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Guest Article: Thoughts on Primary Care and Health Care Reform
By Charles Evans, FACHE

 

Editorial for October 2009

The Outlook for Primary Care Physicians

As Congressional proposals for health care reform evolve and take shape into a single bicameral bill that the president will undoubtedly sign, many onlookers in the health care industry are particularly concerned about the future of one medical specialty in particular--Primary Care.

The importance of Primary Care doctors in our current health system is indisputable, although how their role in health care delivery will be affected by major reform remains to be seen. Even at this juncture, it’s fitting to raise certain questions and address key issues related to what’s in store for our frontline practitioners.

This month’s Special Report, “Primary Care at a Crossroads,” discusses the historical antecedents of today’s problems facing Primary Care and the stance the federal government has taken on important matters, and offers glimpses of what the future may hold as our health system is revamped.

A companion piece, “Thoughts on Primary Care and Health Care Reform,” penned by a noted health care industry executive, Charles Evans, offers insights concerning significant challenges facing Primary Care doctors as the nation moves toward health care overhaul.

Additionally, a summarized article entitled “Surf, Turf and the Future of Primary Care,” written by an influential health policy and ethics analyst and consultant, Emily Friedman, points out the ramifications of the current shortage of Primary Care doctors and what can be done to remedy the problem in the foreseeable future. It is our hope that what the future holds for Primary Care doctors (and other valuable clinicians) will be worth the wait as Congress acts on one of the most important legislative initiatives of our time.

Cordially,

Calvin Bruce
Managing Editor

 

Special Report: Primary Care at a Crossroads
By J&C Research Associates

 

FEATURE ARTICLES

Leadership in Tough Times

Medical Practices Struggle with Finances in 2009

Revealing the New American Doctor

One Way to Lower Health Costs: Pay People to Be Healthy

Hospital Blogs Can Help During Times of Controversy

Rhode Island Hospital Awarded $11 Million, 5-Year Renewal

60 Doctors Took Speaker Fees from Drug Giant

10 Health Reforms Docs Want

How to Mayo Up

Physician Employment 2.0

Stricter Self-Referral Rules May End Some Physician Contracts with Hospitals


Additional Categories

Industry News

Staffing & Recruitment

Employment & Compensation

Medical - Legal Matters

Medical Specialty Focus

Payer & Reimbursement Issues

Credentialing, Licensure, Quality Management

Healthcare Technology

Physician Practice Management


 
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Leadership in Tough Times
Source: H&HN Magazine
Date: 10/29/2009

Crisis equals opportunity, or so the saying goes. It’s no secret that the health care industry, if not the economy on the whole, is in a state of crisis; so then it follows that this is a period of great opportunity as well. An article in H&HN Magazine looks at what you need to do as a leader to toughen your organization and take advantage of extraordinary opportunities that may present themselves.

Central to crisis leadership is your perspective on your institution. While it may be tempting to cut costs and stick to what you know will save money, you will ultimately wind up with an institution that’s behind the times. Instead, it’s advisable to take full stock of your institution and focus on the following opportunities:

-Strategic plan–You’ve got one, yes? If not, you should, and now’s as good a time as any to develop one. Develop a strategic plan that addresses your patient load, payer mix, and overall bottom line. Map out the foreseeable future and orient your institution to deal with it.

-Managing costs, growing the business–Develop metrics to determine the best cost levels for your business. Define your costs to find out which services make you the most money and which do not. But on the whole, try to keep growing. This is the best way to ensure that important staff members and resources are still around when economic conditions improve. Try to “repurpose” staff instead of cutting them.

-Focus on core business–Investment income is nice, but you should really be making money off services that contribute substantially to the bottom line.

-Technology as a success driver–Numerous incentives are available for institutions adopting health information technology; so take full advantage of these opportunities to incorporate technological innovation into your hospital operations

-Watch your competition–Imitation is the highest form of flattery. If something’s working for your competitors, don’t be afraid to try it yourself. Never stop looking for opportunities to learn.

It’s tough times out there, but these are the times that define an organization. Take a fresh look at your hospital and think of where you’d like to see it after the current financial crisis subsides; then keep moving forward to accomplish that objective.


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Medical Practices Struggle with Finances in 2009
Source: AAFP News Now
Date: 09/09/2009

What are the top concerns among American medical practice managers? According to a recent survey, practice managers are largely concerned with the rate of increase in operating costs, maintenance of compensation levels, electronic health record systems, collections, and the effect of Medicare reimbursement declines on revenues.

MGMA’s 2009 Medical Practice Today survey is the second of its kind from MGMA. The concerns raised in this year’s edition of the survey are largely similar to those raised in the previous year, with one change being a reorganization of the number one and two slots. Additionally, a concern that was ranked number nine last year leapt into the top five this year, as practice managers expressed more concern about collecting payment from self-pay, high-deductible health plan, and health savings account patients. The top five concerns are as follows:

-Dealing with operating costs that are rising more rapidly than revenues (73.2%);

-Maintaining physician compensation levels in an environment of declining reimbursement (68.9%);

-Selecting and implementing a new electronic health record system (61.6%);


-Collecting from self-pay, high-deductible health plan, and/or health savings account patients (60.1%); and

-Managing finances with the uncertainty of Medicare reimbursement rates (56.4%).

Physician recruitment, a concern that had previously ranked number four, was pushed to number six this year. The health plan payment issue reflects the increasing use of such plans among consumers. A study by America’s Health Insurance Plans found that eight million Americans were covered by these sorts of plans at the beginning of this year. In dealing with the growth in these plans, practices are trying to accelerate collections by requiring payment up front, though this is not an option with health savings accounts, in which the bill must be submitted to the insurance company before determination of compensation.

Additionally, the survey questioned participants as to the easiest functions they had to perform. Among these were the design and implementation of practice websites, collection of payment from Medicare, implementation of patient safety improvement policies, credentialing, and Stark requirement compliance.


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Revealing the New American Doctor
Source: Physicians Practice
Date: 10/01/2009

While one out of three American doctors often wishes she could change her job or employer, at least eight out of ten doctors agree with the statement, “I like being a physician”—this according to Physicians Practice’s first-ever “Great American Physician Survey.”

The survey covered nearly 1,600 physicians, asking questions concerning work, life, politics, and family. A third of respondents were private practice physicians, while another third were employed in a hospital or other institution. Among the interesting findings of the survey were the following:

-Three out of four doctors make it home for dinner a few nights a week, with one out of three getting home in time for dinner every night.

-Nearly eight in ten doctors would rank themselves a 7 or above on a 10 point scale of happiness.

-More than a third of respondents do not have a primary care physician of their own.

-Nearly nine in ten want to see tort reform for reduction of malpractice awards.

-Nearly six in ten would like to see financial incentives to encourage people to go to medical school.

The survey also found that the work-life balance for doctors is a real cause for concern. Forty-four percent of respondents indicated spending ten or more waking hours with their families during the work week, with nearly one in four reporting seeing family less than six hours during the week. Two-thirds of physicians reported not having enough time for their own personal lives.

