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As hospitals and healthcare facilities finalize staffing budgets for 2009,
determining equitable physician compensation is of utmost importance. This
month’s Special Report discusses some conventional and innovative compensation
models that have been adopted by various hospitals and medical groups.
Hospital administrators and physician recruiters can use this information in
designing compensation packages for new hires or possibly revising contracts
that are winding down for their current professional staff.
Coming soon! Jackson & Coker’s 2008-2009 Return on Investment Calculator.
Each year, our research staff compiles the latest statistics on average physician
compensation associated with revenue generated for specific medical specialties.
This handy online tool is useful in determining “what a doctor’s worth” in terms
of contributing to the institution’s bottom line. Stay tuned for additional
information in an upcoming edition of the Jackson & Coker Industry Report.
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By J & C Research Associates
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Looking Forward
Now that the 2008 presidential election has been decided, the medical community
can focus on the future of health care in the United States given the stated
priorities of the new administration.
A future edition of the Jackson & Coker Industry Report will examine in detail
what physicians and other medical professionals can likely expect as we move
toward some form of Universal Health Care which, supposedly, will include the
millions of US residents who are currently uninsured.
Our slate of feature articles in this issue includes interesting topics such as
how a physician’s personality can affect depression diagnosis, avoiding e-mail
abuse, consumer health concerns during a shaky economy, physician “dashboards”
for grading a doctor’s clinical performance, reentering the work force as a
locum tenens provider, and CME applications for physicians who use iPhones.
As always, our goal is to provide a well-rounded selection of news items and
related medical information that benefits hospital administrators, physicians
and other health professionals.
Cordially,
Calvin Bruce
Managing Editor
The Shaky Economy: Is It Changing The Way People Take Care Of Their Health?
Source: Business Wire
Date: 10/08/2008
According to recent CIGNA surveys, around one third of Americans say that the uncertain economy has affected the way they take care of their health. Of that group, just over half report taking better care of their health by exercising, eating healthier food, and/or getting regular check-ups and screenings, while around forty percent report taking worse care of themselves.
With a struggling economy that has caused most Americans to pay more attention to how they are spending their money, it is more important than ever for people to understand the details of their health plan and to take full advantage of any benefits it may offer to them.
People make a clear link between health and economic well-being, according to the survey discussed in the article, which presents an opportunity for physicians, health educators and health coaches to help people put their beliefs about the connection between health and prosperity into action.
The obstacle to Americans’ acting on the belief (shared by nearly two thirds of the population) that their health is a priority is the perception that a healthy lifestyle is more expensive. Health care professionals should take the opportunity to educate the public about the ways in which eating healthy, for instance, does not have to be expensive, nor does a healthy lifestyle in general.
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Private Money Looks For Cure to Health Care
Source: InjuryBoard.com
Date: 10/16/2008
The X PRIZE Foundation and the WellPoint Foundation are teaming up to offer a $10 million prize to individuals, employees, health care providers or consumers who can identify a way to “revolutionize health care and make it available to everybody.”
In an effort to find innovative solutions for health care affordability and availability, the challenge is open to all solicitations, and the results will be shared and open for public use.
Former U.S. Senator Bill Bradley and former Speaker of the House Newt Gingrich have applauded the application of a prize concept to enhance social public policy innovations.
The final rules and guidelines of the competition will be issued early next year, although an X PRIZE video currently offers a broad explanation of the challenge. WellPoint will test the finalists’ health care proposals in real-world situations in the company’s state plans in order to determine the recipient of the $10 million prize.
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Physician’s “Dashboard” Takes a Measure of Communication Skills
Source: ScienceDaily.com
Date: 10/06/2008
Your dashboard tells you if you’re doing the speed limit, whether your bright lights are on, and if your engine needs maintenance. But can a dashboard tell doctors if they’re treating their patients right? A new trial by the Medical College of Georgia aims to do just that.
The “dashboard” in question would be a touch screen kiosk available to patients for quick grading of physician performance across a number of metrics. Aggregate patient responses would then be relayed to the associated doctors through a dynamic 24- inch display that doctors would consult. Performance would be measured on a continuum by color: red meaning bad service in a particular area, yellow meaning okay service but with room for improvement, and green meaning good service.
Currently, the kiosks are set up for eight weeks in primary care practices in Tifton, Jesup, Blackshear, and Moultrie, Georgia. Patients are asked if the doctor explained problems in a helpful manner, if the doctor showed respect to their concerns, and various other evaluative questions.
It is hoped that the kiosks will aid doctors in improving their communicative skills in that doctors, if scoring badly on communication, can call in others who perform better for assistance on their bedside manner.
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California Gov. Signs Assisted Suicide Bill Into Law
Source: CNS News
Date: 10/06/2008
California Governor Arnold Schwarzenegger has signed into law a bill that is criticized on the grounds that it may open up the possibility of physician-assisted suicide. The bill, AB 2747, mandates that physicians, nurse practitioners and physician assistants provide patients diagnosed with a terminal illness (or who have less than one year remaining to live) with “comprehensive information and counseling regarding legal end-of-life options.” If health care providers feel they cannot comply with the request for reasons of conscience, they will be required to refer or transfer the patient.
Critics are calling the law a “backdoor” way of bringing assisted suicide to a state that has rejected the practice by referendum and claim that two organizations that openly promote assisted suicide and helped draft the bill will benefit from the law, since they currently provide information about assisted suicide to patients with terminal illnesses.
Defenders of the bill say that patients have the right to be made aware of all possible options once a terminal diagnosis has been made and that many patients in California with terminal illness are ignorant of what their true options are.
