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The Jackson & Coker Industry Report is a compendium of healthcare news,
commentary, and other important information for busy physicians and hospital /
practice administrators. The monthly newsletter incorporates original research
and studies supplied to Jackson & Coker by a nationally recognized research
firm.
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As physician residents anticipate launching their careers, what expectations do
they have concerning practice options, starting compensation and length of time
associated with their first place of employment? Jackson & Coker commissioned a
survey to determine answers to these, and other, critical questions related to
residents’ career plans.
Current residents can compare their employment
expectations and job-search parameters with those of their peers. Residency
program directors can incorporate the survey into their educational programs
focused on career planning. Hospital administrators can utilize the survey to
gauge interest and expectations of 2008-and-beyond residents when designing
appropriate recruitment strategies to attract the best candidates for permanent
employment.
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Residents, remember you can always search all of our open jobs on our website.
Gauging Readers’ Responses
In launching our first edition of the Jackson & Coker Industry Report, we were
anxious to receive reader feedback from providers as well as healthcare
administrators. By and large, the many e-mails and phone calls we received
applauded our efforts to offer something different and helpful from a physician
staffing firm. Generally speaking, positive reader feedback concerning the
newsletter centered on the following features and benefits:
• Variety of news content
• Completeness of the article summaries
• Graphic appeal and attractiveness of the publication
• Helpfulness of the industry survey for hospital recruiters.
We invited readers to select their favorite article categories. The top choice
was Staffing & Recruitment (44%), followed by Industry News (31%). Three
categories tied for third place (25%): Medical – Legal Matters, Payer &
Reimbursement Issues and “Other” specified topics. In future editions of the
Jackson & Coker Industry Report, we will gauge our article selections to
cumulative reader responses. Presenting the most informative and beneficial
content to our valued readers is our prime concern.
Cordially,
Calvin Bruce
Managing Editor
Prices Spike in 2007
Source: Modern Healthcare
Date: 01/21/2008
Looking back from the new year, many analysts are now confirming that 2007 was in fact a year characterized by above-average prices for a wide variety of healthcare services. When compared with economic indicators for non healthcare-related goods, in particular, it appears that consumers paid substantially more for medical care.
In relation to the Consumer Price Index (CPI), hospital prices increased by 8.3 percent from January to December 2007, compared with a CPI increase of 4.1 percent for non healthcare-related goods and services. Using the Producer Price Index (PPI) as an indicator, hospital prices rose 3.1 percent in the same time period.
For individual physicians’ offices, prices rose 4.2 percent using the PPI, up from a 1.1 percent increase in 2006. Using the CPI, prices rose 4.1 percent, over twice as high as the 2006 CPI increase of 1.7 percent. According to Joseph Kowal, an economist at the Bureau of Labor Statistics, prices were “high no matter how you look at it for physicians.” Over the past calendar year, internal medicine prices rose by 11.1 percent, general family practices prices rose by 6.4 percent, and multispecialty practice offices increased by 7.4 percent. Unaffected by price spikes were obstetrics/gynecology, pediatrics, and general surgery.
Given worries of an oncoming recession, analysts insist there is “no immediate cause for alarm,” as healthcare costs should stabilize over the next few years.
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The Profit Potential of Hospital Labs
Source: Hospitals & Health Networks Magazine
Date: 01/01/2008
Are hospital laboratories a “necessary evil” cost center for organizations, or do they hold the potential to actually increase hospital revenues and contribute greatly to the bottom line? An article in the January issue of HHN Magazine contends that the latter option is not only a possibility, but an easily attainable outcome.
The article proposes that—since a hospital lab structure is typically 50% fixed-cost and 50% variable cost—a doubling of the amount of tests run in a lab can result in a cost reduction of 25% on all tests run. This increased workload results in increased revenues for the hospital, a greater utilization of already purchased facilities and equipment, and an overall increase in capital. The authors put forth the main criteria necessary to turn hospital labs into revenue generators:
Control billing: Making sure the billing functions of the lab are up to date, efficient, and sufficiently supplied with capital to allow growth will ensure that the billing services department is fully capable of collecting fees from participating physicians as needed. Since the lab will be operating at a greater volume, leaving the increased billing needs up to the regular hospital billing department could introduce unneeded inefficiencies.
Maximize advantages: Laboratory outreach on the part of a hospital puts it in direct competition with commercial labs. Hospitals must maximize their organizational advantages—staff doctors, community standing, quicker response times—to ensure competitiveness.
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Medical Tourism Taking Flight?
Source: Human Resource Executive Online
Date: 01/24/2008
Despite the potential appeal of receiving medical care at significantly discounted rates, a recent study titled “Health Care Benefits: Eligibility, Coverage and Exclusions,” found that only 11 percent of organizations surveyed include medical tourism as a benefit. The study, conducted by the International Foundation of Employee Benefit Plans, examined the benefits policies of a variety of US companies, industries, and regions.
According to one observer, the difference in prices for procedures in the United States versus offshore facilities with strong healthcare credentials can be more than 50 percent. However, a number of obstacles stand in the way of medical tourism’s widespread adoption, primarily including the unwillingness of patients to leave the comfort of friends and relatives to undergo major medical procedures.
