Innovative health programs counter primary care shortage - by Rita Rubin, USA Today
Date: August 16, 2010

About 65 million Americans live in communities with a shortage of primary care doctors, physicians trained to meet the majority of patients' health care needs over the course of their lives.

How much more difficult will finding a primary care doctor become as a result of the recently passed health care reform legislation, which will extend coverage to an estimated 34 million currently uninsured Americans by 2019?

Massachusetts, which in 2006 passed a law that led to nearly universal coverage of its 6.6 million residents, might provide some clues. In that state, fewer and fewer internists and family practice doctors are taking new patients, and wait times to see family practice doctors are lengthening, according to the Massachusetts Medical Society and the non-profit Massachusetts Health Quality Partners.

Even before Congress in March passed the landmark law designed to make health care more affordable and expand coverage, an aging population and doctors' increasing preference for higher-paying specialites set the stage for a primary care shortage. And what many believe to be an outdated reimbursment system - one that drives doctors to schedule office visits when a quick phone call or email might do - doesn't help.
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New regulations may cut down infections in hospitals - From CNN.com Blog (Paging Dr. Gupta)
Date: August 2, 2010

In the United States, hospital-acquired infections alone afflict almost 2 million patients and kill approximately 100,000 people annually, more than diabetes or influenza and pneumonia. That's according to statistics from the Centers for Disease Control. Beginning next year, Americans will be able to check to see how their hospitals or medical facilities fare when it comes to preventing these types of infections.

Under the new hospital acquired infection reporting regulations adopted by the Department of Health & Human Services (HHS), patients will be able to see how many hospital induced infections have been filed at their particular medical institution. According to the Consumer's Union Safe Patient project, public reporting of infection rates will help save lives and money by pressuring hospitals to improve preventive measures against hospital acquired infections.

"Patients should have to worry about getting sicker with an infection they catch in the hospital but every year nearly two million Americans do," says Lisa McGiffert, Director of the project. "Making infection rates public is a powerful motivator for hospitals to improve care and keep patients safe. This is an enormous victory for patient safety advocates who have worked tirelessly to hold hospital accountable for failing to eliminate infections."
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Saying no to Medicare
Date: July 23, 2010

The decision to opt out of Medicare requires care consideration; here's what you need to know

Physicians in every specialty, in every city and town, in every state in teh country lament almost daily the reimbursement levels and other frustrations associated with caring for Medicare patients. Yet, most physicians continue to see at least some patients who are covered under the government-run plan. Precious few doctors opt out of the system completely, but that could change if steps aren't taken soon to repair a broken system.

"Payments to physicians are about the same as they were in 2001," says Cecil Wilson, MD, president of the American Medical Association (AMA) and internist in Florida. "As you think about the future, about being able to hire staff, give raises, pay for utilities, and purchase equipment to keep current, and you look at a part of your practice that's not keeping up with inflation, you have to make a dreadful decision if you can't afford to do it." According to the AMA Web site, physician costs have risen 22 percent since 2001, while reimbursement from Medicare has gone up only about 1 percent.

It's uncertain how many physicians have completely opted out of the Medicare system, but experts say that anecdotally, the numbers seem to be on the rise; and physicians who do see Medicare patients often restrict their numbers out of sheer economic necessity. "When Congress looks at the figures, they see 97 to 98 percent of physicians still taking Medicare," says Wilson. However, he says those numbers are misleading because so many physicians limit the number of Medicare patients they accept into their practices.

Wilson says the issure will be exacerbated as more baby boomers start to receive Medicare benefits. "Congress made a promise to senior citizens, but they're not adequately funding it." he says, adding that the problem of patient access will continue to get worse until the Medicare payment formula is fixed.

In the meantime, some doctors have decided to "just say no" to Medicare - a decision that requires much analysis, and if it's right for you and your practice, much planning. Provisions in the 1997 Balanced Budget Act give physicians and patients the option to have a fee-for-service relationship in which neither party bills or is reimbursed by Medicare. Simply put, under what's called "private contracting," you set your fees at a level you feel is reasonable and patients pay at the time of service. (For an in-depth legal article on this topic, see the June 4, 2010 issue: Malpractice Consult, "Medicare opt-out decision requires detailed knowledge".)
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Health reform has liability insurers looking at tort alternatives
Date: June 7, 2010

Insurers attending the PIAA's annual meeting received a glimpse into how health courts,
early offers and other concepts might work.

