I have written before about predictions of the actual costs of Obamacare and the probable death spiral of increasing costs and decreasing participants. Several recent reports have brought more clarity to the cost realities. Recently regulators across the country approved rate hike requests by Obamacare insurance companies even greater than they originally asked for. For example, Pennsylvania regulators approved rate hikes of 33 percent, which was ...

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From the mid- to late-2000s, lots of pundits got into the business of shoving electronic medical records (EMRs) down doctors’ throats. There were a few incentives from the feds to help with the upfront costs, but it was a pittance of what it really costed hospitals and physician practices. And there was no consideration made for the ongoing costs of EMRs, except for cuts in already skimpy Medicare and Medicaid ...

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Prescription opioid abuse is on the political radar. “Painkillers” are a recognized cause of thousands of deaths a year. But what to do about it? A FDA panel recently recommended mandatory training for physicians who prescribe opioids. Congress passed a bill calling for more education, presumably physicians as a prime target. We’ve actually been down this road before, but possibly not how you think. The politicians and pundits used to complain ...

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All of us who care for the poor, the illiterate, the poorly educated, the immigrant, the frail, and the abused know this: caring for them involves many challenges that aren’t picked up by Medicare computers or big data. Simplistic calculations about quality metrics such as hospital readmission rates have been way off the mark at capturing the complexities of caring for these patients. A recent study from researchers in Boston ...

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I’ve read several articles recently reporting on a shortage of geriatricians. The writers have some clear misunderstandings of who actually cares for our elderly and where they come from. Susan Jaffe writing for Kaiser Health News stated that the American Geriatrics Society (AGS) estimates that the nation will require 30,000 geriatricians by 2030 to serve our aging population. This is probably true, what the AGS believes. She goes on ...

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A colleague recently told me of a patient encounter he had in an emergency room. When he picked up the chart, it described the patient as a 62-year-old woman complaining of epistaxis, or a nosebleed. He walked into the room and saw a perfectly well appearing 62-year-old woman. There was no blood on her clothes and none on her face. Her nose was not bleeding. When he asked her what could he do for her, she said ...

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Do you like to take pills? I don’t. I bet most family physicians would say they have some patients who should be better at taking pills and some who love taking pills too much. For people who don’t like taking pills, what would a trade-off look like? If you were given the option of living X months fewer, but in return you wouldn’t have you doctor twisting your arm to take pills every ...

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The American Heart Association (AHA) recently proposed new guidelines for all doctors to screen and treat for high cholesterol. For doctors and patients to follow, this would result in a large increase in the number of Americans taking statins. One of the things I like about the new proposal is that there is no more chasing a number. This was frustrating for doctors and patients to keep having lab draws and medication ...

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As much as I have given the "ologists" and other members of the dysfunctional U.S. health care system a hard time in previous posts, it’s only fair that I call out bad family medicine as well. I have a great example. I recently saw patient who is relatively new to the area who had seen another family physician in my community. He is 39-year-old male, and his only significant potential health ...

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There will are lots of things I hope improve in our health care system in 2015, but I’ll just mention one wish today. My wish is that the worthless wellness programs that have sprung up all over corporate America will fade away. I have criticized these programs in the past, but more ammo has come to light. A recent article in Employee Benefit News lists seven factors explaining how wellness programs are ...

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