For a large and growing number of us with meager or no coverage, health care is the ultimate “gotcha.” Events conspire, we receive care and then are on the hook for a car- or house-sized bill. There are few alternatives except going without or going broke. Steven Brill’s recent cover story clearly detailed the predatory health care pricing that has been ruinous for many rank-and-file Americans. In Brill’s report, a ...

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I hate saying I told you so.  But "patient engagement is a physician-patient communications challenge and not an HIT (health information technology) challenge.” Just take a look at the Mayo Clinic’s patient portal experience which was discussed at a HIMSS 2013. The headline: "Mayo Clinic struggles to meet stage 2 meaningful use thresholds for engaging patients." Always innovating, the Mayo Clinic some three years ago introduced a web-based portal to share ...

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Health reform faces tension with integrated health systems The following column was published on March 26th, 2013 in the New York Times’ Room for Debate blog. In the coming years, health care reform will drive consolidation in the industry. Reformers, including the president himself, point to integrated health systems like Kaiser Permanente as the future of health care delivery. While this movement may improve patient care, whether it will shield ...

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The Physician Payment Sunshine Act is here: Are you ready?A guest column by the American Medical Association, exclusive to KevinMD.com. Information is a source of learning. But unless it is organized, processed and available to the right people in a format for decision making, it is a burden, not a benefit.  -Former ServiceMaster CEO C. William Pollard The new Physician Payment Sunshine Act (Sunshine Act) was created by Congress to ensure transparency in ...

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Walgreens moves into primary care, and its our own damn fault Will your next primary care appointment be at a drugstore? Yes, if Walgreens can help it. It was recently announced that the drug chain will have its nurse practitioners and physician assistants begin to diagnose and manage chronic conditions, such as hypertension and diabetes. "We're not trying to take over primary care, but we think we can help support physicians and transform the ...

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As a doctor, I am compelled to write because of what I know is occurring with alarming frequency in our country. Americans are skipping needed and recommended care that could save their lives and allow them to live to their fullest. Patients are more distracted, as life is more complicated and busier than ever. Households have both parents working, sometimes two jobs, just to make ends meet. They easily would ...

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It’s been a month since I started my new practice.  We are up to nearly 150 patients now, and aside from the cost to renovate my building, our revenue has already surpassed our spending.  The reason this is possible is that a cash-pay practice in which 100% of income is paid up front has an incredibly low overhead.  My admitted ineptitude at financial complexity has forced me to simplify our ...

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When I entered the exam room I found my patient, a woman in her 80s who'd come in for a routine visit, holding a photograph. "I need to show you something," she said. Some patients bring me photos at every visit--usually their kids' or grandkids' annual school pictures, or smartphone shots of a wedding or christening--but she never had before. I wondered what it might be. She laid the photo on ...

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The FDA issued a warning about the antibiotic azithromycin (Zithromax). The media stories have some patients terrified and some of them are calling me convinced that azithromycin is poison, a reliable agent for suicide. What’s the hubbub about? Azithromycin is in a family of antibiotics called macrolides, which also includes erythromycin and clarithromycin (Biaxin). Erythromycin and clarithromycin have long been known to very rarely cause fatal abnormal heart rhythms. It ...

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What is each minute of my time is really worth? Countless times during the course of my day, some person, entity or task vies for my time and attention. “If I could just have a minute of your time” begins a request to also see the spouse of a scheduled patient, a sales pitch from a pharmaceutical “rep” or home oxygen vendor, a phone call from a visiting nurse, a message from a ...

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