Category Archives: Doctors

Some states pay doctors more to treat Medicaid patients


Blue doctorBy Michael Ollove

Fifteen states are betting they can convince more doctors to accept the growing number of patients covered by Medicaid with a simple incentive: more money.

The Affordable Care Act gave states federal dollars to raise Medicaid reimbursement rates for primary care services—but only temporarily. The federal spigot ran dry on Jan. 1.

Fearing that lowering the rates would exacerbate the shortage of primary care doctors willing to accept patients on Medicaid, the 15 states are dipping into their own coffers to continue to pay the doctors more.

It seems to be working. Continue reading


Coalition pushes for health care cost and quality transparency


Twenty-dollar bill in a pill bottleBy Lisa Gillespie

As consumers increasingly are being asked to pay a larger share of their health bills, a coalition of insurers, pharmaceutical companies, and provider and consumer advocacy groups launched Thursday a new push for greater transparency regarding the actual costs of services.

The group includes AARP, Novo Nordisk, the National Consumers League, the Ambulatory Surgery Center Association, the National Council for Behavioral Health and Aetna.

Transparency means all consumers have the information they need to estimate cost and quality of health services.

Health care transparency, long a buzz word, means all consumers — whether they are covered by Medicare, work-based insurance or without coverage at all — have access to information enabling them to estimate accurately the cost of health services, and compare physician quality rankings and outcomes.

The initiative, “Clear Choices,”  will add to private and government efforts already underway to get more such information to patients, including Medicare’s Physician Compare, and the Health Care Cost Institute’s ‘Guroo,’ which culls data from private insurers to provide average prices regionally.

The group’s first priority is advancing the Medicare doctor payment legislationp ending in the Senate because it includes a provision requiring Medicare to release for broader use a substantial amount of data on claims at the provider level.

The group’s other objectives include:

  • Improving quality measures for doctors and hospitals so that patients will be armed with more comparative information.
  • Requiring hospitals to be clearer regarding what may or may not be included in their cost estimates for care.
  • Creating better tools for consumers to make medical decisions based on price, quality and safety of medical services.

Continue reading


Medical schools try to reboot for 21st century


By Julie Rovner
Medicine has changed a lot in the past 100 years. But medical training has not.

Until now.  Spurred on by the need to train a different type of doctor, medical schools around the country are tearing up the textbooks and starting from scratch.

Most medical schools still operate under a model pioneered in the early 1900s by an educator named Abraham Flexner.

“Flexner did a lot of great things,” said Raj Mangrulkar, associate dean for medical student education at the University of Michigan Medical School. “But we’ve learned a lot and now we’re absolutely ready for a new model.”

And Michigan is one of many schools in the midst of a major overhaul of its curriculum.


Dr. Raj Mangrulkar and medical student Jesse Burk-Rafel (Photo by Leisa Thompson/For Kaiser Health News)

For example, in a windowless classroom, a small group of second year students are hard at work.

They’re not studying anatomy or biochemistry or any of the traditional sciences. They’re polishing their communications skills.

In the first exercise, students paired off and negotiated the price of a used BMW. Now they’re trying to settle on who should get credit for an imaginary medical journal article.

“I was thinking, kind of given our background and approach, that I would be senior author. How does that sound to you?” asks Jesse Burk-Rafel.

It may seem like an odd way for medical students to be spending their class time. But Erin McKean, the surgeon teaching the class, says it’s a serious topic for students who’ll have to communicate life and death matters during their careers. Continue reading


These doctors want a choice in how they they die


Hoping To Live, These Doctors Want A Choice In How They Die

Photo by Anna Gorman

Dr. Dan Swangard (Photo by Anna Gorman/KHN).

By Anna Gorman

SAN FRANCISCO — Dan Swangard knows what death looks like.

As a physician, he has seen patients die in hospitals, hooked to morphine drips and overcome with anxiety.

He has watched dying drag on for weeks or months as terrified relatives stand by helplessly.

