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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.
“Politicians and physicians need to work in tandem if the United States is to develop the most effective and efficient healthcare delivery system in the world.”
This paraphrase has been repeated by the thousands of physicians that Jackson & Coker speaks to on a daily basis.
As a result, Jackson & Coker commissioned a survey to determine the opinions of health professionals, especially practicing physicians, on the topic of healthcare reform. The survey results convey their views and advance the ongoing debate at this point in the presidential election cycle.
| 1. Which current presidential candidate do you feel
would most improve the US healthcare system? (In alphabetical
order). |
| Hillary Clinton |
 |
28% |
| John McCain |
|
30% |
| Barack Obama |
|
24% |
| Other, please specify |
|
18% |
|
| Physicians' unedited comments listed below: |
| Ron Paul |
| I don;t think politicians or insurance co should regulate healthcare. |
| Whoever adopts the Healthy Americans Act or something similar. |
| View All Comments for this Question |
| 2. How important are healthcare issues when you are
selecting a presidential
candidate? |
| Extremely important |
|
55% |
| Somewhat important |
|
39% |
| Not that important |
|
6% |
|
| 3. How familiar are you with the concept of
Universal Health Care (UHC) proposed for the United
States? |
| Very familiar with the issues |
|
42% |
| Somewhat familiar |
|
47% |
| Admittedly, not too familiar |
|
11% |
|
| 4. How long have you been practicing
medicine? |
| Less than 5 years |
|
12% |
| 6-10 years |
|
15% |
| 11-15 years |
|
12% |
| Over 15 years |
|
61% |
|
| 5. Which model would be most beneficial in the
US? |
| The current healthcare model |
|
2% |
| The current system—with significant
improvements |
|
46% |
| A
universal healthcare delivery system |
|
38% |
| Other, please specify |
|
14% |
|
| Physicians' unedited comments listed below: |
| For better QUALITY care, go back to 100% market-driven, private, fee-for-service care (i.3. get the government OUT of the health care business). For better ACCESS to care (regardless of quality), the governmment would have to "take over" the whole industry (including pharmaceuticals)--quality would undoubtedly suffer, but everyone would have coverage of basic health care. This "in-between" stuff is bad for everyone! |
| Removal of the government from any healthcare plans except catastrophic insurance coverage, and then this should be for everyone. |
| I would like to see the developement of a 2 tiered health care system, with a basic program availiable as sort of a UHC. This could cover basic needs, er care, preventiive care, but would have inherent delays in non emergent care. A second tier would cost more, but allow patients access to care more in the way they wish, more like our current system. This would give basic health care to those who cannot afford the current insurance, but also give choice to those that can afford it |
| View All Comments for this Question |
Hot Topic and Coming Attractions
“Healthcare reform.” The concept is on the minds of most Americans and on the lips of Senators Clinton, McCain and Obama and their political surrogates making their case with the general electorate.
Most surveys and opinion polls query voters concerning the best proposal offered and how to implement it. This month’s edition of the Jackson & Coker Industry Report reveals the results of a recently commissioned survey focusing on the views of health professionals, especially practicing physicians who actually provide medical care. Along with expressing their general opinions regarding some modified healthcare system, such as “Universal Health Care,” survey participants offered informed opinions on which presidential contender appears to offer the best proposal—and why. All three presidential campaigns have requested copies of the survey results.
Also noteworthy: starting next month, our newsletter will showcase two new features that will appear regularly. “Special Reports” will discuss topics of general interest to the healthcare community, paired with guest articles from leading experts in the medical field or other “industry gurus” offering key insights related to the concerns of physicians and hospital / practice administrators.
We are pleased with the positive response to the Jackson & Coker Industry Report and are excited about the more robust content it continues to offer to subscribers.
Cordially
Calvin Bruce
Managing Editor
Many U.S. Consumers Want Major Changes in Health Care Design, Delivery
Source: Deloitte Touche Tohmatsu
Date: 02/26/2008
In a poll of over 3,000 Americans between ages 18 and 75, the consulting firm Deloitte Touche Tohmatsu gathered information on public attitudes towards healthcare.
Financial concerns top the list of important issues, as 93 percent of consumers claim they are unprepared for future health care costs. 84 percent prefer generic prescription drugs over name brands, and 39 percent say they would travel abroad for comparable treatments in order to cut fees in half. 16 percent have already used a walk-in or retail clinic, and 34 percent said that they would.
Increasing online access to healthcare information is another major trend in this year’s survey, with over 60 percent of respondents saying they want to be able to retrieve their medical records and test results online. A further 25 percent would be willing to pay a premium for these services.
For the upcoming presidential election, 79 percent of respondents believe health care will be important, and 46 percent place it in their top 3 voting issues. On the question of increasing taxes to help the uninsured, 29 percent would support an increase, and 37 percent would be willing to “consider” a tax increase. Sixty-six percent are either strongly in support of or lean towards state-mandated health coverage.
Health care still remains enigmatic to many; only 52 percent claim to understand their health plans, and just 25 percent of those surveyed keep a personal health record.
