Monday, March 8, 2010
QD: News Every Day--Health care reform's "endgame"
All the talk is of the endgame to health care reform. You'll find the word used repeatedly as the fourth column discusses the timeframe, strategy and roadmap how to finish the legislation. ACP Internist points out that even if passed, future legislators can continue the game year after year. It's the sport of kings.
Medicare pay cut
Primary care doctor William Schreiber, MD, broke down his practice expenses and figures the pending 21% Medicare pay cut would leave him with the equivalent pay of a minimum-wage job. The pay cut has been pushed back until the end of the month. (CNN)
Labels: health care reform, medicare, practice management, QD, reimbursement
posted by Ryan DuBosar at
10:16 AM
0 Comments
Wednesday, January 20, 2010
The doctor will see you shortly--by law
California debuted new rules that specify patients in health maintenance organizations (HMO) see a doctor within 10 days of asking for an appointment. Calls must be return within a half-hour, and health professionals must be available 24/7. Urgent care must be seen in 48 hours.
Richard Frankenstein, FACP, former president of the California Medical Association, told the Los Angeles Times that this places pressure on the HMOs to have a big enough network to deliver what they promise. Critics contend this will force doctors to rush patient care even more, or be especially damaging to rural areas already facing a shortage.
The law was passed in 2002. It took state officials seven years of negotiations with HMOs, doctors and hospitals to draft the final regulations. Now, HMOs have a year to figure out how to implement the goals, or face consumer complaints to the state and possible penalties.
Physician recruiters Merritt Hawkins & Associates found that patients in San Diego wait an average of 24 days for a routine physical and those in Los Angeles wait 59 days on average. (The results were part of a national survey for major metro areas, comparing results from 2004 to 2009.)
This might be old hat to those who've chosen to adopt the patient-centered medical home model, and can offer such care. But could you practice internal medicine through an HMO contract in California now?
Labels: appointments, health care delivery, health insurance, practice management, rural medicine
posted by Ryan DuBosar at
9:30 AM
2 Comments
Wednesday, December 9, 2009
QD: News Every Day--Senate close to cloture
ACP Internist's daily digest of news and events continues with updates on health care reform and H1N1--both are less severe than predicted, but neither is over yet.
Health care reform
Democratic Senators have reached a deal and details are leaking out. The compromise may replace the public option with a private one like the health plan federal workers use, and also allow people 55 or older to buy into Medicare coverage. Some hospital and insurance groups oppose the idea, as do those who represent rural areas. Meanwhile, the Senate tabled more restrictive abortion language, although that needs to be reconciled with the House bill, which has more restrictions. (CNN, Kaiser Health News)
Family practitioner Jeffrey Brenner, MD, explained how Camden, NJ, one of the nation's most impoverished cities, avoided millions of dollars in ED visits by sending nurse practitioners to housing complexes and nursing homes. Bolstering the idea of using other types of medical providers is family practitioner and micropractice guru L. Gordon Moore, MD, who suggests that "'face to face with MD' need not be the only solution tested." (NJBIZ, Ideal Medical Practices blog)
H1N1 influenza
In the midst of the weakening predictions of the H1N1 influenza pandemic and ramped up vaccine production, availability is increasing and being offered in locations across the country without priority lists, for just one example, in Detroit. Germany is selling more than 2 million doses due to weak demand. (WebMD, CNN, Detroit News, Reuters)
Labels: H1N1, health care reform, practice management
posted by Ryan DuBosar at
12:09 PM
0 Comments
Friday, October 2, 2009
QD: News Every Day
ACP Internist's daily digest of primary care in the news continues with sudden coherence on Obamacare, prescription med fatalities and the trend of falling patient volume and procedures during the recession.
Health care reform
Overnight, Democrats and moderates in the Senate Finance Committee agreed to $400 billion in federal subsidies to defray premium costs for lower-income families and help small businesses offer coverage to their workers. Amendments will seek to let the states form their own public options and make health care affordable. But the compromise doesn't offer a permanent fix for the Sustainable Growth Rate. It could hurt physicians who are the biggest users and discourage them from taking on patients. And it still needs to merge with other bills.
If you're unclear which health care reform bill is which, the San Francisco Chronicle explains them.
In case you missed it:
Drug overdoses, mostly from prescription meds, overtook traffic accidents as the leading cause of death in some states.
The Robert Wood Johnson Foundation warns that not passing health care reform could hurt the states most of all.
Revenue in medical practices declined in 2008, possibly tied to smaller patient volumes and increasing bad debt due to patient financial hardship.
According to the "MGMA Cost Survey: 2009 Reports Based on 2008 Data," multispecialty group practices saw a 1.9% decrease in total medical revenue in 2008. (MGMA captures data on both multispecialty groups and single-specialty practices, but uses multispecialty data as a proxy for overall trends.)
Procedure volume fell 9.9% and patient volume shrunk 11.3% from 2006 to 2008. And bad debt in multispecialty group practices from fee-for-service charges increased 13% from 2006 to 2008, suggesting that patients may be having a harder time paying their medical bills.
