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According to their medical training, physicians are concerned with treating patients according to commonly accepted “standard of care.” What about alternative treatments and techniques that are not considered part of conventional, Western medicine? As these approaches become more popular and requested by patients, doctors must decide what is acceptable in their practice and what isn’t….
Mind, Body and Beyond
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There is a growing awareness among many patients that the likely cause of their sickness or disease may be more than physical. After all, there are hundreds of web sites that discuss the mental, emotional and “spiritual” aspects of personal health and well-being—suggesting procedures, remedies, and therapies that fall outside conventional, Western medical practice. As patients learn more about holistic approaches to wellness, they expect their doctors to be informed on the subject and even make some recommendations as to what might fit into their self-help regimen.
Our monthly survey addresses a number of key questions: How familiar are most healthcare providers with Complementary and Alternative Medicine (CAM)? To what extent do they incorporate these procedures and therapies as part of their personal health program and in their own medical practice? Furthermore, do health professionals see a trend in greater awareness and acceptance of CAM as part of “standard medical care”?
Addressing the topic more analytically, our Special Report, “Making Complementary and Alternative Medicine Mainstream,” focuses on how CAM relates to important matters such as federal regulations concerning safety and effectiveness, clinical trials, insurance reimbursement, standards of practice, and medical malpractice liability.
To offer additional insights, we also feature personal commentary written by an Obstetrician and an interview with an Internist—both of whom are drawn to some aspects of complementary medical approaches that have benefited themselves and their patients. We hope you enjoy the diversity of viewpoints offered on an intriguing topic that is gaining additional exposure within the healthcare community.
Cordially,
Calvin Bruce
Managing Editor
New Plan to Insure Almost All Americans in 2008 Would Save $1.6 Trillion Over 10 Years
Source: Healthcare Finance News
Date: 05/14/2008
Commonwealth Fund researchers have created a plan that would insure 44 million of the estimated 48 million uninsured Americans in 2008 and save approximately $1.6 trillion over the next 10 years.
The plan is expected to cause minimal disruption for people satisfied with their current coverage, says the Commonwealth Fund, and any decisions to switch to the new coverage would be voluntary. Reports indicate financial savings would only be possible if coupled with efforts to reform how the United States pays for health care, investment in better information systems and the adoption of initiatives to improve public health.
As detailed by the article, the approach calls for:
-A national entity known as a “connector” that would offer individuals and small businesses a choice of private plans or a Medicare Extra plan.
-The requirement that all applicants be given health insurance at standardized rates regardless of their health status.
-Tax credits to make sure premiums are affordable. Premium assistance would be available to ensure that premiums do not exceed 5 percent of income and 10 percent of income for higher-income tax filers.
-The expanding of Medicaid and SCHIP to cover all low-income adults and children below 150 percent of the federal poverty level with modest copayments for health care services and no premiums.
-The requirement that everyone enroll in a health insurance plan - including uninsured individuals who file taxes, who would be automatically enrolled.
-The requirement that employers either provide health insurance or pay 7 percent of payroll (up to $1.25 an hour) into a pool to help finance coverage.
-Reforms that would extend Medicare extra benefits to current Medicare beneficiaries, eliminate the two-year waiting period for Medicare for the disabled and allow adults age 60 or older to buy into Medicare.
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The Picture of Healthcare
Source: Unique Opportunities Magazine
Date: 06/01/2008
With the American healthcare system generally agreed upon to have come to a crisis point, the topic is virtually inescapable in political discussions of recent. As 2008 is an election year, opinions on how to solve America’s healthcare woes are numerous and conflicting. An article in the May-June issue of Unique Opportunities takes a look at some of the options and opinions that make up the American discussion.
The article cites a survey by medical software firm Epocrates, Inc. from June of 2007 which found that 80% of respondents said healthcare reform was likely to be a central issue of discussion in the 2008 election. 50% of primary care physicians said that a single payer solution was the best answer to America’s healthcare woes. 60% of those said that the state of healthcare was likely to get much worse over the coming five years. The outlook among young doctors was even worse, with 32% of those responding that American healthcare would reach an even lower state.
Opinions vary, however, as to how to deal with the crisis. While some doctors advocate a single payer system, others advocate increased access to health insurance with government assistance. Still others call for a decrease in government involvement, citing regulations as the primary drivers of prices and trusting in free market powers to straighten out the mess. As is, the issue seems certain to dominate discussion in the coming election and likely for years to come beyond that.
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Health Care in a Lousy Economy
Source: H&HN Magazine
Date: 06/01/2008
The recent economic downturn has troubled the waters in many sectors of American life, from politics to transportation to the energy sector. But what does it mean for the health care industry? An article in the June issue of H&HN Magazine explores what the economic troubles of recent may spell out for your hospital.