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Disease Registries Have Flown Under Clinicians’ Radar Screens
Source: Managed Healthcare Executive
Date: 09/01/2008
Disease registries, also known as chronic disease management systems, are electronic tools that provide physicians clinical support so they can deliver appropriate, timely care, and enable physicians to identify patients who have chronic diseases, tracking patients’ care to ensure that it follows nationally-recognized guidelines. Providers can also use registries to contact patients when an appointment is due to be scheduled.
Studies have shown that chronic disease sufferers receive recommended care only around half the time, and disease registries can help with this problem by tracking multiple chronic conditions to help monitor progress and ensure better follow-up.
While disease registries are not a new phenomenon, they have only recently become electronic, which has vastly increased their usefulness to provider organizations. They also have the potential to be used as tools for scheduling and billing management and will be able to help physicians see patients quickly and efficiently.
Among advocates of disease registries, there is hope that they will become part of the competitive market. While stand-alone registries can serve an important function, their real strength is tapped when they are incorporated into an EHR, making it easier for physicians to act on information and deliver evidence-based care at the time of the encounter.
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Rural Wisconsin Hospitals Provide Lesson in Innovation
Source: Health Leaders Media
Date: 10/08/2008
In its share of the FCC’s $400 million Rural Healthcare Pilot Program, the Rural Wisconsin Health Cooperative Information Technology Network will receive $1.6 million over the next three years, which will be used to offset the cost of building a collaborative information system and electronic medical records initiative.
While the FCC pilot is providing funding for the telecommunications upgrade, the federal Health Resources and Services Administration is providing another $1.6 million for software and EMR hardware. The funding is expected to underwrite around 85% of the cost of establishing collaborative broadband networks that will support telemedicine services for the cooperative’s four small critical-access hospitals, and two physician clinics in the traditionally underserved rural areas. Monthly fees paid by the cooperative members will cover the remainder of the costs.
The collaboration will allow hospitals to negotiate better discounts from vendors, reduce datacenter costs and software licensing fees, and tap into a pooled technical support staff. The four hospitals in the cooperative are now live on a shared system that was implemented over the summer and includes both financial systems and departmental systems.
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Non-Profits Could Bolster Personalized Medicine, Kauffman Report Argues
Source: Genome Web
Date: 10/21/2008
The Kauffman Foundation recently presented a white paper to the U.S. Department of Health and Human Services advocating partnerships between biotech companies and non-profits that are focused on diseases. According to the Kauffman Foundation, the growth of personalized medicine will continue to be hindered as long as the pharmaceutical industry is focused on blockbuster drugs. However, the problem may be reversed if small biotech companies partner with non-profits to help fund their studies.
The Multiple Myeloma Research Foundation, for example, has partnered with biotechnology companies to lead research focused on genomics and credentialing of molecular targets, drug validation, multi-site clinical trials and the study of 250 patient tissue samples using gene expression profiling, comparative genomics hybridization and resequencing.
In addition to providing funding for the development of personalized medicine, non-profits provide “de-risking activities,” which improve the probability of success by filling biotechnology funding gaps. Larger non-profits in particular can use their resources to finance and manage biotechnology research programs by working through “venture intermediaries,” or product development public-private partnerships, to create new specialized medicines. Ideally, these new products are then handed on to large pharmaceutical companies for further marketing and development.
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Report Finds Community-Based Disease Prevention Saves California Money and Improves Californians’ Health
Source: Market Watch
Date: 10/23/2008
A recent report commissioned by The California Endowment released findings stating that both the state of California and private health insurance payers can save significant amounts in annual health care costs by investing in community-based disease prevention programs.
In fact, an investment of just $10 per person per year in proven community-based disease prevention programs has the potential to save California’s health care system over $1.7 billion in the next five years with a return on investment of $4.80 for every dollar spent. In 10-20 years, this number could grow to a savings of over $1.9 billion annually.
The report provides strong evidence that community-based interventions are an essential piece of state and national health care reform, especially considering the continued increase in obesity, diabetes, and other chronic conditions.
Cost-saving community-based disease prevention differs from preventative medicine in that it emphasizes interventions that take place outside the doctor’s office. This type of intervention includes planned communities that encourage walking, increasing the accessibility of fresh fruits and vegetables in communities with few supermarkets, keeping school athletics facilities open longer, and other community-based interventions that work to fight chronic disease.
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Mass. Physician Shortage Worsens
Source: Boston Business Journal
Date: 10/06/2008
As Massachusetts seeks to expand health care coverage to nearly every resident under its health care reform law, the state is running up against recruitment shortages in twelve specialties.
More than 400,000 Massachusetts residents became newly insured over the past year. Many are now looking for primary care physicians. The state is experiencing shortages in primary care providers as well as emergency medicine, general surgery, neurosurgery, orthopedics, psychiatry, urology, vascular surgery, internal medicine, oncology, neurology, and dermatology.
This is the third consecutive year in which internal medicine and family medicine have been affected by shortages in Massachusetts. Recruitment times for new physicians are averaging over a year in most fields, and wait times for patients are longer, with physicians less happy with the practice environments they work in. Adding to the problem, or perhaps because of the problems, some 52% of Massachusetts medical residents are leaving the state when finished with their residencies.
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Towns Need Doctors, and the Doctors Need Visas
Source: The New York Times
Date: 09/30/2008
Medically underserved areas, such as the small towns and rural areas along Lake Ontario and the St. Lawrence River are becoming increasingly attractive for New York City doctors and residents working under the restrictive J-1 “exchange visa,” which requires that applicants return home for two years once they finish their studies unless they can get a waiver to work in a medically underserved area.