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Who Really Pays for Health Care?
Source: Journal of the American Medical Association
Date: 03/05/2008
A commentary in JAMA by Drs. Ezekiel J. Emanuel and Victor R. Fuchs attacks the notion that healthcare coverage in the United States is a “shared responsibility.” In actuality, the commentators argue, healthcare premiums are paid for by individual workers in both public and private healthcare schemes.
The authors point out that when adjusting for inflation over the last 30 years, though healthcare premiums have increased by 300 percent and corporate profits have increased by 150 to 200 percent, employee wages have only increased by 4 percent. Additional studies that further drive home the point show that a 10 percent increase in state health insurance premiums resulted in a 2.3 percent decline in employee wages. Though employers pay the premiums directly to providers, the actual costs are passed along to employees through reduced wages and consumers through increased prices. The same can be said for government healthcare programs that substantially increase taxes as state and federal programs increase their scope.
According to Emanuel and Fuchs, dispelling the rumor that ordinary workers and citizens do not pay the full cost of healthcare coverage is crucial for reforming America’s healthcare system in a responsible manner. As employees begin to understand that they are already paying for their own coverage, they will be more likely to abandon their reliance on a system where employers supposedly foot the burden of premiums.
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US Healthcare Spending to Double by 2017, Report Predicts
Source: HealthDay
Date: 02/26/2008
Already high numbers for healthcare spending in the US could double within 10 years, according to the Center for Medicare and Medicaid Services.
The new government report follows a January 2008 report that revealed an increase in healthcare spending to 2.1 trillion dollars in 2006, a figure that represented 16% of Gross Domestic Product. The new report predicts a major shift in healthcare spending from the private sector to the public sector as the costs of maintaining the Baby Boom generation increasingly fall to the government.
The increase in healthcare spending, coupled with the economic downturn widely forecast, is likely then to increase healthcare spending to 20% of GDP by 2017. While private spending is expected to drop from 6.6% of GDP in 2009 to 5.9% in 2017, Medicare is expected to balloon to $884 billion by that time. Prescription drug spending is expected to more than double in the same time span, reaching $515.7 billion in 2017.
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Hospital’s Accounting is Under Fire by a Union
Source: The New York Times
Date: 02/20/2008
In an encounter that could have far-reaching consequences for hospitals around the country, a powerful labor union is pressuring a Boston hospital to modify its accounting procedures. The outcome of the confrontation could have an effect on non-profit hospitals and other organizations everywhere.
Beth Israel Deaconess Medical Center, a Boston hospital, included the bad debt the hospital had incurred in its calculation of its 2005 and 2006 financial reports. Some $11 million of bad debt was included in the hospitals tally of its 2005 charitable care, raising the total value attributed to charitable care to $67.6 million.
This figure is disputed by the 1.9 million member strong Service Employees International Union (SEIU), which is engaged in a nationwide reform movement. The SEIU contends that the debt write-off is in conflict with the accords of the Sarbannes-Oxley regulations, enacted after the Enron scandal to govern the accounting conduct of for-profit institutions. The IRS has made clear that such debt cannot be ascribed to charitable care, but that decision came after the filings in question and is not retroactive in nature. The matter is currently under evaluation by all involved parties and—though the hospital contends that there is no legal standing for the union’s objection—shows no signs of a quick resolution.
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Doctor Shortage Impacts Rural Areas
Source: Reno Gazette-Journal
Date: 02/26/2008
Medical school enrollment caps in the 1980s and 1990s are the root cause of the shortage of surgeons and primary care physicians nationwide. So says an article in the Reno Gazette-Journal, and the effects of these decisions are said to be especially hard felt in rural areas.
With the expectation that Managed Care would result in a glut of doctors, medical schools implemented caps on enrollments in the 1980s. These caps on enrollment numbers held steady throughout the next two decades, even though the American population increased by 70 million from 1980 to 2005.
Since 2005, medical schools have realized the mistake and taken measures to try to alleviate the coming shortage by allowing more students. This resulted in a nearly 10% increase in enrollments last year over the levels of 2002, but the shortage is still expected to impact American healthcare, with the nationwide shortage being estimated at anywhere between 55,000 and 191,000 doctors by 2020.
This shortage will be especially hard hitting for rural areas, which have a greater need for primary care physicians while at the same time having a harder time attracting physicians. In addition to the general shortage, primary care physicians are in shorter supply, as debt-laden students increasingly take positions in subspecialties that are more lucrative.
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Foundations to Strengthen State Health Care Reform Advocacy
Source: Robert Wood Johnson Foundation
Date: 02/06/2008
Several U.S. states will reform their health systems thanks to two large donations from the Robert Wood Johnson Foundation and the David and Lucile Packard Foundation.
The Finish Line Project, funded by the Packard Foundation, will provide $15 million to organizations in Arkansas, Colorado, Iowa, Ohio, Rhode Island, Texas, Washington, and California to increase coverage for children. In a partnership with The Center for Children and Families at Georgetown University’s Health Policy Institute, the Packard Foundation will provide grants over the next 5 years for children’s health advocacy groups.