The author, a principal in Deloitte Consulting LLP, cites his life experience in the city of Detroit, which has experienced America’s worst economy over the last 18 months, as a reliable predictor of what to look for in the coming economy. The article goes against traditional wisdom that healthcare remains mostly unaffected by economic woes, citing the troubles of Detroit’s metropolitan hospitals as conflicting evidence. The author notes six lessons from Detroit’s situation that may be relevant across the nation as the economy worsens:
-Healthcare isn’t immune to economic cycles
-The payer mix changes as laid-off workers become self-payers
-Patient-responsible portions of bills increase, as does bad debt
-Hospital volumes drop as ER rates increase but admissions go down
-Everybody expands as hospitals increase geographic reaches to make up revenues
-Mergers happen quickly as hospitals join forces to survive.
The downturn can, however, have some good effects. The author notes a drop in nurse vacancy rates during economic downturns as well as strong performance by regional not-for-profits. Also, costs are cut and more efficient organizations emerge when the economy finally goes back on the uptick.
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Kaiser Doctors Making a Different Kind of House Call
Source: Denver Business Journal
Date: 05/02/2008
In August of 2007, Kaiser Permanente’s Colorado division began a program in which physicians join sales associates on sales calls and follow up meetings with current members to address questions related to medical care and to “put a face” on Kaiser’s services. As an MCO, Kaiser Permanente is focused on expanding the number of services offered to each member as much as they are on courting new members outright.
Based on early evidence, it appears that the biggest impact of the physician “sales ambassador” program has been the encouragement of existing member companies to enroll more employees or sign on for more services, perhaps due to an increased level of trust. According to Kaiser, the program also causes members to focus more on care issues and less on bottom-line details. Kaiser claims that the number of employees enrolled by participating members has increased fifty percent since the start of the program.
Twenty-three doctors were originally contracted to be part of the “sales ambassador team” that covers the Denver area. Each physician is expected to take part in only one or two visits per month.
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U.S. Court Of Appeals Upholds FTC Decision on Price-Fixing Texas Physician Association
Source: Mondaq.com
Date: 05/23/2008
Early in May, the U.S. Court of Appeals for the Fifth Circuit upheld an FTC ruling that North Texas Specialty Physicians, “an association of competing physicians and physician groups” in Fort Worth, Texas engaged in price fixing that did not result in “procompetitive efficiencies” or clinical integration.
The price-fixing in question was mostly related to non-risk contracts. In 2003, the FTC charged the group with polling physicians to negotiate and establish minimum payment terms that they would accept from payors. Payors that did not agree with the group’s terms and meet the minimum fee standards were simply not allowed to engage with the group’s participating physicians. Physicians and payors were discouraged from dealing directly.
The Court of Appeals ruling was made without a full market analysis because of the obvious anticompetitive implications of the practice, though the Court did ask the FTC to amend its original ruling that the group not deal directly with payors.
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Hospitals Have New Options to Increase
Source: Healthcarereview.com
Date: 05/01/2008
For hospital administrators, days of cash on hand is a figure that could always stand to be increased. How quickly hospitals can pay their bills is a major factor in determining how they’re run, according to industry finance experts. It is believed that more timely payment of vendor bills would result in increased savings for hospitals as well as lowered overall healthcare costs.
An article on Healthcarereview.com examines an offering from Security Capital called Vendor Insta Pay. The service allows hospitals, surgery centers, medical organizations and larger medical practices to pay vendors in full. Security Capital reimburses the vendor at the generally lower price offered for prompt payment, and then the medical organization pays Security Capital with extended terms, usually an additional 60 days.
The program’s organizers claim the service adds no additional costs for practices and can be easily set up within a few days. The cost savings to hospitals, practices, and other medical organizations is being touted as a means of reducing health care expenditures for organizations and eventually patients.
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As Doctors Get a Life, Strains Show
Source: The Wall Street Journal
Date: 04/29/2008
American medicine is undergoing a cultural revolution as young physicians intent on balancing work and family challenge the assumption that doctors should be available to treat patients around the clock. While quality-of-life issues have been long-festering for physicians, today’s medical field is more accommodating, and younger doctors’ attitudes are giving rise to different types of practice options, ranging from small, membership-based primary-care facilities to hospital-specific jobs that keep doctors on predictable schedules.
At the same time, the attempt by new doctors to lead a less-pressured work life is putting additional strain on America’s healthcare system. Many are eschewing fields such as internal medicine, pediatrics and family medicine, choosing instead specialties that offer both higher pay and more predictable work hours. In family medicine, for example, hundreds of medical residency positions go unfilled every year. But competition for slots in dermatology residencies is fierce.
To adapt, American medicine is drifting away from the old standard—in which a single doctor handled almost all of a patient’s needs—and toward a more team-based approach. This system includes not only multiple doctors but also more nurse practitioners and physician assistants.
