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By J&C Research Associates |
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Physician Compensation and Contribution to Medical Facilities’ Bottom Line
It’s the start of a New Year and decade. We can only hope that in the coming months and years the major changes occurring in the health care field and challenges facing individual practitioners will be addressed suitably and in the best interest of all parties.
In this month’s edition of the Jackson & Coker Industry Report, we focus on physician compensation from two perspectives. First, our Special Report takes a look at physician compensation from the standpoint of proposed health care reform. Not until some final, reconciled Congressional bill passes will we know more precisely what’s in store regarding physicians’ earning potential. But even at this juncture, some key questions deserve attention.
Secondly, using updated compensation data gathered by an independent research firm, Jackson & Coker presents the “2010-2011 Provider Contribution to Operations Percentage Calculator.” This convenient tool enables hospital CEO’s and administrators to view current annualized compensation figures and input their own contractual adjustment percentages and immediately view customized contribution results for their particular facility.
In a time when hospital finances are strained, it’s helpful for administrators to adjust their physician compensation models to meet industry trends, while keeping a close eye on what can be expected in terms of revenue generation from different service lines.
Cordially,
Calvin Bruce
Managing Editor
Calculating Physicians’ Financial Contributions to Medical Facilities
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Charles Evans, FACHE, has remarked on the usefulness of the calculator: |
“I believe that the contribution calculator is an outstanding way for administrators to gain a perspective quickly and easily as to the direct financial impact of an additional physician on their organization.”
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What are doctors worth in terms of revenue generation for their medical services? Jackson & Coker has made available to the medical community the “2010-2011 Provider Contribution to Operations” calculator that is useful in answering this question.
Accounting for contractual adjustments percentages, hospital CEOs and other administrators can use this online tool to calculate average annualized revenue matched against average annualized compensation (updated for 2010 with fresh research data). This information is helpful in updating physician compensation models, planning for seasonal staffing shortages, and creating new service lines.
Another consideration when calculating anticipated revenue concerns “the cascading effect” of revenue generated by interrelated hospital departments.
Edward McEachern, VP of Marketing for Jackson & Coker, explains: “For example, when a hospital’s emergency department is adequately staffed, those physicians refer some patients to the operating room for surgery; the surgeons in turn request anesthesiology and pharmacy services, and so on. If any of the links in that chain restrict the patient flow, all of the following revenue centers will be adversely impacted. Therefore, the value of an individual physician must be viewed as part of a total revenue stream and not as a single billing entity.”
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Risk Management Tip of the Month: Ensure that your prescription pads are secure at all times and are not accessible to patients.
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Doctors Use Social Networks–Facebook, Twitter, YouTube–to Educate Patients
Source:
WSBT TV
Date:
11/14/2009
"Patient crashing, need 2 n2b8!" It's not a joke text from your cell phone-addicted teen. In fact, it could be an update sent out by one of your colleagues, if trends hold. A few Miami-area surgeons are proving that popular social networking sites like Twitter, Facebook, and YouTube aren't just for casual socializing anymore.
At the Miami Plastic Surgery clinic, some doctors have taken to updating patients’ families on the progress of surgeries via Twitter–the phenomenal micro-blogging site that allows for real-time updates. Another hospital in Detroit used the site to give live updates on the progress of a kidney tumor removal. Physicians maintain patient anonymity on the publicly accessible sites by using only an initial and being vague enough with details that unaffiliated parties would have trouble knowing what procedure is being done.
Other physicians have broadcast live video of surgeries. Still others have created iPhone apps to alleviate their own administrative loads.
It's not all live updates and video, though. Some physicians are using Twitter to communicate statistics and vital facts about breast cancer to their patients, while others share facts and product information that would otherwise clog up email inboxes or get caught in spam filters.
Patients, largely, are reporting satisfaction with the technological tweak. Surgeries are often long and complicated, and the Twitter updates keep families duly informed. Some are hailing the practice as a modern extension of classic bedside manner. Regardless, it is yet another example of how information technology is rapidly changing the practice of medicine.
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How to Focus More Attention on Profits in Tight Economy
Source:
Medical Economics
Date:
12/18/2009
With the economy struggling, private practices are increasingly put in the difficult situation of trying to provide the care their patients deserve and at the same time trying to remain afloat financially. An article in Medical Economics takes a look at some of the methods practices are adopting to ensure they can do both.
Doctors are taking a number of measures to try to make ends meet. The article points out at least one doctor who is moonlighting as an emergency room physician just to make up the revenue lost since the economic downturn. With patients losing jobs and insurance, practice bottom lines are suffering. Increasingly, practices are streamlining their billing and collection programs, while other practices are sharing space, and some are starting to offer simple cosmetic procedures.
Another trend among practices is the switch to expedited compensation. Practices are increasingly using electronic payment transfers, credit card processing, and real- time adjudication. Real-time adjudication, in particular, allows practices to determine exactly how much a patient will have to pay taking into account co-pays and deductibles. Additionally, practices are putting more resources toward informing patients as to their financial obligation upon completion of services rendered.
With regard to collections, practices are increasingly setting up more efficient credit and collection processes. They are also discussing these policies with patients, but a number of practices are continuing to see patients even though they know they will not be able to pay. This is operating along the mindset that the patient deserves care and it will be more expensive to treat them in the future if they forego care now.
The recession is hitting just about everyone hard, but these physicians are showing that they can still practice medicine and provide for their patients without making all of the sacrifices themselves.
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850,000 Physicians Urged to Be on Lookout for Signs of Identity Theft
Source:
American Medical News
Date:
10/19/2009
Does your practice contract with BlueCross/BlueShield or a BCBS affiliate? Your personal information, and that of nearly a million other doctors, could be in the hands of identity thieves.
In August of this year, a BCBS employee violated company protocol and downloaded physician data for all contracting doctors onto a personal laptop before taking it home. Later, the employee’s car was broken into and the laptop was among the items stolen. The laptop contained data on every physician affiliated with BCBS, totaling some 850,000 physicians nationwide.
The laptop contained name, address, tax identification number, and national provider identifier information for every physician who is part of the BlueCard network. Of the physicians whose information was stolen, between one in six and one in five had their Social Security numbers as NPI or tax ID numbers. No health data or prescribing information was contained on the stolen laptop.
While BCBS officials say they have taken steps to rectify the situation and ensure such a breach doesn’t happen in the future, the breach does signal a greater need on the part of physicians to guard their personal information. Experts recommend taking part in the free credit monitoring service now offered by BCBS, as it is possible that the information could fall into the hands of identity thieves. If your Social Security number has been compromised, you will want to file for a unique tax ID and NPI. Most of all, watch out for unusual claims activity that could indicate identity theft.