Consumer Voices for Coverage, a $15 million 3-year program sponsored by the Robert Wood Johnson Foundation, will give money to selected comprehensive consumer health advocacy groups in California, Colorado, Illinois, Maine, Maryland, Minnesota, New Jersey, New York, Ohio, Oregon, Pennsylvania, and Washington.
Both projects are expected to provide considerable strength to existing health reforms in the participating states. Organizations in California, Colorado, Ohio, and Washington will receive funding from both foundations.
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Influx of Medical Students Creates Concern
Source: Journal of the Association of Staff Physician Recruiters
Date: 01/01/2008
An increase in medical students across the country necessitates equivalent expansion in resident training programs, according to an article in the winter issue of the Journal of the Association of Staff Physician Recruiters.
A record number of students enrolled at medical schools in the fall of 2007, representing an 8% increase from 2002 to a total level of 17,800. This is largely in response to the American Association of Medical Colleges’ call to increase class size by one-third by 2015 to head off the coming shortage of doctors.
This increase, though, will run into problems as these students encounter obstacles to placement in residency positions. This is because the residency programs in this country depend on federal funding through Medicare, which has remained stagnant. State funding is likely to alleviate some of the problem, but the author recommends that residency programs find some way of securing funding so that they can admit more students and avoid a bottleneck in the American residency system, which will only exacerbate the coming shortage situation.
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Financial Support of Continuing Medical Education
Source: Journal of the American Medical Association
Date: 03/05/2008
Continuing Medical Education (CME) relies on funding, especially from commercial sources, which opens the door to dangerous conflicts-of-interest. In 2006, 75.8% of CME funding for publishing and education companies and 61.8% of CME funding for medical schools came from commercial support. In spite of measures in place to prevent conflicts-of-interest, some CME providers have a dangerously close relationship with the commercial industry, and companies often use CME to promote drugs through measures such as discussion of off-label uses. In April 2007, the Senate Finance Committee determined that pharmaceutical companies would only be providing CME funding in order to receive increased sales. Because drug companies typically fund CME proposals that involve conditions for which the company’s products are used, the committee argued that there could be implicit agreements between CME providers and pharmaceutical companies to promote certain products in spite of restrictions.
Some measures to increase integrity of CME have already been taken. In August, 2007, the Accreditation Council for Continuing Medical Education (ACCME) definition of commercial interest changed to include some medical education and communication companies that have accredited CME units and also promote pharmaceutical companies. Those CME units must become distinct companies by 2009 to continue receiving accreditation. In addition, all CME providers must report relevant financial relationships and resolve conflicts of interest before any educational activity occurs.
In spite of those restrictions, however, there is still a danger for abuse. Some have suggested that additional measures be put into place such as separating grant departments in commercial companies from marketing departments and creating criteria for grants. Many companies have voluntarily adopted these and other measures to maintain integrity, but even the value of these self-imposed measures is unknown. Other recommended policy changes to control industry funding of CME include banning or limiting any direct or indirect commercial support. These measures would require some CME providers to restructure or go out of business and would place more control of the CME industry back into the hands of medical professionals.
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Retained Physician Search: Partnering for Results
Source: Healthcare Review
Date: 01/29/2008
As an alternative to contingency placement, where open positions for physicians are filled by candidates actively seeking a new job, many practices hire consultants who entice physicians to leave their existing posts in favor of better opportunities. The process, known as a retained physician search, finds candidates best suited to the new opening regardless of whether they are currently actively seeking alternative employment.
A retained physician search can be quite expensive, but the payoffs generally outweigh the costs. Factors that influence the price for a retained physician search include the supply and demand of each specialist, the practice location, the scope of the sourcing strategy, the timeframe for filling the position, time spent on recruitment, the cost of bringing a potential physician to visit the practice, and any relocation reimbursements for the physician and the physician’s spouse.
Despite these costs, a retained physician search usually finds the best candidate for a position through targeted recruitment (as opposed to contingency placement, which is primarily geared toward marketing physicians who are actively job hunting), and statistics show that physicians acquired in this manner stay in their new position for longer than 3 years over 85 percent of the time.
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Growth Through Physicians
Source: Healthcare Strategy Group
Date: 02/01/2008
Physicians’ reimbursements are increasing at 2 to 3 percent annually, while the prices of nurse assistance and drug products are increasing at 5 to 6 percent annually. To best deal with rising costs, hospitals should focus on growing physicians’ businesses, increasing their skills, and maximizing patients’ loyalties. Healthcare Strategy Group asks seven questions that can help bring about hospital growth:
-Can the hospital increase patient volume for physicians through “same store sales?” By establishing a hospital brand, physicians could refer patients to one another as a way of keeping patients coming to the same hospital for all of their needs.
-Can the hospital increase geographic reach? By expanding geographically through marketing campaigns and referrals from existing PCPs, hospitals could increase the number of patients who turn to them for care.