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Survey of Medical Schools is Critical of Perks
Source: New York Times
Date: 06/01/2008
A ranking released by the American Medical Association finds that most US medical schools fail to adequately limit the perks handed out to doctors and trainees by pharmaceutical companies, with just one in seven schools receiving above average assessments regarding their conflict of interest policies.
Conflict of interest policies are judged to be important for an untainted educational experience according to student advocates. The exposure to waves of advertising from pharmaceutical companies is thought to lessen the overall experience and even prove to have a negative and biasing effect on the education of future physicians.
The AMA called recently for an outright banning of the free food, gifts, and educational seminars offered to students and their instructors by pharmaceutical companies.
Of the 150 medical schools graded in the study, which was conducted by impartial students knowing nothing of the identities of the schools they were grading, only 7 received A’s, while 14 received B’s. Some 28 of the schools were in the process of revising their conflict of interest policies at press time.
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Physician Recruitment: Are We Using Our Time and Resources Wisely?
Source: Journal of the ASPR
Date: 06/01/2008
The writer proposes the idea of “Advanced Access” scheduling and practice model as a solution to physician recruiter woes. This model uses Queuing Theory to reengineer the standard appointment scheduling system, leaving most appointment slots open for same-day-calling patients. As a result, patients are seen in a more timely manner and the system improves scheduling, quality of care, and continuity. Waits and delays are dramatically reduced. Applying the Advanced Access aesthetic to recruiting, the author recommends moving nonessential tasks from physicians to clerical staff, PAs, NPs and nurses. The same goes for recruiting tasks, ensuring a more streamlined workflow for recruiters and increased overall practice efficiency.
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Neurology: Locum Tenens Specialists Meet Increasing Need
Source: LocumLife
Date: 05/01/2008
An article in the May issue of LocumLife explores the possibilities and opportunities for neurology specialists in the locum tenens field. Besides providing an opportunity for travel to other geographic regions, the locum path allows for practitioners to practice medicine without administrative distractions, experience different settings and practice styles, and learn new techniques, among many other benefits.
The article points out the Midwest and South as areas particularly in need of neurology services. In addition to potential salaries of up to $225,000, the locum tenens profession also provides a great opening for female practitioners, especially in the neurology field. There are also a number of neurology fields in which demand is steadily on the increase: neuro-intensivists, neuro-hospitalists, neuro-rehab specialists, and more.
The article advises those interested in the field to take full stock of its plusses and minuses before commitment to it. Familiarization with unique technological, record-keeping, and scheduling procedures is a must at various institutions. Preparedness for a large number of increasingly complex problems is also a necessary trait. The rewards to be reaped in the field are plentiful, however, for practitioners willing to take the plunge.
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Employment & Compensation
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Is a Contract Needed When Leaving a Practice?
Source: Physician’s News Digest
Date: 05/01/2008
When a physician leaves a practice, voluntarily or not, it is a time of concern for all sides and may lead to liabilities that went unconsidered until too late. For doctors that are forced out, there are the basic concerns for reputation and short-term income, while physicians remaining in the practice must always worry about the impact on revenues and productivity.
Nonetheless, there are many more subtle problems that often go unnoticed if the split is amicable, but that can prove a source for hostility and litigation given other circumstances. Health care attorney Vasilios Kalogredis outlines these concerns in his argument for the use of Separation Agreements any time a physician leaves a practice. While some of these concerns may be addressed in the general Partnership Agreement, it is helpful to revisit the terms or create a separate agreement altogether so that no details go unaddressed.
According to Kalogredis, a proper Separation Agreement will consider and include the following elements:
-The exact nature of the relationship that is ending, along with the termination date
-Terms for addressing all outstanding payment issues, including bonuses or other benefits that may accrue after the physician’s departure
-Likewise, terms for addressing liabilities that may accrue after the physician’s departure such as repayments to third parties or malpractice suits filed against the practice
-A statement of buyout entitlement that includes all assets of the practice
-Retraction of departee from debt guarantees
-Agreement on prepaid expenses such as malpractice insurance that were covered by the practice
-Terms of access to medical records
-A “non-disparagement provision” to maintain the reputation of both parties
-A non-disclosure provision.
In short, it is important to consider how all financial ties and other elements of the relationship will carry over in the short term and address them with adequate clarity.
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The Experience of Pay for Performance in English Family Practice: A Qualitative Study
Source: Annals of Family Medicine
Date: 06/01/2008
The pay-for-performance scheme is bandied about as a partial solution to America’s healthcare system woes, but how effective is it in practice? The results of a recent study conducted in the English system, which has instituted such a practice, possibly yield some positive implications for any American implementation, but with a few caveats.
