| |
|
Complimentary copy only,
click for free subscription. |
|
As the U.S. population ages and the demands for quality health care delivery
increase, the burgeoning physician shortage is all the more critical. How are
hospitals and medical groups addressing the problem in terms of staffing
approaches? This month’s survey spotlights the views of hospital administrators
and physician recruiters concerning this important matter.
Rx for the Physician Shortage
Both commercial and medical publications point out the physician shortage that has occurred in most medical specialties. Here are some of the facts and predictions: |
|
 |
- One-third of active physicians practicing in the United States are 55 years or older and likely to retire in the next decade.
- As doctors’ incomes from third-party reimbursements decrease, more practitioners are opting for early retirement.
- Rising medical malpractice premiums—sometimes seen as “exorbitant”—are driving some physicians to explore other career options.
- Although the number of U.S. medical school applicants has increased, the number of doctors entering the profession has not kept pace with the growing population and, especially, the medical needs of the 78 million Baby Boomers reaching retirement.
- It’s estimated that by 2025, the nation will need at least 70,000 more physicians than currently are practicing medicine.
Our monthly survey, “Addressing the Physician Shortage,” offers the views of hospital administrators and in-house recruiters regarding projected MD staffing needs associated with various medical specialties.
This edition’s Special Report discusses the burgeoning problem of a shortfall of physicians and suggests some remedies. Several Jackson & Coker Industry Report articles also offer practical steps for addressing the problem. “Effective Physician Recruitment” mentions recruitment tools useful in attracting physicians to rural opportunities. Our guest feature article, “Make the Most of Web-based Physician Recruitment,” highlights the benefits of a robust Internet-focused recruitment strategy for attracting more qualified candidates for permanent hire.
The physician shortage problem won’t be remedied over night. However, it’s encouraging that means are being undertaken to minimize the impact of the shortage while the medical profession seeks more substantive long-term solutions to the current staffing crisis.
Cordially,
Calvin Bruce
Managing Editor
National Health Insurance: Could it Work in the US?
Source: American Journal of Medicine
Date: 07/01/2008
As the U.S. has one of the highest standards of living, is a leader in technological innovation, and spends more on health care than any other country, its citizens have reason to expect better care than what many receive.
This gap between expectation and reality is effectively illustrated by a 2007 New York Times/CBS poll which, among other things, found that 61% who were uninsured did not obtain needed care effectively. More to the point, the mortality rate for the uninsured is higher than that for the insured. Compounding the problem is the fact that many have inadequate health care because they have inadequate insurance.
An increasing number of employers cannot afford to offer their employees health insurance, and most individuals cannot afford to purchase health insurance out-of-pocket, which can cost more than $12,000 a year for a family. In addition, the fragmentation of the private insurer system makes for enormous administrative costs—as much as 31% of all health care expenditures. As a result, the cost of insurance continues to exceed the rate of inflation.
Thanks to a lack of cost controls, Americans pay up to two times what citizens in other countries do for their prescription drugs. Cost concerns have been shown to play a large role in failure to take proper dosage or failure to renew prescriptions.
The authors of this article contend that the time has arrived for national health insurance. For those unconvinced that national health insurance could work in America, they point to Medicare, which has provided quality health care to 44 million American at a mere 1/6th the administrative cost of private insurers. They also suggest community-based premiums and fee-for-service payments. Whatever strategy is pursued, we are implored to agree that our status as the only industrialized nation that does not ensure access to health care to all its citizens must change.
Full Article | Comments | Back To Top
Grassroots Movement Grants Medical Home, Access to the Uninsured
Source: Managed Healthcare Executive
Date: 07/01/2008
While most physicians aren’t new to the idea of volunteerism, the grassroots movement Project Access is using the idea of volunteerism and collaboration within the medical community as a solution to the problem of quality and affordable health care for the nation’s 46.5 million uninsured.
The movement provides a network for specialists and general practitioners who volunteer their time to partner with hospitals, pharmacies, insurers and other healthcare stakeholders to provide care for uninsured Americans. This coordinated approach, funded by the Robert Johnson Wood Foundation’s Reach Out program, helps to diminish the organizational, financial and time obstacles that have contributed to the decrease of physicians providing charity care.
The program, which was launched in 1995 in Buncombe County, N.C, began by inviting the county’s 700 primary and specialty physicians to donate time to care for uninsured patients. Within the year, 70% of the county’s physicians had volunteered to help, and today 90% of the physicians in Buncombe County work with Project Access to provide nearly $12 million in medical care for the uninsured in Greater Asheville, N.C.
Strong physician support such as that demonstrated by Buncombe County’s physicians has helped Project Access attract new partners and grow into a national movement. From laboratories, to hospitals, medical equipment companies, medical homes and county commissioners, Project Access has attracted involvement from all facets of the medical community throughout the nation.
Full Article | Comments | Back To Top
Billing Enforcement Pilot Recovered Millions for Medicare, Feds Plan to Crack Down Nationwide
Source: HealthcareFinanceNews.com
Date: 07/15/2008
The Centers for Medicare and Medicaid Services recently reported that the federal government recovered nearly $700 million in improper Medicare payments through a recovery audit contractors (RAC) three-year pilot project in California, Florida, New York, Arizona, Massachusetts and South Carolina.
The RAC report showed that 85% of the recovered overpayments were collected from inpatient hospital providers, 6% were collected from inpatient rehabilitation facilities and 4% were collected from outpatient hospital providers. The majority of the overpayment errors were due to accidental double billing and miscoded claims.
Although the pilot program also discovered $37.5 million in underpaid claims to providers, the primary result of the RAC report is that providers will face “unprecedented pressure” and scrutiny from the nationwide RAC program that will leave many doctors unprepared.