Waivers granting immigrant doctors continued stay in the U.S. can be hard to acquire, and the doctors must have a signed employment contract in order for the waiver to be granted. These doctors, who strongly desire to continue their practice in the U.S., are often willing to relocate almost anywhere.
Foreign doctors are more willing to look outside of desirable locations like New York City in order to stay in the U.S., despite studies showing that newly trained doctors, burdened with loan or debt and seeking status, often gravitate toward urban centers. A 2007 study of physician recruitment by the Center for Health Workforce Studies at the State University of New York at Albany found that physicians practicing in upstate New York were much more likely to have come from outside the state than those practicing in New York City.
Because New York City Hospitals have their pick among residents and would rather hire doctors with green cards rather than sponsor a doctor for a visa waiver, upstate New York hospitals are immensely attractive for immigrant doctors who want to remain on the east coast. Many of these upstate New York hospitals, needing more doctors to serve their medically underserved communities, are not only willing to sponsor visas, but will also reimburse doctors for lawyer fees accumulated during the visa application process.
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Employment & Compensation
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Preparing to re-enter the workforce
Source: Locum Life
Date: 10/15/2008
This article reviews the steps necessary to re-enter the locum tenens workforce for physicians who have been “out of circulation” for a year or more. The steps are the same for all physicians who at some period in time practiced in management, academic, or research positions where they did not provide direct care.
The first step in the re-entry process is to complete the re-credentialing or credentialing process. The standard policy is that locum tenens providers are required to be fully credentialed before accepting contract engagements and must be re-credentialed every year after that. Physicians should be aware that credentialing differs by medical specialty, and that the process of verifying clinical skills is much more involved in fields where standards in theory and practice are frequently updated. In the process of re-entry, physicians should also ensure that their board certification is current.
The next step for physicians wishing to re-enter the workforce is the establishment of current clinical competence though the documentation of clinical skills needed to capably perform the responsibilities associated with the position. Continuing medical education (CME) credits are often used as documentation of clinical competence. Physicians who have been out of practice for an extended period of time have the option of serving in a 3-month unpaid proctorship to verify clinical competence.
In order to ensure a smooth practice re-entry, it is also helpful for physicians to have notarized originals of credentialing documents and a supply of letters of reference and clinicians willing to supply verbal references upon request.
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The Bigger Picture: Another Reason to Go Cash-only?
Source: Physicians Practice
Date: 10/01/2008
Due to this close relationship between the patient’s valuation of care and the physician’s payment requirements, the medical liability company Applied Medico-Legal Solutions Risk Retention Group (AMS) is now offering discounted policies to cash-only and concierge style physicians, as well as most physicians who are members of the Society for Innovative Medical Practice Design (SIMPD). The medical liability company’s discounted policies for such physicians are not based on outcomes data showing that these physicians are better doctors, but rather are based on the reasoning that these types of cash-only or concierge style physicians offer a lower risk to the insurer because of the higher level of involvement they provide for patients.
While the AMS reviews each physician who applies for the discounted policies individually, it hasn’t yet turned down any concierge physicians. AMS’s decision makes sense in terms of the corporate bottom line and may lead to more companies offering similar discounted policies.
However, as of right now, the AMS’s assumption that cash-only and concierge practices have a lower liability risk is not evidence-based, and more time will have to pass before medical liability insurers are able to determine the correctness of this assumption.
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Wisconsin High Court Rules Against Spooner Physician
Source: BusinessNorth.com
Date: 10/08/2008
The Wisconsin Supreme Court has settled a dispute between a physician, his employing health system, and a Minnesota-based addiction treatment facility that said he was an alcoholic.
The suit centered around whether the physician—the only general surgeon on staff for the Wisconsin health center—was ill-served by the treatment center hired to evaluate his alcohol dependency after a drunken incident involving a snowmobile.
The surgeon, who was on call 24-7, contends that the center had no stated policy on physicians drinking while on call. The health center made him go on immediate leave following the snowmobile incident. The surgeon was instructed to undergo treatment in a Minnesota clinic, which diagnosed him as alcohol dependent.
The surgeon, who sought out a lesser diagnosis of “alcohol abuser” for the purposes of the trial, contends that the initial diagnosis of “alcohol dependent” cost him $125,000 as a result of lost work in addition to lost business due to widespread word of his “dependence” rather than “abuse.”
The court, in its finding, decided against the physician’s diagnosis-based complaint. The court found that diagnosis of substance dependency is an inexact art, not a science, and thus the defendants could not be held responsible for variations in diagnoses.
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State Policies in Pain Medicine and Legal Standards for Patient Care
Source: Medscape Today
Date: 10/20/2008
State pain policies typically provide a safe harbor for pain practice management and fair warning to practitioners who opt not to follow the legal procedures. While state medical boards, which are generally also the creators of the state’s pain policy, tend to closely follow the contents of the policy and judge practitioners within the context of the policy’s procedures during legal proceedings, this is not always the case in the court of law.
While practitioners are generally afforded a considerable level of protection during administrative actions, the application of state pain policies is less assured in civil malpractice litigation and criminal prosecution. During civil malpractice cases, state pain policies can be used as a foundation for witness testimony either on behalf of the plaintiff or the defense. In a criminal prosecution, prosecutors and other law enforcement officials may not be aware of a state’s pain policy, although criminal defense attorneys have the option of explaining to the court that a state pain policy is the law. In each of these different types of legal proceedings, the variance in the application of pain policies is related to the degree of rigidity held by the policy.