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The Top 10 Medical Advances of the Decade
Source:
MedPage Today
Date:
12/17/2009
The pace of medical technology advancement continues to accelerate, which means the first decade of the new century brought even more medical advances than one could have anticipated. But which technological breakthroughs and discoveries had the greatest impact this decade? An article in MedPage Today takes a look at ten advances that have changed the face of medicine.
The top two advances have to do with data, but data of two very different types. First, there is the realization of technologies from the Human Genome Project, which has led to genetic tests and treatments for a variety of ailments and disorders. Then there is the rise of health care information technology. The continuing advance of digital technology in health care will likely mean increased efficiencies and improved outcomes through fewer medical errors.
While not specifically a technological advance, one could argue that the prevalence of smoking bans throughout the decade amounts to a societal advance, as more states ban smoking to decrease the risk of stroke, cancer, and many other diseases. Tied to that, we've seen a drop in heart disease deaths of 40% over the past quarter century. This has come about due to pharmaceutical advances and medical device advances as well.
Another huge, though controversial, advance is the rise of stem cell research. Much progress has been made with stem cell research over the decade, and the lifting of the federal ban on embryonic stem cell research earlier this year is likely to accelerate the pace of innovation. Also important is the prevalence of new cancer drugs, which can greatly increase the likelihood of survival for recently fatal cancers.
Other advances of note include the development of new HIV/AIDS treatments; the development of minimally invasive and robotic surgical techniques that allow for greater precision and shorter recovery times; the linkage of heart attack and cancer risk to hormone replacement therapy; and the development of functional MRIs, which allow scientists to see the workings of the brain in real time.
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Doctor-Owned Hospitals Worried Reform Will Cripple Them
Source:
HealthLeaders Media
Date:
12/17/2009
Chalk up one more dissident party in the battle over the health care reform bill trudging its way through Congress. This time, it's the Physician Hospitals of America, a representative group of 235 doctor-owned surgical facilities, that's claiming that provisions in the bill will mean the death of physician-owned hospitals.
According to PHA, provisions in the bill will keep their constituent facilities from being able to expand, purchase new equipment, and competitively recruit top talent. Not a single physician-owned hospital, they claim, can live up to the criteria established for growth in the bill.
The measures at issue are, according to legislators, an attempt at limiting the influence of physician self-referrals and ensuring that physician-owned hospitals do not solely skim high-profit patients off the health consumer pool, leaving Medicare and lower income patients to the larger hospitals. As such, physician-owned hospitals are allowed to expand only if they meet four of the five following criteria:
-Location in a county where population increased at a rate that is at least 150% of the state's population increase.
-A share of Medicaid admissions equal to or greater than the average percentage for all hospitals located in the county.
-Location in a state with average bed capacity less than the national average.
-Average bed occupancy rate greater than the state average bed occupancy rate.
-The largest stake in Medicaid admissions in that county for the previous three cost reporting periods.
Larger hospitals, for their part, contend that the rules are fair and a vital check on the growth of institutions that have no obligation to serve anyone but those that can afford their services. Physician-owned hospitals counter that the reforms effectively maintain the monopoly large hospitals hold over much health care provision. Their facilities, they contend, were born out of the desire for surgeons and practitioners to have greater control over their own provider experience.
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Top 10 Medical Innovations for 2010
Source:
LocumLife
Date:
11/15/2009
The pace of innovation in medical technologies continues to accelerate at a stunning rate. It is not easy to get a sense of exactly where technology will take the treatment aspect of medicine, but a look at recent advances gives us a good idea of what tools you may be using to treat patients in 2010.
The renowned Cleveland Clinic took a look at emerging technologies that seek to shape health care delivery in the coming year and came up with ten technology advances that will have an immediate impact. Chief among the discoveries are non-surgical techniques that will allow for implantation of a device to treat single-sided deafness via jawbone conduction.
Other discoveries include low-volume tracheal tube cuffs for the reduction of ventilator-associated pneumonia and continuous-flow ventricular assist devices. The continuous-flow devices will be attached alongside the heart, allowing them to essentially take over the heart’s pumping job.
Recent advancements in anticoagulants will lead to warfarin alternatives that will let patients dose themselves without fear of clot formation. Furthermore, study results indicate that exercise can improve motor functioning in Parkinson’s patients.
Additionally, the Cleveland Clinic points out advances in fertility preservation that will allow for improved storage of a woman’s eggs, and self-contained, at-home sleep-monitoring devices will allow for easier treatment of sleep-related breathing disorders.
It is challenging to speculate where technology is going to take the health care field, but it seems certain that technologies such as these will lead to improved outcomes, and perhaps an easier load on providers.
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Seven Things You Didn’t Know Were in the Senate Health Bill
Source:
Kaiser Health News
Date:
11/30/2009
As 2009 ended, the Senate went about the lengthy business of hammering out its own version of health insurance reform. Since experts believe the 2,074-page Senate version has a better chance of final passage than its House counterpart, it is probably a good idea to take a look at what is included in the bill, because there might be some surprising facets that will affect your practice.
First up is a requirement that employers provide an unpaid “reasonable break for nursing mothers,” in which nursing women are provided a private place and time to use a breast pump. There is also money allocated for “adult preparation” programs for teenagers, telling them all the particulars of dating, marriage, and other relationship dynamics for $400 million. Another $5 billion goes toward benefits for retirees.
On the practice side, the bill looks to boost payments for medical imaging, promoting the use of bone density scans. The Senate version proposes an increase in Medicare reimbursement rates to 70% of 2006 levels, a welcome bonus after years of decline.
Additionally, the Senate bill will place a cap on the amount low-income uninsured emergency patients are charged for services by nonprofit hospitals. Studies have found uninsured and self-pay patients are often charged 2.5 times what insurers actually pay, and the provision aims to change that as well as to require financial assistance and discounted care programs in all hospitals.
On the payer front, the Blue Cross/Blue Shield plans will have to spend 85% of every premium dollar on health services. Otherwise, they risk losing their tax status. And, finally, pharmaceutical benefit managers will be required to disclose the details of their negotiations in setting drug prices.
Of course, with a 2,000-plus page bill, this is by no means a comprehensive list of what to look out for, but it helps to keep in mind that if and when a final bill is passed, it will likely have a particular impact on specialty practices, and not just the payer industry on the whole.