The nationwide program may result in the forced closing of practices for doctors who haven’t been recording their care properly, but CMS officials say that the RAC program has a limited impact on most providers – the majority of hospitals in the pilot program states faced only a 2.5% impact on their bottom line.
Some critics believe that supporters of RAC have a financial incentive to find overpayments and are calling for a Government Accountability Office evaluation of the RAC program.
Full Article | Comments | Back To Top
E-Prescription Networks to Merge
Source: The Washington Post
Date: 07/01/2008
In an effort to increase the doctors’ usage of electronic prescription technology, RxHub, which sends prescriptions to mail-order firms and provides information about insurance coverage, and SureScripts, which routs prescriptions to pharmacies, have merged to become SureScripts-RxHub.
As a result of the merger, the two electronic prescription networks hope to simplify the electronic prescription process in an integrated network that connects doctors, pharmacies and benefit payers. SureScripts-RxHub plans to use this network to raise the percentage of prescriptions submitted electronically from its current proportion of 2% of 1.5 billion annual prescriptions. Additionally, Sure-Scripts-RxHub claims that electronic prescriptions will help to avoid handwriting errors and decrease the 7,000 patients who die and 1.5 million patients who are injured from prescription errors each year.
Analysts hope that the e-prescription network will contribute to the creation of a national electronic health records system in the nation. The timing of the SureScripts-RxHub network coincides with governmental actions to remove barriers to the adoption of e-prescribing and electronic health records, such as weak incentives to purchase equipment, legal difficulties and privacy concerns.
The proposed Congressional legislation would offer financial benefits to doctors who buy e-prescription technology. Additionally, the Drug Enforcement Agency’s proposed removal of the ban on e-prescribing some controlled substances would contribute to the speedier adoption of e-prescription technology.
However, the medical community has raised concerns regarding the adoption of e-prescription technology. The American Medical Association has stated that public health insurance doesn’t cover the cost of basic health care, let alone high-tech e-prescription services. Privacy concerns regarding the transfer of patient data between company computers also exist.
Full Article | Comments | Back To Top
PhRMA Announces Revised Code Guiding Industry Interactions With Physicians
Source: American Academy Of Family Physicians
Date: 07/10/2008
In an effort to guide “the interactions between company representatives and health care professionals,” PhRMA, the Pharmaceutical Research and Manufacturers of America, strengthened its marketing code for pharmaceutical research companies’ interactions with physicians.
The revised “PhRMA Code on Interactions with Healthcare Professionals” is intended to re-focus pharmaceutical and biotechnology companies’ relationship with healthcare professionals as a relationship solely for the provision of scientific and educational information and support for medical research.
In order to meet this objective, the new code restricts the types of gifts and meals offered to physicians and their staff by the pharmaceutical industry to educational gifts and meals that are part of informational presentations. Meals may not be provided directly to participants at CME events.
The new code also provides stricter standards regarding the nature of pharmaceutical industry interactions with health care professionals who are commercial consultants or members of the pharmaceutical companies’ speakers’ bureaus. Companies’ monetary and meal payments to health care professions must be “reasonable” and all relationships between health care professionals and pharmaceuticals must be fully disclosed.
Full Article | Comments | Back To Top
Military Sweetens the Deal to Entice Medical Students
Source: American Medical News
Date: 07/07/2008
In order to combat decreased medical student enlistment in the armed services, the military is now offering a $20,000 signing bonus to its Health Professions Scholarship Program. Beginning in 2007, the Navy was the first division of the Armed Forces to offer the signing bonus, followed by the Army and the Air Force in early 2008.
The Navy and Army have experienced the most dramatic declines in medical student recruitment since 2005. Speculations as to the cause for the decline in recruitment include the increased rate of female entrance into medical school, the disconnect between the current generation of medical students and World War II veterans, the war in Iraq, and the fact that the current generation of students seems to be less averse to debt than previous generations.
In order to increase military recruitment through the scholarship program, which supplies 80% to 90% of military physicians, the program covers the signing bonus, tuition at any U.S medical school and any additional school-related fees. In exchange for the scholarship, students must participate in officer training during school breaks, complete a military residency and practice as a military physician for four years after school completion.
In addition to the scholarship funds, the Army has begun ad campaigns, face-to-face recruiting and Internet chat rooms hosted by military physicians and residents to increase recruitment.
Full Article | Comments | Back To Top
Effective Physician Recruitment Tools
Source: HealthLeadersMedia.com
Date: 07/30/2008
With the nationwide physician shortage likely to continue, and with young doctors far more desirous of the amenities of a social life, the competition in recruiting doctors is as high as it has ever been. As a result, less attractive areas have a harder and harder time recruiting talent, especially rural areas. Because of this, some areas are turning to incentives as a means of ensuring a flow of talent.
One method of incentivising rural practice is the exposure of first-and second-year medical students to rural life, practice, and hospitals. It is hoped that this will result in at least some students—particularly those that were raised in small towns—taking a liking to the rural lifestyle or desiring to return to a small town environment.
Some states and areas are also shifting their recruiting focus to online spheres. Sixty-three percent of physician recruiters say they are working more with residency/fellowship programs and shifting their recruiting efforts to online venues. Three quarters of those recruiters represent rural areas and cities with populations under 250,000.
For recruiters looking to improve their effectiveness in attracting talent, online physician job posting boards topped the list of a recent survey of recruiting practices, with 40% of respondents citing them as effective. Job posting boards were followed by physical networking and physician recruiting agencies. The digital or personal touch seems essential, as very few respondents indicated that mass marketed efforts—such as burst emails, television, and radio ads—were successful for them.