In 2008, multispecialty practices cut overhead expenses 1.4%, largely by cutting support staff costs by 1.5%--the first decline in several years. Support staff make up 32% of medical practice expenses. While medical groups reduced support staff costs, their total worker count remained constant, indicating that employees may have gone without raises and bonuses or perhaps even suffered pay cuts.
Revenue by specialty:
Labels: drugs, health care reform, practice management, QD, recession
posted by Ryan DuBosar at
12:29 PM
0 Comments
Monday, August 24, 2009
Concierge medicine keeps traditional practices afloat
An interesting twist is happening for concierge care, the controversial practice where doctors eschew insurance reimbursement and enter into private arrangements with patients who pay a lump sum to get longer appointments, more access and often around-the-clock availability.
The practice model works for the physicians who do it, and nationally, about 800 offices have gone to concierge care, according to this profile in the Philadelphia Inquirer. The practice hasn't always earned the respect of internists, though, who say the model drives the burden of community care to doctors in the traditional model. In this twist, however, revenue from concierge arm of the practice keeps the rest of the office in the black.
Labels: practice management, primary care
posted by Ryan DuBosar at
11:59 AM
5 Comments
Wednesday, March 4, 2009
Fight back against feedback
Doctors dissatisfied with their online ratings are seeking to have them removed. One advisor suggests asking patients to sign waivers not to post reviews online.
This issue isn't new. Two years ago Texas doctors took a stand against insurers' rankings by ranking the insurers.
While it's important to protect a practice's good reputation, the best way to get a good review is to offer a good experience. If it's time to brush up on patient management skills, here's some suggested reading:
Make the wait shorter and nicer
Reduce bottlenecks
Consider ACP's Center for Practice Improvement and Innovation
Greet your patients properly
Don't be rude
Labels: patient communication, practice management
posted by Ryan DuBosar at
10:16 AM
0 Comments
Tuesday, January 13, 2009
The patient-centered medical home--at home
Sometimes medicine is cyclical. Leeches went thoroughly out of style, and then it turned out that bleeding patients really was the best treatment for conditions like hemachromatosis.
Now an internist writing in the New York Times is arguing that house calls--rather than hospitalization--are the most cost-effective and high-quality means of care for many patients. Keeping patients at home protects them from hospital-acquired infections, dementia, bedsores (not to mention simplifying discharge!), Dr. Jack Resnick says. But he has a list of complaints about how the system makes home care more difficult that it needs to be and he admits that running from door to door is tough on docs.
So is it worth it? Would you trade hospital rounds for a drive around town?
Labels: practice management
posted by Stacey Butterfield at
8:00 AM
0 Comments
Tuesday, December 23, 2008
Concierge practices reviewed as insurance
Maryland is proposing to regulate concierge medical practices as a type of insurance, prompting at least one internal medicine group to halt its plans to stop accepting private insurance, the Baltimore Sun reported.
Charter Internal Medicine of Columbia, Md., announced it will continue business as usual in a Dear Patient letter on its Web site. The group is made up of a College fellow and four members.
Concierge practitioners in other states have told ACP Internist the management method, in which doctors charge a flat fee to a limited panel in exchange for complete patient access, lets doctors practice medicine the way they see fit. But the method has even drawn fire from other doctors, who feel that limiting the number of patients harms healthcare access for the rest of the community. Maryland is the first time a state has stepped in to review the legality of concierge coverage.
Labels: practice management
posted by Ryan DuBosar at
11:11 AM
2 Comments
ACP Internist hosted Grand Rounds on June 16, wrapping up the best of the medical blogosphere. Click here for the complete wrap-up.
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American Journal of Medicine
Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.
Clinical Correlations
A collaborative medical blog started by Neil Shapiro, ACP Member, associate program director at New York University Medical Center's internal medicine residency program. Faculty, residents and students contribute case studies, mystery quizzes, news, commentary and more.
db's Medical Rants
Robert M. Centor, FACP, contributes short essays contemplating medicine and the health care system.
Everything Health
EverythingHealth is designed to address the rapid changes in science, medicine, health and healing in the 21st Century.
Getting Better with Dr. Val
Getting Better is the continuation of Dr. Val Jones' previous blog at Revolution Health. It is devoted to helping people understand health issues from a balanced, scientifically sound perspective.
HealthHombre
A roundup of health policy news drawn from a database of hundreds of Web sites.
Interact MD
Michael Benjamin, ACP member, doesn't accept industry money so he can create an independent, clinician-reviewed space on the Internet for physicians to report and comment on the medical news of the day.
Kevin, MD
The alter ego of Kevin Pho, ACP Member, is the closest thing to royalty in the medical blog world.
LSUHSC-S Medical Library Evidence Alert
Major guidelines, systematic reviews, meta-analyses and/or major reviews by national and international organizations.
PLoS Blog
The Public Library of Science's open access materials include a blog.
White Coat Rants
One of the most popular anonymous blogs written by a doctor.