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New Jersey’s Tough New Conflict Regs Face Uncertain Future
Source:
Medical Marketing & Media
Date:
12/07/2009
Physicians in New Jersey will not be getting a free lunch from the pharmaceutical industry any more…literally. New regulations from the state’s Division of Consumer Affairs are cracking down on pharma gifts and interaction with physicians. The incoming administration, however, might put the brakes on some of the more stringent requirements.
The Division’s move is the latest in a string of incidents in which state governments have sought to curtail the influence of the pharmaceutical industry on physicians’ prescribing patterns, practice patterns, and medical education. Developed over two years, the proposals would restrict data-mining by pharmaceutical companies and require companies to disclose payments made to physicians for consulting services. These two measures, however, seem unlikely, as they would require legislative action. The incoming governor is said to be “pro-business and pro-pharma” and is unlikely to bring about further restrictions on the industry.
One measure likely to survive the transition is a ban on gifts from pharma companies coupled with a doctor disclosure requirement. Whereas other states make pharma companies disclose gifts, New Jersey would require physicians themselves to disclose gifts on a public database. The regulations would ban company-paid gifts, fees, travel expenses, and...any free food in offices and dinner meetings.
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Video Games May Have Potential Health Benefits
Source:
American Medical News
Date:
12/04/2009
Could that game of Wii Tennis get your pediatric patients active enough to head off childhood obesity? What about the effects of Dance Dance Revolution on your Parkinson's patients' mobility? Video games might not just be time wasters anymore, and some studies with serious money behind them could have you swapping out your prescription pad for a control pad.
The initiative comes from the Robert Wood Johnson Foundation, which has put $1.85 million in grants behind studies to look into the efficacy of games in engaging players in physical activities and driving healthy lifestyle changes.
In the past few years, video games have moved beyond the stereotype of the lonely gamer twiddling his thumbs, blank-eyed in front of a screen. Modern games now integrate player movement with what's happening on the screen. Some researchers believe there are beneficial aspects to this. In one case, the Children's Hospital of Philadelphia is measuring the effects of games on the brain activity and facial perception skills of adolescents with autism spectrum disorder. Researchers at George Washington University are gauging the effects of two video games on physical activity levels in inner-city elementary school students. And the Teachers College at Columbia University will gauge the effectiveness of a smoking reduction game application for mobile phones.
While the full effects of physical gaming have yet to be seen, researchers are optimistic about their potential as a health driver, citing a good deal of evidence that they make good motivators for learning and healthy behavior change.
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Use Medical Staff Membership to Integrate, Not Separate, Satellite Clinics
Source:
HealthLeaders Media
Date:
12/04/2009
Trying to bolster a stronger connection between your hospital staff and their satellite clinic peers? HealthLeaders Media has a suggestion that--while a bit unexpected--might be just the thing to give the various facets of your organization that closer alignment you are, indeed, seeking.
While it is common to see hospitals granting privileges to satellite facility physicians, the article argues that hospitals should go one step further and give clinic practitioners medical staff membership. Granting such membership will result in greater dedication to the organization among clinic staff. This is better than simply granting privileges to satellite practitioners because it also brings them in line with the responsibilities adhered to by your regular medical staff, integrating clinic doctors into organizational operations better than if they just had hospital privileges. Such a move would also likely engender greater participation in meetings, as clinic physicians are then beholden to larger hospital policy.
Other ways to improve the bond between clinics and your hospital include making medical staff meeting attendance mandatory. This will ensure that your staff from multiple locations will gather in one spot for discussion. Also, consider holding social events and departmental meetings at clinic locations. This way, your hospital staff gets to know the off-site facilities better. Lastly, include news updates from clinics in the hospital monthly newsletter. If you have photos for your physician-of-the-month page, that will help all staff get to know each other.
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Medical School Enrollment Continues to Rise, but Are Graduates Prepared?
Source:
LocumLife
Date:
11/15/2009
Efforts to head off the coming physician shortage are in full swing, but are medical schools churning out graduates who are unprepared to function in the business of health care provision? A study published in Academic Medicine suggests that medical school graduates are not ready to handle the economics of practice.
The study, conducted by University of Michigan Medical School researchers, surveyed more than 58,000 medical students between 2003 and 2007. Respondents indicated confidence in their clinical training, but 40% to 50% of respondents indicated that they were inadequately trained in the particulars of health economics, medical record keeping, practice management, and similar issues. Additionally, the study compared graduates of two top-ranked medical schools. One school had a high intensity curriculum in health care systems, while the other did not. The study found that students coming from the high intensity programs were three times more likely to report adequate training in health care systems. Furthermore, the time spent on this training did not appear to adversely affect clinical training confidence.
The number of students applying and graduating from medical schools in the nation has steadily been on the rise. Four new medical schools account for nearly half of the enrollment increases, but twelve other schools have increased class size in recent years. Also, more people are taking the Medical College Admission Test, indicating that the number of applicants will continue to climb. If such is the case, additional measures will have to be taken to ensure that future generations of doctors will know how to run the business of medicine.
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Employment & Compensation
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Grow Your Income
Source:
Physicians Practice
Date:
11/28/2009
The economy is tough on us all, and physician practices are especially feeling the pressure. If your practice is feeling the pinch, you are certainly not alone. A new survey report from Physicians Practice attempts to illustrate how the financial strain is impacting practices and what physicians are doing to shore up the bottom line.
The decline in revenues is felt across the industry as a whole, with approximately 40% of practice owners saying their incomes have declined in the past year. By contrast, approximately 20% of employed physicians took a hit in terms of their income. The trend is especially felt in the primary care arena, as compared to the specialist arena, where physicians are six times more likely to make $300,000 every year. But even specialists feel the economic crunch; both a majority of specialist practice owners and primary-care owners said their net income was disappointing.
In light of these trends, the practice arena is seeing an increase in the use of physician extenders. These non-physician caregivers are often quite useful for lowering costs and increasing efficiencies. As doctors are increasingly concerned with work-life balance, physician extenders, as well as the practice of hospital employment, are becoming increasingly common.
If you are looking to increase revenues, you might want to consider taking advantage of hospitalist services. It is common for physicians to make more money seeing patients in the office instead of daily morning rounds at a hospital. While hospitals are somewhat notorious for poor billing, the time you free up to see additional payments may in fact make up for any potential financial hit.
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Training Residents in Community Health Centers: Facilitators and Barriers
Source:
Annals of Family Medicine
Date:
12/01/2009
Could a partial solution to the primary care workforce shortage be sitting right under our noses? Researchers at the University of Washington are saying that might very well be the case.