Full Article | Comments | Back To Top
Take Your Staff From Good to Great
Source: Medical Economics
Date: 07/04/2008
In the fast-changing medical community, it can be difficult for doctors to retain good employees, ensure employees are working up to their potential and adapt to the flux in staffing demands. But today’s physicians have the power to fight stagnating reimbursements and increasing costs, as outlined in a recent article with a number of recommendations for physicians to ensure that they have the “right staff doing the right things.”
One way for physicians to ensure they find the right staff for their practice is to become smarter recruiters. Better recruitment techniques include the development of a clear job description with a detailed list of responsibilities and qualifications. It is also important to examine the best media approach for recruitment – depending on the market and location of the practice, print, broadcast, online or word-of-month advertising may be most effective in finding the right staff. Once qualified candidates are identified, it is essential to standardize the interview process.
After the right candidates are hired, the next step towards retaining good staff is to build employee loyalty via a number of employment practices. These practices include limiting front desk personnel from duties better done by someone else, sufficient and continuous on-the-job training that orients staff to the practice and their specific job skills, rewarding achievements with positive feedback, upgrading pay whenever possible and the choosing the right number of staff to meet the needs of the practice.
Although determining the right staffing levels can be difficult because practice models, patient scheduling systems, facility design, inclusion of ancillary services and technology use varies widely between practices, physician’s use of a systematic approach that compares practice performance and staffing levels with that of peers helps to determine the appropriate staffing level.
Full Article | Comments | Back To Top
Job Sharing: Flexibility Has a Price
Source: Contemporary OB/GYN
Date: 07/01/2008
Job-sharing arrangements have many benefits. They have enabled doctors to balance the roles of doctor, spouse, parent and daughter or son. In addition to pro-rated benefits and other perks, job-sharers enjoy general acceptance as a full-time physician. It allows employers the opportunity to retain or hire valuable employees, offer better work coordination, and facilitate better integration with full-time staff.
Despite these benefits, job sharing is far from common. For one thing, it can be difficult to pull off. The two physicians must not only have the same work ethic but also a cooperative attitude, an open communication style, flexibility and respect for the other person. In addition, job sharers require full malpractice insurance even though they are working fewer hours.
For individuals who are considering pursuing a job-sharing relationship, those who have negotiated this relationship successfully offer some hints. It is recommended that you pair with someone that you know well and have worked with before. In addition, job-sharers have found that the best partner is one who is “in the same place in life at the same time,” that is, a person who can easily empathize when you may need to take extra time off.
One reason for failure is different interpretation of what job sharing should entail; for instance, when one partner believes that it should entail full call responsibilities while the other believes it should only entail half. Another is different orientations toward patient care; for instance, when one partner believes that patient care should be split and the other would prefer that it be shared.
While such a relationship can be difficult to navigate, for those who have been able to do so successfully, job sharing allows physicians greater control over their lives. Online resources for developing a job-sharing proposal can be found at http://jobshareconnection.com/.
Full Article | Comments | Back To Top
Building a Physician Employment Strategy
Source: HealthcareStrategyGroup.com
Date: 06/01/2008
Due to a number of factors, hospitals are increasingly hiring physicians as part of their institutional staff, but doing so without much practical experience.
Physician employment is growing due primarily to economic factors. The costs of private practice are becoming increasingly stifling, with a 4-5% annual increase in staffing costs versus limited reimbursement growth. Malpractice and information technology costs are also growing while Medicare reimbursement remains either low or even shrinks year over year.
In addition to the economic concerns, there is a shortage of physicians. While demand increases across the country, the supply of physicians is limited due to geographic and demographic constraints as well as the continuing increase in specialists at the expense of the primary care population.
Hospitals sometimes consider physician employment in order to ensure patient access to a quality level of care for underserved populations and less attractive payer mixes. Other times, physicians are brought on as a means of attaining a strategic advantage or leverage on payers or to protect a hospital’s referral base. This also lessens dependence on private practices and shores up specialty or subspecialty ranks within a hospital, which, if the specialties are profitable, can result in an improved bottom line.
In hiring full-time physicians, a number of strategies can be employed to ensure that both sides get the maximum benefit from the arrangement:
-Structure deals with proper incentives. Physicians should be expected to treat a targeted number of patients, with compensation adjusted if target goals are not met.
-It is difficult to have an efficiently functioning practice with only one or two doctors per location. The article cites six to eight doctors per location as an ideal number.
-Hospitals should aim for at least 35% market share within their draw area to ensure better compensation rates.
-The impact of taking on new practices should be fully understood by administrators. Projections of incremental revenue, costs of providing incremental care, recruitment costs, and IT are necessary.
-Performance standards should be mutually agreed upon and understood by the hiring hospital and the physicians being brought on.
Full Article | Comments | Back To Top
|
|
 |
 |
|
Employment & Compensation
|
|
|
| |
|
 |
Enjoying the Rewards of a Locum Tenens Lifestyle
Source: LocumLife
Date: 07/15/2008
The locum tenens profession allows for a large amount of variety in lifestyle due to the lack of traditional restraints coming with private practice or other practice arrangements. In an article in the July issue of LocumLife, a practitioner relates his experience with the locum lifestyle, from prison practice to Bangladesh and back again.
The writer, who has accepted 50 opportunities since taking up the locum tenens lifestyle, has spent the last five years between state prison facilities and Mid-Atlantic outpatient clinics. While the job is tough, the psychiatric services he provides in prisons pay well and offer a greater degree of challenge. He cites the “exemplary” relationships he’s developed with colleagues and staff as well as the enduring attachments he’s formed during each of his temporary assignments.
The author further cites the flexibility of the locum lifestyle as a primary benefit. He now accepts shorter contracts with fewer workdays in order to maximize his free time. This provides him comfortable earnings plus the invaluable benefit of increased free time. This particular doctor has taken up photography, visually documenting the over 50 countries he’s visited and having shots published in such publications as National Geographic. In addition, he composes music in a self-made studio in his permanent home when in residence there.