Recently, however, his thoughts about how seriously ill people die have become personal. Swangard was diagnosed in 2013 with a rare form of metastatic cancer.

To remove the cancer, surgeons took out parts of his pancreas and liver, as well as his entire spleen and gallbladder.

The operation was successful but Swangard, 48, knows there’s a strong chance the disease will return. And if he gets to a point where there’s nothing more medicine can do, he wants to be able to control when and how his life ends.

“It’s very real for me,” said Swangard, who lives in Bolinas, Calif. “This could be my own issue a year from now.”

That’s one of the reasons Swangard joined a California lawsuit last month seeking to let doctors prescribe lethal medications to certain patients who want to hasten death. If he were given only months to live, Swangard said, he can’t say for certain whether he would take them.

“But I want to be able to make that choice,” he said. Continue reading


Even in nursing, men earn more than women


woman_doctor_surgeon_bigBy Julie Rovner

Women outnumber men in the nursing profession by more than 10 to 1. But men still earn more, a new study finds.

The report in this week’s Journal of the American Medical Association found that even after controlling for age, race, marital status and children in the home, males in nursing out-earned females by nearly $7,700 per year in outpatient settings and nearly $3,900 in hospitals.

Even as men flowed into nursing over the past decades, the pay gap did not narrow over the years studied: 1988 to 2013.

According to the Census Bureau, men made up about 9 percent of registered nurses in 2011, roughly a three-fold increase from 1970. And even though men were not permitted in nursing programs at some schools until the 1980s, they have overall earned more, just as in society at large.

The biggest disparity was for nurse anesthetists, with men earning $17, 290 more. Continue reading


Teaching doctors to empathize


empathy-770By Sandra G Boodman

The patient was dying and she knew it. In her mid-50s, she had been battling breast cancer for years, but it had spread to her bones, causing unrelenting pain that required hospitalization.

Jeremy Force, a first-year oncology fellow at Duke University Medical Center who had never met the woman, was assigned to stop by her room last November to discuss her decision to enter hospice.

Employing the skills he had just learned in a day-long course, Force sat at the end of her bed and listened intently. The woman wept, telling him she was exhausted and worried about the impact her death would have on her two daughters.

“I acknowledged how hard what she was going through was,” Force said of their 15-minute conversation, “and told her I had two children, too” and that hospice was designed to provide her additional support.

Unlike sympathy, which is defined as feeling sorry for another person, clinical empathy is the ability to stand in a patient’s shoes.

A few days later, he ran into the woman in the hall. “You’re the best physician I’ve ever worked with,” Force remembers her telling him. “I was blown away,” he says. “It was such an honor.”

Force credits “Oncotalk,” a course required of Duke’s oncology fellows, for the unexpected accolade.

Developed by medical faculty at Duke, the University of Pittsburgh and several other medical schools, “Oncotalk” is part of a burgeoning effort to teach doctors an essential but often overlooked skill: clinical empathy.

Unlike sympathy, which is defined as feeling sorry for another person, clinical empathy is the ability to stand in a patient’s shoes and to convey an understanding of the patient’s situation as well as the desire to help. Continue reading


Recruiting retired physicians to help solve a looming doctor shortage – The Washington Post


doctors-300An online program created in collaboration with the UC San Diego School of Medicine faculty aims to help address the nation’s shortage of primary care physicians, a critical health-care issue highlighted by the Association of American Medical Colleges on Tuesday.

Created by educators at the medical school and primary care physicians who are renowned experts in physician training and assessment, Physician Retraining and Reentry (PRR) provides physicians of all backgrounds, retired and otherwise, the tools needed to offer adult outpatient primary care in their current practices or at understaffed clinics across the country.

via Recruiting retired physicians to help solve a looming doctor shortage – The Washington Post.


Rush University Adds Patient Scores to Doctor Profiles — Doctors Lounge


Patient feedback goes on doctors’ profile pages

C plus gradeRush University Medical Center’s website has started adding the results of patient surveys to individual physician profiles, according to a report published by the medical center.