The researchers examined the relationship between family medicine residencies and community health centers. Their thinking is that the population of family medicine residents provides a worker base from which to address the needs of underserved communities, all while training the next generation of physicians.
The study involved interviews and focus groups with informants from residency programs and community health centers. The researchers eventually hit on four major themes dictating the success of CHC-FMR training partnerships: mission, money, quality, and administrative/governance complexity. The partnership is of the sort that needs to address both the education of residents and the health needs of the community.
The researchers concluded that a CHC-FMR training partnership is a viable option, but it is reliant upon the development of a shared mission incorporating education, service, innovation, and flexibility. In an age where the physician shortage is likely to leave numerous communities critically short on primary care providers, these findings might help alleviate a very serious problem.
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Can Health Courts Cure the Malpractice System?
Source:
Physicians Practice
Date:
01/01/2010
The Obama administration is spending $25 million to fund studies and pilot programs to determine the impact of medical liability reform efforts on health care costs. One solution, argues an article in Physicians Practice, is to move the malpractice system out of the civil courts entirely. Instead, they should fall under the purview of specialized medical courts. Could this be the solution to both physician and patient needs?
In theory, the medical malpractice court might look something like a worker's compensation proceeding. Instead of a jury, parties would argue in front of a health care judge versed in malpractice law and the practice of medicine. The court would also have need of access to independent experts to provide the judge with unbiased opinions on the facts at hand.
Instead of capping malpractice awards, the health court system holds to the concept of a ladder or schedule of claim awards. In this system, the claimant is compensated for specific medical losses as well as noneconomic claims. The system, proponents say, works better than a cap system because it simplifies and expands the award system rather than simply capping it at a maximum. Research suggests the system would also lead to more speedily expedited claims.
The medical court system would save money by replacing the negligence standard with the idea of avoidability: Did the injury result from medical care or the withholding of medical care? Could it have been avoided, given best practices? If the answer is “yes,” then damages are awarded.
While this model would bring about much needed changes to malpractice in this country, it's essential to know that the best method for preserving your practice is to stay out of the malpractice court altogether, whether civil or medical. Experts recommend that physicians go the extra mile to get their coding processes down and efficient. More than a few malpractice suits have been headed off due to diligent documentation and proper coding.
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Strategies to Avoid a Malpractice Suit When a Patient Commits Suicide
Source:
Psychiatric Times
Date:
11/03/2009
Beyond the tragedy of the loss of a life, the suicide of a patient can put you at a severe risk as a psychiatric practitioner. That said, it is important to ensure that you take every reasonable measure to prevent patient suicides. An article in Psychiatric Times examines how you can better protect your patients from themselves and yourself from possible litigation.
The key to suicide prevention is documentation of risk factors. Noting suicidal ideation is simply not enough: psychiatrists need to gather input from family and note patient behavior before releasing patients from the hospital. Psychiatrists must systematically gather data on a patient’s protective factors–those factors making them less likely to carry through with a suicide attempt–like custody of a minor, presence of a support group, and coping skills. These are important to note when considering discharging a patient, as their absence raises the likelihood of a suicide attempt.
With inpatients, psychiatrists need to make sure to keep a close watch on possible suicides, as you are required by law to prevent foreseeable attempts and take precautions after the identification of a patient at risk. It is important to note signs of improvement: e.g., appetite, sleep schedule, group therapy attendance, and disposition. The law expects you to catch noticeable risks and take all the necessary precautions.
Your liability risk increases if you put too much faith in your patient’s statements over their behavior. For this reason, you should not rely too heavily on no-suicide contracts, as patients are known to lie to psychiatrists if they have already decided on suicide. It is also essential to involve a patient’s family in treatment, since patients are over three times as likely to say goodbye to family as to a therapist. That said, there is perhaps no way to prevent every single attempt, but if you look for the signs and look closely, you can potentially save your patient and save yourself a great deal of difficulty.
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Litigation amidst Reform – The Boston Medical Center Case
Source:
New England Journal of Medicine
Date:
11/05/2009
As with many areas of political reform in America, major overhaul in the health care industry is unlikely to come to fruition without many a litigious action. Indeed, a case before a court in Massachusetts might very well forecast coming litigation on a national scale.
Massachusetts’ health care reforms are widely touted as a possible solution for America on the whole, but the overall plan has run afoul of the state’s safety-net hospitals—those charged with caring for patients least able to pay. Under Massachusetts law, those hospitals are required to provide service to patients regardless of their ability to pay. Additionally under Massachusetts law, the state is required to pay them a “reasonable” amount for Medicaid services.
The conflict arises in that the state, in an effort to extend coverage to all citizens, has had to reduce Medicaid reimbursements. For institutions servicing a large amount of Medicaid patients, this constitutes a huge problem. In the resulting lawsuit, the Boston Medical Center (BMC) alleges that the reductions in compensation amount to the state making nonconsensual use of BMC’s facilities. The state counters that BMC agreed to treat Medicaid patients at a reasonable compensation rate.
This is not the first lawsuit between hospitals and governmental bodies. The 1990s saw a number of suits based on “reasonable” state reimbursement rates. Additionally, previous cases from earlier this decade handled similar matters. This case, though, is the most significant to come about in the midst of sizable health care reforms. As such, it is an object of interest, in that it may have some impact on the larger national reform scheme as it works its way through Congress. Furthermore, the success or failure of BMC’s effort in the courts portends heavily for organizations that are likely to be affected if national measures look to increase coverage on the backs of safety-net organizations.
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Baylor's Kelsey-Seybold Clinic Family Medicine Residency to Close in 2011
Source:
AAFP News Now
Date:
11/30/2009
With all the recent focus on shoring up the primary care provider base, the last thing you'd expect to be closing would be a family medicine residency program, right? Wrong, apparently, as the Baylor College of Medicine's family medicine residency program has announced it will be shutting its doors come July 1, 2011.
The program, which recently received a 5-year accreditation cycle from the Accreditation Council for Graduate Medical Education, has been experiencing major financial troubles for at least three years. This was around the time that stipends from a major teaching hospital were reduced by half, which, in turn, forced Baylor to cut its resident component by a third. Since then, the program has endured financial shocks that, eventually, made the program unsustainable.
Administrators reached the decision to close earlier this year, and announced the decision to residents and faculty in late September. The teaching program will endure through July of 2011, which means that current second- and third-year residents will be able to complete their training within the program, but students beginning their residency this year will need to find new positions beginning in July of 2010.