Another potentially significant obstacle concerns insurance carriers. Current healthcare networks are unlikely ready to accommodate offshore medical care, and insurers are reluctant to be the first to move forward on this issue. Nevertheless, the study concludes that medical tourism as a healthcare benefit has strong potential in promoting the highest quality care at the best price, once “real and psychological” hurdles are cleared.
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HHS’ New Year’s Resolutions
Source: Modern Healthcare
Date: 01/21/2008
Coming into the final year of the Bush Presidency, there are many issues of concern to healthcare professionals in the following months. Topping the list of concerns is a comment by Health and Human Services Secretary Mike Leavitt that suggests the Medicare Advantage program, a proposal to increase Medicare payments to physicians, will most likely not come to fruition.
President Bush promised that he would not levy a tobacco tax to pay for the Medicare Advantage program, and many are left wondering how Medicare physicians will be paid. “It’s really unlikely the Hill is going to accept the president’s budget if there’s deep cuts to hospitals,” argues Chip Kahn, president of the Federation of American Hospitals, but economic indicators suggest that there could be a growing gap for hospital funding in the near future.
Should HHS not find a suitable arrangement in the next few months, Medicare physicians could feel the full brunt of a 10 percent reduction in physician funding that is scheduled for July 1 of this year, with the additional 5 percent cut taking place on January 1, 2009.
The physician funding problem will not be easily fixed, and the Congressional Budget Office argues that a full overhaul of the existing scheme will cost the federal government upwards of $262 billion over the next 10 years, in addition to the $70 billion in higher costs for Medicare beneficiaries.
All eyes are fixed on Congress’ actions over the next year, and healthcare professionals are awaiting the release of President Bush’s fiscal 2009 budget request for HHS, expected to come in early February.
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Med Schools Adjusting to Millennial Students
Source: American Medical News
Date: 01/01/2008
A new generation of medical students is making its way into American medical schools and changing the status quo as they come. A recent article on the American Medical Association’s news page, amednews.com, explores the impact of the so-called “millennial generation”—young Americans born between the early 80s and the early 2000s—on medical education in this country.
The primary effect of the Millennials has been a shift toward collaborative learning in medical education. Millennials are a tech-savvy and group-oriented generation and are more likely to embrace team-based learning. Consequently, schools are developing more collaboration-intensive structures for instruction. Students now frequently collaborate with older students and students from nursing and physical therapy fields. The result is a more interconnected generation of future doctors who are almost certain to have a transformative effect on American medicine in the years to come.
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Quick Clinics and Health Kiosks Are Taking Off at Airports
Source: American Medical News
Date: 02/11/2008
Onsite medical clinics have recently been appearing in airports across the country in hopes of drawing travelers to receive small-scale medical care while waiting for their flights. Originally initiated to address medical issues of airport and airline employees, clinics and medical kiosks have recently been drawing in broader crowds of passengers and are providing them with flu shots, diagnostic testing, and medical identification.
The University of Illinois at Chicago Medical Center has been conducting clinics at O’Hare International Airport since 1995. The clinics began issuing flu shots at a single kiosk and provided the majority of their services to busy airport and airline personnel. Recently, the medical kiosks have been utilized more readily by traveling passengers and have been placed throughout four terminals in the airport; the kiosks are now in the process of expanding their services year-round.
Future airport clinics are set to include diagnostic blood testing services where patients can receive their test results once arriving at their destination via a secure website. The clinics are also aiming to provide patients with a health identification card listing the important details of their medical history.
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Are You Recruiting a Disruptive Doc?
Source: The Journal of the Association of Staff Physician Recruiters
Date: 10/01/2007
Over the past few years, statistics have shown a stark increase in diagnoses of mental health problems among physicians, including psychopathology, personality disorders, and behavioral abnormalities. Since medical recruitment potentially samples a number of physicians suffering from mental illness, it is important to be able to distinguish traits in a physician’s behavior as potential disruptions to medical practice. In order to aid in trait identification, one psychologist who specializes in organizational behavior and healthcare consultation offers recruiters some warning signs to watch for when screening potential candidates for medical positions:
Inappropriate Anger
-How does the candidate speak to others?
-Does he use intimidation or unnecessary sarcasm when conversing?
-Does he criticize or scorn authority to whom he should be showing respect?
Inappropriate Words/Actions
-Does he use untoward racial, economic or socioeconomic comments?
-Does he make sexual comments/innuendos or portray seductive or aggressive behavior?
Inappropriate Response to Patient Needs and Staff Requests
-Does the candidate respond to pages with respect and concern or with impatience and rigidity?
-How does the candidate respond to changes in his schedule?
-Is he able to readily adapt or does he show irritability when things do not go according to his plan?
Overall Measure of Candidate’s Behavior
-Pathological – Has the behavior surpassed the boundary of “normal”?
-Persistent – Is there evidence that this behavior has happened frequently elsewhere?
-Pervasive – Does the behavior carry across settings and with various types of people?
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Job Sharing: Flexibility Has a Price
Source: Medical Economics
Date: 01/18/2008
As a reaction against increasing time constraints for private practice physician offices, some doctors are turning towards job sharing models with varying levels of success. Instead of searching out part-time jobs, more and more doctors simply split their time in an office and on-call with another physician. Since the 2 doctors are effectively employed in the same position, there are many difficulties with this arrangement, though some have found all of the rewards of being a physician with the flexibility of part-time employment.