The study, conducted by physicians at the National Primary Care Research and Development Center at the University of Manchester, explored the beliefs of physicians and nurses regarding the effectiveness of the new pay-for-performance system. The physicians surveyed 21 family doctors and 20 nurses in 22 practices across England between February and August of 2007. The semi-structured interview format was meant to elicit opinions as to the effect of the pay scheme on the quality of care delivered and attitudes brought about under the scheme.
The study authors found that participants believed the financial incentives were enough to change behavior and even cause staff to achieve non-incentivized treatment targets. Their findings suggested alignment of targets with professional priorities and values results in increased enthusiasm among physicians and greater understanding of and compliance with guidelines. However, the scheme did seem to result in decreased personal and relational continuity of care as well as resentment by care team members not receiving a financial benefit from the new scheme. As such, the authors indicate that care should be taken in the implementation of any such system, in that, while increasing efficiency and improving medical outcomes, the scheme potentially raises dangerous alterations to practice cultures and morale.
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Medical Doctors Attracted to Cosmetics: Physicians can earn more with lasers and Botox than primary care
Source: Houston Chronicle
Date: 06/02/2008
With insurance and Medicare reimbursements dropping, many family doctors are turning to out-of-pocket services such as cosmetic surgery to make ends meet. Obstetrician-gynecologists (OB/GYNs) in particular have found they can’t rely on medical patients alone to keep their businesses profitable. Treatments ranging from Botox injections to plastic surgery are bringing in hundreds of thousands of dollars a year in additional income for some of these practices.
As one doctor points out, delivering a baby involves nine months of care, a delivery, and then “waiting 21 years to see if the child will sue me.” All for between $800 and $1,600. A single vial of Botox from manufacturer Allergan, on the other hand, costs only $525 and contains enough for eight injections—a cost of $65 per shot. Patients, however, are charged around $500 per shot, a significant profit to the physician. Many patients spend $2,000 or more on a single visit and pay immediately, compared with a 30 to 90 day wait for insurance and Medicare payments. Add in procedures such as laser vaginal rejuvenation, labiaplasty, and laser hair removal and some practices are finding that treating medically ill patients simply isn’t as profitable as cosmetic work.
This trend has some specialists worried that growing demand for these treatments will lead to neglect of basic OB/GYN checkups like pap smears, while others worry that physicians without specialist training will be tempted to use treatments they may not be trained in. Still, with demand for cosmetic procedures like Botox on the rise—from 1.6 million shots administered in 2002 to 4.6 million in 2007—it appears that more OB/GYNs will look to fill in their bottom line with these treatments.
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Doctors Say ‘I’m Sorry’ Before ‘See You in Court’
Source: The New York Times
Date: 05/18/2008
For decades, malpractice lawyers and insurers have counseled doctors and hospitals to “deny and defend.” Many still warn clients that any admission of fault, or even expression of regret, is likely to invite litigation and imperil careers. But with providers choking on malpractice costs and consumers demanding action against medical errors, a handful of prominent academic medical centers, like Johns Hopkins and Stanford, are trying a disarming approach. By promptly disclosing medical errors and offering earnest apologies and fair compensation, they hope to restore integrity to dealings with patients, make it easier to learn from mistakes and dilute anger that often fuels lawsuits.
Hospitals are reporting decreases in their caseloads and savings in legal costs. Malpractice premiums have declined in some instances, though market forces may be partly responsible. At the University of Michigan hospital, for example, legal defense costs and the money it must set aside to pay claims have each been cut by two-thirds, and the time taken to dispose of cases has been halved. Similarly, the number of malpractice filings against the University of Illinois has dropped by half since it started its program just over two years ago.
Some advocates argue that the new disclosure policies may reduce legal claims but bring a greater measure of equity by offering reasonable compensation to every injured patient. Recent studies have found that one of every 100 hospital patients suffers negligent treatment, and that as many as 98,000 die each year as a result. But studies also show that as few as 30 percent of medical errors are disclosed to patients, and only a small fraction of injured patients—perhaps two percent—press legal claims.
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When You’re on the “Hot Seat”
Source: AAOS Now
Date: 05/01/2008
Encounters with the tort system can be harrowing experiences, no matter what side a physician is on. Being deposed as an “expert witness,” however, carries its own class of anxieties and concerns. How will one’s testimony be interpreted? How will it be used? Will it be fully understood? Has one’s incomplete understanding of the complexities of the tort system resulted in an unfair proceeding? An orthopedic surgeon with experience in expert testimony gives helpful hints for these court appearances in the May issue of AAOS Now.
The author lays out five strategies for ensuring the smoothest possible experience in testifying.
-Memorize dates: A witness gains credibility by having dates memorized. At least in appearances, it accentuates the “expert” part of “expert witness”.
-Pay attention to your Curriculum Vitae: Your CV will be entered into the record as evidence. It should look professional, with no errors.
-Tell the truth: No equivocating, tell the truth to avoid looking like you’re hiding something.
-Avoid bias: Bias, perceived or real, can be turned back on you and damage your testimony and credibility.
