I went to my physical therapist yesterday for knee treatment and we talked about the fact that Blue Cross is cutting their reimbursement to the point that the cost of providing care will not even be covered. All I could do was lament with him and listen. One insurer even told him (the owner of the business) to just "make the sessions shorter and don't give as much care." Clearly the insurance ...

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One of the joys of practicing at an academic center is that I get to do many different things in my job. The foundation of my work is seeing my own patients in a large group (more than thirty doctors!) primary care practice. Two months a year, I take my turn rotating on the hospital inpatient services, supervising teams of residents and students who are the primary caregivers for patients with illnesses ...

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Originally published in MedPage Today by Michael Smith, MedPage Today North American Correspondent Physicians are working fewer hours than they once did, the result of a decade-long decline that coincided with lower fees for their services, a study showed. After two decades of stable hours, a steady decrease began in 1997, according to Douglas Staiger, PhD, of Dartmouth College, and colleagues. The decline coincided ...

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What if your local hospital went national? In a growing trend, big name institutions are partnering with smaller hospitals nationwide, looking to leverage their reputation. Drew Weilage, blogging at at our own system, highlights a local hospital in Ft. Lauderdale, Florida which signed a partnership agreement with Boston's Massachusetts General Hospital. Indeed, he asks, "Who wouldn’t choose, if they could, the Mayo Clinic for neurosurgery? Or the Cleveland Clinic for heart treatment? Or ...

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During residency, there was always a case of misdiagnosed chest pain to discuss in conference.  Incorrectly sending a patient home and missing the diagnosis of cardiac chest pain was an infrequent, but repetitively observed, phenomenon. So as to tread carefully with words, it is sufficient to say that even now, chest pain triage remains a vexing problem. Chest pain diagnosis is like appendicitis; there are always small numbers of unusual cases in ...

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Part three of a series. See also parts one and two. Previously, I have suggested that patients should do their best to get their doctors as free from the influences of their biases as possible. In order to do that, patients (and doctors) need to recognize what forces are working against them. Here's what negatively influences a doctor’s decision making: 1. They fall behind in clinic. Your doctor may be naturally ...

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I made a New Year’s resolution to become a vegetarian. Or a mostly vegetarian. I’ve been thinking about it for a long time, but with young children who love meat and don’t have the broadest palates, I think it’s important to feed them protein any way I can get it in them. Having passed 40, I’ve finally realized that I can no longer eat what I want with impunity. Further, as a ...

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I've often given doctors too little credit when it comes to business decisions. But, in an op-ed published at Reuters, physician Ford Vox argues otherwise. He notes that doctors, indeed, have tremendous business sense:

How can anybody say that doctors don’t have business sense, when not only do most American physicians forge their way in small private practices, but new doctors lay their cards on the table every year? The competitiveness of ...

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Originally published in MedPage Today by John Gever, MedPage Today Senior Editor Many hospitals that spend relatively little per patient deliver good-quality care, researchers said. Medicare data indicated that hospitals in the highest quartile of per-patient cost for initial treatment of pneumonia or congestive heart failure (CHF) did not have markedly lower readmission or risk-adjusted mortality rates than hospitals in the lowest ...

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Primary care's woes have been well documented, especially on this blog. Pressure on reimbursement, combined with rising bureaucratic impediments to the doctor-patient relationship, are both causing primary care physicians to retire early, or seek another career path. But what about on the other side of the spectrum, namely, newly graduated primary care doctors? Well, they're no dummies, as it's obvious to them how difficult it is to practice primary care in a traditional ...

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