The travel and potential for free time make the writer recommend locum tenens as the perfect remedy for the practitioner weary of the nine-to-five lifestyle. The sacrifice of a bit of security can result in broadened horizons, giving a practitioner the option of his own choices, his own options, and his own preferences in practice and life.
Full Article | Comments | Back To Top
Some Health Centers Work With Doctors’ Part-Time Needs
Source: Detroit Free Press: freep.com
Date: 07/14/2008
The current generation of physicians, unlike the previous 100-hour workweek generation, is looking to increase work-life balance by working part-time. Despite reports of a nationwide shortage of doctors, more doctors, particularly female physicians with families, are seeking part-time work.
And as the past decade has witnessed a gender shift from the primarily male practice to an increase in the number of female practitioners – with women comprising about 53% of the incoming U.S medical student population – this trend of increased part-time work seems set to continue into the future.
But it is the combined different work-level expectations of men, as well as of women, that has contributed to the increase of physicians practicing part-time, from 13% in 2005 to 19% in 2007. Of the 14,705 physicians surveyed nationwide, 12% of women and 7% of men scaled back their hours to part-time.
Today, many healthcare centers are working to accommodate physicians’ desire to work part-time in their effort to retain quality physicians. However, hospitals often find themselves to be most negatively impacted by the trend because it can be hard to meet financial targets with part-time physicians.
Full Article | Comments | Back To Top
Revisiting Physician Employment
Source: Trustee Magazine
Date: 07/01/2008
As hospitals have worked to improve quality of care and patient safety in recent years, they have found a growing need for more primary care and specialty physicians. However, due largely to negative experiences in the 1990s, hospitals have been hesitant to employ new physicians. Many hospitals at the time were losing over $100,000 per physician per year thanks to complicated and expensive employment relationships. Today, physician shortages and competition in local marketplaces is leading hospitals to revisit that subject.
While the experiences of the past give many hospital boards pause, employment strategies have changed significantly since the 1990s. Integrated delivery networks and lack of productivity and quality standards have given way to more adaptable and diverse systems including short-term and part-time employment as well as pay-for-performance standards and integration of physicians into hospital strategy and culture alongside the board and the administration.
Hospital boards need to consider strategic alignment, market position, and likely return on investment before going forward with new employment. After this process, however, there are fortunately a number of new employment models which have helped address some of the old problems. Under the incubator model, hospitals employ new physicians short-term or part-time for a year or two while they build up referral arrangements and eventually establish their own practice. A second option is to employ physicians in the emergency department or clinic and then reimburse the physician for using their clinical expertise to build a service line. The third, and more traditional option, is simply to employ physicians for the long-term—three, four, or even up to ten years.
Full Article | Comments | Back To Top
Too Much Variety in Pay-for-Performance Programs?
Source: Managed Care
Date: 04/01/2008
A new report by the health industries group at PricewaterhouseCoopers suggests that institutions are not doing enough to evaluate and track pay-for-performance (P4P) programs. Hindy Shaman, a director at PricewaterhouseCoopers says performance of these programs “has been mixed as far as the level of resources commercial plans have put in, the level of financial or nonfinancial bonus that providers get, and the amount of cost and quality tracking that payers do.”
She suggests an “all-payer approach” which establishes a framework for design, quality, and reporting. The report interviewed executives from ten major commercial payers about their P4P programs.
Full Article | Comments | Back To Top
Specialty Physician Compensation Barely Keeps Up With Inflation: Primary Care Physicians Report Nominal Pay Increases Despite Large Increase in Production
Source: Medical Group Management Association
Date: 07/14/2008
The Medical Group Management Associations’ Physician Compensation and Production Survey, which includes data for physicians and non-physician providers in 105 specialties and data on nearly 52,000 providers, recently released its findings regarding physician compensation.
The report found that specialty physicians’ compensation remained flat in 2007 – with an increase of just 0.31% over inflation, to a median income of $332,450 a year. Among specialists, emergency medicine physicians and hematology/oncology physicians’ compensation failed to keep up with inflation, and invasive cardiologists’ compensation decreased even before inflation. Interestingly, noninvasive cardiologists’ compensation increased 11.72%, and compensation for anesthesiologists and urologists also reported gains in compensation above inflation.
Primary care physicians’ compensations also fared slightly better, with a median compensation increase of 3.35% over inflation, to $182,322.
The nominal increase in primary care physician compensation marks a shift in a trend of flat or declining compensation for primary care physicians. However, this increase is primarily due to primary care physicians’ 7.59% increase in production, and most physicians report that overall practice costs are continuing to increase at a fast rate – creating an uncertain reimbursement environment for physicians.
The MGMA survey also noted a shift in regional trends of primary care physician compensation. In past years, physicians in the South have reported slighter higher compensation than the national median, but in 2007 primary care physicians in the West reported the highest median compensation.
Full Article | Comments | Back To Top
Med School for Judges: A Crash Course in Medical Litigation
Source: AMedNews.com
Date: 07/28/2008
At the National Judges’ Medical School held at the Indiana School of Law-Indianapolis in May, more than 200 state and federal judges from 39 jurisdictions across the country were afforded the opportunity to address questions regarding complex medical cases to doctors, scientists, lawyers and fellow judges. The School, intended to equip judges with a better knowledge of medical science so that they can interpret complex health care cases, was established more than two years ago as part of a larger initiative – the Advanced Science and Technology Adjudication Resource (ASTAR) Center. In addition to the medical school, judges must follow a two-year, 120 hour curriculum after attending a “boot camp” to get up to speed with medical terminology in order to complete the ASTAR advanced science training.