-Is the primary care base adequate? By understanding how many PCPs versus specialists are needed for everyday operations, hospitals could better plan how to increase hospital traffic through referrals.
-Can the hospital increase rates? If a hospital garners enough market power through consolidations and brand strength, it can demand higher rates for services.
-Does the hospital offer the most profitable services? Understanding which services produce the most profits is crucial for deciding what offerings a hospital could begin offering to patients.
-Are there enough physicians in areas targeted for growth? Hospitals should assess whether they have adequate staff and physician levels for each area where they are considering expanding. If there are too many gaps or recruiting new physicians is difficult, the hospital may want to reevaluate its priorities.
-Is there a retail medicine strategy? Hospitals should evaluate whether providing more expensive offerings, typically not covered by insurance, is worthwhile. Ultimately, the ability to offer all available services to patients, regardless of cost, is crucial to strong, forward growth.
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Creating a Sustainable Physician Strategy
Source: Healthcare Financial Management
Date: 01/01/2008
Due to an impending shortage of physicians (particularly gerontologists, oncologists, PCPs, neurosurgeons, rheumatologists, and emergency care practitioners) along with increases in equipment and insurance costs, competition, and regulations, hospitals are going to be pressured over the next five years to reevaluate and bolster relationships with partnering physicians. Hospitals that are able to effectively structure complimentary relationships during this time of change will be rewarded with more dynamic business at the expense of other hospitals as well as physician-owned ambulatory centers, which are expected to be hit hard by reduced Medicare and Medicaid payouts over the next four years.
There are six “must-do” actions for hospitals to undertake in order to achieve optimal physician-hospital relations.
-Engage physicians in strategic decision making (beyond day-to-day operations) by creating a physician advisory council along with other boards and committees.
-Investigate all possible physician-hospital engagement practices (e.g. joint ventures, marketing support) but be sure to brush up on all new laws and regulations—in particular Stark III.
-Directly employ physicians with specialties in short supply.
-Be aware that arrangements will have to vary with the physician’s age and specialty according to expectations.
-Renew focus on relationships with PCPs, enticing them with IT support. Referrals from PCPs will be an increasingly important source of business.
-Develop a formal plan and garner both capital support and the involvement of key leaders.
Such initiatives are both imperative and opportune, for as the authors of this article point out, “Both hospitals and physicians are more likely to succeed through collaboration than competition.”
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Employment & Compensation
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Older Physicians Trim Hours in Lieu of Retiring
Source: American Medical News
Date: 03/17/2008
Physician shortages are expected to increase as older doctors enter retirement age, and some estimates predict that by 2020, the gap between available and necessary physicians will be somewhere between 85,000 and 200,000 doctors. To fill this void, many older physicians are softening the blow by turning to part-time practice.
Research in 2006 by the Association of American Medical Colleges’ Center for Workforce Studies found that 21 percent of doctors over 50 worked part time and a further 46 percent were considering working part time. About 50 percent reported that they could be convinced to work longer before retirement if their hours were reduced or they could work fewer days.
Transitioning to part-time employment is not always easy, particularly for doctors with on-call obligations. Many smaller practices simply cannot afford to lessen on-call requirements. Additionally, doctors turning to part-time employment are finding that their income drops substantially.
Many older doctors are also turning to locum tenens employment as an alternative to part-time practice. Patrick Donovan, president of the National Association of Locum Tenens Organizations, reports that his Linde Healthcare company in St. Louis has increased locum tenens positions for individuals over 50 from 26 percent to 34 percent in the past year.
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A Measured Approach
Source: Minnesota Medicine
Date: 02/01/2008
Though pay-for-performance tactics are becoming increasingly more popular for both private and public health plans, there are many difficulties associated with the trend. Providing financial incentives for physicians to provide better care often causes more problems than solutions.
One major problem with pay-for-performance is establishing an authoritative standard. Depending upon which healthcare provider is offering incentives, different doctors may be subject to completely different standards for the same type of care. Standards can also be incredibly rigid, hurting doctors who have provided exceptional care for unhealthy patients who improve dramatically but fall short of an arbitrarily normalized level of health. This ultimately incentivizes doctors to provide the best treatment to patients who are already in good health.
Gathering and organizing all of the data on patient treatment histories is also an administrative headache. Without a thoroughly organized database that contains accurate information on each individual treatment case, some doctors are finding that they are not rewarded for a level of care that surpassed the minimum standards for earning bonuses. Many clinics have added staff specifically devoted to ensuring collected information is current and correct.
Many doctors are also complaining about the socioeconomic divide that is caused by pay-for-performance. Studies at the University of Minnesota have found that the greatest determinant for health outcomes is the economic status of the patient, leading critics of pay-for-performance to complain that since programs often rely on patient outcomes, clinics that serve poorer patients are less likely to reap the benefits of any incentives.
Pay-for-performance is still a relatively new phenomenon, and there are many kinks that still need to be worked out. Nonetheless, some clinics are finding success with specially customized pay-for-performance tactics designed by the clinics themselves, not their payers, with the doctors optimistic that the programs will remain fair and effective through the future.