On the political end, the respondent pool turned out to be diverse. A third of respondents were registered Democrats, with nearly another third registered Republicans, and one in ten weren’t registered at all. The need for reform, however, cut across party identification lines, as more than half saw the health care system as needing fundamental reform, while another 24% saw the system in trouble but not in need of a major overhaul. And don’t look to doctors to solve the question of how to reform: their answers were just as varied as the general public’s. Suggestions ranged from insurance reform to malpractice reform as a panacea. Indeed, the character of American doctors on the whole is as varied as that of the country itself.

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One Way to Lower Health Costs: Pay People to Be Healthy
Source: Knowledge@Wharton
Date: 06/24/2009

You’ve tried lecturing patients. You’ve tried pleading with them. But have you tried... paying them? An article from Knowledge@Wharton argues that maybe the best way to get patients to cease unhealthy behavior is to drop a little change their way.

Unhealthy behaviors such as smoking, over-eating, and failure to maintain a prescription schedule are responsible for about 40% of premature deaths in the United States each year. One in five Americans is a smoker, and seven in ten are overweight or, despite the well-known negative effects of these behaviors. That’s because patients aren’t generally able to make the tradeoff between instant gratification and delayed, but tangible benefits. But researchers at Wharton and Carnegie Mellon University, among others, have discovered that cash might well be a suitable incentive for healthy behavior.

A smoking cessation study conducted among GE employees found that smokers who were offered $750 in incentives to quit were able to remain smoke-free for 18 months at nearly three times the rate of those without the financial incentive. This sort of pay-for-performance for patients could reduce health care costs down the road at a lower price than current methods. While the studies show that the methods have a lot of room for improvement, they represent at least some progress in motivating patients to adopt healthier behaviors. A similar study found that dieters given daily reminders of potential financial rewards for weight loss consistently lost more weight than control groups with no financial incentives, though follow-up studies found that participants in all three groups had gained much of the weight back.

Researchers believe the programs show promise so long as they retain the lessons on the importance of feedback and incentives as well as the threat of regret. All these have been shown to be strong motivators in changing patient behavior. Unfortunately, studies consistently show that behavioral improvements tend to cease as soon as the financial incentive is removed. While the programs aren’t perfect, they do appear to be more effective than previous attempts at engendering healthier behavior, a fact that pretty much ensures they’ll continue to be observed closely for results.

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Hospital Blogs Can Help During Times of Controversy
Source: HealthLeaders Media
Date: 09/28/2009

Hospital blogging: a publicity accident waiting to happen, or the perfect public relations outlet for your institution? A hospital CEO turned blogger says a blog could be the perfect way for hospitals to keep in contact with their communities.

One CEO blogger reports a high number of opportunities to smooth over controversial issues via his blog. Hospital blogs can be used as a means of dispelling rumors, addressing patient concerns, and quelling employee fears. The blog also functions as a terrific outlet for social connection, as administrators are able to push their message to the public without having to go through other channels. The real-time nature of blogs and the Internet also allows for quashing of rumors and misinformation in a very timely manner.

Additionally, executives contend that the popularity of a blog has immediately positive effects for its affiliated hospital. This aids an institution in recruiting and spreading its message of care.

For those starting a blog, experts recommend that attention be paid to the quality of the blogger rather than the rank. An institution must decide if it wants a creative personality or a conservative, operations-based personality as the institution’s digital scribe. It’s advantageous to start with one blogger, as that blogger will then be able to gain the trust of the audience. There is always the potential for calamity due to candid posts or misunderstandings; so it’s best to make sure the blog fits into a larger institutional outreach plan in a thoughtful, planned, and well executed manner.

But, if you can institute a blog and keep it going, no matter what problems pop up here and there, your institution has an unfiltered gateway to the public. No more making sure you weren’t misquoted in a newspaper. And your institution will have taken a giant step toward greater transparency.

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Rhode Island Hospital Awarded $11 Million, 5-Year Renewal
Source: Medical News Today
Date: 09/01/2009

Cancer research efforts at Rhode Island Hospital recently received a boost when it was announced that the institution had received an $11 million renewal of a National Institutes of Health grant to fund its Center of Biomedical Research Excellence Center for Cancer Research Development. The Center provides researchers with access to the latest molecular pathology and proteomics technologies.

The Center specializes in proteomics–“the identification and quantification of proteins with the goal of determining how they interact, how their expression changes by disease and how they are modified by environmental change.” It is expected that this research will lead to significant breakthroughs in treatment methods. Additionally, the Center specializes in molecular pathology, which “deals with the characterization of the molecular and cellular events critical to the development of cancer.”

Since opening in 2003, the Center has had a hand in numerous discoveries, including the identification of two tumor suppressor genes and a gene that determines sensitivity to anti-cancer drugs. Representatives for the Center expressed gratitude at the continued funding of their research.

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60 Doctors Took Speaker Fees from Drug Giant
Source: The Boston Globe
Date: 09/29/2009

The Boston Globe reports that at least sixty Massachusetts doctors may have improperly accepted at least half a million dollars in speaking fees from pharmaceutical giant Eli Lilly & Co. Among them are two Boston Medical Center physicians now under review by the hospital for violating marketing activity policy.

It is fairly common for pharmaceutical companies to use “bureaus” of doctors to present product information to their peers, but the practice is under increasing scrutiny as many academic medical centers are looking to clamp down on perceived conflicts of interest. The focus on bureaus comes as others are concerned that doctors are presenting biased or incomplete information for a fee.

For their part, the bureau physicians and drug companies contend that the information is accurate and well-screened, and that the bureau format is ideal for educating fellow doctors about drugs. The doctors involved all contend that payment and consultation were done in accordance with FDA and industry guidelines.

Lilly is among the first pharmaceutical companies to publicly divulge a list of its consultants and speakers. This list included more than sixty Massachusetts doctors, who were given nearly $600,000 in compensation for their speaking duties in the first three months of 2009.

Boston Medical Center already has a policy in place regarding doctors speaking on behalf of companies. Physicians are prohibited from doing so unless they themselves have determined the content and materials contained in a presentation. Other area hospitals are developing similar policies in response to the findings.


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10 Health Reforms Docs Want
Source: Physicians Practice
Date: 09/01/2009

Much is said about what kind of reform is best for the country. Politicians, health industry executives and talking heads go on and on about what the effects of this or that measure will be. Seldom are doctors asked what reforms they most want to see, but Physicians Practice’s 2009 Great American Physician Survey asked just that: what do doctors think is necessary to fix the system?

The survey queried 1,598 physicians regarding the simple question “What healthcare reforms would you like to see?” The ten most-suggested reforms are as follows:

-Narrow the income gap between primary care doctors and specialists.

-Stabilize medical school costs through loan forgiveness and tax credits to encourage students to go into primary care.

-Create tax incentives for healthy living among citizens.