-Exercise professional discipline: do not criticize other experts. Stick to what you know.
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Malpractice Consult: Your Responsibility for No-Shows
Source: Medical Economics
Date: 06/01/2008
“I felt better after I took my medicine, so I just skipped our follow-up appointment.”
How many times does a doctor hear such an explanation from a no-show? Many times, the patient will be fine, but an article in the June issue of Medical Economics explains that a physician still bears responsibilities in order to assure patient safety and lack of physician liability.
The article recommends informing patients why follow-up visits are important, even if they have stable conditions. Exhaustive notation of such recommendations is also advisable in order to insulate the physician from subsequent liability.
The article further points out that legal trouble regarding no-shows most often arises with less than stable patients or patients with problematic diagnoses and/or treatments. For these, it is recommended that the physician fully explain the condition and its accompanying risks and necessities. The patient must be made fully aware of the necessity of the follow-up appointment for his own safety’s sake.
If all else fails, the author recommends taking a proactive stance: contact patients to schedule follow-ups and remind them on the day before or day of the appointment. If all this has been done and the patient still doesn’t show, and barring any negligence on the physician’s part, it’s generally okay to consider oneself in the clear.
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Mental Health Parity: At Long Last?
Source: Managed Care Magazine
Date: 04/01/2008
Signaling a shift in the nation’s attitude toward and willingness to treat mental health issues, two bills on Capitol Hill currently address the disparity between treatment plans for physical health and mental health. An article in the April 2008 issue of Managed Care Magazine addressed the significance and differences between the two bills.
The two bills—the Paul Wellstone Mental Health and Addiction Equity Act of 2007 and the Mental Health Parity Act of 2007—aim to “completely end insurance discrimination against mental health and substance abuse disorders.” Of the two, the Senate version enjoys greater popularity among involved parties and, with President Bush indicating that he is more inclined to sign the Senate version, stands a greater chance of enactment. The House bill would add new regulatory requirements for providers to cover all disorders listed in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders. The Senate version would also cover all listed disorders but leave open more options to providers for degrees of coverage and treatment.
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Social Networking Site for Cancer Docs: Bang or Bust?
Source: PharmExec.com
Date: 06/04/2008
A startup web company in Scottsdale, Arizona hopes to profit by creating an online forum where oncologists can share personal experiences in order to benefit the industry of battling cancer. MedTrust Online allows physicians to use the internet to post their successes and failures with various treatments for different types of cancer, including off-label prescriptions for many rare cases. Online discussions are tightly connected to credible medical information like peer-reviewed medical journals, clinical trial information, FDA announcements, and treatment guidelines, and the website contains a fully functional search engine.
The off-label prescription component of MedTrust Online is considered the most revolutionary aspect of the forum. Pharmaceutical companies are strictly regulated in what sorts of information they can release about off-label uses for their products, despite that 60 percent of all cancer drugs are prescribed off-label, according to the Agency for Healthcare Research and Quality (AHRQ). By streamlining discussions about the variety of uses for different drugs, physicians can make better decisions about oncology treatments in substantially less time than before.
The off-label component does raise some eyebrows, however, as MedTrust Online, which does not charge doctors for the use of the website, uses advertisements from big pharma as its primary revenue source. Questions about a conflict of interest may dissuade many physicians from taking full advantage of the services. Whether this will happen remains to be seen.
MedTrust Online seems to be weathering the initial storm of criticism and has already teamed up with Oracle and Dell to establish a closed institutional forum for South Texas Oncology and Hematology (STOH).
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Proposed Rule Would Strip Health Care Access from Millions
Source: American Academy of Family Physicians
Date: 05/22/2008
The American Academy of Family Physicians (AAFP) and six other organizations are calling on the U.S. Department of Health and Human Services (HHS) to rescind a proposed rule that could undermine access to care for millions of patients by stripping areas across the United States of their status as health professional shortage areas (HPSAs) and medically underserved areas (MUAs).
HHS issued the proposed rule earlier this year in putting forth a plan to consolidate the criteria for HPSAs and MUAs into a single new methodology called the Index of Primary Care Underservice. The AAFP believes that the consolidation of HPSAs and MUAs could strip 600 areas of their HPSA status while de-designating more than 900 MUAs, creating new health care shortages and exacerbating existing ones.
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Payer & Reimbursement Issues
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Misfortune Telling: Folding Together Data to Forecast Your Patients’ Health Futures
Source: American Medical News
Date: 05/26/2008
Health plans are trying to gauge their members’ future health problems by using health risk assessment surveys, demographic data, and past medical, pharmacy and hospital claims, and then applying some heavy math. This technique is called predictive modeling, and health plans are using it more and more to forecast medical costs rather than relying on typical insurance underwriting, which assesses risk based on an insured’s age, gender, location and (sometimes) past history.
