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

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posted by Ryan DuBosar at 12:29 PM   0 Comments

Internist asks patients to leave co-pay ... for the next patient

James S. Braude, ACP Member, of Atlanta, has started asking patients to leave a dollar (or any other amount) in an envelope at the front desk after a visit. That donation is applied toward the visits of patients without insurance--Dr. Braude comps the rest of the cost. The local TV report is here:



(The text version is here in case video is restricted on your computer.)

In May ACP Internist polled its readership how they handled uninsured patients, and doctors spoke of a variety of ways they help their patients who don't have insurance.

Labels: health insurance, primary care, recession

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posted by Ryan DuBosar at 8:00 AM   0 Comments

Internists, FPs alike trying to help their patients through the recession

The economy is prompting internists and family physicians to increase charity care, discount fees and offer free screenings, according to a survey by the American Academy of Family Physicians.

ACP Internist reported its own poll results earlier in May asking internists how they handled patients who couldn't afford to pay. ACP members reported they most commonly offered free care or reduced payments (66.7%), offered free samples for prescriptions (61.1%) or referred to community clinics (34.7%).

Nearly 90% of the AAFP crowd reported their patients expressed concerns over their ability to pay, 58% had seen more appointment cancellations and 60% had seen more health problems caused by patients forgoing needed preventive care such as such as pap smears, mammograms and colonoscopies, or failing to return for follow-up visits or refills.

Also:

• 66% were discounting fees, increasing charity care, providing free screenings, and moving patients to generics;
• 54% have seen fewer total patients since the recession began in January 2008;
• 73% saw more uninsured patients;
• 64% of respondents reported a decrease in the number of employer-sponsored/privately insured patients; and
• 87% saw more patients with major stress symptoms since the beginning of the recession.

Labels: health insurance, primary care, recession

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posted by Ryan DuBosar at 11:40 AM   0 Comments

Your Thoughts Exactly: Handling patients who can't afford to pay

With the economy uncertain and unemployment rising, ACP Internist readers reported they are facing patients in their offices who are ill, but unable to pay for health care. The situation has left many physicians with the unexpected dilemma of how to treat such patients while also trying to manage a practice. Or worse, patients may not seek health care at all, an option suspected by virtually all respondents in our latest poll, Your Thoughts Exactly: Caring for unemployed/uninsured patients.

Results were collected anonymously throughout April. The results are not scientific and do not reflect any ACP policy, and are reported for their news value only.

When faced with a patient who was unemployed, uninsured or otherwise unable to pay, physicians fell back on a few options:
When faced with a patient who was unemployed, uninsured or otherwise unable to pay, physicians fell back on a few options:
Options (respondents could choose more than one; n=73)

• I've offered free care or reduced payments. 66.7%
• I've offered free samples for prescriptions. 61.1%
• I've referred them to community clinics. 34.7%
• I've reduced or eliminated co-pays. 18.1%
• I've deferred billing. 16.7%
• I've had to refuse care to delinquent patients. 6.9%
• I've let the front desk handle it. 6.9%

Among those who offered other options, hospitalists who responded are generally able to refer to their own facilities. One reported, "As a hospitalist I try to take care of them as I do the others ... but I have the devil's own time getting consultants to see them, and arranging outpatient follow-up is often difficult or impossible."

Another respondent said, "I have the luxury of practicing in an academic setting where most of these decisions are made for me. I would hate to be faced with the situation of not providing care due to inability to pay. I can say that since our institution has implemented a co-pay policy, attendance at our resident teaching clinics has fallen off dramatically. I see a future where residents graduate with even less ambulatory care experience than they're already getting."

Office-based practitioners are setting up payment plans, steering patients toward low-cost or no-cost generic options through their local chain pharmacy or grocery. A few have some sort of sliding scale for payments; others suggested downcoding services, even comprehensive exams, so the overall cost would be less.

"I provide them information on how to shop for their prescriptions, explain the excessive cost of needless over-the-counter products, attempt to keep the costs of tests and other health care to a minimum, refer to the physicians who will provide the same level of care and concern that I have whenever possible; I also refer to the state."

Many are referring to local support groups or working at free clinics--in one case the doctor opened a free clinic. Many physicians are doing more chronic care management by phone, which as one person said, "I have done it in previous recessions."

Nearly all (72 of 73 doctors, or 98.6%) said that they know or suspect their patients are skipping needed care, while the other respondent replied he or she wasn't sure. Among the patients suspected of skipping care, they were thought to be rationing medications or not coming back for follow-ups. "I suspect this is a much bigger problem than any physician actually knows about," one physician added.

One doctor suggested a way to prevent losing patients to follow-up: "Be sensitive to proud patients who do not want to admit they are having financial troubles."

Labels: health insurance, primary care, recession

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posted by Ryan DuBosar at 3:23 PM   0 Comments

Good news for dentists

One might think the recession could be useful in getting overweight patients to shed pounds. The less you eat, the less you pay for food, right? But an unexpected foe has emerged in the battle of the bulge: the cheap, nostalgic thrill of candy.

The New York Times reports candy sales have spiked in response to the recession, as consumers seek an inexpensive way to treat and comfort themselves amid all the rotten news of late. One woman, who runs Weight Watchers meetings in Manhattan, is quoted in the article as saying that candy comes up as a foil to dieters much more frequently than it used to.

Something to keep in mind when counseling patients about diet and nutrition in these unsteady economic times. Perhaps it'd be worthwhile to help patients think of other, more low-cal ways to soothe themselves when faced with a dwindling 401K balance. A few bags of M&Ms might score you a used yoga DVD, for example...

Labels: Nutrition, recession

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posted by Jessica Berthold at 3:39 PM   0 Comments

Insurance insurance (no, that's not a typo)

Worried that the recession might lead you to lose your job and therefore your health insurance? Relax. UnitedHealth is here to ease your mind with a new policy that will ensure your right to buy insurance in the future if you get sick, the New York Times reports.

Got that? They're not selling you insurance. They are selling you, a healthy person, the opportunity to buy insurance later, should hard times befall you and you get laid off, then stricken with illness. All for the low-low monthly cost of 20% of an individual policy premium. That's $50 a month for Richard A. Collins, the president of UnitedHealth's individual insurance unit.

Mr. Collins calls the policy a "hedge." (You know, sort of like credit default swaps.) It's a huge vote of confidence for heath insurance reform, no?

Labels: health insurance, recession

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posted by Jessica Berthold at 12:03 PM   0 Comments