In a successful example of job sharing, two female physicians in a private practice in South Carolina alternate three and four day workweeks, with each physician spending about 20 to 25 hours in the office. With 3 children each, this agreement allows them to spend more time with their families than a traditional practice.
Likening job sharing to a marriage, Medical Economics recognizes that physicians must be in similar places in their lives, and have a lot in common professionally and personally. Doctors who are familiar with one another’s work and have similar management styles are the best candidates for job sharing, as both partners will be required to do the exact same work at different times throughout the week.
There are some downsides to job sharing. Medical malpractice insurance policies are the same price as for full-time physicians, though job sharers only take in 50 percent salaries. Income is lowered considerably, and physicians with relatively fixed scheduling caps may have difficulty working extra hours to earn substantial funds beyond what covers overhead. Additionally, doctors with different expectations about what job sharing entails will most likely result in a failed business venture. The article warns of one sharing practice that failed when two doctors could not cooperate on a variety of simple organizational tactics.
For doctors with the need to reduce their working schedules and a willing and agreeable partner, job sharing can be a unique way to continue practicing medicine with the flexibility of a much less demanding job.
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Employment & Compensation
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How Doctors are Paid Now, and Why It Has to Change
Source: Managed Care
Date: 12/01/2007
Despite the growing popularity of pay-for-performance programs among health plans, most doctors are still paid on a fee-for-service basis. The American College of Physicians, along with other professional groups and health plans, has begun to criticize these payment practices, claiming that they devalue crucial services such as doctor-patient discussions, while over-rewarding expensive procedures and larger volumes.
These groups also claim that fee-for-service plans are increasing pressure on primary care doctors to shift into specialty fields in search of higher pay. According to a 2007 survey conducted by the Medical Group Management Association, primary care physicians reported an average 4 percent increase in income while specialists saw a 6 percent rise on average. Some specialty fields have seen even larger increases, as infectious disease specialists experienced a 9 percent average rise, and pulmonary disease specialists reported an increase of more than 11 percent. Analysts warn that these incentive structures could cause a shortfall in primary care physicians in coming years.
As a solution, the ACP is recommending a new compensation plan that would combine risk-adjusted capitation with pay-for-performance programs, along with fee schedules to ensure that doctors are still compensated for the volume of work they perform. With this in mind, WellPoint, Aetna, the Blue Cross & Blue Shield Association, Cigna, Humana, MVP Health Care, and UnitedHealthcare have joined the Patient-Centered Primary Care Collaborative in an attempt to advance this new physician compensation approach.
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New County Program Reimburses South LA Doctors for Indigent Care
Source: Southern California Physician
Date: 01/01/2008
A new reimbursement program is now available from the Los Angeles County Department of Health Services for nine private hospitals affected by the closure of the Martin Luther King Jr.-Harbor Hospital.
Under the PSIP-Impact Hospital Program, the county is paying 100% of Medicare fees for as many as six hospital days’ length of stay. This service is being provided to those patients who enter the surrounding private hospitals from the area previously served by the MLK hospital.
The new program is simple for doctors as it requires most of the patient screening to be conducted by the hospitals. The hospital simply has to verify that the patient came from the geographic area relative to the MLK hospital and is a resident of Los Angeles County.
The MLK-area hospitals received notice of the new program in November, and seven of the nine potential hospitals had already signed on by early December. Funds are readily available to physicians residing in the participating hospitals.
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Oops, Did I Do That?
Source: Unique Opportunities Magazine
Date: 02/01/2008
Can an unedited cover letter cost you a job? Could an innocuous comment knock you out of the running for a dream position? An article in the Winter 2008 issue of Unique Opportunities Magazine says yes.
The most common mistakes candidates make in job searches are often the easiest to avoid. In the article, a professional recruiter for hospital organizations lays out what these mistakes are and how to avoid them:
-Be careful with the send button. Electronic communication, while convenient, is also instant and permanent. It must be thoroughly edited and proofread before sending. Typos and unspecified letters are a definite turn-off for recruiters who are tired of reading badly edited cover letters.
-Be polite. Much as it seems evident on its face, apparently it needs saying: do not threaten or otherwise be rude to recruiters or potential employers. Not only does it lessen one’s chances of getting that particular job, but one never knows when or where that recruiter may pop up again.
-Money shouldn’t lead. Leading off recruitment letters with salary range restrictions reflects badly on the applicant. Money is important, of course, but such talk can always come later, once the applicant and recruiter have a better idea if the applicant is a fit for the job.
-Be consistent. A candidate who constantly changes geographic, compensatory, or professional demands comes off as inconsistent and unreliable. Recruiters notice these things and do not remark kindly upon them.
-Tailor a geographic target. The recruiter recommends keeping an open mind as to geography. Don’t just stick to one city and pursue a position there with blinders on. A fair look at surrounding areas may show you something you didn’t even know you wanted.
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Smarter Scheduling Puts You In Control
Source: Medical Economics
Date: 01/18/2008
How doctors schedule their patients’ appointments can make or break a steady flow into a private physician’s office, and Medical Economics analyzes 4 popular scheduling practices employed across the country.
