Health care is in crisis. Reimbursements from insurance companies continue to dwindle, while the expenses of running an office continue to rise. Looming cuts in Medicare are only weeks away, and many physicians may stop taking Medicare. If these cuts go into affect, it is possible that primary care physicians could lose up to 50% of their salary. Just recently CNN reported that some doctors are going bankrupt.How ...
Matthew Mintz, MD
Primary care doctors are set to lose more than half of their salary
Fortunately, the 27% reduction in Medicare payments to physicians that is set to take place in a matter of weeks unless congress acts is getting some press. Fox News published a piece recently, as did the Washington Post. Writer Merrill Goozner breaks things down nicely in his article, "Is There a Doctor Fix in the House ... and Senate?"However, one thing that seems to be getting confused in all ...
Give meaningful use value for physicians
Before I took over one of the classes that now teach at the medical school, I asked students why the value of that class was so low. One of the reasons they gave was that it was so hard to do well in the class, and there were so many other things to study, students only put in enough effort to pass. In other words, incentives are only good if ...
Using Twitter as an audience response system
In general, educators are often trying to find unique ways to engage their students.This is certainly true of medical educators, given that little has changed in medical education in the past 100 years, and for that reason there have been many recent efforts to change this. Similarly, there is often a generational gap between teacher and learner, and thus teachers look for ways to connect with the younger generation they ...
Cigarette taxes work and why they are still too low
Not to be negative about public health educational campaigns, which I believe are important, but the two major factors that have led to the decline in US smokers over the past decade are most attributable two two things: smoking bans and taxes on cigarettes.When it becomes difficult to smoke in public places and expensive do to so anywhere, people are more motivated to quit.An article in the New York Times ...
Requests for OTC prescriptions for a FSA burdens primary care
As reported by MSNBC, the federal government will no longer allow flexible spending accounts (FSAs) to be used for over the counter medications, without a prescription. FSAs, which are offered by many employers, allow you to use tax free dollars for medical expenses that aren't covered by your insurance. FSAs are a great idea and can be used for things like eye glasses, dentistry, or even nicotine patches ...
Adding tiotropium (Spiriva) to an inhaled steroid a mistake?
There is a lot of press about a study recently published in the New England Journal of Medicine that shows that adding tiotropium (Spiriva) to an inhaled steroid might have benefit in asthmatic patients. This study is creating a lot of buzz due to recent concerns of ICS/LABA safety and might prompt doctors and patients to start switching (some already have before this study came out). However, this ...
Avandia, Actos and behind the scenes of study 175
Though I am not going to say that the New York Times lied, they either purposely and grossly misrepresented the truth or did a horrible job of reporting.In their article, "Diabetes Drug Maker Hid Test Data, Files Indicate" the Times states that Avandia maker GSK "secretly began" a study which "provided clear signs that it (Avandia) was riskier to the heart."In fact, the study in question, called study ...
Switching diabetes patients from Avandia to Actos
I have a lot of diabetes patients and have been an avid user of the thiazolidinediones (TZD) class. There are many reasons to like the TZD's:
- The older, generic medicines like metformin and sulfonylureas are known to fail over time. After 3 years, most patients on one of these drugs lose control of their blood sugar. In contrast, patients on TZD's maintain glycemic control (at least up to 4-5 years which ...
Incentives for switching patients from branded drugs to generic
There's an interesting video from WCVB in Boston about doctors getting kick backs from the insurance company to switch patients from branded medications to generic medications: New Rules To Protect Prescription Drug Customers.If people were concerned about undue influence when drug companies used to give physicians pens and other novelties (now currently banned by most companies), they should really be concerned about actual monetary payments.The patient interviewed in ...
Facebook friend issues between doctor and patient
My friend and colleague Katherine Chretien has a provocative op-ed in USA Today entitled, "A doctor's request: Please don't 'friend' me," which asks the question whether doctors and patients should interact in social networking sites such as Facebook.Social networking has huge potential in health care regarding the sharing of information and ideas, and could possibly even enhance communication between doctors and patients. However, as Dr. Chretien points out, many ...
Fracture risk with Prilosec and other proton pump inhibitors
The FDA released a Drug Safety Communication warning about a possible risk of increased fractures with acid blocking medications called proton pump inhibitors or PPIs.PPIs have been a major advance in medical science. Prior to these and earlier medications, the treatment for severe gastroesophageal reflux disease (GERD) was major surgery. PPIs are now commonly prescribed for GERD and less serious heart burn, many are generic, and some are now sold ...
Your asthma or COPD inhaler is not available, and what to do
As reported in MedPage Today, the FDA announced the end for CFC-propelled inhalers. Of the seven inhalers with deadlines for removal, only three are still being made:Flunisolide (Aerobid Inhaler System) on June 30, 2011 Albuterol and ipratropium combination (Combivent Inhalation Aerosol) on Dec. 31, 2013 Pirbuterol (Maxair Autohaler) on Dec. 31, 2013The reason for this is because CFC's are harmful for the environment, and the newer inhalers have to be replaced ...
Primary care access isn’t guaranteed by health insurance
An excellent article appeared recently in the Washington Post, entitled, "Having health insurance doesn't ensure it will be easy to find a doctor," where a young, otherwise healthy and insured woman discusses her extreme difficulty in finding a doctor in Washington, DC who will see her."I was just 23, basically healthy and, most important, insured. So I pulled out my computer, looked up the UnitedHealthcare list of pre-approved doctors ...
Health care reform needs to pass now, and here’s why
There are certain actions we take even though we know that ultimately we will not be successful. Sometimes we do this out of hope for a better tomorrow (like playing the lottery) or because we are taking a moral stand (like supporting a candidate that has no chance of winning).Supporting health care reform is probably a little of both.Even if any of the currently proposed health care reform plans pass, ...
Why primary care doctors need to practice insurance free medicine
I never thought I would be in academic medicine for so long.When I was hired about 12 year ago, I figured I would stay in academics for a few years and then join a private practice Internal Medicine group. Now, I can't even fathom that idea. One of the reasons I have stayed at my institution for so long is that I love teaching and the academic environment.However, a second ...
How a psychiatrist can write 100,000 prescriptions a year, and what that means for primary care
The Miami Herald is reporting an investigation of a psychiatrist who wrote almost 100,000 prescriptions a year. Sen. Grassley and the feds have halted payment to this Miami psychiatrist who stated that "he prescribes only what is medically necessary" and "works long hours, seeing patients for 10 minutes at a time and many of his patients need four or five medications."I have no personal knowledge, interaction, acquaintance with psychiatrist Dr. ...
Why doctors are doing so many unnecessary Pap smears
The Wall Street Journal and other sources reported on a study from the Annals of Internal Medicine that showed that most US doctors don't know the guidelines of how often women should get a pap smear. More importantly, doctors were doing a lot of pap smears on women who didn't need them. In all the talk about health care reform, reducing costs by eliminating unnecessary testing has been mentioned multiple ...
Why you should stop taking Vytorin for high cholesterol
At the American Heart Association meeting in Orlando, the results of the ARBITER 6-HALTS study were released. No Vytorin was used in the study, but I am sure that all the headlines will mention Vytorin.The actual study published ahead of press online in the New England Journal of Medicine. Essentially, they enrolled over 200 patients from Walter Reed and Washington Adventist who had known heart disease or were at ...