-Implement a national electronic health record system.

-Cap insurance and pharmaceutical company profits.

-Get the government out of medicine entirely.

-Institute a single payer system.

-Allow patients to choose their care and provider, not the insurance companies.

-Do away with or reform medical boards and certifications.

-Hold payers more responsible for fair treatment and fair reimbursement of physicians.

As can be seen above, the opinions among physicians are about as varied as the patients those physicians treat. Some argue for greater influence of government, while others argue for complete removal of government from the process. Amongst the rest of the nation, there is no shortage of ideas on how to solve the health care problem, and, as these results show, the same holds true within the health care provider community.

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How to Mayo Up
Source: H&HN Magazine
Date: 09/14/2009

Everybody has an opinion on how to reduce health care costs. And everyone has a model that’s their favorite to point to. But what do the lowest cost hospital models in the United States have in common?

The Mayo Clinic and Cleveland Clinic are both exemplars of health care delivery at a low cost with an important common factor being an integrated care model. In the most expensive places to be treated, a common thread is a distinct lack of just such a model. Nonintegrated, fee-for-service medicine, due to its very nature, causes prices to remain high. So how, then, to transform your institution to be more Mayo-like? It’s not easy. These institutions are the way they are because of specific organizational cultures developed over decades. It might seem as simple as hiring physicians, but that’s not the case. True integration is a philosophy and a way of life for an institution.

-Moving toward an integrated structure will require adherence to laws which may stand in your way, such as the Certificate of Need laws and laws banning the corporate practice of medicine.

-With regard to structure and ownership, don’t assume having the health system own everything is the best way to go.

-Distinguish “intuitive medicine” from “precision medicine” with separate business models. Intuitive and precision medicine refer to different ways of organization the resources needed to provide certain services. Precision medicine is more factory-like, and thus, low-cost; while intuitive medicine follows a more collaborative, problem-solving approach. A clear understanding of where, when, and why these approaches are taken can help a hospital better understand its costs relative to value.

Assuming the move toward imitating the Mayo system takes hold, the new hospital model will be something different from what most currently know. The new hospital model to come will have to be a big tent covering many procedures over a wide area. Experts recommend that institutions have their own health plans and act aggressively with regard to control of financing mechanisms. Further, they encourage taking on partnerships with specialty institutions that can help with the staffing and running of specialty centers.

The hospital of the future may very well be vastly different from the one of today, but that doesn’t mean that administrators cannot start laying the groundwork for that transition right now.

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Physician Employment 2.0
Source: H&HN Magazine
Date: 09/21/2009

Physician employment is making a comeback, and in the midst of the current health care system flux, it’s likely that this recurrence will have a sizable impact on the hospital of the future. An article in H&HN Magazine takes a look at the trend.

The American Medical Association (AMA) recently noted the trend towards physician employment, as the total number of community hospital-employed physicians jumped 24% from 2003 to 2007, compared with only an 8% overall increase in the number of physicians in that time frame. While this isn’t the first time physician employment has boomed, some think this time around will be better for hospitals and physicians than previously was the case.

The current physician employment trend grows out of a number of factors. Declining wages and changing demographics among physicians are key, as fewer physicians are willing to sacrifice a personal life for the decreased compensation facing private practice doctors. Additionally, the coming physician shortfall plays a role, as well as the growth of the hospitalist model and increasing incentives for alignment.

The first wave of physician employment failed in large part because hospitals haggled over practice value and then weren’t sure where to place physicians in or how to help them work toward institutional goals. By contrast, the new wave of physician employment benefits from physicians less willing to start private practices or haggle over the prices of those practices. Additionally, better management techniques and incentives help hospitals resolve issues related to integrating new physicians.

The percentage of employed physicians on hospitals’ staffs is expected to jump from 10% today to 25% by 2013. As such, it’s best for all involved that the industry avoid a repeat of past failures. It’s likely, though, that institutions have learned enough that, combined with the changing landscape of the health care world, will make this round of employment go more smoothly.

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Stricter Self-Referral Rules May End Some Physician Contracts with Hospitals
Source: American Medical News
Date: 09/28/2009

New Stark regulations are going into effect, and ignorance is no excuse for non-compliance. An article from American Medical News examines the changes and what institutions should look out for as a result.

The changes to Stark regulations, approved more than a year ago, take effect at the beginning of October. The anti-self-referral laws are strict-liability statutes, in which violators of the law are subject to penalties regardless of intent to violate. The new alterations to policy include revisions to Medicare inpatient prospective payment restricting “under arrangements,” “per-click” payments, and percentage-of-revenue based compensation deals.

Experts contend that the changes will have considerable effects upon the operations of many practices. Physician groups in indirect compensation arrangements with hospitals will now be considered to have direct ownership stakes in the designated health services they provide, which will preclude referrals to these services unless the groups can meet ownership exceptions. Experts recommend a thorough examination of any extant deals with hospitals, which may fall under the purview of the new regulations.

As to patient care, some groups claim the rule changes will restrict access to services. Physician groups decry the addition of new regulatory layers, but some have moved beyond protest to lobby for an extension of the effective deadline so as to allow doctors more time to adapt.

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Employment & Compensation

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Job-Hunting in a Recession: It May Take Some Searching
Source: American Medical News
Date: 09/07/2009

Typically for physicians, the job-hunting market has proven reliably kind. There is generally a demand for physician services, and the health care industry is historically viewed as recession-proof. This recession, though, is shaking up these established notions, and physicians looking for work in the present economy are finding that employment is harder to come by than they would have expected.

While physician turnover reached a high of 6.7% in 2006, the recession has seen that figure drop to 6.1% in 2008, reflecting a general trend of stability in employment. In other words, more physicians are holding on to the jobs they have rather than investigating the job market.

The inability of physicians to sell their homes in the process of relocating has been mentioned as a barrier to hiring by some 53% of companies, according to one survey. Physicians that would have retired have been forced to stay on due to the hit that their investments took in the stock market downturn. This means that older physicians aren’t leaving the profession at the rate that they otherwise would. All of this results in a rather saturated labor market in which it is hard to find a position... unless you work in primary care or general surgery, two specialties that have shrunk in relation to other specialties in recent years.

For physicians looking for work, experts recommend extending the range of your search. Physicians traditionally work within 100 miles of where they trained, but it may be necessary to extend that search to non-urban and underserved areas. Only one in four physician searches in the past year were for positions in communities larger than 100,000. Four of ten searches were in communities smaller than 25,000. Experts also recommend job-searchers not forget the power of networking. In a tough job market, letting anyone involved in hiring know that you are looking is absolutely essential. Resources such as specialty organization membership directories and other medical societies are an indispensable tool for physician job seekers.

Also helpful are listings on medical society and scientific journal web sites, as are the services of recruitment agencies. Finally, locum tenens positions provide doctors-in-transit with a great opportunity for networking and exposure to different practice locations and styles.

