October 25th, 2010 by Debra Gordon in Better Health Network, Health Policy, Opinion, Research
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I spent last week in Gothenburg, Sweden covering the European Committee for the Treatment of Multiple Sclerosis (ECTRIMS) meeting. Lots of good science, lots of excitement over the new oral and targeted therapies coming on the market to treat this awful disease. But what I want to write about isn’t the science, but about how it will play out in the brave new world of healthcare in which we all live in today.
For instance, consider the first oral therapy to hit the market: Gilenya (fingolimod), which the FDA approved in September. Last month Novartis announced the price: $48,000 a year.
This is not a rant against the high cost of drugs, however. It is a rant against the inability of our healthcare system to take the long view of the impact of such drugs, a view that is particularly important with a chronic disease like MS that strikes healthy young adults in their early 20s and 30s. Read more »
*This blog post was originally published at A Medical Writer's Musings on Medicine, Health Care, and the Writing Life*
August 17th, 2010 by John Mandrola, M.D. in Better Health Network, Health Policy, Opinion
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I present interesting cases to colleagues often because it’s educational and good for patient care and because I like to. But it has been many years since I was mandated to present a case.
It seems that I’m not the only doctor exasperated by a pesky new barrier to patient care: Doctors in cubicles.
An old friend and mentor, Dr. Richard Kovacs, now chair of the American College of Cardiology’s Board of Governors (and IU guy), has written about these same pre-certification barriers. Dr. Kovacs, being a professor and distinguished ACC official, kindly terms these obstructionists “radiology benefit managers” (RBMs). Read more »
*This blog post was originally published at Dr John M*
August 13th, 2010 by RyanDuBosar in Better Health Network, Health Policy, Humor, Opinion, True Stories
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My car was making a chirping noise when I drove forward and a high-pitched whine when I went in reverse, so I took it into the mechanic and, while he’s under the hood, for some long-deferred routine maintenance (an oil change).
So when the phone rang, I was expecting him to tell me I need new brakes. Nope, it’s the pharmacy, which can’t refill a prescription. I have to see the doctor in person. I’m not sick, but I’d deferred my routine maintenance for too long. In this case, because I’m on a maintenance drug, he needs to check my blood pressure (which by this point was rising). Read more »
*This blog post was originally published at ACP Internist*
July 21st, 2010 by Toni Brayer, M.D. in Better Health Network, Health Policy, Opinion, True Stories
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Most doctors have a love/hate (and mainly hate) relationship with health insurance companies. We struggle with their confusing and complex coding rules in an effort to be reimbursed for our care of patients. When patients leave the office, they may think that a bill is sent to their insurance company and payment follows. More often than not it rarely happens that way.
I am staring at an explanation of benefits (EOB) from Blue Shield of California for a patient I saw for a physical exam and Pap test. This patient had recently been hospitalized with a life threatening throat infection and abscess and saw me for needed follow up. I spent about 45 minutes with the patient, reviewing the events leading to hospitalization, coordinating the medications, as well as addressing the routine screening and examination of a middle aged woman with some chronic health problems. Read more »
*This blog post was originally published at ACP Internist*
May 26th, 2010 by BobDoherty in Better Health Network, Health Policy, Humor, Opinion, Research, Uncategorized
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Here is Edward Bear, coming downstairs now, bump, bump, bump, on the back of his head, behind Christopher Robin. It is, as far as he knows, the only way of coming downstairs, but sometimes he feels that there really is another way, if only he could stop bumping for a moment and think of it.
— From A.A. Milne’s “Winnie the Pooh and the House at Pooh Corner.”
Internists, I expect, will identify with Edward Bear.
Richard Baron’s study in the NEJM on the amount of work he and his colleagues do outside of an office visit — the “bump, bump, bump” of a busy internal medicine (IM) practice — has resonated with many of his colleagues.
Jay Larson, who often posts comments on this blog, did a similar analysis for his general IM practice in Montana, and found that for every one patient seen in the office, tasks are done for 6 other unscheduled patients. Jay writes: “So really there [are] internists [who] are managing about 130 patients per day. Not much consolation when they only get paid for 18 per day.” Read more »
*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*