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How to Do a Medical Practice Buy-In
Source: Physician’s News Digest
Date: 02/01/2008
In this article, health care attorney Daniel M. Bernick offers some insight on the process of buying into an existing medical practice. For convenience, Bernick sticks to a scenario in which a physician wishes to buy into a practice that has previously been a solo operation.
According to Bernick, the first thing to understand is that the senior partner will not be willing to offer a fifty percent stake in a well-established practice off the bat even though he or she could build job protection clauses or a special self-serving bonus structure into the contract.
Regardless of share distribution, Bernick points out that while there are three elements of a practice’s value—hard assets (equipment, furnishings, etc), accounts receivable, and intangibles or “goodwill,” new partners prefer to leave accounts receivable and intangibles estimates out of the stock valuation, paying for these assets instead through a reduced income. It is in the best interest of senior partners to account for all assets in the stock valuation, but it is common practice to factor only hard assets, siding with the new partner’s interests. The shifting of a certain amount of income from the junior to the senior partner is akin to “paying dues” (gradually reduced over a short period of time) until an equal partnership is established.
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Deposition Dos and Don’ts: How to Answer 8 Tricky Questions
Source: Current Psychiatry Online
Date: 03/01/2008
Since 90 percent of malpractice suits are settled out of court, doctors who are facing malpractice suits should prepare for a pre-trial deposition as if it were the real thing. Further, testimony revealed in a deposition can be used if the case goes to trial, and doctors should be extremely careful what they reveal to an opposing attorney.
Doctors at SUNY Upstate Medical University and Case Western Reserve University Medical School provide useful advice for doctors involved in an upcoming deposition for malpractice suits.
Opposing attorneys will usually try to force doctors into providing testimony that will ultimately secure the case in favor of the plaintiff, and any doctor involved in a deposition should consult with his or her attorney at least two times before the deposition is scheduled. Carefully reviewing all of the details of the case is important here, and doctors should be extremely careful before providing seemingly extraneous information or making broad generalizations about the case.
Any deposition should be treated as if it were a real trial, and the standard rules for cross-examination apply. Avoid words like “always” or “never,” and be highly wary of unconditionally agreeing to a plaintiff attorney’s statements. Overall, doctors in malpractice depositions should be very conservative with the facts they reveal and should make thorough preparations with their attorneys prior to the meeting.
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AMA Analysis Reaffirms: Tort Reforms Work
Source: American Medical News
Date: 03/08/2008
An American Medical Association study proclaims that tort reform measures do indeed work to reduce insurance premiums, but trial lawyers and others call the study misleading and its solutions incomplete. An article in the March 3 issue of the AMA’s American Medical News explores the controversy over the efficacy of tort reforms.
Reviewing ten independent, peer-reviewed studies that looked at limits of pain and suffering awards and the effects on insurance premiums, physician supply, and defensive medical costs, the resultant summary concluded that the research supported the claim that caps on noneconomic damages result in reductions in insurer claims payouts. These savings, the study concludes, are then passed on to doctors in the form of lower rates, who then pass the same on to their patients in the form of lower prices.
The analysis also indicated that tort reforms can help alleviate physician shortages and reduce overall healthcare spending. Also among the study’s findings:
-Premiums for internists have been found to be 17% lower in states with caps, while general surgeons’ and OB-Gyn rates were 21% and 26% lower, respectively.
-A $250,000 award limit in states without effective reforms could result in savings of up to $1.4 billion on premiums.
-States with caps have 4-7% more physicians in high risk specialties than those without.
-A 60% increase in medical liabilities from 2000 to 2003 is linked to $7.1 billion increase in spending on physician Medicare Services.
Opponents of the study—representatives from the American Asociation for Justice, a national trade group for trial lawyers—voiced concerns about the paper as one-sided and pointed to contradictory evidence from other studies in the past.
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Arbitration a Growing Trend in Health Care
Source: Philly.com
Date: 02/10/2008
How are doctors getting around the potential pitfalls inherent in the litigious modern doctor-patient relationship? An article in the February 10 edition of Philly.com claims that many doctors are asking their patients to agree to arbitration before any services have been provided.
Though not providing in-depth numbers on the frequency of doctor-patient arbitration agreements, the article claims it is a common and growing practice on the west coast and shows signs of spreading nationally. It is common in nursing homes especially, with the Golden Living chain—which operates 40 nursing homes nationally—stating that about half its residents agree to arbitration.
The practice has come under fire from consumer groups and trial lawyer trade unions, but doctors and organizations adhering to it claim it is the best means of protecting their practices in the face of litigious patients and exorbitant damage awards. Some doctors and patients alike complain that the practice sets an adversarial tone for the doctor-patient relationship from the very start. Partly in response to the controversy, Senator Russ Feingold of Wisconsin introduced legislation last year to prohibit pre-dispute arbitration clauses in medical and other consumer contracts.