Despite the variance in the role that state pain policies play in administrative disciplinary actions, civil litigation, or criminal prosecution, the extent to which the pain policy is restrictive or flexible significantly effects the legal outcomes and practitioner protection. Overly restrictive pain policies can serve “as a list of ‘gotchas’ and works to the detriment of the practitioner defendant.” Flexible state pain policies, on the other hand, afford practitioners a higher degree of protection that allows for better pain care management.
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Courts Examine Peer Review: Maintaining a Proper Sense of Balance
Source: American Medical News
Date: 09/29/2008
Congress passed the Health Care Quality Improvement Act of 1986 (HCQIA) with the intention of promoting physician participation in peer review by granting confidentiality and immunity from liability for money damages to those who conduct reviews in good faith. In addition, all 50 states, on top of their immunity laws, recognize a privilege that generally protects information generated during the review process from discovery during unrelated litigation, such as medical liability cases. Nonetheless, peer review issues still make their way into court.
Recent cases have affirmed the protections, maintaining strongly the protections associated with peer review and asserting that doctors shouldn’t be chilled from conducting honest peer reviews. However, some doctors and legal experts believe courts have gone beyond the intent of federal immunity standards by failing to consider potentially malicious intent.
Peer review confidentiality safeguards will not necessarily be protected in courts. The right of the court to unveil private, sensitive information may cause some doctors to be unwilling to participate in peer review in the future.
Laws regarding peer review privacy privileges vary greatly from state to state. AMA policy supports peer review confidentiality and advocates for federal legislation that would prohibit the discovery of records related to such proceedings.
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Service Secrets: Lessons for Physicians from McDonald’s
Source: Medical Economics
Date: 09/19/2008
With food that is hardly savory and has a negative nutritional value, why has McDonald’s dominated the globe as it has? An article in the September issue of Medical Economics has the answer, which—surprisingly enough—the author believes applicable to the emergency room, of all places.
McDonald’s success comes down to one word: Service. The author highlights the vast array of choices available once one walks through the doors of a McDonald’s. Not only does one have options, but—ideally, at least—a customer is made to feel as if he is special. And, as much of a role as McDonald’s may play in getting patients into the Emergency Room, the author believes that hospitals have something to learn from the model behind the Golden Arches.
Eighty-five percent of patients enter the Emergency Room with some affliction that will, with or without the assistance of a physician, sort itself out. Most ear, throat, and sinus infections will go away sans medication. Babies can be delivered without a doctor. Cuts will heal. So, mostly, ER doctors—according to the author—turn out to be rather unnecessary. So why are they there?
The author contends ER doctors are there in large part because patients come in response to pain or fear. Offer quick pain management and clear communication to alleviate patient fear and you’ve done the yeoman’s work in ensuring patient satisfaction. The author says this is no excuse for not knowing your craft, however. All the bedside manner in the world won’t help you intubate. But the author contends that the service aspect is all-important for doctors to understand because patient experience depends so heavily on it.
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Kaiser’s “Roving” Dermatologists Alleviate Physician Shortage
Source: East Bay Business Times
Date: 09/26/2008
The average wait in the United States to see a dermatologist is 33 to 36 days. As the population ages and more patients are likely to develop skin conditions that are more serious, this wait is likely to become a greater problem. As the rate of skin cancers and other serious skin conditions has increased, though, the field of dermatology—like most other fields in medicine—has experienced a shortage of practitioners. Kaiser Permanente, however, has developed an interesting approach to this problem: the roving dermatologist.
The program consists of Kaiser-connected dermatologists equipped with cell phones to respond to calls from primary care doctors seeing patients with suspicious moles and/or suspect rashes. Dermatologists then provide same-day service, sometimes arriving at the site for a consult within minutes.
As a result, patients are saved time, anxiety, and—through simultaneous billing—money due to the lack of a second co-pay. The system, which started in Pleasanton, is now used throughout the surrounding regions, alleviating at least in part the effects of the larger dermatologist shortage throughout the region.
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Hospitals Put Some Muscle into Sports Medicine
Source: Hospitals & Health Networks
Date: 10/01/2008
In an effort to attract more ambulatory patients, medical centers have begun to move sports medicine centers out of hospitals as a way to distance sports medicine from hospitals and their association with illness and inpatient treatment. Medical management experts say that the building of new facilities to attract sports medicine patients is profitable both in terms of hospital and physician income.
Performance enhancement is responsible for much of the growth in sports medicine programs. This focus is particularly lucrative for hospitals and doctors because many patients interested in performance enhancing treatment are healthy and are willing to pay out-of-pocket if the treatment isn’t covered by insurance.
The number of orthopedic procedures is projected to grow about 20% in the next decade, fueled in part by the aging population’s desire to remain active. Yet as the aging population shifts to Medicare coverage, medical practitioners should be aware that hospitals may lose room for negotiation regarding the use sports medicine treatment options versus other forms of treatment. The complexity of treatment for athletes at any skill level involves a full range of medical professionals, from orthopedic surgeons, to primary care doctors, physiatrists, nutritionists, athletic trainers and physical and occupational therapists.
Medicare payment options have not yet affected the popularity of sports medicine, and the populations’ desire for new treatments for arthritic joints is pushing treatment innovations and research further.