Feedback is gathered each year using data from approximately 17,000 patients who receive mail or e-mail surveys after appointments. Patients are asked for feedback about care and service in more than 30 questions, including 10 that focus on their care providers.

Patient feedback will be made available for any provider for whom the medical center has received 30 or more surveys in a one-year period.

via Rush University Adds Patient Scores to Doctor Profiles –Doctors Lounge.


Arguments provide few clues about how Supreme Court will rule on Obamacare subsidies


U.S. Supreme CourtBy Julie Rovner

For the second time in three years, the federal Affordable Care Act went before the Supreme Court Wednesday. And before a packed courtroom, a divided group of justices mostly picked up right where they left off the last time.

Once again, commentators and experts were left to wonder where Chief Justice John Roberts and Justice Anthony Kennedy, considered swing votes in the case, stand. A decision is expected by the end of June.

Unlike in 2012, the current case, King v. Burwell, doesn’t challenge the constitutionality of the law’s centerpiece that requires most Americans to have health insurance or pay a penalty.

In a 5-4 ruling, the court that year decided the law could continue, albeit with a twist: states could elect not to expand Medicaid.

But the latest case does challenge another piece that’s pivotal to making the law work: Whether tax credits to help moderate-income Americans afford coverage can be provided in the three dozen states where the marketplace is being run by the federal government.

To read the full transcript go here

The court’s most conservative justices seemed to side with the challengers, who say that a sentence in the law stipulating that tax credits are available only on health insurance exchanges “established by the state” means just that. In other words, credits would not be available in the three dozen states that are using, the federal exchange.

“If Congress did not mean ‘established by the state’ to mean what it normally means, why did they use that language?” asked Justice Samuel Alito.

Liberal justices, however, seemed much more comfortable with the Obama administration’s argument that the phrase encompasses both federal and state-run exchanges — and that reading the text to allow tax help only on state exchanges runs counter to the rest of the law.

If they were to read the law the way the challengers argue, said Justice Elena Kagan, “there will be no customers and no products” on the federal exchange, because no one would be eligible.

“When you’re interpreting a statute generally, you try to make it make sense as a whole,” she said.

But almost nothing could be gleaned from the questioning and comments of Roberts and Kennedy. Continue reading


Some dementia can be treated, but my mother waited 10 years for a diagnosis

Pauline Rabin with granddaughters Emma and Aviva Rabin-Court near the C&O Canal in Great Falls, Md. (Photo courtesy of Roni Rabin).

Pauline Rabin with granddaughters Emma and Aviva Rabin-Court near the C&O Canal in Great Falls, Md. (Photo courtesy of Roni Rabin).

By Roni Caryn Rabin

When my mother, Pauline, was 70, she lost her sense of balance. She started walking with an odd shuffling gait, taking short steps and barely lifting her feet off the ground. She often took my hand, holding it and squeezing my fingers.

Her decline was precipitous. She fell repeatedly. She stopped driving and she could no longer ride her bike in a straight line along the C& O Canal. The woman who taught me the sidestroke couldn’t even stand in the shallow end of the pool. “I feel like I’m drowning,” she’d say.

A retired psychiatrist, my mother had numerous advantages — education, resources and insurance — but still, getting the right diagnosis took nearly 10 years. Each expert saw the problem through the narrow prism of their own specialty. Surgeons recommended surgery. Neurologists screened for common incurable conditions.

The answer was under their noses, in my mother’s hunches and her family history. But it took a long time before someone connected the dots. My mother was using a walker by the time she was told she had a rare condition that causes gait problems and cognitive loss, and is one of the few treatable forms of dementia.

“This should be one of the first things physicians look for in an older person,” my mother said recently. “You can actually do something about it.” Continue reading


Sign-up season is over, but the list of special enrollment events is expanding


CalendarBy Michelle Andrews

When the annual sign-up period for individual Obamacare coverage ended earlier this month, it meant that in general, people are locked into their plans for the year.

There are exceptions, however, for those who experience life changes such as marriage, the birth of a child or the loss of their job-based coverage.