Dividing each hour into blocks of 15 or 30 minutes is the standard approach, though it fails to account for no-shows or patients arriving to the office late. With minimal flexibility, this strategy is most likely to lead to substantial backups throughout the day. More popularly, many offices schedule multiple patients for the same time and hope that within the given time frame, all patients can be treated. This approach, known as wave scheduling, works well in the case of a no-show or general tardiness, but problems arise when every patient shows up at the scheduled time. Medical Economics suggests using a modified wave schedule where two or three patients are front-loaded at the top of the hour while the remaining slots within the block are given to individual reliable patients.
Open-access scheduling, where large numbers of slots are left open for same- or next-day appointments, is also an option. This allows doctors to treat patients more immediately, and works best when only a portion of the day, say 40 percent of the time slots, are left open for patients seeking immediate medical help. Clustered and group visits, where doctors can treat multiple patients with the same medical issues, can work, though there are significant privacy issues that need to be considered.
The most successful practices employ some mix of these strategies, and the authors reiterate that there is not a turnkey solution that can work at all practices. Understanding what approaches work best for each individual practice is crucial, and having a qualified full-time scheduler who knows what works best is equally important.
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Locum Tenens 101
Source: LocumLife
Date: 01/15/2008
Currently seen as a sustainable career alternative to those in the medical field, locum tenens is becoming a readily accepted form of medical provision. In order to educate providers on how best to transition from traditional medical practice to locum tenens, experts in the field have outlined preparatory steps to make the transition easier.
First, medical providers should seek out medical staffing agencies to determine what is expected of locum tenens candidates. Staffing agencies often require a full education and employment history, licensure verification, and a criminal and drug background check of potential candidates. They might also review medical malpractice claims and may require the candidate to complete a clinical skills assessment to determine clinical aptitude and competence in a given field. To complete the staffing registration process, most agencies require at least three professional references to verify clinical abilities and professionalism in medical practice. Experts recommend that candidates apply with more than one agency to increase options for medical placement.
Upon being matched in a potential position, a locum tenens candidate should find out as much as possible about the location of the work to determine if the position is suitable. Information collected should include the name and location of the position, shift schedules, patient demographics, and housing accommodations to name a few.
Lastly, prior to beginning a career in locum tenens, it is recommended that candidates speak to other locum tenens providers who have had extensive practice in the field. By learning about locum tenens experiences first-hand, future candidates can make an informed decision as to whether or not this is a suitable career.
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Research in Hospice Possible, Even Helpful
Source: American Medical News
Date: 02/04/2008
Is it ethical to conduct clinical trials with hospice patients? The increasingly data-driven nature of medicine brings this question to the forefront, and a recent article on the American Medical Association’s news site contends that such research can have a beneficial effect while maintaining ethical standards.
The article puts forth that knowing what constitutes the “best possible care”—the creed and purpose of hospice care—is not in fact possible without research and comparison of results. For example, research into cardiac disease yielded the discovery of beta blockers as an effective method of treatment.
Furthermore, the authors contend that hospice patients aren’t universally non-functional and helpless, as they are often perceived to be. Many are cognizant and capable of making treatment decisions on their own. Proper and full education of hospice patients as to their treatment options and possibilities for research participation is, according to the article, in full keeping with established ethical norms.
The authors propose novel rearrangements of placebo trials in order to minimize any ethical concerns that can arise from the use of placebos, such as a case wherein patients in one arm of the research receive the shorter-acting morphine solution plus a placebo in pill form, while patients in the other arm get the longer-acting pill plus a placebo in solution form. This way, participants and providers are adequately blinded to the intervention, ensuring that the data obtained is unbiased and applicable to future patients. Finally, the article contends that the ethical hurdles of hospice research are not insurmountable. Well-designed trials can provide valuable research data while maintaining the highest ethical standards and upholding patient dignity.
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Your Risks When Practicing Telemedicine
Source: Medical Economics
Date: 01/18/2008
Given growing trends in telemedicine, Medical Economics provides several suggestions for physicians looking to protect themselves from problems with licensure, conflicting state laws, and malpractice insurance coverage. Since telemedical doctors usually evaluate patients across state lines, there are many legal issues at stake.
While some states offer limited licensing for physicians practicing telemedicine, it may be necessary to gain licensure for every state in which potential patients live. Additionally, if a patient living in a different state files suit, the laws of that particular state will most often apply. Doctors should familiarize themselves with malpractice laws in other states and make certain that their malpractice insurance covers operations in other states. Standards of care are becoming increasingly uniform, but doctors still need to recognize the potential problems that interstate practice can cause.
There are as yet too few cases of major telemedical disasters to establish standardized practices at the national level, and there is very little evidence of doctors practicing telemedicine internationally. Given the novelty of the industry, doctors looking to practice medicine remotely need to exercise legal caution whenever possible.