Preeminent in the minds of the judges and the doctors involved with ASTAR is preventing “junk science” from derailing the judicial process. At the medical school, junk science is debunked through a crash course in litigation involving medical errors. Simulated treatment conversations among doctors, a patient, a health insurance executive and a hospital ethics committee provide judges the opportunity to immerse themselves in the actual medical processes to give them an understanding of what has occurred before the case comes to court. It is hoped that if judges are trained to know what questions to ask about the credibility of an expert’s qualifications or a peer-reviewed study, they can toss out irrelevant evidence or seek another opinion from an independent, court-appointed expert.
As science continues to evolve, judges are likely to see a range of novel legal issues involving public policy concerns. The 233 judges expected to complete the ASTAR advanced science training by the end of 2008 will serve as resources for fellow judges in their jurisdictions and help train the next generation of selected judges, with the goal of developing a corps of 500 specialized judges by 2010.
Full Article | Comments | Back To Top
Why Doctors Should Worry about Preemption
Source: New England Journal of Medicine
Date: 07/03/2008
Next fall, the court case Wyeth v. Levine may decide a new era for the rights of drug companies.
The Supreme Court will decide whether the law implies preemption of state tort litigation with its review of the case, which concerns a patient who lost her arm after an injection of an antiemetic drug made by drug manufacturer Wyeth. If the Supreme Court sides with Wyeth, it will mean that drug companies will be protected from state-level tort litigation if their products that have been approved by the Food and Drug Administration are later found to be defective.
The upcoming court case reflects the government’s shift in viewpoint from the belief that tort litigation is an important part of an overall regulatory framework that enhances patient safety to its current view that tort liability stifles product development and delays the approval process.
FDA approval of a new drug does not guarantee its safety, due in part to the fact that FDA approval is primarily based on short-term rather than long-term studies. As a result, many drug safety issues become apparent only after a drug has entered the market. However, if consumers are preempted from tort litigation, the incentive for drug manufacturers to ensure product safely will be decreased, resulting in drugs and medical products that are less safe.
Doctors should worry about preemption because of the potential of a negative shift in the doctor-patient relationship caused by preemption’s effect on consumer confidence in drug safety. Without the possibility of legal action in the case of unsafe drugs, doctor and patient confidence in the safety of drugs and medical products will be undermined, which may cause patients to seek other courses of treatment.
Full Article | Comments | Back To Top
Primary Care Physicians: Get Paid for Hospital Visits
Source: Medical Economics
Date: 06/20/2008
The nation’s hospitalist movement is here to stay, due to changes in the health care system such as the increased profits for health insurers and hospitals, increased productivity for primary care physicians, and the need for the constant availability of health professionals. Some worry, however, that the positive financial consequences of the hospitalist movement are mitigated by the consequences of a discontinuity in patient care and a system in which hospital-based physicians often do not have the time to build the relationship with patients that allow for individualized needs assessment and treatment.
In order to address these negative aspects of the hospitalist movement, the article suggests that PCPs make regular hospital visits to interact with patients and their hospitalists to ensure the communication of all patient information. PCPs, however, are unlikely to make these visits unless insurance companies are required to reimburse them for their time.
While insurers may argue that the short-term cost of primary care hospital visits would be prohibitive, it is possible that in the long-term, the coordinated continuity of care would serve as a preventative measure protecting against extraneous medical and personal costs. As it currently stands, the discontinuity between PCP and hospitalist communication does a disservice to the timely and effective treatment of patients.
Full Article | Comments | Back To Top
Insurers Using Radiology Benefit Managers To Cut Down On Unnecessary, Costly Imaging Procedures
Source: Kaiser Daily Health Policy Report
Date: 07/30/2008
With medical imaging procedures costing nearly $100 billion a year in the U.S., health insurance companies have started to deny coverage for procedures that are recommended by physicians but judged by the company to be unnecessary. With costs so high and approximately half of all scans for some conditions failing to improve diagnosis or treatment, insurance companies are increasingly turning to radiology benefit managers to judge and reject unnecessary imaging procedures.
Medicare has begun denying some scans and aims to cut back more. However, as Christopher Ullrich, the managed care committee director for the American College of Radiology, said, this attempt to cut costs could endanger patients: "You're going to find patients with a headache who turned out to have an aneurysm or who had abdominal pain that wasn't investigated and turned out to be a tumor.”
UnitedHealth Group uses “advanced notification,” requiring physicians to notify UnitedHealth by phone, fax or the Internet before giving a patient a non-urgent scan. If the insurer suspects the procedure may be unnecessary, a UnitedHealth physician calls the prescribing physician and discusses it. Physicians who don’t notify the company risk not getting paid.
A similar program used by HealthPartners has helped the company avoid 7,000 scans through computerized “decision support” integrated in the patient’s electronic health record.
Full Article | Comments | Back To Top
Most Generalists Reluctant To Provide Primary Care For Young Adults With Chronic Illness
Source: Medical News Today
Date: 07/30/2008
A new study shows that general internists and pediatricians are largely uncomfortable providing primary care for young adults with chronic illnesses originating during their childhood. The study looked at physicians treating patients with cystic fibrosis and sickle cell disease, finding that only 15% of internists would be comfortable treating a young patient with CF and 32% comfortable treating a patient with SCD.
Thirty-eight percent of surveyed pediatricians said they would be comfortable serving as primary care providers for CF patients, with 35% saying the same for SCD. Both groups (internists and pediatricians) said they would be more comfortable treating common conditions such as asthma or hypertension rather than CF or SCD.
While patients with these conditions are generally recommended to transfer from child-oriented to adult primary care around the age of 14, these results suggest that internists and generalists are unprepared to meet the demand for this kind of primary care.
Internists, in particular, were found to be likely to worry that insufficient training would limit their ability to care for patients with these conditions, while pediatricians worried about the amount of time they could spend with the patients.
