Why Healthcare Regulators Fail to Regulate

Health Plan Regulators and the Revolving Door

Why do healthcare regulators so often fail to enforce their own regulations?  Let’s look at some examples for an answer.  In 2015, the Department of Managed Health Care in California did a survey of plans and risk bearing organizations (RBOs) … Continue reading


Anthem Declares War on Emergency Medicine in California

Anthem Blue Cross (BC) in California announced in its December Professional Network Update that, beginning in January of 2016, the plan will begin a pre-payment review of all ED visits billed with CPT 99285 (professional service) or HCPCS code G0384 … Continue reading

Group Practice Structure – A Cost / Benefit Analysis

Pros and Cons of Group Practice Modes

In a recent three-part discussion in ACEP eNOW about democratic vs. limited equity holder emergency medicine groups (now both are more often evolving into Acute Care Continuum groups involving EPs, hospitalists, anesthesiologists, radiologists, on-call specialists, urgent care docs, post-acute care … Continue reading

Fear and Anxiety in the Emergency Department

Fear and Anxiety in the ED

When patients come to the ED, there is almost always some level of fear or anxiety that plays a role in their presenting symptoms and their response to treatment. Recognition of this overlaying factor is often just as important as … Continue reading

Medical Dreams in Retirement


Now that I have retired from clinical practice, the dreams that I have related to medicine have seemed not only more frequent, but more vivid, or disturbing, or impactful, and certainly more difficult to interpret. In fact, I have given … Continue reading