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Dispatch from the Pharmasphere: An Industry’s Fault Lines on Display
Source: Annals of Emergency Medicine
Date: 02/01/2008
An Annals of Emergency Medicine correspondent reports on business practices at global pharmaceutical companies, noting that big pharmas keep a detailed database of doctors’ habits. Information kept on MDs includes how they prescribe (does the doctor have a “heavy pen”?), what they publish (are they a “Big Kahuna” or an “up-and-comer”?), and even how they feel about pharmaceuticals (do they have a sense of “industry affinity”?). Accordingly, this information is used to find doctors who are the best candidates for distribution of new prescription drugs and treatments.
The report underscores a growing concern that pharmaceutical companies see doctors as sales agents, and pharma-friendly doctors see these companies as “The Bank.” Complaints about this data-gathering practice range from philosophical to legal, where significant privacy laws regarding the distribution of personal information differ across various jurisdictions.
Yet, the report argues, there is little reason to indicate that pharmaceutical companies are as unethical and greedy as they may initially appear. Evidence from a recent conference of KOLs (“Key Opinion Leaders,” or influential doctors who negotiate with pharmaceutical companies regarding appropriate practice) confirms good faith that pharmaceutical representatives are doing their best to foster responsible communication with doctors.
Whether the relationships between doctors and big pharmas are ultimately deleterious to public welfare remains to be seen, and time will tell if practices like MD habit databases are healthy business practices.
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Take Care When Firing a Patient
Source: American Medical News
Date: 02/04/2008
While there are a number of reasons why a physician would be justified in terminating a physician-patient relationship, including a failure to pay bills, continual rude disruptive, or threatening behavior, patient dissatisfaction with care received, or a patient’s requirement of specialized services a physician cannot provide, special care should be taken in acting on this decision. Steven M. Harris, a partner at McDonald Hopkins, a firm concentrating on healthcare law, suggests that the physician should handle the termination like any other contractual relationship, by drafting a letter to the patient that specifically details why the relationship has been terminated. Additionally, it is prudent for the physician to consult an attorney, to avoid any possible legal issues in the termination process.
In general, Harris advises the physician to:
-Clearly communicate his or her decision, in as compassionate and supportive a manner as possible.
-Offer assistance and provide the patient a reasonable timeframe in which to select another physician.
-If medical care is needed during the patient’s search for a new physician, care should be continued by the original physician in the interim.
-Notify the patient’s other physicians of his or her change in care provider.
-Carefully document all related proceedings, including detailed records of discussions with the patient.
Above all, the physician must be sure to always act in the best interest of the patient.
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Hospital Emergency On-Call Coverage: Is There a Doctor in the House?
Source: Center for Studying Health System Change
Date: 11/01/2007
Community hospitals are finding it difficult to obtain on-call specialist physicians for 24-hour patient care, as a recent study notes that 73% of emergency departments in the U.S. report insufficient on-call coverage. Factors contributing to the reluctance of physicians to provide on-call services include decreased dependence on hospital admitting privileges, payment for urgent care treatment, and increased medical liability. Although hospitals have adapted strategies to secure on-call coverage, many continue to toil with insufficient coverage that threatens patient care and may increase healthcare costs overall.
In the past, doctors agreed to provide on-call care in exchange for hospital admittance privileges. More recently, physicians are moving away from practice in hospital settings or shifting to specialty hospitals that don’t have emergency departments.
Payment for medical care also proves to be a limiting factor, as physicians note that the payment they receive for on-call care is often inadequate, and the opportunity cost of leaving their private practice to attend the hospital is great.
Furthermore, cases seen in the emergency department are often large and more challenging, which translates into a greater risk for those physicians who provide care, to say nothing of the quality of life issues involved with being on-call.
To combat this deficit, hospitals are engaging in numerous strategies, including weekly or daily payment for on-call coverage, payment per-patient-seen while on-call, and more direct employment of specialty physicians by hospitals.
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Outcomes of Care by Hospitalists, General Internists, and Family Physicians
Source: The New England Journal of Medicine
Date: 12/20/2007
This 2007 study compares the efficiency of the hospitalist model in patient care and health outcomes to healthcare provided by general internists and family physicians. The study found that after controlling for numerous patient, hospital, and physician-related factors, patients treated by hospitalists had a shorter length of stay and lower healthcare costs at the time of visit while exhibiting similar death rates and readmission rates to those patients treated by the other groups.
Patients included in this retrospective cohort study were diagnosed with one of seven common illnesses (pneumonia, acute exacerbation of chronic obstructive pulmonary disease, ischemic stroke, chest pain, acute myocardial infarction, heart failure or urinary tract infection). Primary analyses showed that the majority of patients (43%) in the study were cared for by general internists, 32% received care from hospitalists, and the remaining 25% received care from family practitioners. The results of the multivariable analyses, after controlling for factors including the patient’s principal diagnosis, patient demographic characteristics, hospital characteristics, physician case volume and clustering of patients with physicians and of physicians with hospitals, show that patients cared for by hospitalists had a 0.4-day shorter length of stay (p<0.001) and costs that were $268 lower (p=0.02) than those patients treated by internists and family physicians.
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The Palliative Care Initiative
Source: The Safety Net
Date: 10/01/2007
With over 90 million people living in the US with chronic illness, many Americans will need some form of palliative care in the near future, but increasing healthcare costs translate into a huge burden for those requiring this form of care. Statistics show that approximately 75% of the nation’s healthcare spending goes to care for those with chronic illness. While many of those receiving palliative care are older and receive some coverage under Medicare, many out of pocket costs weigh significantly on individuals and families of chronic disease patients.