Health plans are developing predictive modeling capabilities in-house, because they (and their employer customers) figure that by anticipating and trying to prevent illness, they can avoid paying even more for care.
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Hospitals Give Payers Low Marks on Image, Reputation
Source: Managed Care Magazine
Date: 05/01/2008
Health care plans received overwhelmingly low marks from the nation’s hospitals, according to a survey detailed in the May issue of Managed Care Magazine.
The survey, conducted by Davies Public Affairs, measured hospital executives’ perceptions of the nation’s largest health insurance companies. It was based on 113 interviews from executives representing more than 500—or 10%—of American hospitals.
In what is certain to be at least embarrassing news for payers, the largest providers showed significant amounts of negative sentiment coming from hospital executives. United Healthcare received 91% negative reviews, while Wellpoint/Anthem, Coventry, and Cigna received 48, 35, and 48% negative marks.
The results are indicative of a continuing trend in which large numbers of care providers grade companies as difficult or very difficult to deal with. An overall unfavorable rating of 41% was recorded for the payers as a whole. The only company scoring a majority positive review was Aetna, with 57% of respondents rating the company positively versus a 37% negative rating.
Representatives for the payer industry were noted as saying the survey doesn’t fully reflect the positive relationships the industry maintains with hospitals not represented in the study.
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Small Practice Evolution: Cash-only Medical Practices Skip the Middleman
Source: Medical Economics
Date: 05/16/2008
According to the author, many of the doctors who choose the cash-only payment model do so as a matter of personal morality, since, according to one doctor, “Third-party payments are set so low that you’re forced to run patients through the office like animals every five to 10 minutes. It’s unethical to accept contract terms that aren’t good for patients.” Furthermore, most of the cash-only doctors interviewed for this story said the current economic downturn hasn’t hurt their bottom line.
Furthermore, cash-only medicine has many payoffs. Because doctors with cash-only practices typically book fewer than 20 appointments a day, they spend more time with patients. With insurers out of the picture, cash-only doctors say they’re free to do more for their patients during those longer visits. Removing the middleman also trims overhead, because cash-only practices collect virtually all their charges at the time of service and therefore don’t need a traditional billing operation that eats up six to nine percent of gross revenue.
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Hospitals Look to Courts, Congress to Put the Breaks on Medicaid Cuts
Source: Hospitals and Health Networks Magazine
Date: 05/01/2008
Public health systems are worried about losing massive amounts in annual revenues if two new Medicaid regulations take effect on May 25.
Hospital officials are mainly concerned about two new Medicaid rules: one limits payments for public hospitals to the cost of care; another curtails payments to teaching hospitals. But a total of seven rules—estimated to trim Medicaid spending by $15 billion over five years—are drawing heat from nearly all corners.
Among the regulations in dispute is one limiting payments to public hospitals and narrowing the definition of a public hospital. Another proposed rule would prohibit the use of federal Medicaid funds for graduate medical education.
Hospital advocates argue that Congress has barred the Centers for Medicare & Medicaid Services (CMS) from imposing cost limits on Medicaid payments to governmental providers. The regulation also reclassifies some public hospitals to nonpublic if they do not have direct access to tax dollars. These hospitals would no longer be able to contribute to the state share of Medicaid funds, which are then matched by federal dollars. Some hospital advocates see the regulations simply as a budget-cutting maneuver, but CMS officials say the regulations will help stop abuses.
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Aetna Now Scores High on Doctor Relations
Source: Hartford Courant
Date: 05/01/2008
In 2003, Aetna settled massive class action litigation by medical societies claiming the managed care companies delayed and denied payments improperly and otherwise stymied doctor and hospital attempts at proper compensation. The company, among others, had a very damaged reputation. So how has the company rebounded five years later to an overall positive rating from hospitals? The Hartford Courant takes a look at the company’s efforts to redeem its image.
Aetna’s outreach efforts began before the settlement. The turnaround is generally credited to Aetna’s former chief executive, who led the outreach efforts and, a physician himself, directed the attempts at addressing physician concerns. The company began giving health care professionals 90 days advance warning of changes in fee scheduling and established a physician advisory board in addition to coordinating with physicians’ groups to better understand physician concerns.
Alterations to policies such as those listed above have resulted in a marked improvement in the company’s image, as seen in a recent survey which listed the company at a 57% positive rating from hospital administrators, the highest of any of the large providers. The company has recommitted itself to further improving its relationships with physicians and health care providers and closing the gap on whatever dissatisfactions still exist.
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Credentialing, Licensure, Quality Management
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CMS Seeks to Add 9 Hospital-Acquired Conditions to No-Pay List
Source: AMA News
Date: 05/01/2008
Centers for Medicare and Medicaid proposed to stop payment on nine conditions it says are hospital-acquired and preventable, saying the cuts in payment could save Medicare some $25 billion that was spent last year.