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How to Handle a Prejudiced Patient
Source: American Medical News
Date: 03/08/2008
As the American medical field grows increasingly multicultural, there is greater potential for hurt feelings when health care workers encounter patients with xenophobic tendencies. An article in the March edition of American Medical News aims to instruct doctors on how to deal with these patients.
The article examines the potential for these types of conflicts, which is heightened in the wake of the 9/11 attacks and increasingly xenophobic media coverage. The author notes that it is not easy to deal with such situations, as they represent a conflict between a patient’s freedom of speech and harassment like unto the sorts classified as workplace hazards by the AMA.
The author, however, puts forward a number of potential means for dealing with such troublesome patients:
-Remain courteous at all times. The sense of grief and injustice of remarks should never prevent a doctor from doing his job.
-Voice your disagreement without being combative. A firm but polite statement reestablishes the physician’s authoritative role and confidence without overly damaging the doctor-patient relationship.
-Try to educate your patient. Perhaps approach your patient’s prejudice in a manner similar to the way you’d approach your patient’s alcoholism or smoking: as a habit that is poisonous and needs to be broken through encouragement and support.
-Defuse the situation with humor. Keep in mind that the doctor patient relationship is the primary concern, and try to laugh it off or make your patient laugh it off.
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Where Are the Women Orthopaedists?
Source: American Academy of Orthopaedic Surgeons
Date: 02/01/2008
In medical school, women comprise 49 percent of applicants and about 48 percent of enrollees, yet only about 10 to 12 percent of applicants for orthopaedic surgery residencies are women, leaving the field to be dominated by men. Despite that technological advancements have reduced the need for great physical strength in the operating room, many doctors continue to view orthopaedics as an “old boys” network.
As the number of orthopaedic surgeons is expected to drop in the near future, substantial efforts need to be made to recruit women to the profession, oftentimes before they even enter medical school. High school career fairs are a good place to start spreading the word about the gender gap, and medical schools, like Johns Hopkins, Harvard, and the University of Minnesota, are developing explicit initiatives to boost the number of female applicants to orthopaedic surgery residency programs. Some other medical schools are beginning to point out these gender discrepancies when students are first enrolled.
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Emerging Role for New Niche Specialists
Source: Managed Care Magazine
Date: 01/01/2008
Niche markets for specialty physicians have been emerging over the last few years as a way for new doctors right out of residency to gain valuable positions. As opposed to traditional roles for doctors, there is an increased market for laborists (doctors who treat women, usually uninsured, in labor), surgicalists (doctors who provide 24-hour surgical care), and nocturnists (doctors who primarily work during night shifts).
Compensation levels are slightly lower for specialists, and 17 percent of physicians in these categories reported a decrease in overall cash compensation from 2006 to 2007; however, overall salaries for specialists increased by 4.5 percent in 2006, slightly higher than the 4.3 percent increase for primary care physicians.
Other specialist categories include hospitalists and pediatric hospitalists.
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Primary Care Emphasis Relies on Payment Reform Measures
Source: AAFP News Now
Date: 02/27/2008
The current US healthcare system of payment has structural and conceptual flaws that encourage expensive and specialized procedures while discouraging primary care, this according to a recently released report by the government’s General Accounting Office.
The GAO’s report indicts the current fee-for-service system as undervaluing primary care services and encouraging growth in specialty services. The report advocates a reform of the payment system that would include increased fees for primary care services as well as a recalibration of payments to properly value all services.
The report goes on to advocate for expansion of non-specialty services such as preventive care, coordination of care for chronic illnesses, and continuity of care in order to achieve overall improvement of outcomes and cost savings.
The paper extols the values of the medical home model put forward by the American Academy of Family Physicians (AAFP)—a model designed to provide patients with more accessible and comprehensive care with a “basket of services” method. The study also makes mention of the shortage of primary care physicians, pointing out that specialty training program growth has recently outpaced primary care resident growth 8% to 6%. The paper regards this decrease and the impending shortage of PCPs as contributing factors to oncoming difficulties in the health care market.
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Payer & Reimbursement Issues
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Decreasing Reimbursements for Outpatient Emergency Department Visits Across Payer Groups From 1996 to 2004
Source: Annals of Emergency Medicine
Date: 03/01/2008
With the considerable attention recently given to the lost payments for emergency department (ED) visits, a study in Annals of Emergency Medicine sought to understand specifically how much discrepancy exists between payments charged and payments received for ED visits in recent years. Using the proportion of charges that were successfully collected as the criterion, researchers found the overall proportion of charges paid for outpatient ED visits decreased from 57 percent in 1996 to 42 percent in 2004. During the same time frame, charges paid decreased from 43 to 33 percent for Medicaid patients, from 50 to 38 percent for Medicare patients, from 71 to 56 percent for privately insured patients, and from 42 to 35 percent for the uninsured. The authors point out that with a 35 percent rate of charges paid for uninsured patients, hospitals should not see the uninsured as “universally poor payers.” Medicaid patients are actually the biggest source of hospital losses as states and the federal government continue to increase enrollments while decreasing funding.