For the incredible costs that patients receiving palliative care incur, the improvements in their health and overall quality of life are not always guaranteed. A new model of palliative care has now become necessary to aid in cost control and to solidify the promise of comfort and care with chronic disease. There has never been a better time to strengthen the use of palliative care within hospitals. Use of this care within hospitals has been shown to decrease costs by $6,580 per patient. It can also be performed by a multidisciplinary team that can work together to improve patient health, overall quality of life, control of symptoms, and direct management of pain.
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Payer & Reimbursement Issues
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Major Trends Affecting Hospital Payment
Source: Healthcare Financial Management Association
Date: 01/01/2008
As healthcare spending continues to increase, hospitals need to act more efficiently in key areas in order to maintain sustainable profit margins.
Payment policing efforts will be very important, as hospitals are currently seeing 8 to 14 percent of revenues go uncollected. Hospitals should install monitoring systems to find out how and why underpayments are occurring and increase communication with payers like Medicaid, Medicare, or PPOs. Additionally, hospitals should analyze contract performance through modeling systems that predict how profitable each contract will ultimately be.
Payers are increasing pressure to shift volume and cost risk to hospitals. To prevent hospitals from having to accept lower payments, hospitals should understand their preferred payment methods as well as what sorts of risks are acceptable to assume. By shifting risk back to providers as much as possible, variability of cost and volume will stabilize and hospitals will receive higher payments.
As patients begin gaining more leverage through consumer-driven health plans, hospitals should establish benchmarks to ensure that their level of service is as attractive as possible for patients shopping for medical services in an open market. As health plans are consolidated in the name of efficiency, hospitals should strive to make sure that these efficiencies are not reached at the hospital's expense. Healthcare executives should strive to provide the highest level of care possible while remaining cautious about accepting too many financial concessions in negotiations with payers.
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How to Collect From Patients Without Scaring them Away
Source: Medical Economics
Date: 02/15/2008
Realizing that missed payments can be a major source of discomfort to physicians’ offices, Medical Economics makes recommendations for dealing with irresponsible patients.
Rather than treating all patients as freeloaders, doctors should assume that everyone wishes to pay their bills in good faith. Oftentimes patients do not realize that they are obligated to pay for every visit, or that certain procedures are not covered by their insurance. Educational tactics that gently remind patients of their obligation to pay for services can be very helpful as they do not antagonize passive individuals.
When involving third-party collection agencies or reporting patients to a credit bureau, doctors should be certain that all other means of asking for payment have been utilized. Using an overly abusive collection agency that threatens patients can generate much unneeded negative publicity, and ruining a patient's credit by involving a credit bureau can have a ripple effect among the local community. In rural areas, doctors will find that losing long-term customers from word-of-mouth smear campaigns is much more financially troublesome than losing a payment or two from individual patients.
Physicians must be firm in requiring timely payment, so as not to seem a pushover, but treating all patients with respect in regards to financial issues will ensure better long-term success at a private practice.
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It’s Everywhere
Source: Modern Healthcare
Date: 12/24/2007
A recent survey conducted by the Leapfrog Group and Med-Vantage has shown that Pay-for-Performance (P4P) is widely utilized among hospitals and physician groups nationwide, and the programs are also increasing in number to include a broader base of physician specialties. Yet while its practice is becoming increasingly apparent, the overall effectiveness of P4P is much more difficult to measure.
In an attempt to evaluate P4P practice, Med-Vantage surveyed 75 P4P sponsors including government agencies, health plans, and purchaser coalitions. Seventy-five percent of survey respondents reported that P4P helped to improve health care quality - including clinical health outcomes and overall patient satisfaction – and helped to decrease medical errors. Almost one third of respondents reported that cost performance improved upon initiation of P4P. The majority of respondents to the survey were physician P4P groups, which outnumbered hospital-based programs 4 to 1. Almost half of respondents said that their P4P programs were between one and two years old.
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Simulated Data Study May Boost Hospitals’ Bottom Line
Source: Healthcare Finance News
Date: 01/04/2008
The Methodist Le Bonheur Healthcare Research Center in conjunction with the University of Memphis Center for Healthcare Technology has recently developed an innovative approach to finding ways to boost nurse capacity and efficiency. Data farming is a technological way of examining what nurses do in one day in order to determine the best way to utilize them as resources within the hospital setting.
First developed by the Marine Warfighting Laboratory for use in improving the understanding of combat situations, data farming uses computer simulations to analyze nurse workflow to find ways to increase nursing time at a patient’s bedside.
Not to be confused with data mining, which uses de-identified real-patient data to study patterns in marketing, data farming essentially creates data to generate scenarios within a group of imaginary patients. Data farming can also find ways to improve physical environments in nursing areas. By developing ways to group nurses together and requiring them to do less walking between patients, nurses can perform better and more efficiently overall.
Preliminary data from this study has shown the potential of data farming to decrease patient hospital stays, which can reduce healthcare costs for the hospital’s bottom line. Decreased patient stays may help improve nursing work capacity which, overall, may also aid in the retention of nursing staff and a reduction in nurse-to-patient ratios.