Baylor's program is yet another in a counterintuitive trend of family medicine residency program closings. According to the American Academy of Family Practitioners, the academic years from 2003 to 2008 saw the closings of some 30 family residency programs. Experts blame the current funding mechanisms for graduate medical education, which do not route funding directly to residency programs.
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Doctors Called on to Screen All Adults for Depression
Source:
American Medical News
Date:
10/26/2009
Primary care providers are being asked to take on another responsibility. This time it is for greater vigilance regarding their patients’ mental health, as the American College of Preventive Medicine (ACPM) has released new recommendations regarding depression screening.
Depression, in any given year, affects 6.7% of American adults. In other words, about fifteen million people every year report depression symptoms. As primary care physicians are the main point of contact for most people, the ACPM has noted the vital role primary care providers can play in improving mental health.
The ACPM’s new guidelines build upon extant recommendations from the U.S. Preventive Services Task Force, which called for clinical practices to have systems in place for diagnosing depression screening and enabling follow-up. ACPM officials note that they want depression to have the same sort of screening importance as high blood pressure or any other serious condition. They contend that, while it does mean an increased time commitment, screening generally only takes a few extra minutes unless the patient has major symptoms. Others argue that, with reimbursement rates on the decline and patient visit time declining as well, it is difficult for primary care providers to fit even one more screening criterion into their visits.
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CT Scans May Predict Survival in Colorectal Cancer
Source:
Medline Plus
Date:
12/01/2009
Innovations in the use of imaging technology might save colorectal cancer patients the pain of unnecessary surgery, as researchers from the University of Texas now claim that CT scans can detect patient response to cancer treatment.
Researchers at the University of Texas M.D. Anderson Cancer Center have announced preliminary findings indicating that CT scans can help doctors more easily personalize treatment for patients. Whereas most doctors currently rely on tumor shrinkage to gauge effectiveness of treatment, this typically requires invasive surgery. UT researchers, working with radiology specialists, developed a screening protocol for CT scans of colorectal tumors.
The study in question involved 234 colorectal liver metastases from 50 patients who had undergone tumor removal and treatment with Avastin and chemotherapy. Radiologists studied the images of the tumors to look for changes in shape and structure and noticed clear patterns differentiating good-response patients from poorer and no-response patients.
The study’s authors caution that these are still preliminary results, but the technique could wind up saving a significant number of patients the discomfort of surgery.
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Diabetes Care Will Cost $336B by 2034
Source:
MedPage Today
Date:
11/27/2009
Diabetes looks to only increase in prevalence over the next two and a half decades, by all accounts; and that will undoubtedly lead to an escalation in spending for the treatment of the disease. This is the assessment of researchers at the University of Chicago.
The continuing obesity epidemic is resulting in earlier diagnoses of diabetes. This, in combination with the costs associated with lengthy durations of the disease, means that costs will only continue to rise. While some 24 million Americans are currently living with diabetes, costing the system about $45 billion, the cost is expected to quadruple by 2034 to $171 billion. This is a faster rate of increase than was previously expected.
The figures come from studies modeled off current BMI and obesity trends in the United States. Cost figures were derived using the U.S. Government's Medical Expenditure Panel Survey, and the model is said to account for the natural history and change in the life of a patient with diabetes. The study does not, however, take into account potential future changes in diabetes screening rates, immigration by people younger than 24, or baseline age-specific rates of obesity.
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Hospitalists and Primary Care Physicians: Strategies for Keeping in Touch
Source:
Medical Economics
Date:
10/23/2009
Communication is absolutely essential, especially when it comes to admitting patients. Communication among hospitalists and primary care physicians can streamline the hospital process for patients and improve outcomes. It is recommended for hospitalists to ask primary care physicians how they want to go about handling patient-related communications, as the primary care provider is the one that will be seeing the patient after discharge from the hospital. While some have adopted EMRs, some prefer phone communication, and more still prefer faxes or secure e-mails.
It is generally a good idea to keep patients in the loop as well when it comes to communication. Patients may be somewhat confused at moving from their primary care provider into the hospital environment. Doctors can alleviate these fears by informing patients of exactly whom they are being handed off to, what role that doctor will play, and the referring doctor’s confidence in the hospitalist.
Additional ways of keeping patients informed include hospitalist websites, which can give greater detail about the profession. Also, you might want to point patients and families toward the hospital’s website or a hospitalist group’s information page and set clear expectations between all parties about the amount of communication to expect. Inform referring physicians when a patient is admitted, when major procedures and tests are being performed, and when patients are discharged.
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The Ethics Inventory
Source:
Psychiatric Times
Date:
12/01/2009
While contemporary bioethics focuses largely on big issues such as end-of-life care, genetic technology, and resource allocation, the majority of practitioners deal with day-to-day ethics that are much less likely to garner headlines. But it is these daily ethics that pose the greatest issues for modern practitioners; so an article in Psychiatric Times takes a look at how to make it through the modern world of ethical practice by taking regular account of oneself.
The idea is the “ethics inventory,” based on the American Psychiatric Association's publication The Principles of Medical Ethics: With Annotations Especially Applicable to Psychiatry. The professional statements contained therein are largely applicable to other behavioral health professions. For psychiatrists, though, the code can emphasize the personal responsibility clinicians should take for their own moral attunement.
The ethics inventory, while having no set rules, is generally centered around four principles:
-Choose a period of clinical work for self-observation.
-Keep a journal to avoid the problems of memory bias.
-Exercise your best therapeutic technique on yourself, while focusing on growth rather than blame.
-Choose a couple of aspects that need ethical alignment and give thought to the factors underlying the problems in your approach.
Do note that this is not meant to be an exercise in self-flagellation and guilt. Rather, take any less-than-stellar marks you receive from your self-evaluation and use them as targets, goals to achieve by the time your next inventory rolls around. No one is perfect, and that goes for mental health professionals as well. But exercises such as these can make sure that you are at least on target, and if you miss the mark, you're not too far off the goal.
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Payer & Reimbursement Issues
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Cost to Primary Care Practices of Responding to Payer Requests for Quality and Performance Data
Source:
Annals of Family Medicine
Date:
12/12/2009
Quality reporting is a major topic nowadays, as is the idea of pay-for-performance. Both are touted as ways to improve efficiencies, lower costs, and improve patient outcomes. While this all may be true, nothing comes for free, and the party that tends to wind up paying for these sorts of initiatives is the participating practice. So what does participation in these programs wind up costing practices? A new study out from researchers at the University of North Carolina has the details.
