Our noble profession is being destroyed by legislators and administrators – KevinMD – CATHLEEN LONDON, MD | Aug 2017
A doctor describes the frustration of her hard-won knowledge and expertise being overruled by an insurance company minion with barely a high school degree.
I had a great day in the office today. Not that I came up with any brilliant diagnosis nor cured anyone.
I was able to just be a physician. No time wasted on the phone with insurance companies. No prior authorizations to do.
It was a reminder of how much I love my job. Continue reading
Doctors, Revolt! – Feb 2018 – The New York Times by Rich Joseph
Dr. Lown identifies first and foremost as a healer. In 1996, he published “The Lost Art of Healing,” an appeal to restore the “3,000-year tradition, which bonded doctor and patient in a special affinity of trust.”
The biomedical sciences had begun to dominate our conception of health care, and he warned that
- “healing is replaced with treating,
- caring is supplanted by managing, and
- the art of listening is taken over by technological procedures.”
Pay for performance: a dangerous health policy fad that won’t die – By Kip Sullivan and Stephen Soumerai – Jan 2018
Pay for performance, the catchall term for policies that purport to pay doctors and hospitals based on quality and cost measures, has been taking a bashing.
Balancing these two factors is unfair because “quality” is not measurable, but cost certainly is. It’s easy to cut costs, but cuts to quality are difficult to detect and thus be enacted with impunity.
Last November, University of Pittsburgh and Harvard researchers published a major study in Annals of Internal Medicine showing that a Medicare pay-for-performance program did not improve quality or reduce cost and, to make matters worse, it actually penalized doctors for caring for the poorest and sickest patients because their “quality scores” suffered. Continue reading
Abuse-Deterrent Opioids and the Law of Unintended Consequences | Cato Institute – By Jeffrey A. Singer – February 6, 2018
In the hope of reducing opioid use, abuse, and overdoses, policymakers have focused on developing and promoting tamper-resistant or abuse-deterrent formulations (ADFs) that render diverted opioids unusable if individuals attempt to use them for nonmedical (i.e., recreational) purposes.
Although the benefits of ADFs seem to be nonexistent, these formulations have led to real harms. ADFs have encouraged users to switch to more dangerous opioids, including illegal heroin.
ADFs unnecessarily increase drug prices, imposing unnecessary costs on health insurance purchasers, taxpayers, and particularly patients suffering from chronic pain. Continue reading
Failing health of the United States | The BMJ – BMJ – Feb 2018 “The role of challenging life conditions and the policies behind them.” by Steven H Woolf, director, and Laudan Aron, senior fellow
The subtitle says it all: our country doesn’t know how to handle “challenging life conditions” because we’ve been the “land of plenty” for so long.
But with surging income inequality, the number of people living in poverty is on a relentless climb. With the previously existing economic and social safety nets dismantled, what is to become of us? Continue reading
Using the PA (Prior Authorization) Process to Deny Necessary Medication – National Pain Report – January 15, 2018 – By Steve Ariens, PD.
Retired pharmacist and chronic pain advocate Steve Ariens has some tips for chronic pain patients in fighting their insurance companies.
As we enter a new year, many PBM (Prescription Benefit Managers) and insurance companies are using the war on drugs and “opiate crisis” as an excuse/reason to cut back on the coverage of pain medications and other controlled medications
Placing a medication on an insurance company’s formulary plan gives the patient the impression that a particular medication is covered until the “asterisk” behind its name indicating that it simply requires a Prior Authorization (PA) in order to get it paid for. Continue reading
Doctors Make Big Money Testing Urine For Drugs, Then Ignore Abnormal Results –
In April 2014, state and federal drug agents raided Jeffrey Campbell’s medical clinic in Jeffersonville, Ind. Some of the seized records would show that Campbell endangered patients by prescribing opiates without any medical need, according to federal prosecutors.
Campbell, who collected millions of dollars from Medicare for urine tests run at his office lab, also failed to act when test results revealed patients were abusing prescription and illegal drugs, according to a government medical expert’s report. Continue reading
Moral Choices for Today’s Physician | Humanities | JAMA | The JAMA Network – Donald M. Berwick, MD, MPP
The current generation of physicians is the most challenged by moral choices in perhaps a century. Those choices come in three tiers: personal, organizational, and societal.
This is the moral choice in its simplest, purest, most elemental form. To tell the truth, or not, when “not” is perhaps in your short-term self-interest.
A second form of choice comes in equal silence and has to do with one’s self-image as a physician. It is the choice between being a hero and being a citizen. Continue reading
Science is a public good in peril – here’s how to fix it | Aeon Essays
The rise of the 20th-century research university in the United States stands as one of the great achievements of human civilisation – it helped to establish science as a public good, and advanced the human condition through training, discovery and innovation.
We argue that over the past half-century, the incentives and reward structure of science have changed, creating a hypercompetition among academic researchers.
Part-time and adjunct faculty now make up 76 per cent of the academic labour force, allowing universities to operate more like businesses [just like healthcare -zyp], making tenure-track positions much more rare and desirable. Continue reading
Liquid Gold: Pain Doctors Soak Up Profits By Screening Urine For Drugs | Kaiser Health News – Nov 2017 – By Fred Schulte and Elizabeth Lucas
The cups of urine travel by express mail to the Comprehensive Pain Specialists lab in an industrial park in Brentwood, Tenn., not far from Nashville.
Most days bring more than 700 of the little sealed cups from clinics across 10 states, wrapped in red-tagged waste bags. The network treats about 48,000 people each month, and many will be tested for drugs.
Gloved lab techs keep busy inside the cavernous facility, piping smaller urine samples into tubes. Continue reading