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Aetna to Stop Paying for Anesthesiologists During Colonoscopies
Source: American Medical News
Date: 02/04/2008
At a meeting in January between Aetna insurance representatives and one of Atlanta’s largest gastroenterology groups, fifty doctors gave out letters of resignation to the company and threatened to pull out of the insurer’s network in protest of a change in the company’s policy regarding anesthetizing patients during colonoscopy procedures.
Beginning in April, the company is set to end its coverage of anesthetization of patients during the invasive procedure. Physicians of the Atlanta-based gastroenterology group are asking Aetna to rethink their decision since it will most likely discourage patients from undergoing the important cancer-screening procedure.
Aetna is following suit in withdrawing coverage of the colonoscopy procedure after Humana and Wellpoint made similar change in their coverage within the past two years.
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Credentialing, Licensure, Quality Management
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Study Supports Periodic Re-Certification For Doctors
Source: Reuters Health
Date: 01/21/2008
In 2006, specialty medical boards began requiring periodic re-certification for physicians, though scientific justification for the decision was at the time lacking. A new study led by Dr. Alexander Turchin of Brigham and Women’s Hospital in Boston found a positive correlation between recent physician re-certification and proper medical treatment for hypertension patients. The study’s results, to be published in the February issue of Circulation, supports current mandatory re-certification practices, according to Turchin and his colleagues.
For patients admitted to hospitals for hypertension, increased intensity of care is indicative of higher quality care. Looking at 54,000 medical visits from 2000 to 2005 where patients showed signs of high blood pressure, Turchin compared changes in treatment intensity with the most recent time doctors were re-certified.
The highest frequency of treatment intensification occurred where physicians were certified within one year of the hospital visit. For every decade since the most recent board certification, treatment intensity was diminished by roughly 21 percent, with the worst care given by the six physicians who were last certified over thirty years ago.
The study gives credibility to specialty boards’ decision to require re-certification, and Turchin hopes the research will be used to increase educational efforts to “help improve quality of care delivered by physicians.”
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Microsoft, Mayo Clinics join to empower patients, protect privacy
Source: Healthcare IT News
Date: 01/25/2008
Microsoft and Rochester, Minnesota's Mayo Clinic recently announced a partnership that will focus on increasing patient-to-physician dialogue for individuals using the Mayo Clinic Health Solutions.
The partnership will focus on providing new technology that enables patients to have more control over decisions affecting their health. Using Microsoft's HealthVault program, the partnership will build "solutions that are dynamic, secure and focused on the needs of the user, in order to effectively improve health and well-being," according to Peter Neupert, corporate vice president of Microsoft Health Solutions Group.
Protecting patients' personal information has been a major focus of the program, and a spokesperson for the Coalition for Patient Privacy has stated that the HealthVault technology is the first system to pass the coalition’s rigorous privacy standards.
Further details of this project are expected to be announced in the near future.
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Engage Employees to Improve Staff and Patient Satisfaction
Source: Hospitals & Health Networks
Date: 01/01/2008
In hospitals, there is a well demonstrated correlation between patient satisfaction and employee satisfaction. Creating a hospital that provides the highest level of service for patients also means that employees should be given the best possible environment in which to work.
According to a study by Press Ganey, the biggest cause for employee dissatisfaction is lack of participation in decision-making processes involving hospital organization or improving customer service. Strategic management initiatives that involve staff members in decision-making will benefit the hospital as a whole and in turn increase patient satisfaction levels.
Exemplifying the idea of employee participation, at King's Daughters Medical Center (KDMC) in Ashland, Kentucky, the hospital management created a program to generate ideas for improving hospital operations. All employees are encouraged to submit proposals for improving customer service. KDMC team leaders vote on which initiatives to implement, and winners are given an unbudgeted capital item. Other management techniques include sponsoring a Customer Satisfaction Innovations Fair where employees are shown new opportunities for improving customer service.
Involving employees in the management of a hospital can be a useful way of improving customer service all around. Hospital executives should continue to monitor patient satisfaction levels, making this information available to all employees. Further, rewarding employees who show a unique commitment to customer service will ensure that staff and management are working together towards an overall improvement of hospital operations.
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Mapping Opens Hospitals’ Eyes to Patient Experience
Source: Strategic Health Care Marketing
Date: 02/01/2008
A growing number of hospitals are beginning to employ “experience mapping” techniques to gain better insight into their patients’ expectations and experiences. Such processes, which combine in-depth patient interviews with general research on patient needs, are proving useful when undertaking major planning initiatives such as designing a new facility, selecting a new information technology strategy, or embarking on a rebranding campaign.
Hospitals utilizing experience mapping techniques typically start by establishing a team of internal stakeholders responsible for delivering care in a specific project area. The team works with researchers to draft an “experience map” to serve as a guide for patient interviews. They next employ a variety of interview methods, including one-on-one settings, small groups, or patient intercept techniques. In small group or one-on-one interviews, patients are asked to recall their first experience with the hospital and then compare it to later experiences. When conducting a patient intercept, researchers follow patients through their entire hospital visit, from admittance to discharge.
As a final step, team members and other hospital staff examine interview transcripts and research and try to devise ways to translate what they have learned into practice. Results from such projects have ranged from more patient-friendly online services to ads incorporating physician and staff photos to humanize care as part of a rebranding initiative.
