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Latest Posts

Emergency Care’s Ambiguity In The Affordable Care Act

There’s just so much hidden and buried in the Affordable Care Act (ACA) that it’s like trying the find all the goodies in an Easter egg hunt. ACEP News pointed out one hidden goodie, nicely illustrated in this article from Kaiser Health News:

Under the new health law, insurance companies must extend several new protections to patients who receive emergency care. One of the biggest guarantees: Patients who need emergency treatment will have their costs covered at the same rate, regardless of whether they are treated at “in-network” or “out-of-network” hospitals.

The law also bars health plans from requiring prior authorization for emergency services. And it mandates that plans follow the “prudent layperson” rule. For example, if a person goes to the ER with chest pain, but ends up being diagnosed with indigestion, the claim has to be covered because going to the hospital under those circumstances made sense.

The provisions go into effect for every health plan issued after Sept. 23 – six months after the law was enacted — that offers emergency coverage.

This is potentially quite significant. As with so many things, the devil is in the details, and the implementation is not yet actualized. Read more »

*This blog post was originally published at Movin' Meat*

Medical Moonlighting: How About Doctor Derby?

Medical moonlighting. That’s what you’d better be thinking about as the healthcare finance reform trap continues its destined pursuit of bankrupting America.

The only possible outcome to all of this mess is the biggest man-made healthcare recession of all time that will make the current economic implosion look like a walk in the park.

What are some possible second jobs for doctors? Every week I get offers to respond to surveys and telephone conferences by private industry asking for my opinions on up-and-coming pharmaceuticals. Just the other day I was offered $500 for a 90-minute interview. (That reminds me, I had better call them back!)

Other second jobs for doctors? Read more »

*This blog post was originally published at The Happy Hospitalist*

Why We Need Private-Practice Primary Care Doctors

A recent post on Kevin MD by Joseph Biundo, a rheumatologist, challenged my assertion that primary care doctors can save money:

(In reference to my claim…) That may be true in theory, but I see patients in my rheumatology office every day who have been “worked up” by primary care physicians and come in with piles of lab tests and X-ray and MRI reports, but are diagnosed in my office by a simple history and physical exam.

Prior to that, an article in the New York Times along with a post by Kevin Pho noted the fact that more solo practitioners are leaving private practice and joining hospital systems. Why are they doing this? Read more »

*This blog post was originally published at Musings of a Distractible Mind*

Healthcare Reform: Mandating Mediocrity

Health care reformers say they want to improve the quality and affordability of health care.

It sounds good.  But it’s not like there’s no one out there trying to do that.  Employers of all sizes have been working on this problem for a long time, and they’ve come up with a great many interesting successes and failures.

So what’s the problem?

Well, it seems like reformers in Congress are completely uninterested in these things. Read more »

*This blog post was originally published at See First Blog*

Medical Records: One For The Insurance Company And One For Doctors & Patients?

Apparently, there are some legitimate reasons why a patient may lie to their physicians.

A recent article in the Los Angeles Times discusses the phenomenon, which as Dr. Gregory House would aptly summarize as, “Everyone lies.”

In fact, a recent survey suggests that “38% of respondents said they lied about following doctors’ orders and 32% about diet or exercise.”

One interesting reason is that patients are wary disclosing potentially damaging information to health insurance companies. Indeed, when patients apply for individual health insurance, their medical record is pulled up. And since trivial details can cause insurance companies to deny health coverage, patients certainly may have second thoughts about giving an accurate history.

Furthermore, “when processing a claim, the insurance company finds something in a patient’s records that contradicts something the patient said when purchasing the policy, the company can retroactively cancel the policy.”

That’s pretty harsh.

But making medical decisions on inaccurate information has consequences as well, including providing poor patient care.

One suggested option would be to maintain two sets of medical records, one that is shared with the insurance companies, and a private one that is not released to third parties. Some patient advocacy groups even go as far as saying, “If your physician won’t do that, it’s reason enough to leave the physician.”

I currently don’t offer such an option. I wonder how many other practices do.

*This blog post was originally published at KevinMD.com*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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