, and security” of medical drugs and devices. The FDA takes its marching orders from Congress via the legislative process. One such law is the Compounding Quality Act of 2013, passed in response to a series of fatal infections due to improper compounding pharmacy processes. While such oversight is important and well meaning, the unintended consequences may be ...

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The first lecture in a radiation oncology residency program is “Radiation Oncology Emergencies,” to educate the new residents how to manage inpatient consultations and emergencies. While preparing my lecture this year, it occurred to me how useful this basic information would be to the physicians calling for the consultation. Sharing our thought process in triaging patient explains why we don’t rush to utilize radiation, even in cases of a cord ...

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I may not accept your insurance, but I will always accept you Just for the record: I am happy to see you -- irrespective of your insurance. I accept most insurance plans. And if I don’t accept your insurance, I have a very good reason. I will not sign a contract with a health insurer that: Abuses and bullies me and/or my patients. Denies all my first claims. Reimburses me so little that I may go out of ...

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Top stories in health and medicine, July 29, 2014From MedPage Today:

  1. Smoking Worsens Psoriatic Arthritis. Patients with psoriatic arthritis who smoke have worse patient-reported disease features at baseline and don't respond as well as nonsmokers to anti-tumor necrosis factor (TNF) treatment.
  2. Heart Defects Still Often Found Late. Prenatal diagnosis of critical heart defects has increased, but more than one in ...

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She seemed awfully angry and at the very least dubious that I couldn’t do more for her father. After 7 hours of surgery trying to salvage her father’s leg, I tried patiently to explain that this new (third) bypass we had just successfully completed was unlikely to provide her dad with a long-term solution. Ultimately, he would lose the leg, if we were lucky he’d have it for another year ...

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It's a seductive idea.  We doctors possess knowledge and experience which can not only help people, but can save their lives.  We get opportunities to be the right person at the right time to offer the right help that makes all of the difference.  It's one of the greatest things about our profession.  It's also one of its greatest traps. I've heard many doctors refer to themselves as "healers," as if ...

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Doctors today: Young, broke and human “Oh, you’re my doctor? A woman?” Who do you picture walking through the exam room door at your new doctor’s office? Is it the Norman Rockwell depiction of an older, jolly looking male? After residency I was alarmed at how many patients commented on my age and gender: “How old are you, 12?” or, “Oh, you’re my doctor? A woman?” This got me thinking about ...

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The 2-1 decision by the DC Court of Appeals striking down federal premium subsidies, in at least the 27 states that opted for the feds to run their Obamacare insurance exchanges, has the potential to strike a devastating blow to the new health law. The law says that individuals can get subsidies to buy health insurance in the states that set up insurance exchanges. That appears to exclude the states that do ...

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Recently, the American Board of Medical Specialties' (ABMS) Maintenance of Certification (MOC) program debate reached a larger mainstream media audience when the Wall Street Journal published their article by Melissa Beck entitled "Skill Reviews Upset Doctors." While it is certainly nice to see an article reaching the main stream media concerning doctors' concerns with the MOC program, the issue with the MOC debate is not that doctors are upset.  The real issue is ...

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Let me begin with by extending a hearty congratulation on matriculating to medical school. The pre-med years were tough with organic chemistry, staying involved with leadership activities, chasing down the elusive letter of recommendation, and sitting for the MCAT. But you did it. Be proud of what you've accomplished because you're one step closer to becoming a doctor. You may have fears, concerns or misgivings about what is coming your way and this ...

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Part of a series. Is concierge medicine for everyone or is it just for the rich, the 1%? Most people assume it is for the elite and cannot be afforded by the common man, the masses. That is unfortunate because in many cases it can be quite affordable. Here are three examples. AtlasMD in Kansas City and others like it think of themselves as “blue collar” concierge practices. According to ...

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An interview with Jessie Gruman Jessie Gruman, who sadly died July 14, 2014, was someone I greatly admired as a person and as a patient activist. I interviewed her in late April for research I was conducting on patient activism, and she graciously allowed me to publish the interview, wanting, not surprisingly for those who knew her, to do everything she could to use ...

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Top stories in health and medicine, July 28, 2014From MedPage Today:

  1. Time to End Lethal Injection? The third botched execution of a death row inmate in a year should serve as proof enough that lethal injection won't work as an execution modality.
  2. HIV Cure Still Years Away. The African journalist asked a simple, clear, and direct question: When, people want ...

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One of the skilled nursing facilities I work with has a hospice unit.  We occasionally have patients on the hospice unit who might benefit from physical therapy.  The physical therapists that see patients in the skilled nursing facility say they will talk with the patient about their goals, and if their goals are to maintain their current level of functioning, they will work with the patient.  If the goals are ...

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As a family physician whose practice deals exclusively in the treatment of obesity, it strikes me as remarkable how little we understand about the disease, which is Canada’s second-leading cause of preventable death. In every region of the developed world, obesity doubled in the twenty years between 1988 and 2008, according to World Health Organization, which now count more than a half-billion of Earth’s population as obese. The Public Health Agency ...

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