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Healthcare Providers Will Broaden Adoption of Clinical Technology in 2008
Source: Healthcare IT News
Date: 01/23/2008
According to an annual study published by the Gallantry Group, 2008 should see major increases in available clinical technology at healthcare facilities of all sizes. Nearly half of healthcare providers will spend upwards of 40 percent of their existing technology budgets to increase current offerings, and by the end of 2008, more than 80 percent of healthcare facilities should have invested in the following technologies:
-Digital medical imaging
-Medication management/e-prescribing
-RIFD patient identification/drug distribution
-EMR/EHR
-Computerized physician order entry
-Mobile applications (e.g. charge capture, rounding, prescriptions)
-Patient documentation
-Patient care planning solutions
The report surveyed facilities of all sizes, from 150 beds to over 1,000 beds, including both public and private hospitals.
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California Could Be the Next Health IT Model, Medicare Officials Say
Source: iHealthBeat.org
Date: 01/10/2008
A recent meeting of California healthcare officials brought together members of various sectors of healthcare and health technology to discuss the state’s standing amidst the US Healthcare IT model. Currently, California leads the race in utilizing healthcare technology in certain large medical practices.
Studies by the California HealthCare Foundation have shown that 37% of Californian practitioners utilize electronic health records compared to 28% of physicians within the greater US. These physicians in California, however, often work for large practices or integrated health systems. Doctors in small practices in California accounted for only 25% of those using EHRs, while 13% of Californian providers in solo practices and 3% in community clinics use EHRs.
As one attendee noted, the costs of supporting EHR are great, and currently no such funding system exists to support the practices that need it most, namely small clinics and private practices. Currently, preliminary data is being collected through a pilot program conducted in Arkansas, California, Massachusetts, and Utah in which physicians at small clinics and solo practices providing care for chronically-ill Medicare beneficiaries have been incentivized to report performance data through an electronic system. Results from the study are due out in six to nine months.
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How to Make the New Doctor-Patient Relationship Work
Source: The New Physician
Date: 02/01/2008
With an increase in the use of internet health resources over the past few decades, the dynamic relationship between the physician and the patient is rapidly changing. While the doctor once provided paternalistic caregiving to his passive patient, the patient is now taking a proactive approach to his own health.
A 2007 survey found a 37% increase in the number of Americans who had searched for health information online from the previous year. While the vast amount of information readily available can prove to be useful at times, it can also complicate the relationship between the doctor and patient.
Difficulties arise because many of the available sources are either inaccurate, out-of-date, or provide information in the context of selling a commercial product. Seeking and obtaining false or misleading health information on the web can cause patient anxiety, which can oftentimes lead to a patient questioning his doctor’s orders.
Outside of these potential drawbacks, internet health searches can be beneficial for certain health information-seeking populations. Residents and doctors can easily utilize websites maintained by medical schools, professional medical organizations, and federal government organizations. The web can also provide physicians with medical information that is not available elsewhere, including newly released studies and up-to-date information, and resourceful physicians may even use the internet to find ways to better engage their patients in a dialogue on health.
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Insurers’ Online Forums Invite Patients to Vent
Source: American Medical News
Date: 01/28/2008
The internet has always been an open forum for patients to anonymously complain about poor medical care, though a new forum is raising doctors’ eyebrows. A website that debuted in November 2007, The Healthcare Scoop, is run by Blue Cross Blue Shield of Minnesota and asks patients to openly discuss the quality of care they recently received. Physicians are assigned a score that is used to evaluate quality at practices across the country.
Many doctors are concerned about The Healthcare Scoop and argue that this quality-control practice is counterproductive. “It is extremely difficult whether patient dissatisfaction, resulting from denied or delayed services, or a failure to obtain a certain prescription, is due to the decision of the physician or the demands and restrictions of the health insurer,” says Edward L. Langston, MD, chair of the AMA Board of Trustees. Anonymously pointing fingers at doctors in such a way does little to encourage better treatment, doctors argue. Further, physicians have no way of responding to comments on the websites and fear that such modes of communication only create barriers between patients and physicians
Blue Cross Blue Shield emphasizes that consumer ratings will not affect physician reimbursements and notes that positive comments outnumbered negative ones four to one. A similar site was launched by WellPoint on January 8 of this year, basing its physician grading on the Zagat restaurant ratings scheme.
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California Docs Participate in Remote Monitoring Program for Diabetes
Source: Healthcare IT News
Date: 02/15/2008
Physicians in Southern California are participating in a trial run of XTend Medical Corporation’s Medical Disease Management Program, designed to remotely monitor 500 diabetes patients. Utilizing an Eocene transmitter, patients take their glucose readings and transmit the results from their homes. The readings are sent as encrypted data to a central server for physician review. Physicians may then reply with information regarding adjustments in medication, compliance, or follow-up visits for the patients.
This new program will allow physicians to closely monitor their patients from their offices while minimizing disruption of their patients’ daily lives. With continuous monitoring technology, XTend Medical believes that physicians will be able to reduce the likelihood of complications such as diabetic shock or hospitalization. The company reports that it is ready to implement the system nationwide.
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