Full Article | Comments | Back To Top
|
|
|
|
|
Payer & Reimbursement Issues
|
|
|
| |
|
|
Long-Term Fix is Elusive in Medicare Payments
Source: The New York Times
Date: 07/13/2008
Senator Ted Kennedy’s return to Congress in July helped the Democrats pass a bill blocking a 10.6% cut in Medicare payments to doctors. Although the bill will grant physicians an 18-month reprieve from pay cuts, it does not address the need for a long-term solution to the flawed physician fee schedule.
The White House says that President Bush will veto the bill because it also proposes reductions to subsidies paid to insurance companies that care for some Medicare beneficiaries, but Democrats believe they have the needed two-thirds majority to override the veto.
The Medicare payment structure is supposed to control the growth of Medicare spending for doctors’ services by linking services to the gross domestic product – a formula that works well when the economy is booming, but in the current period of recession, many doctors say that their costs are rising faster than Medicare payment rates.
Under the current fee schedule, there are limits on payment for each type of service, and when actual spending exceeds the goals, payments to doctors are supposed to be reduced. Each time Congress steps in to block a cut to payment, Medicare recoups the money by making deeper cuts the subsequent year.
Lawmakers are pleading with physicians to propose a comprehensive plan for a Medicare physician payment system – but such a plan is difficult to develop because it is likely to favor some types of doctors more than others.
Full Article | Comments | Back To Top
New Issues Emerge in Healthcare Finance
Source: BNET Healthcare
Date: 07/09/2008
In the fast-changing world of health care, it is important that healthcare professionals stay up-to-date on the latest challenges in managing hospitals and healthcare system finances.
The Healthcare Financial Management Association’s Annual National Institute, held this June in Las Vegas, covered a variety of the most pertinent challenges facing the healthcare system. Of primary concern were increasing numbers of underinsured and uninsured patients, ineffective pay-for-performance initiatives, the effects of new technology for hospital consolidation and demands for transparency within the medical community.
Among the topics covered was the issue of hospital quality and cost-effectiveness rankings. While the rankings measure hospital quality based on “process improvements,” the rankings are less clear on outcomes, such as whether the patients got better or survived. Additionally, the rankings have no clear standard of cost-effectiveness, making it difficult for health professionals and the public to compare true cost-effectiveness between hospitals.
Other areas discussed included the need for hospitals to review administrative procedures as a measure of protection against aggressive Medicare cost-recovery audits, competition for outpatient services in new healthcare fields and its effect on the increasing trend of physician-owned hospitals, and concerns about the complexity of appropriately compensating physicians at hospitals without the appearance of paying physicians kickbacks for patient referrals.
Full Article | Comments | Back To Top
Payer Offers Patient Data on CDs
Source: HealthData Management
Date: 07/31/2008
Philadelphia-based Independence Blue Cross has started giving out compact discs (CDs) with patients’ clinical information about chronic conditions ranging from diabetes, heart failure, and coronary disease, to asthma and chronic obstructive pulmonary disease.
Known as Smart Registries, the reports had previously been available only in hard copy, but the new electronic format allows data sorting and helps physicians identify when a patient needs certain tests, procedures, or treatments. Results are also integrated into the system. Moreover, the system records patients’ “medication persistence,” or how often they fulfill prescriptions and refills.
Full Article | Comments | Back To Top
Getting What We Pay For: Innovations Lacking in Provider Payment Reform for Chronic Disease Care
Source: Center for Studying Health System Change
Date: 06/01/2008
The increasing prevalence of chronic disease conditions has a detrimental effect not just on the health of the nation but on the continued escalation of health care costs.
Although current physician and hospital payment methods – often based on a piecemeal approach to care delivery instead of coordinated care approach – do not promote high-quality, efficient care for those with chronic health conditions, little movement has be made to change provider payment strategies.
Most of the recent efforts to improve the care of patients with chronic conditions have centered around paying disease management firms and vendors to intervene with patients and care delivery instead of reforming the underlying physician and hospital payment method problems.
The most important of these barriers includes fragmented care delivery, lack of payment for non-physician providers and services supportive of chronic disease delivery, potential revenue reductions for some providers, and the lack of a viable reform champion.
As the number of people with chronic conditions and related health care costs increases, the creation of a better payment system is essential to provide high quality and cost-effective care. However, it is unlikely that payment reform can occur without more support from employers and other health care purchasers. While Medicare has conducted several recent demonstrations on chronically ill patients and is planning a demonstration of a patient-centered medical home, such projects take time to evaluate. In order for lasting change to occur, it is imperative that stakeholder support and commitment to chronic condition payment change cause Congress to mandate a shift from demonstrations to the implementation of a revised payment system.
Full Article | Comments | Back To Top
|
|
|
|
|
Credentialing, Licensure, Quality Management
|
|
|
| |
|
|
P4P Found to Have Little Impact on Care Quality
Source: AMedNews.com
Date: 08/04/2008
Pay for Performance is all the rage in political and industry discussions of recent, but does it result in improved patient outcomes? A new study suggests the scheme may have little impact at all, if any. An article from American Medical News examines the study and its implications.
The study, published in the July/August issue of Health Affairs, examined 81 Massachusetts physician groups that were eligible for quality incentives and 73 that were not. The study had more access than other studies to data from a cross section of doctors and payers. The study found an overall improvement in treatment outcomes from preventive measures from 2001 to 2003, but statistically indistinguishable performance was observed among physicians regardless of compensation schemes.
A number of other studies have shown results from Pay for Performance, such as a Centers for Medicare and Medicaid Services evaluation finding participating practices hitting at least 70% of quality metrics for care with P4P. The authors of the study, however, contend that their study, which takes into account control practices, represents a better model of P4P effectiveness.