Some hail the effort by Medicare to encourage patient safety, while others say they should wait to gauge the value and efficacy of a similar implementation of non-pay status for eight other conditions enacted last year.
Under the system, hospitals cannot code and charge for the following conditions as “complicating conditions” if they are developed during the patient’s hospital stay:
-Surgical-site infections after total knee replacement, laparoscopic gastric bypass and gastroenterostomy, or ligation and stripping of varicose veins.
-Legionnaires' disease.
-Diabetic ketoacidosis, nonketotic hyperosmolar coma, diabetic coma or hypoglycemic coma.
-Iatrogenic pneumothorax.
-Delirium.
-Ventilator-associated pneumonia.
-Deep-vein thrombosis or pulmonary embolism.
-Staphylococcus aureus septicemia.
-Clostridium difficile-associated disease.
Critics claim the “preventability” of some conditions is questionable and that the regulations would discourage hospitals from caring for the sickest of patients, which are the ones most vulnerable to these conditions.
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NY Initiative Couples Payment and Practice Reform
Source: AAFP News Now
Date: 06/01/2008
A physician-founded, physician-governed health plan now underway in New York State, it is hoped, may eventually bring about beneficial structural changes to the American health system with regards to physician payment methodology. The program links primary care practice outcomes to physician payment and is the first such program in the country.
Outcomes in the study will be measured in areas of Patient Centered Care, Economic Performance, and Medical Outcomes. It is hoped that the study will lead to increased recruitment and retention of primary care physicians as well through demonstrating the efficacy and cost effectiveness of primary care as opposed to later specialized treatments.
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Doctors to Provide Online Consultations in War Areas
Source: Chicago Tribune
Date: 05/22/2008
The Center for International Rehabilitation, a Chicago-based organization, is recruiting 300 volunteer physicians to provide online consultations to doctors in war-torn areas around the world. The program, known as "iCons in Medicine," looks to use telemedicine to improve the status of healthcare in countries where there is a shortage of qualified physicians and a large number of civilian casualties.
Participating doctors hope to share both their technical skills and their medical knowledge to unstable countries across the world like Iraq. From using the internet to discuss results on X-rays to giving advice on day-to-day clinic operations, the program is expected to be an innovative approach to humanitarian aid that takes full advantage of developments in communication technologies.
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The State of Health Information Technology in California: Use Among Physicians and Community Clinics
Source: California Health Care Foundation
Date: 05/01/2008
A survey released by the California Health Care Foundation found that California physicians use IT more so than their peers in other states, but there is still progress to be made. Most physicians still rely on paper records and manual systems.
The study—which was drawn from studies by Medical Group Management Association, Harris Interactive, Cattaneo & Stroud, the California Medical Association, Manhattan Research, and the Community Clinics Initiative, all of which were conducted between 2005 and 2007—found that the use of digital equipment in medical records keeping isn’t widespread among providers at community clinics. The study also found that over half of physicians reported they routinely have electronic access to patient test results and electronic scheduling tools.
Other notable findings of the study included:
-13% of medical practices use electronic health records systems
-2% of independent practices and 3% of community clinics have fully installed EHR systems
-EHRs were reported by nearly all physicians to result in better care
-Cost is a large barrier—the biggest reported—to adoption of electronic solutions
-More than a third of medical groups have at least one chronic disease registry.
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Physician Survey Gauges Satisfaction with EHRs
Source: Healthcare IT News
Date: 05/01/2008
Survey designers at the American Academy of Family Physicians recently published the results of a satisfaction survey of physicians that use electronic health records (EHRs). The survey questions addressed physician satisfaction with EHR functionality, ease of use and flexibility, support and training, cost, interoperability, security and overall satisfaction with the technology.
According to one of the designers, “The best EHR for a large practice is different than the best EHR for a small practice. A lot of personal preferences and situational factors enter into an assessment of an EHR. Nevertheless, we tried to present the data in the richest form we could, and I think the results can be useful for physicians.”
The three highest rated EHR systems, according to survey respondents’ “overall satisfaction,” were Praxis EMR, Amazing Charts and eClinicalWorks EMR. More than 80 percent of respondents using these systems said they were inclined to choose the same EHR again, were disinclined to return to paper recordkeeping, and believed the EHR did not cost more than it was worth.
In regard to detailed functionality ratings—which measured 22 distinct functions performed by an HER—the leaders were e-MDs Chart, Praxis EMR, and Practice Partner EMR. The three EHRs with the lowest overall satisfaction and detailed functionality ratings were Cerner PowerChart Office, TouchWorks from Allscripts, and Misys EMR.
The relatively small number of survey respondents for each EHR system has, as expected, drawn some criticism. The results for Praxis EMR’s top rating in overall satisfaction, for instance, were based on 12 physician responses. Meanwhile, 53 physicians assessed the EHR from Centricity (formerly Logician), which finished 9th in overall satisfaction.