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20 Most Common Employer Mistakes That Could Cost Your Hospital
Source: HealthLeaders Media
Date: 09/11/2009

It’s no secret that we live in a highly litigious society. The ability of juries to decide upon damage awards in civil lawsuits, in combination with other factors, has led to exorbitant fines being levied upon large employers due to charges of discrimination and similar practices. As such, it is essential that hospitals and other health care entities take steps to reduce their potential liability in the case of possible litigation. An article in HealthLeaders Media explores the two most common errors employers make with regard to litigation risk in employment.

The first group of mistakes could be termed “pre-employment mistakes.” These are the errors that take place during the recruiting and hiring process. Such errors include failure to conduct background checks, inconsistent recruitment and hiring practices, and inappropriate questioning and commenting during interviews. Employers will want to maintain consistency throughout the hiring process for all employees.

Next come the mistakes made during employment. These include failure to compensate employees fairly for breaks and training, provide and follow personnel policies, and properly document employment material. Other mistakes include failure to properly train, appropriately evaluate performance, adequately discipline employees, address employee complaints, or curtail favoritism. It is essential that the workplace be one in which all the rules are equally and judiciously applied to all.

Finally, there are the post-termination mistakes. These are largely due to a failure to ensure that you’ve tied up loose ends when dismissal occurs. Employees should not be allowed to make copies of their personnel files. Also, employers should not make inappropriate comments about former employees. Additionally, failure to prepare for unemployment compensation appeals or failure to tell former employees about their right to COBRA coverage also constitutes grounds for civil action.

Last, employers should keep in mind how personnel decisions might look to a jury. If it looks like you’ve taken away someone’s livelihood unfairly to benefit you, just think how it will look to a jury of that person’s peers. While it’s impossible to guarantee against civil action, it’s more than likely that following this advice will keep your organization out of the courthouse and save you a few headaches.

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Medical - Legal Matters

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End-of-Life Care: Who Decides When to Pull the Plug?
Source: Medical Economics
Date: 09/18/2009

Lost amid all the talk of “death panels” during the health care debates of the summer was any real discussion of the very serious issue of paying for end-of-life care. This debate may not be far off, however, as precedents are being set in an important case in New Jersey centered on a 73-year-old man in a permanent vegetative state.

The man is on artificial life support and, though doctors wish to discontinue dialysis, the family objects. In court, the doctors argued the futility of continued treatment. The family produced a physician arguing that the standard of care required physicians to provide the care requested by the family. Initially, the court ruled for the family, stating that no circumstances would justify withholding treatments so long as the family deemed them warranted.

This seems contrary to the position of the American Medical Association, the code of ethics of which has, since 1994, recognized that physicians are not ethically obligated to deliver care they do not believe to be beneficial to patients. The AMA’s position, though, does not cover the concept of “futility.”

While the decision keeps the family’s loved one alive for now, the decision possibly represents a harmful precedent, as it is generally agreed that such decisions should be left to physicians acting upon recognized standards of care. For families looking to find end-of-life treatment that best fits their wishes, it is likely advisable to sort out such a matter with a doctor beforehand.

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White House to Offer Grants Aimed at Curbing Medical Malpractice Suits
Source: Los Angeles Times
Date: 09/18/2009

A step in the right direction or an empty gesture? Those are the terms put to use by Democrats and Republicans, respectively, regarding the Obama administration’s recent announcement that it would offer $25 million in grants for the purpose of identifying practices to reduce medical errors, scale back malpractice insurance premiums, and reduce nuisance litigation.

The announcement came as a part of the administration’s wider efforts to reform aspects of the American health care system. The malpractice reform element was intended as a concession to Republicans, who typically argue for malpractice reform as a crucial solution to the nation’s health care woes. Capitol Republicans, for their part, spurned the offering, claiming that it doesn’t do nearly enough to reduce junk lawsuits.

Some studies have claimed that malpractice reform can save anywhere from $120 to $500 billion over a decade, and Republicans and sympathetic organizations claim that the Obama administration isn’t doing nearly enough to approach such reform.

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Challenges to Medical Liability Caps Go Before Georgia, Maryland High Courts
Source: American Medical News
Date: 09/28/2009

Caps on non-economic damages in medical liability cases are slated for rulings in Georgia and Maryland. Both cases threaten to undo the cap systems which, proponents claim, prevent unnecessarily high medical liability awards.

The case in Georgia revolves around the constitutionality of that state’s $350,000 cap, while Maryland’s case is one of applicability. In Georgia, opponents of the cap argue that the cap interferes with the determination of a jury and thus infringes upon the equal protection rights of citizens. Proponents of the cap argue that it is a necessary measure to prevent needless financial damages being heaped upon doctors.

Georgia’s cap was passed in 2005. Since then, the state has seen declines in liability insurance rates and claims filings of 18% and 39% respectively. At the same time, the state has gained 1,000 doctors and seen increased competition among medical liability insurers.

Maryland’s case, while it centers on the applicability of the cap to certain cases, has the potential to effectively eliminate the cap if the ruling is upheld. The state’s cap applies broadly to all medical liability cases since its passage twenty-three years ago. However, the current case centers on a decision in which a judge ruled that the cap only applied to cases that went to arbitration. If the ruling is upheld, essentially no cases will be subject to the cap within the state.

Advocates of the caps are confident that the caps will survive in both cases. Further, they contend, the cases are indicative of a larger need for an overall federal policy on malpractice caps, preferably one that brings about substantial tort reform.

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Malpractice System Breeds More Waste in Medicine
Source: New York Times
Date: 09/22/2009

With proposals flying hard and fast on how to reform health care, malpractice reform often gets left behind in the debate. One side sees it as a reduction of patient rights, while the other side sees it as a necessary protection of doctors from the frivolity of the modern American litigious society. But now, research is giving us a clue as to just how effective malpractice reform might be in reducing health care costs.

Economists from a number of institutions have researched the issue, coming to several conclusions:

-The direct cost of malpractice lawsuits is so small in relation to overall health spending that it doesn’t merit consideration.

-The threat of malpractice suits does lead to wasteful treatment, with estimates as high as $60 billion, or 3% of health spending per year.

-The current system appears to treat malpractice lightly, with only 2 to 3% of cases of negligence leading to a malpractice claim.

All this isn’t to stipulate that either position in the left-right debate on tort reform is correct; rather, the point is that the system is imperfect, though not necessarily as much as some would suggest. The United States does experience more medical errors than other rich countries, with a small portion of victims receiving compensation. Even with this lowered level of compensation, the threat of malpractice has doctors practicing costly defensive medicine.

The solution? Well, tort reform isn’t the be-all, end-all solution some make it out to be, according to this article. Rather, it should be a facet of an overall reform effort. Economists and experts recommend, then, putting money into reducing malpractice suits, but also into evidence-based medicine and similar measures to increase physician effectiveness.