The article mentions the California Integrated Healthcare Association’s P4P programs: the biggest non-governmental program of its kind. An analysis of that program showed some positive effects of P4P, but these were not strong. The authors of the study as well as administrators from numerous systems contend that Pay for Performance is not an end in and of itself, but rather the first step in a restructuring, a foundation for further payment reform which they hope the system will adopt going forward.
Full Article | Comments | Back To Top
One Answer to EMR Data: Hire a Scribe to Do It
Source: AMedNews.com
Date: 07/14/2008
One of the biggest hindrances to the use of electronic medical records is the fact that doctors are comfortable with the way they conduct examinations and take notes and do not have time to sit and enter this information electronically. Scribes, on the other hand, can be contracted to take notes of patient exams—allowing more freedom for the doctor—and reenter the information electronically in between appointments.
While EMR vendors claim that practices can save money by removing the need for transcriptionists, scribe companies are actually developing a niche in support of EMR technology and could play a growing role in the future. Critics of the practice maintain that it is important for doctors to understand how EMR technology works and that the use of scribes will only delay this process.
Full Article | Comments | Back To Top
Physicians Debate Value of ‘Most Wired Hospitals’ Survey
Source: Healthcare IT News
Date: 07/17/2008
Physician IT leaders discussed the importance of the “Most Wired Hospitals” list, a ranking of hospitals based on the annual Most Wired Survey and Benchmarking Study at this July’s Physician-Computer Connection Symposium. The study, conducted by Hospitals & Health Networks magazine, ranked 556 U.S hospitals and health systems on a number of criteria, including “25 Most Improved,” “25 Most Wireless,” and “24 Most Wired – Small of Rural.”
At the Symposium, physicians speculated that the ranking system might lead hospital executives to mistakenly believe that installation of technology alone increases the quality of a hospital, rather than a system of information technology carefully planned to coordinate with other medical care components.
Some physicians worried that the 100 Most Wired list is used only a as a marketing tool for hospitals and suggested that the Hospitals & Health Networks survey adopt a more “Consumer Reports” approach that would not allow hospital and health system participants to use the “Most Wired” label as a marketing tool.
While the adoption of information technology is important for long-term hospital improvements in efficiency, physicians suggested the need for the development of industry IT data that separates awards program from benchmarking data.
Full Article | Comments | Back To Top
The Tech Doctor: Best-of-Breed or Integrated Systems?
Source: Physicians Practice
Date: 06/01/2007
“Should I keep my existing practice management system and interface it with my new EMR or should I purchase an integrated system that combines a new EMR with new practice management software” is a question that physicians must inevitably face.
The former option, known as the “best-of-breed” approach, enables a physician to select each software application based on its inherent qualities. In addition, by allowing physicians to keep the software they have in place, it can save money and minimize disruption to the practice. However, setting up an interface can be complicated, and even with an interface, data sharing may not be as seamless as with an integrated system.
On the other hand, the integrated system not only saves physicians the trouble of building an interface and likely will present fewer data exchange problems than the best-of-breed system, it also offers physicians more shared applications and allows for more sophisticated interactions between the EMR and the practice management system. If and when problems do arise, the physician benefits from the fact that there is a single point of contact for support and technical concerns.
For those who choose the best-of-breed approach, a registration interface that saves staff from having to enter registration information on practice management and EMR systems separately is likely to provide the most benefit, as demonstrated by the fact that it is the most commonly chosen interface. Those who opt for the “integrated system” approach should beware that buying products from the same vendor does not guarantee that the system is integrated. In order to receive the benefits of the integrated system, the EMR and practice management systems need to share a database.
Full Article | Comments | Back To Top
Leavitt Promotes E-Prescribing Amid Provider Concerns about Barriers
Source: Healthcare IT News
Date: 07/22/2008
Health and Human Services Secretary Michael Leavitt continues to promote the launch of a nationwide healthcare information technology infrastructure—specifically electronic prescribing—despite industry and physician concerns about the financial and logistical obstacles, calling it “a top goal” of this administration.
The Institute of Medicine’s figures indicate that more than 1.5 million Americans are injured each year by drug errors and that pharmacists make some 150 million calls per year to clarify illegible prescriptions.
Health and Human Services, due to recent legislation, will begin rewarding providers with 2% incentives in 2009 for adoption of e-prescribing measures. The move is estimated to save Medicare $156 million over 5 years due to fewer adverse drug events. The extant incentive program has already paid out $36 million to 56,000 healthcare professionals.
According to officials, providers can expect a $3,000 cost for implementation of e-prescribing technology, including training and additional fees for a data exchange line. Only 9% of the American Academy of Family Physicians report using e-prescribing, with 37% reporting that they have Electronic Health Records.
Full Article | Comments | Back To Top
|
|
|
|
|
Physician Practice Management
|
|
|
| |
|
|
Getting Advice: How to Hire a Consultant
Source: Physicians Practice
Date: 08/01/2008
It’s hard for doctors to admit they don’t know something or need help sometimes, but many come to the realization that something is wrong in their practice: something they don’t know how to fix by themselves. To whom do you turn in these situations? An article in the July-August issue of Physicians Practice examines the best practices in finding and hiring a consultant for your practice.
The continually changing landscape of the healthcare industry leaves practices open for inefficiencies that can spring up overnight. A skilled consultant can help build processes to stay abreast of these changes and keep your practice moving smoothly. The key indicators in choosing a consultant for your practice are:
-Experience: Veteran consultants know their stuff. If a consultant can guess your problem without you explicitly stating it, take note of their skill and be ready to take advantage of their knowledge.
-Trust through good rapport: Consultants should be able to effectively communicate not only their plans, but the rationale behind their plans.
-Flexibility: Deciding on a suitable strategy for achieving important objectives may require some give-and-take.
