When I talk to medical practices about hierarchical condition category (HCC) and risk-adjusted diagnosis coding, I receive a lot of questions that point to the existence of persistent urban legends! Let’s separate fact from fiction. Urban legend #1: CPT fee-for-service coding will be a distant memory when we switch from volume to value Not anytime soon. Medicare’s newer payment models starting with Medicare Shared Savings Programs (MSSP) and Accountable Care Organizations (ACOs) are ...

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The beverage industry derailed the movement for soda taxes in California by convincing state elected officials to pre-empt local taxing authority in exchange for cancelling a ballot initiative that would have made all new taxes difficult to pass. But taxes are not the only way to reduce sugary beverage consumption in California or the U.S. as a whole. The beverage industry has come up with several ideas on how to ...

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In country after country, I witness the same sad situation: caring, often-brilliant men and women toil in the health care industry to care for others, but to do so they must battle the system itself. That system has lost sight of what matters, which is humans caring for other human beings. To simplify things a bit, every health care system on earth has three main stakeholders:

  1. Patients
  2. Physicians and clinicians
  3. Administrators
Yes ...

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There are now more than 700 million obese people worldwide, 108 million of them children, reported the New York Times in 2017. In Brazil, food giant Nestle sends vendors door-to-door hawking its high-calorie junk food and giving customers a full month to pay for their purchases. Nestle calls the junk food hawkers, who are themselves obese, “micro-entrepreneurs.” Big Food is increasingly targeting poor countries as “emerging markets” ...

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Being self-aware sometimes to the point of turning self-critical — I, as a constituent of an anesthesiologist’s society, am writing this freestanding letter to bring forth our ethical questions and concerns regarding a shortage of not only medications but also skills, funds and time. Scenario 1: Patient requests for spinal anesthesia for cesarean section, but a shortage of hyperbaric spinal anesthetics warrants epidural anesthesia as its replacement. What must be done? ...

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So many moving parts. Just last week, a patient I've cared for over 20 years came to see me, and she was despondent over a number of issues. First and foremost was that her partner of over 60 years has had progressive dementia, and finally things got so bad that he had to be transferred to a long-term care facility, no longer safely able to be cared for at home despite all ...

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As I explained to my medical student this morning that I was ordering an ultrasound on a patient first because the insurance company wouldn’t authorize a CT scan without it, it occurred to me that medicine derailed from its true purpose. Shortly later, I found myself again pointing out why I was prescribing a certain medicine rather than the one I wanted because it was not on the formulary of ...

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Unhealthy behaviors such as smoking, overeating, or lack of exercise lead to chronic health conditions, and many patients wanting to make positive changes to their health may seek the advice of their doctor to do so. But our insurance payment system works against supporting people when they want to act in a healthy way, and some of these payment decisions seem rooted in prejudices against those suffering from certain conditions. Smoking ...

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ama_logoA guest column by the American Medical Association, exclusive to KevinMD.com. Since the 1970s, women have been carving out an increasingly large role in medicine, and the profession is becoming more representative of our society. September is Women in Medicine Month, a great time to acknowledge the changing face of medicine, but also to note that female physicians are not ...

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Well, cement trucks and health care used to have a lot in common. Now all of that has changed. Cement plants have a market that is determined by the time it takes for special trucks to transport wet cement and get it in place before it sets. We see those cement trucks out on the roads with their spinning cargo bins — and all of them are bound to a local, ...

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