Policy

Are the poor more likely to sue their doctors?

Policy
May 26, 2012

Many physicians, including myself, have the misconception that the indigent patient is more likely to be litigious than those patients with greater financial resources.  A well-organized study that was reported in Clinical Orthopeaedics and Related Research reported that socioeconomically disadvantaged patients tend to sue physicians less often than their more affluent patients.

Dr. Ramon Jimenez and his colleagues at the Monterey Orthopaedic and Sports Medicine Institute and his team demonstrated that patients …

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Healthcare reimbursement will change dramatically in the future

Policy
April 22, 2012

Based upon the past and the current state of affairs in healthcare, healthcare reimbursement will change dramatically in the future.  I believe that reimbursement based upon fee-for-service will gradually disappear and be replaced by models based upon the ability to better manage patient diseases and conditions.  That is, reimbursement will be based upon the quality of service delivered by the provider.  For insurers, whether private or governmental, I believe that …

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Does contracting with third party payers compromise ethics?

Policy
April 9, 2012

Physicians have historically been fairly well compensated for their efforts and thus have enjoyed many of the comforts of modern life. Most would agree this is the result of years of hard work, perseverance, intellect and dedication. In general these are also traits along with professional integrity, which raised physicians to a position of relative prominence and trust within our society. But in recent years that social position and economic …

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Is medicine a science?

Policy
April 2, 2012

Here’s something I read recently in a blog post (The Limits of (Neuro)science at Neuroskeptic) that started me thinking: “Will science ever understand the brain? … The notion that humans are complex and hard, while nature is easy, is an illusion created (ironically) by the successes of reductionist science. Some of the biggest questions facing mankind for eons have [been] answered so well, that we don’t even …

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10 strategic questions to ask yourself about the future of health care

Policy
March 19, 2012

Today and for the next few years the weather of this industry will be dominated by pervasive, discontinuous change. Structures, revenue streams, relationships of every level: All are shifting in fundamental ways. Specifically, the weather will be driven by:

i) invention and propagation of new business models;
ii) shifting risk onto both the provider and the patient, accompanied by building of new risk-based relationships, contracts and alliances;
iii) smart primary care coming to …

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Why this pediatrician quit medicine

Policy
March 17, 2012

There are an awful lot of reasons that led up to my eventual resignation from a career in primary care medicine.  I don’t know that any one of them is more important than the other (it really just depends on which day you ask me).  One that stands out for me though as a universal problem shared by millions is Managed Health Care, and the imposition it has posed on …

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Denying payment for unnecessary emergency room visits

Policy
March 5, 2012

Just when American healthcare system seems so dysfunctional that it seems impossible to imagine how it could be screwed up further, a decision is made that restores one’s faith in the creativity of Man.  But before you run out of guesses as to which particular decision we’re talking about today, we’ll just blurt it out.  We are referring to a recent decision by Washington State Medicaid to deny payment for …

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A sick care system instead of a health care system

Policy
March 1, 2012

An excerpt from The Future of Health Care Delivery.

We Americans like to pride ourselves on having the best health care system in the world, but unfortunately that is not the case. We have a medical (that is, sick) care system—a system that waits until we become ill before it kicks into action—instead of a health care system focused on helping us stay healthy. We give lip service to prevention and, …

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Why are labor and deliveries closing?

Policy
February 18, 2012

Labor and deliveries are slowly closing across the United States:  California, Pennsylvania, and Ohio.  In regional areas where there have been no closures, conversations in hospital boardrooms are probably questioning whether they should be.  But why?  Because of health care reform, increasing medical expenditures, hospitals are making less money due to reduced reimbursement, and because of the financial margin of obstetrics.  To explain the complex answer further, we need to …

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Our healthcare system is unfair and unbalanced

Policy
January 5, 2012

About six weeks ago, while in clinic, I developed pain in my stomach — specifically, in my right upper quadrant, just below the ribs.  I had experienced this a few times before, but this time it seemed more persistent than usual.  Following the rule that physicians make the worst patients, I kept working through it until my nurse told me I looked poorly, and made me see my own primary …

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Why do non-profit hospitals compete with each other?

Policy
November 13, 2011

While we are talking about things that drive health care costs up, this one has bothered me since I was in practice years ago. I am a believer in competition, I think it forces us to be creative and provide better, cheaper, more efficient products and services.

But there is the mindset of leadership at play as well. Are we competing to provide better patient services to improve patient care, or …

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The new definition for a medical emergency

Policy
November 9, 2011

The recent budget crisis in many state Medicaid programs has led the directors of these health care programs for the poor to cast about for ways to cut their costs, and many have landed on a ‘solution’ that puts lives at risk and undermine the financial viability of an emergency care safety net that is already severely underfunded and overwhelmed.  Some 21 states use a variation of the old definition …

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Why doctors should accept protocol medicine

Policy
August 13, 2011

We hear that doctors do not like “protocol medicine” – they do not want to follow a “cookbook” when every patient is different. It is not a good understanding of the issues.

Some years ago when I worked in a branch of he National Cancer Institute and then the University of Maryland Cancer Center, we admitted many patients with acute leukemia. The treatment approach including the necessary special tests to …

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Why healthcare is a responsibility, not a right

Policy
July 26, 2011

There is no “right” answer to the healthcare reform issue. There are facts, opinions, myths, politics and reality, all in no particular order of magnitude. Unfortunately, thus far and likely in the future, the reform will be political and thus costly and painful and will not address the core issues involved in fixing the inherent systemic problems.

There have been many things written with regard to this topic and I …

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Policy makers aren’t doctors, and why that’s a problem

Policy
July 25, 2011

Sometimes you just don’t want to be right.  Over the past 5 years, I have seen an alarming pattern arise in my profession.  Many of my patients have heard me talk about Soylent Green, an old Charleton Heston movie.  The premise of the movie seems absurd.  Can you imagine the government of the United States providing for all the needs of its people including healthcare, food, clothing, and even death?

David …

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How to minimize the costs of surgery

Policy
June 5, 2011

Surgery is expensive, there are no doubts about that. However, there are a few things a patient without insurance who desires surgery can do to minimize the costs as much as possible. Before going into cost-cutting measures, you first need to understand where the costs come from.

In rank order, the costs of surgery come from (highest to lowest):

How an ACO will affect physicians and Medicare patients

Policy
April 14, 2011

by Benjamin P. Geisler, MD, MPH

Everybody is talking about Accountable Care Organizations or ACOs these days.

The reason being that the Centers for Medicare and Medicaid Services or CMS has released the rules for shared savings between ACOs and CMS.

The complete proposed rule is 429 pages long and they’re seeking comments on it now until early June.

What is an ACO?

ACOs will take care of …

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Physicians referring patients to a diagnostic facility they own

Policy
April 10, 2011

Federal law generally prohibits physicians from referring their own patients to a diagnostic facility in which they have an ownership issue – a practice called “self-referral” – unless the facility is located in their own practice.

This exemption exists to allow patients with access to a laboratory test, x-ray, or other imaging test at the same time and place as when patients are seeing their physician for an office visit. Less …

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