Recently, ACP offered practical solutions to physicians’ concerns about Medicare’s proposal to implement the new payment system created by the Medicare Access and CHIP Reauthorization Act (MACRA). The College’s detailed recommendations, summarized here in a press statement that is linked to the comment letter itself, would replace CMS’s proposed and unnecessarily complex quality scoring system with a much simpler and understandable approach as developed by the College. We challenge CMS to completely ...

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Small, independent private practices are closing, increasing numbers of physicians are retiring, and fewer medical school graduates are choosing primary care.  The old-fashioned practice my father and I have built is a dying entity.  Parents say coming to see us for an appointment feels more like a visit with a friend than a medical encounter.  I am fighting for the survival of primary care practices.  MACRA proposed reimbursement will decimate ...

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It turns out that when Shakespeare asked, "What's in a name?" he didn't have medical providers in mind. In the last decade, the nondescript and confusing term "provider" has crept into the American medical lexicon thanks to the Centers for Medicare & Medicaid Services (CMS) which defined a provider as a Medicare participant that is contractually obligated to provide health care to Medicare beneficiaries. This was beginning of clubbing all ...

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In the wake of the Orlando shootings, the usual battle lines are drawn in the usual, predictable way. Urban liberals and many Democrats call for more regulations and enforcement to limit access to firearms (especially assault weapons); hunters and conservatives and many Republicans -- and especially the National Rifle Association (NRA) -- ...

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In his recent article “Feed Me, Pharma,” ProPublica’s Charles Ornstein has been calling attention to studies showing that the prescribing decisions of doctors are linked to the amount of money that drug companies can bestow on them, usually in the form of meals, travel expenses, tuition support to attend courses, and so on. I find nothing surprising about that, and Ornstein need not be so scrupulous when he clarifies that “the ...

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I’m feeling pretty good about myself today. My patient, recently admitted to home health care, was just not herself, low O2 sats, irregular heart rate with pain on inspiration and feeling a little clammy. While her recent surgery was a neck fusion, it still didn’t completely eliminate the possibility of a pulmonary embolism. Instead of spending 15 to 30 torturous minutes in her primary doctor’s voice mail hell, I made ...

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Once a month, she waits patiently in my exam room, despite the fact that I’m almost always running an hour late in my hectic community health center practice. She is 86 and suffers from mild dementia, diabetes, arthritis and an arrhythmia for which she takes warfarin, a powerful blood thinner. At every visit, she comes to me with some sort of homemade gift -- a scarf, a tin of cookies, ...

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Sometimes, I think that that guiding principal of the medical profession, “first, do no harm,” is hopelessly out-of-date. Clearly, a physician should understand her limits, and never should she give care, which hurts, more than helps. Nonetheless, this axiom implies that the doctor is in control, and decides the treatment. Some of the time, a modern motto, which recognizes the true position and limits of the modern doc, might be, ...

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I accompanied my husband to an office visit with his orthopedic surgeon. Jamie had been experiencing setbacks in his recovery from major surgery. I went with him because I understand how hard it can be to distill medical information on the spot, much less remember it. Documenting what the surgeon said would allow us both to reference it later. The more information Jamie had about his condition, the more of ...

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I glanced at my watch before responding to the pager. It was almost 2 a.m., with the end of my 24-hour call as the in-house surgery resident still dangerously far away. The page was for a new consult from the medical service, on a patient with necrotizing pancreatitis. Apparently, she had been in the hospital for over a month, in and out of the ICU with multiple drain placements, and ...

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