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Apologizing for Medical Errors May Not Stop You from Being Sued
Source: American Medical News
Date: 09/22/2009

Apologies in medicine are a source of some contention. Some argue that it is best to preserve an institution’s legal safety, and thus, argue against apologies. Others press the importance of openness with patients and the likelihood of a non-litigious solution if an apology and explanation are offered. Regardless, a new study indicates that patients’ perceptions of how a doctor apologizes may, in fact, be more important than the content of the doctor’s actual apology.

The study, conducted by researchers at the Johns Hopkins Bloomberg School of Public Health, had volunteers watch taped vignettes depicting physicians relating a failure to spot a lesion, a slow response in emergency, or an overdose of a treatment to a patient. The extent of apology varied from vignette to vignette, and volunteers were asked to describe their estimation of the doctor’s apology.

Researchers found that viewers were more likely to want to sue incomplete apologists or those doctors who did not accept responsibility. Doctors who were perceived to have accepted responsibility were given higher ratings of trust and likelihood of referral. Whether or not a physician apologized wasn’t found to have an effect on likelihood of litigation, but the degree to which he apologized was definitely a factor. The study authors claim their results indicate that disclosure of errors is essential, and they recommend that physicians ask questions of patients to ensure that their message has gotten through.

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Medical Specialty Focus

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Surf, Turf and the Future of Primary Care
Source: H&HN Magazine
Date: 06/03/2008

Just about every proposal for overhauling the American health care system has to do with increasing access to primary care physicians. At the same time, though, the growth in the field is steadily outpaced by general population growth and growth in specialty physician ranks. How did we get to this point, and what can be done about this? An article in H&HN Magazine takes a look.

The current primary care crisis is rooted in a number of causes. Since World War II, the number of medical specialties has increased significantly, as has compensation for these specialties. Additionally, the cost of medical education has increased greatly, though certain government subsidies for primary care education have been slashed in recent years. Add to this an increased patient reliance on the Internet for health care information and a generation of doctors more desirous of free time and an enjoyable personal life and you have the makings for the crisis the country currently faces.

The primary care shortage isn’t happening in a vacuum. The shortage of providers has resulted in increased emergency department usage among patients unwilling or unable to wait to see their primary care provider. The shortage also opens up the door for non-physician providers to shoulder much of the noncritical care load. Nurse practitioners, certified registered nurse anesthetists, and others are lobbying for broader powers to practice. This, of course, has brought on tension between physician groups and nurse practitioner groups.

The shortage of primary care providers raises a number of questions. Foremost among them is whether the shortage is really a shortage or simply a result of physicians not wanting to practice in certain areas. If the latter is the case, it would take, perhaps, financial incentives to get physicians to move into less desirable areas. Also, the various health professions will need to sort out “turf issues” as other practitioners gain greater practice powers. Standards will need to be set with regard to competency and referrals, immigration, and associated issues.

Solving the problem is another issue entirely. Certainly, the physician shortage will require increases in pay and greater respect for primary care physicians as well as a change in the overall medical school culture to encourage students to go into primary care. The future of primary care in this country is unknown, but it is bound to be the emergent result of a number of factors and forces.

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Cardiologists Crying Foul Over Obama Medicare Cuts
Source: Bloomberg.com
Date: 08/28/2009

In the midst of the debate over health care reform, the Obama administration is receiving some pushback from cardiologists claiming an administration proposal to cut Medicare payments to heart and cancer doctors is cause for great concern. The fight over the matter, some say, could weaken efforts to bring about reform.

The proposal to cut $1.4 billion in Medicare spending next year is part of an effort to focus compensation on preventive care. The proposed measures to extend coverage to all Americans are expected to cost about $1 trillion over ten years. Cardiologist groups claim that the cuts to reimbursements–more than 10% in reductions for cardiologist and oncologists–are an unfair method of increasing payments to family doctors and nurses. They claim that the cuts in reimbursement to Medicare-reliant small-town cardiologists would prove unsustainable for their practices, and some cardiologists claim that they would have to close their doors rather than operate under the decreased reimbursement rates.

In response, the American College of Cardiology has its members “‘fighting tooth and nail on these other issues rather than fighting thoughtfully for expanding access’” and has developed fliers and even a sample letter for physicians and patients to send to Congress.

Reductions in payment come along with an across-the-board reduction of 22% for all physicians under new federal budgetary guidelines. Administrators and legislators claim that the cuts are necessary to preserve the fiscal solvency of the program. Medicare is entering a budgetary crisis just as a “silver tsunami” of baby boomers is reaching the age of eligibility for the program. Without changes, administrators argue, the program is bound to break the federal budget. Others argue, though, that a reorganization of Medicare payment on the whole is necessary, stressing that a system that pays doctors more for improved outcomes and cooperation amongst generalists and specialists is likely the best way to go.

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Successful Treatment of Physicians with Addictions
Source: Psychiatric Times
Date: 08/28/2009

Physicians, of course, are not immune from ailments themselves. While they typically have better overall health and lower rates of mortality than the public at large, this is generally due to their education, nutrition, and lifestyle. When it comes to substance addiction, rates of prescription drug misuse and dependence are overall much higher, though. An article in Psychiatric Times looks at the treatment of addiction in physicians, examining what works and what apparently does not.

The question of prescription drug abuse among physicians is largely one of access. Some even argue that exposure to small quantities of prescription drugs may neurobiologically predispose physicians to addiction. No matter the causes, the problem is real and has consequences for physicians friends, peers, and family and endangers patient safety and institutional security. Drug abuse is also linked to physician suicide. As such, organizations would be well served to help physicians on the road to recovery. Aiding physicians in addressing and recovering from their abuse problems is a moral, ethical, and legal obligation for coworkers.

In treating addiction in physicians, it is critical for programs to avoid punishment and promote the treatment of the addiction disorder. Physician Health Programs are available now in most states for the help and treatment of addicted physicians. Referral to such a program is typically a first step in successful treatment. Treating a physician within his own medical community is inadvisable, due to concerns about transference and confidentiality. In PHP programs, recovering physicians lead the treatment process, which typically focuses on assessing the abuse and evaluating a physician throughout detox to locate the reasons for abuse. Physicians in these sorts of programs are treated more aggressively due to the potential impact of relapse. While physicians might like to carry on with their daily lives during the course of treatment, it is not advisable to allow them to be treated in a non-restrictive environment.

Following the treatment regimen, physicians should undergo a full performance-based competency assessment. Studies have shown that the medical license is a useful bargaining chip with regard to ensuring maintenance of sobriety following treatment. Following release back into the work force, regular sobriety testing is advisable, and such regimens have been shown to result in 70% sobriety rates among physicians no matter the original addiction.

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Payer & Reimbursement Issues

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Here’s How to Get Paid for Administering H1N1 Vaccine
Source: AAFP News Now
Date: 09/16/2009

With the return of flu season approaching, concerns are especially high this year on account of the H1N1 influenza A virus, and while the FDA approved four H1N1 vaccines for administration, physicians need to be careful how they report the use of these vaccines to make sure the charges for what is likely to be a popular service are reimbursed. Fortunately, new billing codes have been created specifically to cover the administration of these vaccines.

