Now that the children have shouldered their muskets and taken aim -- figuratively speaking, of course -- against the gun lobby, maybe we can interest them in another partisan conflict that’s even more sweepingly about their survival: climate change. Not to minimize the horrific consequences of school shootings, but there are many more lives at stake from climate calamities. Threats from sea level rise, flooding, wildfires, and storms are multiplying ...

Read more...

Eye surgery is a delicate business. It involves operating within an orb the size of a large marble to remove a cataract or repair a retinal detachment. Not only is superb eye-hand coordination a must, but also an awareness of the myriad other medical issues in the elderly population most in need of eye surgery. Traditionally, patients undergoing cataract surgery had a preoperative medical evaluation, including blood work, chest X-ray, and EKG, ...

Read more...

A hundred years ago, the practice of medicine was just that: the practice of professionals specially trained to alleviate suffering and heal the sick. Doctors had a fiduciary responsibility to put the needs of their patients before their own. A small town doctor might be paid for his efforts in chickens — living or cooked. Flash forward. Medicine is big business. Trillions of dollars are spent every year in the health care ...

Read more...

Medical practices with risk-adjusted contracts must sharpen their diagnosis coding. Practices that are part of accountable care organizations (ACOs) or that have risk-adjusted contracts with commercial payers have an economic incentive to accurately report the disease burden of their patients. In fee-for-service medicine, physicians are paid based on the fee schedule associated with a CPT code, and any modifier attached to that code. The diagnosis code establishes the medical necessity ...

Read more...

By their nature, fee-for-service reimbursement schemes incentivize procedures over prevention. This creates a serious moral hazard: If you keep your patient panel healthy through early interventions and exhaustive lifestyle counseling, then there are fewer profitable procedures to do. On the other hand, if you let your patients become critically ill, then you will be rewarded handsomely for all of the (now) medically necessary procedures and tests that you can perform ...

Read more...

You go to your doctor because you are suffering pain, fatigue, or some equally debilitating ailment. Your doctor examines you and is worried there may be a serious underlying medical reason for your symptoms and orders a test. But, before you can have that test done to determine the cause of your symptoms, the insurance company must agree that you need it in order for them to cover the cost ...

Read more...

It is wildly popular to say that the chief culprit in the U.S. health care system is the traditional fee-for-service payment system, which rewards physicians for volume but not quality, leading to high-cost, low-quality health care. It supposedly follows that the fix is a system of “value-based” payments. Despite the popularity of these arguments, both aspects have been shown to be wrong. Studies show that the rising cost of American health ...

Read more...

I was behind schedule (again). My next patient was Helen, a non-compliant diabetic that hadn’t been into my office in over two years. Her blood sugars weren’t controlled at her last visit when I’d tried to impress on her the serious health problems that could develop if she didn’t take better care of herself. Clearly, I’d failed. Maybe I’d even chased her away? No pill I prescribed would help her diabetes ...

Read more...

I’ve got a confession to make. I own stock in a firearms maker. Seems ironic that someone like myself -- a physician has cared for countless victims of gun violence and someone who advocates for evidence-based policies to avert gun deaths -- would not only own guns himself but also be a stockholder of a company that manufactures them. Let me explain how this happened. When I first got out of residency, ...

Read more...

I recently opined about a decision by Anthem to deny paying for emergency room (ER) care that it deemed to be non-emergent.  My point was that insurance companies should not be obligated to pay for routine, non-emergent care, recognizing that we need a fair and reasonable method to define a medical emergency.   In my view, payment should not be denied to a patient who reasonably believes he needs ER care, even ...

Read more...

Most Popular

Join 140,000+ subscribers

Get the best of KevinMD in your inbox

Sign me up! It's free. 
close-link
✓ Join 140,000+ subscribers 
✓ Get KevinMD's 5 most popular stories
Subscribe. It's free.
close-image