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More Than 10-Fold Difference in Number of Psychiatrists Across Europe
Source: Medical News Today
Date: 10/09/2008
A new report released by the World Health Organization’s European office provides new data on the policy and practice of mental health care across Europe. Indicators studied include numbers of psychiatrists, financing, community services, training of workforce, and frequency of antidepressant prescriptions.
It was found that treatment and other aspects of mental health care vary widely from country to country. The number of psychiatrists with respect to the general population, for example, is 30 per 100,000 citizens in Switzerland, while in Albania that number is much lower, at 3 per 100,000. The average for the 41 countries surveyed is 9 per 100,000. Clearly, the availability of treatment depends heavily on where one lives.
The study also found that there is significant variation between countries in their willingness to use involuntary admission, restraint, and seclusion as treatment tactics for the mentally ill. Training requirements for nurses were found to be inconsistent across borders, raising questions about competency in some countries, and the widespread lack of mandated continuing education for health care workers is of some concern.
The report concludes that across Europe there has been considerable progress in policy development, deinstitutionalization, and the establishment of services at local levels, but much of the continent still suffers from a lack of consistency in practice and education.
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The Uncertain Future of Primary Care
Source: Trustee Magazine
Date: 10/01/2008
The primary care physician is the gateway to health care in this country… or, at least, he should be. But why is the nation in the throes of a primary care physician shortage more acute than the larger physician shortage?
The problem stems in part from payment, of course. Neurosurgeons average $438,426 per year. Cardiovascular surgeons average $558,719 per year. Family physicians? $147,516. These numbers are not lost on medical students and recent graduates looking at average debts of $140,000. In addition, students are less likely to desire the hard life of traditional medicine: the long hours and little sleep. Thus, they take up specialties more fitting to their desired lifestyles: good pay, consistent hours, no emergencies, no call.
As a result, primary care physician populations are depleted. Allied health care positions are on the rise to take up the slack, with recent years seeing the rise of nurse practitioners, retail clinics, and the like. Increasingly, nurse practitioners can prescribe drugs, order tests, diagnose, and refer. Their services are also more accepted by payers. This rise, though, steps on the toes of organized medicine; so “turf struggles” are likely to result.
Solutions to the primary care crisis include reducing the debt load for physicians, paying more to primary care providers, and ending the medical school bias against primary care in general. Additionally, administrators and payers could encourage the growth of multispecialty groups, wherein primary care would not be a stand-alone function but part of a larger whole, which would result in greater respect for the field and, likely, increased numbers of doctors.
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A Team Approach to Orthopedics: Hospitals and Physicians Need to Work Together
Source: OrthoSupersite.com
Date: 10/01/2008
The medical field is undergoing massive changes. At least part of the seismic disruption from these changes is due to the fact that we have a health care system delivering 21st Century treatments on a 19th Century model. The whole system needs significant reconfiguring, with a team structure as the ultimate goal.
Among surgeons, the team mindset is particularly helpful. The author relates his experience in a medical center using the team model. Teams had a head physician of some renown surrounded by supporting physicians, physician assistants, and other professional staff. As a result, lab studies and data collections were non-intrusive, with visits coordinated for completion within the course of a single day, allowing patients to conduct their lives with minimal interruption. In general, the experience was more pleasant, with teachable moments for other institutions.
The author recommends the adoption of a time-saving approach, streamlined from pre-op visits through to post-op follow-ups. Such a system would allow for initial visits, diagnoses, imaging, and treatment discussions to occur on the same day, thus freeing up time for patients and clinics. A big step toward implementing such a system is instituting a system of pre-authorizations for payments.
Practices unaffiliated with a hospital should consider closer ties with a larger hospital, with such attachments making it easier to institute structural changes with minimal risk to the bottom line.
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Physician’s Personality Can Affect Depression Diagnosis
Source: AndhraNews
Date: 09/25/2008
A new study by University of Rochester Medical Center researchers shows that the personality of a physician can influence practice behavior while inquiring about patient mood symptoms. Some doctors are reluctant to bring up sensitive topics such as depression or suicide, and some use a screening questionnaire to avoid having to ask such questions. This accounts for the fact that depression is infrequently diagnosed, and physicians often do not inquire about suicidal thoughts in their patients.
The study used audiotapes and medical records from a study in which six female actors were trained to portray patients with major depression adjustment disorder with depressed mood. Forty-six physicians were studied, with eighty-eight patient visits, and physicians studied were scored in the categories of dutifulness, vulnerability, and openness to feelings.
Doctors who scored high in “dutifulness” were more likely to document a depression diagnosis but asked fewer questions about depression, with no difference in how likely they were to ask about suicide as compared to their peers.
One explanation may be doctors’ concern over time-economy: in spite of an apparently high level of vigilance, they were likely to ask fewer questions about depression, and unlikely to ask about suicide, which is arguably the most important symptom of depression.
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Payer & Reimbursement Issues
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Anthem Blue Cross Of California Pays Out Over $75 Million In Physician Bonus Incentives
Source: Street Insider
Date: 09/30/2008
Anthem Blue Cross has announced physician bonus incentives as part of its 2007 HMO Quality Scorecard program. One hundred and seventy-six participating physician groups throughout the state were paid incentives, which had a total value of over $75 million.
Since the implementation of the program in 2001, the performance level of physician groups has shown a significant increase in both clinical quality and member satisfaction. Those singled out for praise included, notably, health care professionals who conduct preventative screening, as well as those who have made particular efforts to improve the level of care available to patients who suffer from chronic conditions and diseases.