The Centers for Medicare & Medicaid Services created a unique health care common procedure code for billing for the H1N1 vaccine. The code is G9141, but private insurers are not required to use this code. For the largest private health insurers and Medicare, billing for the vaccine is as follows:

-UnitedHealthcare–submit the CPT vaccine administration code that is appropriate for patient age, route and type of administration. CPT code 90663 must also be submitted for the vaccine itself, specifying an amount of $0.01.

-CIGNA–bill using the G9141 code.

-Aetna–use age appropriate CPT codes–90465-90468 for children, 90471-90474 for adults, or use the G9141 code.

-Humana–use the G9141 code.

-Blue Cross/Blue Shield–consult your local BCBS plan.

-Wellpoint/Anthem–no instructions yet released.

-Medicare–use the G9141 code. Payment is the same as seasonal influenza vaccines.

Regardless of how widespread H1N1 cases will be during the coming flu season, hospitals and medical practices need to be prepared to designate proper codes for patient treatment to avoid administrative confusion or delays in reimbursement.

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Healthcare Reform: Locum Tenens Perspective on Single Payer
Source: Locum Life
Date: 08/15/2009

Since the early nineties, proposals for a single payer system have been presented a number of times to no avail. The recent move toward reforming the American health care system has, though, resulted in some progress on the single payer front. The House Committee on Education and Labor recently approved an amendment to a bill that would enable the adoption of single payer systems for individual states, a measure that passed with both Republican and Democrat support.

Proponents of a single payer system claim the model is the best way to ensure complete coverage for all. They also cite cost reductions in the form of decreased paperwork and administrative waste. Opponents of the model claim it doesn’t fully address the complex failings of the American system. Further, they argue that the top-down structure of a single payer system will introduce unnecessary restrictions to health care delivery and remove patient choice as well as lowering salaries for doctors.

Despite disagreements on the model, generally all sides agree that the health care system is faced with a staffing shortage that will preclude any real reforms that might bring millions of new patients into the system. The system faces a shortage of physicians and physician support staff in virtually all areas, but especially primary care. In such a shortage, the importance of temporary workers such as locum tenens practitioners has increased greatly. Opponents of a single payer system further argue that such a system would make work more difficult for temporary and traveling health care professionals, who would, they say, be more vulnerable if decreased reimbursements result in permanent employees putting off retirement, taking up spaces that would otherwise be filled by temporary health care workers. No matter the side one takes, no matter what shape reform takes, it remains clear that the argument over a single payer system is nowhere near finished.

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How to Negotiate Better Fees with Health Plans
Source: Medical Economics
Date: 08/21/2009

Could anything good possibly come out of the primary care physician shortage? An article in Medical Economics argues that, in fact, the physician shortage could very well bring about benefits for doctors negotiating with health plan payment schedules.

Due to the physician shortage, health plans are moving rapidly to institute policies placing greater focus on patient-centered care provision. As such, doctors have more influence over their contracted health plans than they might assume. Physicians note increases in fee schedules from major health plan contracts due to negotiating tactics. Physicians looking to get more out of their payment partners should follow some simple procedures in the course of negotiations in order to maximize reimbursements.

First, it’s necessary to do your homework. Physicians should fully familiarize themselves with the workings of their fee schedule contracts. It is advisable for practices to concentrate their efforts on the top five payers with which they contract. Putting together a simple spreadsheet containing the rates by payer for the top procedures and payers for your practice will give you a baseline for negotiations with payers.

Next, know the value of your practice. Taking a look at reimbursement reports will let you know what the norms are for your specialty and your area. If your payers are underpaying you with regard to your competition, this is another negotiating edge.

Then it’s time to work any leverage your practice holds. Be persistent in contacting payer representatives for fee schedule negotiations, as they are likely to delay these processes. The goal of your negotiation is to show the value of your practice with regard to the payer’s network. Demonstrate cost reductions, favorable referral rates, anything that gives your practice the edge. You’re not likely to solve all your payment problems with one simple negotiation session, but persistence and preparation are likely to net you financial benefits that will help your practice to maintain its bottom line.

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California Could Serve as Model for Physician Payment Reform
Source: Healthcare Finance News
Date: 09/11/2009

As California goes, so goes the nation? If the California HealthCare Foundation has its way, the old saying could very well apply to the nation’s health care reform efforts as well.

The California HealthCare Foundation is floating a proposal for insurers nationwide to dispense with the current system, which provides compensation for procedures performed according to their quantity and complexity. Instead, they argue, insurers should adopt a system of financial rewards aimed at engendering the best health outcomes and most efficient use of resources.

CHCF’s issue brief–“Reforming Physician Payments: Lessons from California”–argues that federal proposals tend to share three primary concepts that are similar to California’s extant “delegated model”: payment bundling, accountable care organizations, and the medical home model. The brief goes on to recommend the establishment of formal physician groups in order to ensure proper compensatory arrangements between payers and providers.

Furthermore, CHCH representatives argue that the adoption of a system such as the one in California can, with appropriate oversight, result in reductions in undesirable outcomes, both clinical and economic. More research is needed, though, the report authors say, in order to establish the effects of payment via capitation, which would offer a better idea of the degree to which the California system could be implemented on a wide scale.

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Value-Based Insurance Design: Spend a Little More On Selected Patients for Payoff Down the Line
Source: Managed Care Magazine
Date: 08/01/2009

Much of the health care debate focuses on increasing value in the health care system. But if the question is how to increase value, the answer may be hard to define. An article in Managed Care Magazine explores the question of value in health plans.

Easily put, value is “quality relative to cost,” and herein lies the problem with health care coverage today. Modern health plans reimburse for services and procedures, but not for the value generated from these. To combat this, some parties have endorsed the development of value-based insurance design (VBID). Such a system aims at promoting the use of services where the benefit outweighs the cost and discourages such procedures when the benefit does not outweigh the cost. This would result in a reorganization of care delivery to focus on coordinated care, rather than the uncoordinated system that currently exists. This system would require a practical definition of value, and the proponents of the system have developed one that relies on measurements of outcomes, safety, and service while taking into account cost and time.

Studies have shown that a VBID system might be most effective in grouping services according to value, a crucial element in increasing the value of health care delivery. Currently, the system is used largely in targeted segments, and, as such, is applied for clinically valuable services targeted for co-payment reduction (e.g. beta-blockers). Such programs have been shown to provide benefits for some patients, but not necessarily for others. Additionally, select clinical diagnoses are often targeted for the VBID system–such as congestive heart failure–and reductions in copayments have, in these cases, been shown to have a positive impact on patient outcomes.

In summation, the VBID system is said by proponents to increase savings through improved health outcomes, increased productivity, and a shifting of costs by identifying less valuable practices. While, of course, the system doesn’t solve all problems, it does, at least, represent some progress on the quest to improve the health care coverage system.