-Demonstrated ethics: Ask the candidate the usual length of client relationships and his usual terms.
-Don’t be afraid to ask if your prospective consultant is accredited with the National Society of Certified Healthcare Business Consultants.
-A service agreement should be clearly delineated with express terms regarding payment, services expected, and length of term.
Above all, the article recommends remembering to get your money’s worth out of a consultant, but to remember that they are “paying you” at the same time with their consultation. Therefore, practices must be willing to make changes for the relationship to be worth the effort.
Full Article | Comments | Back To Top
Physicians Issues, Economic Uncertainty, IT Major Concerns to Group Practice Managers: MGMA Survey
Source: Healthcare Financial Management Association
Date: 07/10/2008
A new opinion research survey by the Medical Group Management Association asked medical group practice management professionals, physicians and members about the greatest challenges they faced while protecting their practices’ finances.
The survey, conducted in March 2008, asked members who managed medical group practices to rate their level of challenge on 34 practice management and professional issues and also invited them to write their own comments. With a 12% response rate, 1,393 participants responded with over 500 written comments.
Survey results indicate that the primary challenges associated with running a group practice include increasing operating costs, the financial and time costs and implementation of an electronic health record system, physician recruitment, finance management in the case of uncertain Medicare reimbursement rates, and the need to maintain physician compensation despite decreasing reimbursement.
Full Article | Comments | Back To Top
The New Doctor-Patient Paradigm
Source: Medical Economics
Date: 06/20/2008
Patients empowered, or at least emboldened, by Internet-based medical information and uncoupled from traditional family doctors due to shifting changes in insurance are more comfortable than ever challenging medical advice and switching doctors. This switch from the “paternalistic doctor” of the past has led to a growing discussion among physicians about their relationship with patients.
While some physicians have hailed this shift, saying they learn from their patients and enjoy the more collaborative nature of the work, others worry that institutional structures like large group practices have driven a wedge between physicians and their patients. This, combined with growing skepticism and cynicism among patients, in addition to the growing threat of litigation, worries many doctors. Ahmet Ucmakli, an FP in Temeluca, CA, says that, "neither physician nor patient trust each other anymore. Owing to the intrusive effects of third-party payers, physicians are, at best, advisors; more realistically, we're waiters who take orders from patients, insurers, and administrators."
The growth of HMOs and the increased paperwork associated with complex insurance policies have cut into some of the face time patients and doctors once shared, resulting in both physicians and patients feeling more rushed. And while doctors acknowledge that better-informed patients tend to have better outcomes, discussing treatment options takes far more time than a “doctor knows best” approach. Moreover, when patients find inaccurate or even dangerous information online it can undermine doctors’ advice and again prove costly. For many doctors facing these changes, patient education and openness to collaboration has proved helpful.
Full Article | Comments | Back To Top
Small Practice Evolution: The Medical Micropractice
Source: Medical Economics
Date: 06/20/2008
Defying practice management experts who urge doctors to increase productivity by delegating non-physician duties, the micropractice is an increasingly popular method of practice management wherein a single physician is the only employee in a small practice space.
Although this minimalist approach to medicine means that micropractice doctors earn approximately 25 percent less than their peers, it also decreases overhead by 40 to 50% percent, enabling micropracitioners to increase the amount of time they spend with each patient while treating fewer patients.
The idea of a micropractice is particularly appealing to younger and more idealistic doctors who see smaller practices as a way to provide a high level of care for patients while maintaining control of every aspect of the medical process. Micropractitioners feel that the small practice allows them to better accommodate and work with patients in a routine that best suits the doctor and the patient. The smaller patient load also enables doctors to make themselves more accessible to patients, even to the extent of providing a cell phone number so that the patient has an emergency contact method.
However, the high level of autonomy of micropractice work requires that physicians wishing to start a micropractice must have a specific skill set – one that includes a high degree of business and information technology savvy.
Before starting a micropractice, the article recommends that physicians develop a business plan with an income target and a calculation of overhead expenses, rent an office space between 100-200 square feet, acquire necessary IT software and office systems, set up a billing and collection system, and identify and eliminate insurers with cost-ineffective rates to protect finances.
Although lower earnings and the continuous pace of traditional practices discourages many medical students from pursuing primary care, this trend may soon be reversed by the reports of increased contentment experienced by physicians who provide a high level of personal care to patients within the framework of a micropractice.
Full Article | Comments | Back To Top
Reducing Administrative Costs
Source: Physician’s News Digest
Date: 07/01/2008
Research estimates that administrative complexity and inefficiencies raise annual health care costs by almost $300 billion, with processing medical claims alone accounting for $210 billion in raised costs.
Because the complicated fee schedules, formularies, covered services, preauthorization, diagnostic and procedural coding policies vary by commercial health plan, most physicians divert approximately 14% of their revenue to ensure accurate insurance payments for their services. The standardization of physician-payer transactions and data communications between physicians and health insurers and the adoption of health information technology would help to reduce administrative burdens on physicians.
The Medical Group Management Association (MGMA) lists six additional areas of administrative health care complexity most in need of simplification. These areas include the standardization of insurance product design, the creation of a single state-specific contract between payer and provider, standard state-specific billing and payment processes, standardized credentials verification, a standard physician fee schedule, and standardized clinical guidelines and disease management protocol for common conditions.
In order to increase public awareness of the price of administrative complexity, the Healthcare Administrative Simplification Coalition, with the American College of Physicians, the American College of Surgeons, the American Medical Association, the Centers for Medicare & Medicaid Services and many other national organizations, have formed a campaign that highlights administrative issues in order to find solutions that will simplify the administrative process and decrease healthcare costs.
Full Article | Comments | Back To Top
|
Complimentary copy only,
click for free subscription. |
|
|