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Seven Reasons Google Health is Overblown
Source: BNET Health Care
Date: 05/21/2008
Google, Inc. recently launched its free “Google Health” service to allow patients to manage their medical records online and access relevant health information. The service also gives people the option of sharing their records with doctors and other providers. While the concept is sound, and the service’s launch has been highly anticipated for over a year, some find the actual application to be severely underwhelming and cite the Google brand name as the only reason for any potential short- term success.
Furthermore, there are still some kinks that will keep “personal health records,” i.e. those created by patients, from having much of an impact on the practice of health care any time soon.
-Patients are asked to enter their own information on their conditions, medications, and procedures. The process is cumbersome and error-prone.
-Only 14 percent of U.S. doctors use electronic medical records in the first place, and even fewer are set up to transmit that data to a PHR like Google Health
-Doctors have little reason to trust patient-entered and patient-edited information
-Google Health is not covered by HIPAA regulations
-The service’s third-party partners are allowed to operate under their own privacy and information-sharing regulations
-Data that is input cannot be exported to alternative services
-Data also cannot be easily shared with applications used by health care providers.
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Physician Practice Management
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Exploring the Costs of Going Digital
Source: Southern California Physician
Date: 05/01/2008
When doctors’ offices convert over to electronic medical records (EMRs) from paper records, there are headaches of installation, implementation, and training. But in the end, according to most anecdotal evidence, offices wind up with a system that works well. Despite the growing evidence that EMR systems are greatly beneficial, it often takes doctors a long time to implement them. What is the primary reason behind this lag? Cost.
Adopting an EMR is an enormous undertaking: the typical cost for a small office is around $10,000 to $40,000 for software and basic equipment with a number of additional (and often unforeseen) costs. There is also a significant direct cost of training staff how to use a new EMR system, as well as the cost of lost productivity due to time the practice takes out of the workday for training.
The typical EMR system is purchased with a big upfront payment for software licenses, hardware, and other necessary items and services. Smaller ongoing charges for things like IT support, data backup and hardware repair and replacement follow. As with any other large purchase, EMR system buyers can put some money down, borrow more and pay back finance charges over time.
But fairly recent technology and business developments can change an EMR system into more of a utility, with services purchased as part of a monthly bill. Such a pricing trend might not be attractive to larger practices, which may have their own IT departments and the resources to obtain most of the other necessary EMR components up front, leaving relatively small ongoing costs, but small practices may find a lower but consistent cost more attractive.
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Performance Measures for Physician Practices
Source: Physician Strategy News
Date: 05/01/2008
The measurement of a practice’s performance is an indispensable facet of physician strategy. Proper management of performance identifies areas in need of improvement and aids in resource management. As a result, informed decision making is easier and continual improvements in performance can be seen. An article in the May issue of Physician Strategy News looks at what goes into a successful performance measurement.
The article notes a few caveats to be taken into account when performing a measurement:
-Each practice is unique, and these idiosyncrasies must be taken into account when benchmarking one’s practice.
-Benchmarking should only be carried out with the goal of producing valuable, purposeful reports. Otherwise, the process only results in busywork for the measurer and those reviewing the report.
-Relevancy and brevity are essential in any presentation.
-Information should be used to effect positive change in a practice. Other purposes risk damaging practice morale without achieving anything useful.
For data sources, the article recommends using the AMA’s Annual Compensation and Productivity Survey and the Medical Group Management Association’s surveys.
For suggested benchmarking measures, the article suggests making sure to measure a practice by:
-Gross and Adjusted Fee for Service (FFS) Collections
-Days in Accounts Receivable
-Accounts Receivable Aging by Payor
-Gross Charges
-Ambulatory and Hospital Encounters, in total and per provider
-Surgical/Anesthesia Cases, in total and per provider
-Physician Total and Work Relative Value Units (RVUs)
-Number of new patients
-Operating Overhead as a % of Net Medical Revenue
-Revenue and expenses per encounter.
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Tough Choices Face Underserved Patients and their Physicians
Source: The New Physician
Date: 06/01/2008
Although blacks, Hispanics and Native Americans together comprise just under a quarter of the U.S. population and are expected to comprise more than a third by 2030, the Association of American Medical Colleges says that only six percent of currently practicing physicians are from one of these minority groups. As a result, many organizations are making a concerted effort to diversify medical occupations by diversifying medical school populations.
Increasing diversity among medical school students is often linked to research showing that underserved patients may be better reached by physicians from ostensibly similar backgrounds, but for some students, that connection implies an obligation—or at least expectation—for their career track. Patients often express preference for physicians from their own race because of cultural, language, and geographic similarities.
Some studies show minority physicians are more likely to return to their communities and provide care for minority and underserved populations.
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