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Credentialing, Licensure, Quality Management

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Pilot Program Planned for Hospitalist Certification
Source: Modern Healthcare
Date: 09/29/2009

In a move that supporters hale as critical to establishing recognition and credibility within the health care industry for the specialty of Hospitalist, the American Board of Medical Specialties has announced that it is preparing to launch a five-year pilot program with the goal of establishing a procedure for board certification in hospital medicine.

Under the program, hospitalists would be certified as internists before seeking certification in hospital medicine prior to the expiration of the ten-year period of internal medicine certification. Proponents of the measure note that the specialty includes unique facets that differentiate it from other specialties. For instance, established specialties are focused, of course, on specialization. The hospitalist specialty, however, requires a broader base of knowledge and, as such, is built on accomplishment, knowledge, and skills that can only be gained through practice.

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California Hospitals Fined for Errors
Source: Los Angeles Times
Date: 09/25/2009

Eleven California hospitals faced stiff fines from the Department of Public Health for serious medical errors. The Department levied fines of $25,000 to the institutions for violations leading to death or serious injury.

The fines stem from a failure on the part of surgical teams to follow proper surgical procedure. Half of the hospitals fined were Southern California institutions, and about half the fines stemmed from health workers leaving foreign objects in patients after surgery. For one institution, this marked the third time in two years that the institution was cited for leaving surgical material inside a patient. In their defense, the hospital’s administrators claimed that the institution performs about 1,000 surgeries a month, including a quarter of the county’s trauma cases.

Other incidents cited include the unnecessary amputation of a leg due to a mix-up of patient results and another hospital leaving surgical clamps inside a patient during surgery. Yet another institution was fined for failing to follow surgical procedure, which resulted in a fire erupting during surgery and the patient’s face being burned.

The penalties are from a California law passed in 2007, which allows for them to be levied in response to procedural failures on the part of institutions. Since the passage of that law, 115 penalties have been issued to eight hospitals. One in five of those penalties were related to foreign objects being left in patients after surgery, making that occurrence the second-leading violation. The leading violations are medication and pharmacy errors, which account for 36% of fines.

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Survey Tool Delivers ROI for Disease Management Program
Source: Healthcare Finance News
Date: 07/30/2009

Can a survey tool help patients and physicians achieve significantly improved clinical outcomes? If the findings from recent studies are to be believed, the answer is yes.

These findings come from a study published in the American Journal of Managed Care. The study centered on the Patient Activation Measure (PAM), a survey tool used for coaching disease management patients. A study of the effectiveness of the tool found that patients using the PAM tool showed a 33% decline in hospital admissions as compared to the control group, which showed no change from prior to the experiment. The PAM tool also resulted in a 22% decrease in ER visits among the trial group, while the control group showed a 20% increase during the study. The researchers calculated the savings generated by the tool at $145 per member per month due to fewer hospital stays.

The tool was developed with the goal of aiding the measurement of the necessary confidence, knowledge, and skills in patients to successfully manage their own health care. The subsequent patient coaching is structured on the survey results.

The study’s results are supported by a similar study conducted by the Washington State Aging and Disability Services Administration’s Chronic Care Management Program, which found reductions of $109 per patient per month among Medicaid patients. Researchers say that the results indicate that the PAM tool can be effective in measuring how well patients are doing and providing information crucial to improving patient outcomes with patient cooperation.

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Medicaid Patients Often Lack Preventive Care: GAO
Source: Modern Healthcare
Date: 09/14/2009

While preventive care is an oft-repeated term with regard to the ongoing health care reform debate, it turns out that those patients on the rolls of government-provided assistance aren’t always receiving the preventive services they need—this according to a report recently released by the Government Accountability Office.

The report analyzed national survey data and interviews from state Medicaid directors as well as federal officials. The GAO found obesity, diabetes, high cholesterol, high blood pressure, or a combination of these conditions in more than half of Medicaid adults aged 21 to 64. What’s more, these patients were not actually receiving the preventive services deemed necessary for these conditions. The report states that the rate of preventive service provision for Medicaid adults is lower than that for individuals with private insurance. Additionally, children on Medicaid programs are not receiving recommended checkups.

In its report, the GAO recommends that Centers for Medicaid and Medicare Services ensure the regular review of states’ provision of periodic screening, diagnostic, and treatment programs.

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Healthcare Technology

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Temple U: iPods Help Docs Improve Stethoscope Skills
Source: Physicians News
Date: 08/28/2009

Usually, students listening to their iPods in class would be discouraged, no? Well, if the results from recent trials at Temple University are to be believed, listening to an iPod in class could very well result in better skills among cardiologists. What’s more, the results suggest the best way to improve practicing physician skills might be to have them listening to their iPods during their morning commute.

The study, presented by investigators from Temple University’s School of Medicine and Hospital, took 149 general internists and let them listen to five common heart murmurs some 400 times during a single 90-minute session. The average rate of correct heart sound identification in physicians is around 40%, but participants in the exercise improved to 80% after the exercise. Follow-up studies with cardiologists yielded similar results.

The organizers of the exercise have stated great satisfaction with the results and indicate that they are looking forward to duplicating the program next year. Temple’s School of Medicine has implemented a four-year curriculum on cardiac auscultation wherein medical students are exposed to heart sounds throughout their education to better acclimate themselves to the sounds of the heart. Organizers of the program envision a future in which doctors listen to heart sounds during their morning commutes, on iPods or any other sort of listening device.

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Health Technology Said to Reduce Care Disparity in Poor and Minorities
Source: Healthcare IT News
Date: 09/23/2009

Some would call it a dark spot on the nation’s health care industry: the disparity in health care received by poor people and minority populations. But administrators at the Department of Health and Human Services are saying that the health care gap can be closed with the aid of health information technology.

The announcement, from the Deputy Assistant Secretary of Minority Health at HHS, calls for health care providers to invest more in health information technologies such as electronic medical records and electronic prescriptions. HHS cites the fifteen- to seventeen-year gap in life expectancy between wealthy urban Americans and their rural or minority population counterparts. In as much as minorities are more likely to seek out health information on the Internet, this represents an opportunity for health providers to reach out to them with information on certain medical conditions and treatment solutions.

To this effect, administrators stress the importance of the HITECH Act, a health information technology portion of the earlier-passed American Recovery and Reinvestment Act. The Act emphasizes data collection on demographic factors to better document discrepancies in care between groups.

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Use of Telehealth Could Save Billions
Source: Managed Healthcare Executive
Date: 09/01/2009

With everyone focused on reducing health care costs, one would think that any measure that could significantly cut costs would have the spotlight, no? So why is a technology that could conceivably save $197 billion being paid little attention?

The technology is telehealth, which includes remote monitoring. It has been estimated that wider use of remote monitoring could save the U.S. health system nearly $200 billion dollars over the next 25 years. And consumers are ready for it, too, as a recent survey found that 73% of respondents would be open to using remote monitoring, and half of respondents were likely to use the computer to access information on health care.