Anthem Blue Cross is the largest participant in the Integrated Healthcare Association’s Pay-For-Performance Program in the country, paying out more physician bonus incentives than any other health plan. The HMO Quality Scorecard program rewards physician groups for improving the quality of care given to HMO patients using health outcomes and patient satisfaction information from a number of clinical and service categories.
The quality measures include patient satisfaction surveys, clinical measures, patient waiting times before appointments, numbers of complaints and grievances, and a review of medical group or IPA functions.
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Blame Medicare for Primary Care Shortage?
Source: Managed Care Magazine
Date: 08/01/2008
According to researchers at the Cambridge Health Alliance and Harvard Medical School, the shortage of primary care physicians can be blamed largely on the Medicare system.
Their study, published in the Journal of Geriatric Internal Medicine, examined data from the 2004 Medical Expenditure Panel Survey. The survey estimates expenditures and utilization of health services. It was found that government payers account for 32% of physician income, with geriatrics, hematology-oncology, nephrology, and rheumatology deriving more than half their income from public payments.
Researchers contend that the public pays for quite a bit of the income gap between specialists and primary care physicians, which accounts for the movement of students toward specialties. Less disparity in payment might result in better primary care populations, they contend.
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Doctors Know Little About Consumer-Directed Health Plans
Source: National Institutes of Health
Date: 10/07/2008
A new study, which highlights doctors’ nebulous role in counseling patients on financial matters, finds that few doctors are adequately prepared to help patients navigate newer, so-called “consumer-directed” health plans, which are meant to shift more responsibility for health care decisions to the individual patient, and often come with high deductibles and include a health savings account.
Forty-three percent of doctors said they have heard little, if anything, about these plans, and less than half feel ready to discuss medical budgeting with their patients. It is important, therefore, to educate doctors about these plans, and to make them aware of the differences between the traditional and newer models of insurance.
Insurers do not appear to have a clear idea of what role they want doctors to play, and the physicians themselves do not appear to have a clear idea of what they are comfortable with. This situation is compounded by the problem that most patients have little idea of what sort of role they want their doctors to play, either. There is a certain stigma amongst both doctors and patients discussing money in a clinical context.
The article suggests that people enrolled in consumer-directed health plans should take advantage of online tools, which enable the consumer to compare costs and evaluate quality in order to make better medical decisions. One remaining problem, however, is that physicians remain skeptical about information provided by government and insurance websites.
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Credentialing, Licensure, Quality Management
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Revving Up the Quality Campaign
Source: H&HN Magazine
Date: 09/01/2008
An important issue facing the nation’s health care system has to do with the quality of care provided. In March, the federal Agency for Health Research and Quality reported a 2.3% improvement per year in quality of health care between 1994 and 2005 and a 6.7% increase per year in cost over the same period. In short, cost is greatly outpacing quality in the American health care system.
Proposed solutions abound for dealing with varying aspects of the outcomes quality problem. Some propose the use of short checklists for teams to fill out before treating patients in order to prevent adverse outcomes. In particular, one source indicates that surgical outcomes are improved significantly if surgeons go down a checklist that includes naming the patient, the patient’s affliction, and everyone participating in the surgery. Others believe payment systems must shift from the current per-service fee to a system of bundled payments in order to encourage greater cooperation among physicians, leading to improved patient outcomes.
Among measures gaining traction, quality metrics are at the forefront. Quality metrics that attain much publicity tend to be highly adopted by systems across the nation, according to numerous studies. Hospital Compare—a joint effort of CMS and the Hospital Quality Alliance—tracks 20 measures related to heart attacks, heart failure, pneumonia, and prevention of surgical infections. Additionally, efforts are underway to implement changes in quality measurements in payment. Current pay structures encourage the fragmentation of care instead of collaboration among physicians. A significant big payer player—such as Medicare—could, if it chose, start shifting toward bundled care pay. CMS has, in fact, unveiled just such a pilot program to test that pay strategy.
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Protecting Patient Privacy the New Fashioned Way
Source: Science Daily
Date: 09/29/2008
HIPAA regulations are widely recognized as crucial for the protection of patients’ personal health information but can also complicate the process of safeguarding public health. HIPAA regulations hinder the collection of information aggregated from multiple patients’ medical records that is needed in the development of new drug therapies and treatments and the prevention of epidemics and other life threatening events.
However, the most recent issue of the Journal of the American Medical Information Association discussed a new computer program that may resolve issues of public good vs. patient privacy that arise from the HIPAA regulations. The new Medical De-identification System (MeDS) is a software program that de-identifies patient information while retaining essential data for medical research. MeDS works by deleting identifying data in the patient’s history and physicals, discharge notes, and laboratory, pathology and radiology reports. This data is then replaced by the software with a symbol so that the research knows something was removed.
While there are currently some software programs that attempt to remove patient identifier data, the MeDS is the first to be described in peer-reviewed literature as being able to detect and eliminate misspelled names. While the program may sometimes eliminate information that does not identify the patient, its creator, Dr. Friedlin, says that he would rather there be “over-scrubbing” of information instead of risking patient privacy by setting the data elimination bar too low.
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Bridges to Excellence—Recognizing High Quality Care: Analysis of Physician Quality and Resource Use
Source: American Journal of Managed Care
Date: 10/01/2008
A recent study by the Harvard School of Public Health claims that the Bridges to Excellence Program—launched in 2002 by a group of large employers, health plans, and provider organizations to identify quality physicians—is, in fact, correlative to physician performance on claims-based quality measures and less resource-intensive practice styles by primary care physicians.