While the study makes few scientific claims about the explanation for these figures, the authors make several key observations. First, though the proportion of charges paid has decreased substantially, the actual amount of money paid by patients has actually increased. This could be attributed to hospitals raising the “sticker price” for various services with the expectation that increased patient payments will compensate for any losses. However, a similar study by the California Medical Association has shown that emergency departments lost approximately $46 per patient treated, causing the number of EDs to decrease by 12 percent during the 1990s, despite increases in ED charges.
Second, hospitals may look to further increase charges in the future to hedge themselves against future losses associated with a decreased proportion of payments. This will ultimately harm uninsured patients who would continue to face increased charges for ED visits. Decreases in payment proportions would be magnified as hospitals are legally required to provide care to any patient regardless of their economic status.
EDs are an invaluable resource, and substantial thought should be given to sorting out how they can remain financially stable as current trends continue.
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AAFP Leaders Call on Congress to Replace Flawed Payment Formula
Source: AAFP News Now
Date: 02/27/2008
A .5% increase in the Medicare Physician Payment Rate for the next 18 months is necessary to give lawmakers enough time to develop an alternative to the current sustainable growth rate formula. So says the AAFP in its recent request to members of Congress to take means to stave off deep reductions in Medicare payouts.
The last increase in the payout rate came in December of 2007 when Congress approved a .5% payout rate increase that would last through the end of June of 2008. That will expire, however, on July 1, causing a 10.6% cut for physicians, which would be followed by another cut of 5% in 2009.
In mid-February, board members of the AAFP met with Congress members to persuade them to amend the current SGR and extend the present rate increase. The AAFP also took time to discuss restructurings to the nation’s healthcare system that are deemed necessary, such as restructuring of pay for primary care and the switch to a “medical home” model of care.
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Deciphering the Cost Impact of Managed Care in Medicaid
Source: American Journal of Psychiatry
Date: 02/01/2008
A study published in the February issue of American Journal of Psychiatry looked at current models for managed care in Florida. The study concedes the findings from previous studies that individuals in the private sector who are accustomed to paying large out-of-pocket fees for mental health services decrease their personal burden through parity and managed care programs. However, this new study uncovers that as managed care reduces the overall cost of providing mental health care to Medicaid patients, costs for individual patients and their families are increasing.
The study highlights a growing concern about trends in financing Medicaid programs, namely that they save money for governments and taxpayers while increasing burdens for the patients who require the care. For the editors at American Journal of Psychiatry, this is not an acceptable solution for health care financing. The question of who should be paying for healthcare services can only be answered by addressing the full societal cost for each initiative so that all individuals can receive quality mental healthcare.
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Credentialing, Licensure, Quality Management
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Develop an Effective Risk-Management Program
Source: Medical Group Management Association
Date: 02/26/2008
All medical practices need to be vigilant in responding to unexpected events as part of an overall risk-management program.
Practices should begin requiring incident reports for events like falls, medication-related occurrences, allergic reactions, equipment failures or improper use of equipment, improper consent, lost or broken valuables, patients signing out against medical advice, misdiagnosis, unanticipated patient outcomes, and when the wrong patient is treated or a wrong procedure is performed. Information in the incident report should include the name of all parties involved, the date and time of occurrence, a description of the event, any equipment that was involved, and the names of any witnesses. Some incidents - death, brain or spinal damage, or procedures performed without informed consent - may legally need to be reported to the state. Staff should be educated in exactly when and how to fill out an incident report.
A quality improvement team should be created to address specific instances across all areas of risk-management. By analyzing information in the incident reports, the team can identify trends in medical malpractice and physician mistakes in order to find how to both improve the overall performance of a practice and mitigate the occurrence of accidents and incidents in the future.
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Involving Patients in Safety Improvement
Source: Hospitals & Health Networks
Date: 02/22/2008
Passavant Area Hospital in Jacksonville, Illinois began involving former patients and community members in their safety improvement initiatives over 5 years ago. Passavant’s experience working with individuals outside of the hospital in order to improve safety highlights a unique approach to hospital safety programs.
Seeking input from former patients can be an extremely useful tactic for hospitals because these individuals can provide outside advice as to how a hospital can be made safer. It can be difficult to find community members who are willing to be honest and open about their concerns with hospital safety, particularly in a smaller community, but Passavant has been highly successful in treating safety issues they never knew existed.
There are some legal concerns with disclosing incident reports or other hospital-specific data to individuals who are not employed by the hospital, and many institutions, particularly in states where privacy is more heavily regulated, are finding that involving former patients in the safety improvement process is too much of a legal liability. Passavant has responded to these concerns by only discussing individual incident reports at a level above the safety committees. Community members still discuss general safety issues within their committees but are prevented from learning any details about specific incidents. Other hospitals ask community members to sign confidentiality agreements that protect hospitals from illegally leaking private information.
There are some difficulties involving former patients or community members in safety improvement initiatives in a hospital, but the increased input can be a valuable asset to any hospital seriously concerned with improving safety.