The study, conducted by Family Medicine and Health Policy faculty at the University of North Carolina at Chapel Hill, used mixed quantitative-qualitative methods to gather data from eight North Carolina practices and examine the impact of Medicare's Physician Quality Reporting Initiative, Community Care of North Carolina, Bridges to Excellence, and Improving Performance in Practice.
The researchers found that compliance with the quality and reporting initiatives resulted in sizable expenses incurred by practices. This came in the form of personnel time for planning, training, registry maintenance, visit coding, data gathering and entry, and modification of electronic systems. For each full-time equivalent clinician, the costs ranged as high as $11,100 during implementation and up to $4,300 thereafter. These costs were found to vary along program characteristics and personnel expertise.
The authors of the study concluded that the cost of these programs varies greatly depending on a number of factors. They call for greater financial incentives for the adoption of such programs, as well as improved training regimens for personnel. Otherwise, the price of compliance is likely to continue to fall largely on individual practices and discourage their participation in quality-reporting programs.
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Cash Flow Squeeze: 2012 IRS Rule Will Withhold Some Medicare Pay
Source:
American Medical News
Date:
12/07/2009
2012 might prove to be a year to dread after all, as a much-overlooked provision deep in a 2005 tax bill looks to have an impact on a physician’s bottom line.
The provision, a little-known portion of the 2005 tax bill, calls for the IRS to withhold 3% of payments to any contractor doing work for federal, state, or local governments. While Medicaid is excluded, Medicare is not. That means, starting in 2012, practices and hospitals serving Medicare patients may receive only 97% of what they are owed.
The withholdings would be applied to the next year's tax obligations, and a refund would be sent for an overpayment. This may not be such an issue for for-profit organizations and large group practices, but smaller practices and nonprofit organizations with high numbers of Medicare patients are likely to feel the pinch.
The withholdings are meant to cut down on tax evasion committed by federal contractors–particularly those working for the Department of Defense. However, the way the tax law is structured, it casts a wide enough net to pull in Medicare providers.
A number of attempts have been made in Congress to either repeal the measure entirely or to carve out an exception for practices and hospitals. As of yet, those attempts have failed or stalled. Physicians groups are actively lobbying the legislature to address the issue, but physicians and hospitals must also accept the possibility that nothing will be done, and a 3% payment cut might just be on the way.
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Hospitals Ease Off in 'Sick Tax' Battle
Source:
Salt Lake Tribune
Date:
12/17/2009
With a name like the "sick tax," you know it can't be good for hospitals. But Utah hospitals are looking to hold their noses and swallow as they work with state legislators to create a new levy on themselves for treating Utah's poor.
They're reluctant to go through with it, but Utah hospitals have given their okay to a deal that would bring in $75 million in new funding, about $50 million of which would be federal funding, to cover treatment costs for Medicaid patients. Hospital group representatives acknowledge the current financial strain present on state and federal coffers as a primary reason that they're going along with the plan.
Under the plan, the state would levy a new tax of about $23 million on Utah hospitals. That tax would allow the state to qualify for further federal funding to the tune of more than $50 million. Since both the state and the hospitals are laboring with strained budgets, organizers of the effort are trying to arrange it so that the hospitals will pay the $23 million to the state after they've received the compensation funds from the federal government. This, of course, will have to pass federal scrutiny.
Hospitals in the state have, for years, been struggling against legislative efforts to increase taxes on hospitals. This tax was denounced as a "sick tax," since the costs are passed on to patients who stay in hospitals. The hospitals finally gave in to legislative demands when the most recent budget made large cuts of fifteen and seventeen percent in Medicaid funding for this year and the next respectively. The new funding is expected to restore some of the funds from those cuts, but reimbursement levels are still expected to be about ten percent lower than those of two years ago.
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AAFP Opposes Effort to Postpone Physician Payment Rule
Source:
Physicians News
Date:
12/12/2009
A recently proposed amendment to the health care reform bill working its way through the Senate has met with strong resistance from the American Academy of Family Physicians, which claims the amendment constitutes a continuance of wasteful spending policy and weakens the primary care field at a time when that is precisely the sort of care most suffering under the current system.
The amendment, proposed by Arlen Specter, a Democratic senator from Pennsylvania, would postpone the implementation of the CMS 2010 fee schedule. That CMS rule eliminates consultation codes and redistributes savings to all evaluation and management office visits. This would result in an increase in payment for primary care office visits of six percent.
In opposing the amendment, the AAFP points out that its passage would result in continued overpayments by the Medicare system, citing an Office of the Inspector General report that faulty consultation billing costs the system almost a billion dollars each year.
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Credentialing, Licensure, Quality Management
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Learning from Our Mistakes 10 Years After to Err Is Human
Source:
HealthLeaders Media
Date:
12/02/2009
In the health care world, with patients' lives often at stake, the notion that "to err is human" isn't quite good enough. Medical errors cost lives and money, and the industry is constantly on the lookout for ways to lower the frequency of their occurrence. An article in HealthLeaders Media explores some of the most recent best practices to cut down on the likelihood of serious medical errors occurring.
With medical errors, it typically comes down to a matter of checking and double-checking. Technological advances can take practitioners only so far in ensuring that a sponge isn't left inside a patient after surgery or the wrong leg isn't amputated. In the end, it comes down to practitioner insistence upon verifying every detail. To that end, the following best practices are credited with reducing the occurrence of medical errors in hospitals:
-Three-step universal protocol for performing invasive procedures like surgery: verify in advance the presence of all needed tools and information; mark off surgical site in advance with the patient; double check patient identity, procedure, and site immediately before surgery.
-Greater attention to hand hygiene: facilities have moved sinks closer to doors and placed hand-gel dispensers everywhere.
-Greater comfort with dealing with mistakes: Mechanisms are now in place in hospitals to locate and address the root causes of serious medical errors.
-Central venous catheter infection checklist protocols: reducing the possibility of infection would help significantly in improving medical outcomes.
-Requiring nurses and caregivers to read back physician orders in a doctor's presence. This cuts down on misunderstandings that can have serious consequences.
-Using two identifiers on patients, not just entering a room and asking for Mr. Brown, but verifying with a patient that he is, in fact, Mr. Brown.
While there's no way to eliminate medical errors altogether, there are ways to reduce their likelihood. Following best practices such as those listed above is a great start on the path to improved patient safety.
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Popularity of Web-Based Credentialing Tool Soars
Source:
AAFP News Now
Date:
12/02/2009
There are many questions about the value of information technology in introducing efficiencies into the health care industry, but at least one bit of technology is having an undeniable effect. The advent of web-based credentialing has taken hold with a majority of American physicians, saving them time and money.