Bridges to Excellence was one of the first multi-stakeholder programs to implement pay for performance. Physicians are invited to seek BTE certification, whereupon they receive payment for all patients covered under the program’s sponsors.
The study used a claims data set of all commercially insured members from six health plans in Massachusetts. It examined population-based quality and resource use measures, comparing BTE physicians with controls. Differences in performance were tested using generalized linear models.
BTE physicians performed significantly better than their peers. Diabetes care, in particular, saw better performances, but overall patients were served in lower resource-intensive methods by BTE physicians. The study authors conclude that BTE could be a good accompanying program for a larger pay- for-performance system, though they hesitate to draw a direct causal relationship and cite the need for further research to examine the effects on patient flow and performance improvement.
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Kaiser Daily Health Policy Report: Unique Patient Identifier Technology Could Reduce Medical Errors, Increase Efficiency, Editorial States
Source: The Henry J. Kaiser Foundation
Date: 10/23/2008
Recently, the Houston Chronicle reported on a new RAND study that found a reduction in medical errors, a simplification of electronic transaction and an increase in efficiency and patient confidence resulting from the creation of unique patient identifiers (UPI). The UPI systems use a product bar code for each patient, limiting the risk of privacy breach from statistical matching programs that use patient identifiers such as name or social security number to retrieve records.
Despite a usage mandate from the 1996 Health Insurance Portability and Accountability Act, post 9/11 concerns regarding security issues and identity fraud have stalled the development of UPI systems. However, the results of the recent RAND study advocating the UPI system’s ability to reduce medical errors is encouraging for the increased implementation of error and cost-reducing innovations like the UPI system. Although the one-time implementation cost of the UPI system, which ranges from $1.5-$11.1 billion, is large, the start-up cost is minimal compared to the potential cost savings from a reduction in medical errors after the adoption rate of UPI systems reaches 90%.
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Quality Improvement of Psychiatric Care: Challenges of Emergency Psychiatry
Source: The American Journal of Psychiatry
Date: 10/01/2008
Mental illness compounded by risk factors such as alcoholic dependence or previous suicide attempts can quickly bring a patient to the emergency room. However, once there, appropriate care can be difficult to implement given the variety of patient- and procedural-related factors involved. Nonetheless, ten quality factors of emergency psychiatric care have been identified by the authors in an effort to highlight potential obstacles and enhance quality of care.
Timeliness: At the hospital studied, it was found that emergency wait times had steadily increased over the past 10 years. Part of the delay is caused by the hospital’s being a teaching hospital, where it is important that a certain group of people get a chance to experience the patient’s initial evaluation as a learning experience.
Insurance-Related Delays: Unlike patient admissions for medical or surgical problems, patients admitted with mental illnesses require a lengthy pre-authorization process in order to ensure proper insurance coverage prior to admission.
Absence of Therapeutic Relationship: If a patient is admitted initially at an out-of-network hospital for treatment and only later informed that he or she must move to a network hospital in order to receive insurance coverage benefits, a disconnect in the therapeutic relationship between patient and doctor occurs.
Delayed Care: Emergency rooms have become short-stay psychiatric services by default due to the lengthy wait times experienced by patients.
Patient Safety: Patients with mental illnesses tend to become increasingly agitated and restless when subjected to lengthy emergency room wait times. Overcrowding, risk of violence, and the lack of privacy in emergency rooms could escalate tension experienced by a patient already in distress.
Confidentiality and Privacy: Emergency departments are noisy and crowded, with patients asked to provide detailed, personal medical information out loud with others around. The emergency room setting is not conducive to sharing information comfortably. This can have an effect on the quality of information received by the staff.
Patient Satisfaction: Patients tend to perceive lengthy emergency room waits as evidence of poor care, in part because of the lack of meals, showers, and comfortable seating available. The time it takes for a patient to be seen also has a large bearing on patient satisfaction.
Determination of Dangerousness: All staff members must communicate regarding the perceived dangerousness of a mentally ill patient.
Relationships within the Emergency Department and Continuity of Care: Direct communication and careful handoffs between shifts are vital to ensuring the safety of all parties involved in treating a mental patient in an emergency room setting.
Efficiency: The emergency room staff does not have control over all factors that can lead to a delay in a patient’s processing time. However, issues such as appropriate triaging, bed availability, and continuity of care can be controlled by hospital staff, and efforts must be made to do so.
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Nintendo Wii Fits in Neurorehabilitation
Source: Health Care Review
Date: 10/09/2008
Fairlawn Rehabilitation Hospital is just one of the many medical centers across the country using the Nintendo Wii as a treatment tool to augment rehabilitation. The Nintendo Wii system, a video game console that includes a wireless Wii Remote controller, has received positive reviews from physicians and researchers regarding its ability to act as a rehabilitation device that improves patients’ strength, ROM, coordination, balance and visual tracking. Additionally, patients and medical staff report that the fun involved improves patient effort and compliance during treatment.
Rehabilitation experts have made simple adaptations to the Wii system to increase the number of patients who can benefit from the tool. For example, the Wii’s balance board can be placed on a treatment mat, and similar bolsters can be used to support patients while completing the Wii games from a kneeling or seated position. For patients with vision problems, projectors can be used to enlarge the virtual image.
Specific studies examining the efficacy of the Nintendo Wii as a treatment tool have not yet been completed, but patient experiences provide case-based evidence of successful interventions and previous studies on virtual reality exercise in rehabilitation provide some evidence of effectiveness. One such study regarding the use of a virtual reality training program in neurorehabilitation provided evidence of neuroplasticity and associated locomotor recovery after virtual reality training, and another study demonstrated improvements to functional mobility and balance after virtual reality treatment sessions.