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Providers Promote Customer Service to Attract Patients
Source: Tri-Cities Business Review
Date: 02/27/2008
In the fierce competition between hospitals and independent treatment centers, some hospitals are improving their customer service component to better attract patients. A recent article in the Michigan-based Tri-Cities Business Review explores the tactics in use.
The “emotional, social, and spiritual support for caregivers, patients, and their families” will be a major point of focus in programs like St. Mary’s of Michigan’s “The Patient Experience,” its new, customer service initiative begun in February.
St. Mary’s customer service focus began in 2003 with the institution of a 30 minute wait time guarantee throughout the hospital. The time limit was achieved by all departments through the alteration of hospital procedures for registration, radiology, and labs. As a result, the hospital is able to meet the 30 minute mark for 98% of emergency room patients. (Those who wait longer than 30 minutes are compensated with two free movie tickets.) Patients are also able to schedule appointments online or by phone, 24 hours a day.
Procedures such as these have allowed St. Mary’s to greatly reduce its turnaround time and to eliminate a large amount of its waiting time. The result is a highly satisfied customer base. As a result, patient volume has nearly doubled since the plan began, with the hospital’s patient load nearly at capacity on a regular basis. The focus on customer service resulted in greater efficiency, increased customer base, and a better bottom line.
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Pilot Program Reveals Increased Physician Support for e-Prescribing
Source: Healthcare IT News
Date: 02/27/2008
E-Prescribing allows physicians to practice better, this according to a recently released survey by Haldy McIntosh & Associates. The study, performed for the Southeastern Michigan e-Prescribing Initiative (SEMI), surveyed 500 physician practices over the course of three years to gauge their satisfaction with e-prescribing.
The study found that three out of four physicians surveyed strongly believed that the technology had resulted in an improvement of their practice. They cited the safety alerts in the program that warned of potential drug-drug interactions as a large plus in the program. More than 70% of those surveyed said they were quite happy with the technology, with nine out of ten stating that the technology had met or exceeded their expectations. More than seven in ten doctors reported decreased communications with pharmacies to clear up misunderstandings or correct mistakes, thanks to the technology. Of those, 40% reported a substantial reduction in negative pharmacy contact. More than half of the doctors surveyed reported that the technology saved them and their practices time and increased overall productivity.
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Google reveals plan for health database
Source: Financial Times
Date: 02/28/2008
Online search giant Google, Inc. announced an online repository for health information storage. The move is believed to be aimed at aiding national adoption of electronic medical records.
The service, Google Health, will allow consumers to enter their own medical data, which can then be updated by their doctors, insurers, and other health care workers who have been granted access. The system would put health records at the center of a health information system that would include health insurers, doctors, hospitals, and others.
The move puts Google at odds with Microsoft—which launched its own personal health records system, HealthVault, last year—in yet another arena. Google’s system will be based on records that patients authorize their insurers, doctors, and others to move into Google’s database.
Google plans to eventually allow the service to become a “platform”—a base upon which other companies can build other software applications using the data. One possible application: a client for automatic management of medications, reminding patients when they should be low on a prescription or in need of a refill. There are, as of yet, no plans to sell any advertising on the service. Google has said the site is intended for now to expand the company’s brand name.
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Health Record Banking: A Viable Option for Consumers
Source: Medical News Today
Date: 02/28/2008
According to a study conducted by the Louisville Health Information Exchange, a sizeable majority of consumers would in fact be ready to support community-wide health record banking systems.
Health record banking systems are a sort of central repository, a private and secure location for patients to store their records from all sources via a deposit/withdrawal system. This bank would also be accessible to doctors and other clinical providers.
In a telephone based survey also backed by the Noblis Center for Health Innovation, it was found that 69% of respondents would consider a health record banking system valuable, provided it was supported by their particular physician. Twenty-four percent of respondents indicated they would be willing to pay an average of $5 a month for such a service. Most respondents indicated that they would want the ability to opt into or out of the system as they wished and not be automatically enrolled without their consent.
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Heading for an Iceberg
Source: HHN Magazine
Date: 02/01/2008
Electronic medical record (EMR) systems can increase hospital efficiency, improve patient safety, and cut costs, but can their implementation also blind executives to other important healthcare IT issues? An article in the February issue of HHN Magazine warns not to get too zoomed in and lose sight of other IT goals and developments.
Given the size of the investment in EMR installations, it is understandable that executives could have a rather single-minded approach to the process. However, offerings from private companies, government agencies, and others present options that are more likely to be widely adopted and satisfactory to customers than a particular hospital’s individual system:
-Google recently announced Google Health, a free service that will store editable consumer health data that can be accessed by patients, payers, and physicians alike.
-Microsoft has debuted a similar system to Google’s in partnership with a smaller company.
-The Department of Veterans’ Affairs has 30,000 veterans managed with in-home chronic disease monitoring and coaching.
These services are often interoperable with hospital EMR systems but preferred by institutions and patients over individual hospital EMRs. The article recommends that administrators keep an eye open toward healthcare IT developments so as to be able to adopt better implementations and use these resources and services in conjunction with a hospital’s own EMR.
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