The list of situations that trigger a special, 60-day enrollment period will get longer in April, when a new rule issued by the Department of Health and Human Services takes effect.

The rule’s additional circumstances include:

  • Losing a dependent or dependent status because of divorce, legal separation or death. This provision would enable someone who no longer needs family coverage, for example, to switch to single coverage. Although not required until 2017, exchanges are encouraged to offer this as soon as possible.
  • An increase in an individual’s income to the federal poverty level in states that haven’t expanded Medicaid to adults with incomes up to 138 percent of the federal poverty level ($16,243 in 2015).At that income level, the person could qualify for premium tax credits that are available for those with incomes between 100 and 400 percent of the poverty level to make marketplace coverage more affordable.Last year, such individuals could also qualify for a special enrollment period, “but we read this as a bit broader,” says Sarah Lueck, a senior policy analyst at the Center on Budget and Policy Priorities. Last year, “you had to have applied for Medicaid to qualify.” Now, that’s not necessary.
  • If a court order requires someone to provide health insurance, the coverage must be available the first day the court order takes effect.“It’s extremely important for ensuring the coverage of children,” says Dania Palanker, senior counsel at the National Women’s Law Center.
  • People who are currently enrolled in non-calendar year plans will qualify for a special enrollment period when that coverage ends, even if they could renew them.

Please contact Kaiser Health News to send comments or ideas for future topics for the Insuring Your Health column.

Please contact Kaiser Health News to send comments or ideas for future topics for the Insuring Your Health column.

khn_logo_lightKaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.


Top five health stories of the week

Credit: Dan Shirly

Credit: Dan Shirly


Going abroad to get medical care – Tips from the CDC


From the US Centers for Disease Control and Prevention

Receiving medical care abroad can be risky.
Learn about the risks and how to minimize them.

Going Abroad for Medical Care

Airplane“Medical tourism” refers to traveling to another country for medical care. It’s estimated that up to 750,000 US residents travel abroad for care each year.

Many people who travel for care do so because treatment is much cheaper in another country.

In addition, a large number of medical tourists are immigrants to the United States returning to their home country for care. The most common procedures that people undergo on medical tourism trips include cosmetic surgery, dentistry, and heart surgery.

Risks of Medical Tourism

The specific risks of medical tourism depend on the area being visited and the procedures performed, but some general issues have been identified: Continue reading


How much does it cost?


A new website,, allows you to find out how much care for common conditions will cost. The site provides local, state and national average charges for these conditions. The site was created by the Health Care Cost Institute (HCCI), an independent, non-partisan, non-profit organization that promotes research and analysis on the causes of rising US health spending. Demo from Health Care Cost Institute on Vimeo.


States strive to keep Medicaid patients out of ERs


Sign for an emergency room.By Michael Ollove

Nearly half the states use higher copayments to dissuade Medicaid recipients from unnecessary visits to emergency rooms, where care is more costly.

These states require patients to make the payments, which are as high as $30 per visit in Oklahoma, when it is later determined that they did not experience a true medical emergency.

But at least one multistate study has found that charging higher copayments does not reduce emergency department (ED) use by Medicaid recipients.

One reason might be that copays are hard to enforce, since EDs are legally obligated to examine anyone who walks through the doors, whether or not they can pay.

ED doctors and others in health policy also criticize copays as potentially dangerous, since they may lead people to think twice about seeking emergency care when they really need it.

Washington state and some Medicaid managed care plans around the country are trying a different approach. Instead of using financial disincentives, they are trying to keep frequent users out of the emergency department (practitioners prefer the name “emergency department” to “emergency room”) by enrolling them in primary care practices, scheduling appointments for them and, in some cases, making sure they get to the doctor’s office on time. The hope is that giving people comprehensive health care will make many ED trips unnecessary.

Reliable data are still sparse, but the early signs are encouraging: Washington state reported that a year after implementing its program, emergency room visits by Medicaid beneficiaries had declined by nearly 10 percent. Among frequent ED users, the drop was slightly greater. Continue reading