So what’s the issue? The technology generally hasn’t proven scalable for large patient populations. Also, cost and ease of use are complicating factors. Finally, the data that these systems collect has been deemed typically insufficient for widespread use. However, the newest generation of telehealth systems has undertaken to address many of these concerns, and equipment is now being devised so that patients can manage their own health.

When implementing a telehealth program, remember to keep it simple and make it accessible. The system won’t be worth anything if it is not decidedly user friendly. Additionally, providers should be given the data they need in a hassle-free format. Telehealth systems should incorporate clinical informational databases, and the system must be affordable in order to encourage adoption.

The health system is in a state of flux, with an aging population and a physician shortage. Fortunately, a good deal of technology exists currently or in a state of development which has the potential, if used properly, to address many of the problems facing the system.

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Physician Practice Management

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The Physician of the Future
Source: HealthLeaders Media
Date: 09/24/2009

Much is made of the health care system of the future: one in which more informed patients interact in a number of ways with varying clinical professionals. But what will the physicians operating in this system of the future look like? What skills will be necessary for the doctor of the future to practice medicine effectively? An article in HealthLeaders Media takes a look.

The doctor of the future will have to contend with increasingly informed patients. Already, three quarters of U.S. adults have investigated health information online, with two-thirds of American adults indicating that they do so regularly. While one would hope they’re getting their information from reliable sources, such isn’t always the case. As such, physicians will have to deal with both informed patients and misinformed patients to varying degrees.

An essential element of the practice of the future will be electronic health records and other health information technologies. While the financial barriers to such practice elements may be foreboding, there’s really no way to move toward patient-centered care that doesn’t involve these technologies.

Also essential is a redefinition of the physician’s relationship with patients. Physicians will need to acknowledge the wealth of information available to patients and instruct them on how to navigate these sources. For instance, at the end of a visit, a doctor could take a patient into a room with a computer and explain how to use MedScape or provide him with links to other sites that can explain a diagnosis or condition further.

While just one example, a practice such as that mentioned above can make a difference in improving levels of care and, more importantly, encourage physicians to examine trends from their own perspective and take a shot at a different kind of prognosis.

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When Your Patient Says, “I Don’t Want Blood”
Source: Physicians News
Date: 09/14/2009

Whether from religious belief or personal concern, a number of patients have issues with receiving donated blood during treatment. Treatment is generally still possible in these cases, but some worry about difficulties that may arise if the situation gets complicated. An article in Physicians News looks at the ways one center has addressed these patient concerns.

The Center for Bloodless Medicine and Surgery at Abington Memorial Hospital is a unit dedicated to treating patients while avoiding the use of blood. The Center already has a bloodless medicine team in place before treatments begin in order to increase the odds of a good outcome. The Center’s team includes a variety of health care professionals trained in bloodless medicine and blood preservation techniques to minimize blood loss.

Procedures in the Center heavily stress pre-operative planning, intraoperative techniques, and post-operative plans as a means of ensuring success. Patients meet the Center staff and are educated on the risks, benefits, and alternatives for their treatment. No-blood patients are differentiated with special wristbands and stickers and signs on their charts in order to ensure that their requests are respected. The Center specializes in minimally invasive techniques to reduce blood loss, and patients have the option of having their own blood collected and returned during surgery.

As a result, the Center’s patients experience fewer of the complications related to blood transfusions, such as immunologic maladies, infections, and lung injuries, and the blood management techniques on display at the Center are gaining wider prominence as physicians realize that blood use isn’t quite as necessary as one might think and see an opportunity for a niche service.

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Practices Must Have Plans for Handling Health Data Breaches
Source: American Medical News
Date: 09/14/2009

While patient data security is, of course, a goal of every practice, new regulations soon to go into effect will make it a much higher priority than it might currently be in some practices. It’s best to know the rules and requirements, as, if your practice doesn’t adhere to them, you could find yourself paying a healthy fine.

New patient data regulations, which go into effect on September 23, 2009, are part of the American Recovery and Reinvestment Act. Noncompliance with the regulations could net a practice a fine of up to $1.5 million in the event of a breach, and that is in addition to possible criminal and civil actions against individuals. HHS has the authority to audit practices in order to ensure compliance.

Experts recommend that practices re-examine privacy and security policies to ensure alignment with current law. This point represents an opportunity for practices to retrain staff members for proper standards and policies so that they know what is allowed and what is disallowed with regard to patient information. It is now required for practices to have a documented risk assessment on file detailing what information might be susceptible to breach and the measures the practice has undertaken to address this vulnerability. Also, practices must develop breach response plans. These plans should detail the responsibilities of employees with regard to each kind of breach. Experts also recommend re-evaluation of contracts with business associates so as to ascertain the responsible parties with regard to potential breaches.

Appropriate policies regarding the handling of a breach depend on the type of breach, the type of information involved, and the number of patients affected. Some breaches do not merit wide notification, while others do. For instance, were patient information to be accidentally sent via email, such a breach would have to be reported. If, however, patient data were encrypted on a laptop and that laptop were lost, such a breach would not merit reporting. If a breach involves more than 500 patients, both HHS and the media must be notified immediately. The new law mandates that practices take action within 60 days of notification of a breach. There are also specifications as to the type of notification necessary for breaches. Additional requirements depend on circumstances; so it is best to familiarize oneself with the new regulations so as not to unwittingly find one’s practice in noncompliance.

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Is Your Practice Protected Against Embezzlement?
Source: Urology Times
Date: 09/01/2009

Employee theft costs small business owners $20 to $40 billion annually, with three out of four incidents going unnoticed. With tough economic times unfortunately likely to lead to an increase in employee theft, an article in Urology Times takes a look at some measures your practice can implement to head off this problem before it becomes a true hindrance to operations.

First, it’s necessary to know what exactly you’re looking for. Embezzlement has a number of causes and, as such, a number of things to look for as tell-tale signs. Look for irregularities in audits and inconsistent monthly reports. If you observe a drop in the collection ratio, an increase in accounts receivable, or an increase in expenses for supplies, these are warning signs that you should have your accountant investigate. Also, check for unusual behavior. Employees who refuse to delegate certain financial responsibilities might be perfectionists, but they might also have something to hide. Also, keep an eye on emotionally unstable employees or employees living beyond their means.

As to the prevention of employee theft, the secret is all in the safeguards and internal controls. Divide up tasks so as to prevent any single employee from devising a system whereby they cannot be caught stealing. If one employee opens the mail, he should not also be posting payment to the computer, and so on. Practices must also closely monitor bank statements. Exhaustively reconcile bank statements on a monthly basis. Any irregularities should be noted and raised as an issue with employees. Finally, a strong anti-theft policy is necessary to set up to discourage employees from the beginning. Let employees know that your practice’s policy is to pursue thieves to the full extent of the law both criminally and civilly.

While there’s no way to make absolutely certain that employees won’t steal, these practices can help your practice minimize risk and keep operations moving smoothly.

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