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The Tech Doctor: E-mail Abuse Primer
Source: Physicians Practice
Date: 10/02/2008
The article emphasizes that the quickest way for valuables to be “stolen” from a physician’s office is via e-mail, and recommends that, for practices of any size, it is critical to have a documented e-mail use policy and to ensure that staff are well-versed in that policy. Dangers of misuse of e-mail at work include loss of productivity, clinical liability, and human resources problems. Vital information that may be in electronic format includes spreadsheets of provider/staff pay rates and bonus incentives, tax documents, photos of patients’ symptoms, transcribed chart notes, and thousands of patient records.
Practices can also protect themselves by specifying and documenting exactly what is and is not acceptable to send via e-mail, teaching staff to use the password protection utilities in word processing and spreadsheet application software, not allowing staff to export e-mail to CD/USB Key, or other external devices, and reminding staff that e-mail is subject to the same sexual harassment and other HR policies as verbal communication.
Small offices often consider e-mail servers too costly or impractical, in which case web-based mail is sometimes used to communicate. Free webmail services pose certain risks, however. They limit the owner/administrator’s control over individual e-mail accounts, and difficulties arise if a staff member is fired or leaves the company, as the administrator has no way of re-setting the password for the account or deleting the user’s account, without the employee’s cooperation. There is also little if any way of notifying patients and others that the ex-employee’s account is no longer a means of communicating with the practice.
Practice administrators should talk to IT support technicians about the use of e-mail encryption solutions, which offer enhanced security.
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ReachMD Launches First Ever Continuing Medical Education (CME) iPhone Application for Doctors
Source: Market Watch
Date: 10/23/2008
ReachMD, an XM satellite radio channel, has launched the first ever continuing medical education (CME) application developed for the Apple iPhone and iTouch. The CME application allows users to listen to fully accredited CME programs, get updates on new CME content each week, and take CME tests for credit.
ReachMD hopes that the CME application will help busy physicians stay updated on medical advancements and fulfill CME requirements. The iPhone application provides medical information and education in a multi-channel platform that includes the following features:
-iPhone accessible CME exams,
-References of past and present CME exams,
-Keyword search engine for specific programs,
-Automatic updates of new CME programs, and,
-New program and content alerts.
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Physician Practice Management
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Pharmacist Organization Evaluates Evidence for “Off-Label” Medication Use
Source: Medical News Today
Date: 10/09/2008
The Foundation for Evidence-Based Medicine (FEBM) and the American Society of Health-System Pharmacists (ASHP) are collaborating to launch an initiative which will enhance the current process for studying and publishing evidence for “off-label” uses of medications. The new procedure will compare proposed uses of present medicines with existing scientific evidence in order to speed up the evaluative process and approve new uses more quickly.
Applications for approval of off-label drug uses are submitted to FEBM along with a fee for consideration. FEBM then collaborates with ASHP to draw upon its broad database of scientific medical evidence to determine the eligibility of the proposed use for approval. Determinations will be publicly available at ahfsdruginformation.com. In addition to issuing a “recommended” or “not recommended” verdict, the level of evidence gathered and a graded scale of the strength of the recommendation will also be published.
The information collected and published by ASHP is recognized by Congress, and Medicare and Medicaid often use its approval of off-label drug uses to determine the scope of coverage and reimbursement they provide.
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Generic Drug Sampling Machines Lower Costs
Source: Physician’s News Digest
Date: 09/01/2008
Highmark and MedVantx have partnered to provide general drug sampling machines to approximately 700 physicians in 186 practices in western and central Pennsylvania in 2007. Participating practices include those with a significant number of Highmark members and those with a large volume of prescriptions.
The vending machines are stand-alone units located in physician offices that provide samples of high-quality generic medications for Highmark members at no charge to the physician or patient. The drug samples are usually low-cost medications that are widely prescribed for common ailments including blood pressure and depression.
In order to provide a patient with a sample of the drug, the physician only has to scan the patient’s chart and choose the drug from the machine. The drug is given to the patient with an insert of written instructions, drug benefits and side effects.
A study examining the drug sampling machine program found that the program increased the use of generic drugs and provided long-term savings for patients and employer groups because the program does not require sample co-pays. Additionally, routine return-on-investment analysis shows the programs consistent value to members and groups and high physician satisfaction.
Highmark hopes to provide the vending machines to all interested high-volume and middle-volume prescribers but has no immediate plans to expand outside its Pennsylvania markets.
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Taking Time for Empathy
Source: New York Times
Date: 09/25/2008
Identifying with a patient’s fear, anger, and frustration can be a difficult task for doctors, who so often see a multitude of patients throughout the course of a day. An article in the New York Times, however, claims that doctors must take time out for empathy for a better all-around patient experience.
The article cites a recent study published in the Archives of Internal Medicine, which focused on missed opportunities for interval empathy in lung cancer communications. The study examined recorded conversations between doctors and patients, looking at doctors’ empathy in communication on morbidity, symptoms, smoking, treatment, prognosis, and patient fears. The study identified that doctors only responded to 10% of opportunities and that these responses came mostly in the last third of patient conversations, even though patients had been expressing fears throughout the conversations.
The author claims the 10% statistic to be staggering, lamenting that nine out of ten times doctors are not adequately addressing patient concerns. The figure, she claims, largely grows out of the busy nature of the average clinic, but it is no excuse. Doctors must endeavor to increase such behavior as a way of improving the patient relationship and general outcomes.
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