The system in question is the Universal Provider Datasource (UPD). The system went national in 2003 and eliminates the need for physicians to repeatedly fill out paper-based physician credentialing applications. According to statistics from the Council for Affordable Quality Healthcare, fully 55% of practicing American physicians use the UPD.
Adoption rates vary from state to state, with Rhode Island at 99% adoption while Hawaii ranks last with only 2% adoption. Overall though, the system is receiving much in the way of accolades from physicians, who cite the reduction in paperwork brought about through the electronic process. The streamlining of the credentialing process leaves physicians with more time to focus on the practice of medicine. The technology is even making it easier for professionals focused on credentialing to do their jobs. One credentialing professional reports that the electronic process allows for the completion of credentialing in less than a quarter of the time it would normally take on paper.
The UPD is free to physicians since participating organizations pay a fee for access, and physicians maintain ownership and management of their own credentialing data. It is estimated that the system has saved more than $80 million and has done away with over 2 million paper credentialing applications since the program began. To take part, physicians must be registered with one of over 550 participating organizations.
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Coding Questions?
Source:
Physicians Practice
Date:
01/01/2010
Coding is the source of much confusion for many in the practice of medicine, but the staff at Physicians Practice has undertaken to answer some of the toughest coding questions on three particular topics: primary care exception, critical care coding, and prescription drug management.
With regard to primary care, there is confusion regarding resident billing without physician presence. When billing inpatient services with the GE modifier using the exception, services must be furnished in a primary care center located in the outpatient department of a hospital or ambulatory care entity. Thus, there is no case in which the GE modifier would be used for inpatient services. For preventive services like code 99397, Medicare grants primary care exceptions when teaching physicians are compensated for services performed by the student when the teacher was not present.
In critical care, some question whether it is acceptable to bill a critical care code if a patient becomes seriously ill while in a physician's office. In fact, this is acceptable, so long as the conditions for critical care are met. That means the patient must be in your office for thirty minutes undergoing the direct delivery of medical care regarding the impairment of one or more vital organ systems to the point that there is a high likelihood of life-deterioration.
When using a prescription medication on a new problem, you may automatically qualify for moderate-level decision making. This is a tricky coding issue, though. While prescription drug management is listed in the moderate problem section, the mere presence of prescription drugs does not denote the necessity of moderate complexity. When billing in this area, it is necessary to take a sober look at exactly what you've done and how it relates to medical necessity, as improper or unnecessary billing for prescription drug management could land you on the wrong side of a medical necessity review.
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Two Ways to Correct Safety Regulation Violators
Source:
HealthLeaders Media
Date:
12/04/2009
Recent regulatory changes place a much greater emphasis on safety procedure and infection prevention protocols. To ensure that your practice does not incur any penalties, it is best to make sure that you have a policy in place to deal with repeat offenders and encourage safety in all aspects of practice.
The job of the infection preventionist is by no means an easy one. Often, these professionals run across stubborn employees that refuse to comply with regulations due either to inconvenience or perceptions superfluity. Infection preventionists and safety directors, then, need to find the right approach in dealing with offenders.
When employees are violating safety and infection prevention regulations, they are risking not only their own safety, but that of their patients and co-workers. When correcting noncompliance among employees, preventionists need to explain to violators the dangers they face by resisting compliance, even illustrating to them the infections to which they expose themselves and others through noncompliance.
In approaching violators, it is wise to do so in a non-confrontational manner. Take the violator aside and explain the error while offering means for addressing the violation. Additionally, be certain to take into account the employee’s side of the story. If an employee is not following protocol due to unavailability of equipment, perhaps your organization should take steps to ensure that equipment is placed in an easily accessible area.
If, however, an employee has been alerted to repeated infractions and continues to resist compliance, your organization needs a disciplinary system in place. Likely, this will include verbal warnings, a written warning, suspension, and termination as a final recourse. But your organization will likely be able to avoid such actions, so long as you make sure to have a safety compliance metric that is measured and quantified within the organization just as regularly as any other competency.
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This Is Your Phone Calling: Get to the Doctor
Source:
GigaOM.com
Date:
11/16/2009
You might want to take this call: it’s from your blood pressure. Sound ridiculous? It might not be too far into the future before your patients are calling you on a phone that told them they need a higher medication dose. New technologies being developed for cell phones just might be a doctor’s best friend in the future.
The stunning prevalence of mobile phone use throughout both the developed and developing worlds represents an opportunity for medical technology engineers to place powerful health technology in the pockets of patients. Researchers at UCLA have developed imaging technology that can monitor HIV and malaria conditions by illuminating blood and saliva samples with short wavelength blue light to diagnose a condition. Other researchers have developed cell phone microscopes, and still others think it is not entirely unimaginable that cell phones could be used to image early-stage tumors.
Right now, cell phone health technology is largely in the data-sharing stage. In Africa and Indonesia, the program EpiSurveyor is in use for gathering and sharing medical data via mobile phones. But it is not too difficult to envision a future in which your patient calls you to get a second opinion on a phone diagnosis.
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Maine Docs Pilot 'e-Visits'
Source:
Healthcare IT News
Date:
11/25/2009
Have you ever briefed a patient on drug side-effects...through your computer screen? It is likely that someday you will, and the program that will bring it to you is in the works in the state of Maine.
In cooperation with Eastern Maine Healthcare Systems and Anthem Blue Cross and Blue Shield, physicians in Maine are beginning a pilot program centering around electronic visits with their patients. Initially, the program will allow selected primary care practices to conduct e-visits with patients. Patients will also be able to send health-related questions and messages, communicate via email with doctors on non-emergent issues, schedule appointments, check on test results, and request prescription refills.
Organizers of the program cite benefits from increased ease of access to physician knowledge. This, they say, is a boon for patients with unreliable transportation options such as college students, and partially out-of-state patients. Patients participating in the program also will not have co-pays for the e-visits.
While the program is expected to be popular, it is not expected to replace in-person visits or annual exams. Instead, it is meant as a supplement to regular visits, a means for patients to check in with a physician they've already seen within the past year.
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Federal Tech Panel Still Defining Electronic Health Records Terminology
Source:
Medical News Today
Date:
12/18/2009
It's one of the most important two-word phrases in health care today: “meaningful use.” Those two words, as yet undefined by the Centers for Medicare and Medicaid Services, will likely determine whether or not that expensive electronic medical record system you've invested in or are considering investing in will amount to any cost savings in the near future. So why hasn't any progress been made on defining a term that is so important?
The midway point of December also marked the passage of a supposed "milestone" by which the federal advisory panel governing electronic medical records was to define the term "meaningful use," which determines whether or not practices and hospitals with EMRs are eligible to receive a share of the $34 billion in subsidies handed out as part of the stimulus bill passed earlier this year. The panel has been deliberating since May.
Meaningful use, currently, is only vaguely sketched out. Currently it constitutes the use of certified EMRs for electronic prescribing, information exchange, and quality reporting. Governing bodies have previously recommended increasingly stringent criteria to encourage adoption of acceptable technologies. Those qualifying for EMR subsidies will begin receiving initial payments in 2013 if they began using their systems by 2011 or 2012.
Electronic medical record use has widespread support among U.S. physicians, but concerns exist regarding privacy and cost. Previous studies have shown cost to be a very prohibitive factor in adopting the systems. Other studies have found that one in six doctors is very concerned about privacy breaches with electronic records.
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Physician Practice Management
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Operating Free Clinics While Running Your Traditional Practice
Source:
Medical Economics
Date:
12/18/2009
Would you be more inclined to offer charity care if you didn't have to leave the comfort of your own office? What if you were likely to see patients you already knew? That day might well be here, as increasing numbers of practices are beginning to donate some of their appointment hours to serve as virtual free clinics within their communities.
The economic downturn, coupled with ever-increasing health insurance premiums, has the number of uninsured and underinsured steadily on the rise. The solution? A program called “Project Access” is asking physicians to donate appointment slots in their offices to charity care. This saves physicians time and allows them to practice within comfortable surroundings, without the practice restrictions of free clinics.
Each branch of Project Access–a community-led collaboration of physicians, hospitals, and pharmacists–determines the eligibility requirements for local practices. Paperwork for the donated time is handled by Project Access, including referrals and follow-up appointment scheduling.
Participating physicians laud the program as an opportunity to give back without the time constraints of traditional free clinics. Additionally, they hail the program as gratifying and flexible.
These sorts of programs often have mechanisms built in to ensure their physicians' donated time is well-spent. Patients are required to promise to be on time for appointments and not abuse the emergency room. Other states have laws protecting physicians who donate 100% of a patient's care.
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Practicing Medicine in the Age of Facebook
Source:
New England Journal of Medicine
Date:
09/13/2009
Facebook: you just can’t seem to get away from it nowadays. But between commenting on your co-workers’ embarrassing photos and keeping track of old medical school friends, what do you do when a patient sends you a “friend” request? An article in the New England Journal of Medicine takes a look at the perils of practice in the age of social networking.
Over the years, social networking sites have gone from addictive time-wasters to powerful and useful networking tools used by professionals in numerous fields. At the same time, though, they continue to be used largely for “friending” and general Internet fraternizing. The meeting of these two facets–professional and social–can be a source of trouble for connected physicians. If a patient sends you a friend request, they are, potentially, gaining access to a side of your life you may not be comfortable sharing with a patient. They also have access to your complete list of friends and colleagues, as well as to any private, unprofessional, or otherwise embarrassing photos or videos that you may post.
So what to do then? Well, the short answer is: there is no set strategy. It would be perhaps counterproductive to disconnect oneself entirely from Facebook and similar sites, as they do serve a purpose and can be quite fun. But you will want to be careful whom you add to your friends list and what access they are given. Recognize that everything you put online is easily available for viewing by a plethora of people, and act accordingly. Such information can influence your future career options and even your standing among your peers. For this reason, you should maintain a good deal of caution when posting things online. And, if your patients send you a friend request, maybe you will want to talk to them for a while before accepting it. They could be trying to figure out if you are single, or just looking to keep in contact so you can see how their child grows up.
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Survey: Malpractice Premiums
Source:
Medical Economics
Date:
11/20/2009
According to Medical Economics’ 2009 Exclusive Survey, medical malpractice insurance premium rates have apparently reached a temporary peak, with some specialties even reporting a drop in premium costs. The reasons for the drop, though, are harder to pin down.
The survey found declines virtually across the board in malpractice premiums. Recent trends have shown that insurance premiums rose sharply from 2003 to 2005; but a leveling out or decline in rates began around that time. For example, in 2004, zero companies reported dropping rates from 10 to 20%; however, this number increased to 5.1% of companies in 2006 and 15.6% of companies reporting a decrease in 2008. Premiums are still high for specialties such as obstetrics, but the median premium for the specialty is $10,000 lower than it was in 2007.
The rate drop comes as patient safety initiatives have dovetailed with tort reforms in multiple states to exert downward pressure on litigation. Caps on damage awards, some say, have attorneys thinking twice before entering the already risky business of filing suit. Lowered claims means lower payouts for insurers, which means lower premiums for physicians.
Rates are higher, though, for physicians practicing in the eastern United States: up to a third higher than their peers in other parts of the country. This is likely due to a greater concentration of physicians and a larger number of high-premium specialists. Additionally, older doctors appear to pay more for insurance than their younger counterparts. This is likely because older doctors are buying more coverage to protect the assets they have accumulated over their careers.
If you are seeking to keep your own premium costs low, it is important to follow good practice protocols. That means lowering the number of occurrences in which possible legal action might be necessary. For example, do not let physician extenders perform procedures beyond the scope of their training. Another strategy includes adhering to state and specialty society regulations as well as your own practice guidelines. Also, look into “premium credits” that may be offered by your insurer. These would allow you to receive discounts on your bill for attending specific physician improvement workshops.
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Doctors Spending More Time Now With Patients
Source:
HealthDay
Date:
11/09/2009
With per-patient reimbursement rates continually on the decline, one would assume that, by now, doctors would be seeing more patients for shorter amounts of time. Not so, according to a recent study. In fact, according to HealthDay, the amount of time doctors spend with patients has been steadily increasing over the past decade or so.
Researchers from the University of Michigan Health System conducted the study, published in the November 9 issue of the Archives of Internal Medicine. The researchers examined data on over 46,000 visits to primary care doctors between 1997 and 2005 and found that the number of visits to primary care physicians increased 10% over that time period, and the duration of these visits rose 16% over the same time period. The increases were larger for chronic and serious conditions.
The researchers attribute the increase in visit length to the increasingly aging population; i.e. older, sicker patients require longer visits. At the same time, though, per-patient payment for primary care physicians is steadily on the decline. Experts are trying to alleviate this growing problem by increasingly relying on physician extenders and nurse practitioners to perform the tasks that would normally be reserved to physicians.
Along the same lines, another report in the same journal found an increase in the amount of time patients were waiting for treatment in emergency departments.
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