Tort reform advocates say the medical liability system is in need of serious repair, and the federal health reform law -- while not perfect -- offers some tools to help get the job started.

That was the message delivered in May to medical liability insurers attending the annual meeting of the Physician Insurers Assn. of America, a trade group for physician-owned medical liability companies.

The health reform law, enacted in March, designated $50 million in incentive payments to encourage states to test alternatives to damage caps and other more traditional tort reform. The provisions expanded on a separate $25 million patient safety and liability demonstration program approved by the Obama administration in 2009. The deadline for those grants, overseen by the Dept. of Health and Human Services, was in January. Awards have yet to be announced.

Meanwhile, experts gave insurers a glimpse into four possible alternatives to be tested under the health reform law: health courts, early offers, apology programs and medical review panels. They detailed how the options could alleviate pressures within the current liability system by reducing claims and costs, and by improving efficiency and fairness for physicians and patients.
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U.S. is requiring companies to defend against identity theft
Date: May 24, 2010

With identity fraud on the increase, the federal government is stepping up efforts to make sure businesses are on the alert -- especially financial institutions and other companies that issue credit cards.

The government says that businesses have the responsibility of making sure thieves don't use stolen information to buy goods or open phony accounts. And to that end, the Federal Trade Commission wants businesses that might be targets of identity thieves to develop written plans to spot "red flags" that fraud could be involved and prevent it.

Starting June 1, all businesses that extend credit to customers will have to develop plans to try to prevent identity theft.
"Once the information is in the hands of identity thieves, there's not much more the consumer can do," said Naomi Lefkovitz, senior attorney for the FTC, which will oversee enforcement of the rule as it applies to many -- though not all -- businesses. "Now it's in the hands of the businesses."

The new rule will affect larger institutions such as banks, but also smaller companies that provide services first and charge afterward, for example, a doctor who bills patients for exams and procedures after they are performed.

A department store that issues its own credit cards, for example, would qualify as a creditor under the new rule, and would have to develop a plan, according to the FTC.

To comply, a business must develop a written plan for identifying signs of identity theft, catching it and preventing it.
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Medical Liability: A World of Difference
Date: May 3, 2010

Other countries could offer solutions to an ailing U.S. liability system. But experts warn that some ideas may not translate.

As states and health care systems seek federal grants to test new ways of tackling medical liability issues in the U.S., some observers suggest looking beyond America's borders for inspiration. While they agree no one system offers a perfect solution, experts say other countries could offer lessons to help mend what doctors say are flaws that make the U.S. medical liability landscape more expensive and litigious than that of other nations.

"Nobody is as hospitable to potential liability as we are in this country," said Richard A. Epstein, director of the law and economics program at the University of Chicago Law School. "The unmistakable drift is we do much more liability than anybody else, and the evidence on improved care is vanishingly thin."
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Are Concierge Medical Services on the Upswing?
Date: April 29, 2010

A longtime pediatrician, Natalie Hodge, MD, was living the life of primary care despair.

For years she rushed from patient to patient in her office, giving them a few minutes here and there, doing a ton of insurance paperwork, and then decided enough was enough. Like many physicians, she felt drained and lost.
"People calling, people answering phones, people scheduling, people verifying eligibility, people checking on insurance, people . . ." she says. You get the picture.

It wasn't her style to sit still. Eventually, she founded Personal Medicine, essentially a concierge medical service, which avoids third party payers as much as possible, and adds its own unique touches, like specialization in house calls, and thriving on "virtual" communication. As she sees it, the mix is the bedrock for a "new reality for the future of primary care medicine," built around "emergent technologies." Curtailing insurance has cut costs about 80%, she says.
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HIPPA Regulations Will Come Next Month
Date: April 27, 2010

"Meaningful Use" takes time (HIMSS 2010 Conference)
Date: April 22, 2010

For more than a year, there's been a "hurry up and wait" attitude toward adoption of health information technology, as many doctors delayed buying electronic medical record systems until they got details on how their practices could earn incentive pay for use.

Now that near-final meaningful use criteria have been published, experts and vendors say many doctors are shifting to "hurry up and adopt." But they warn that practices should allow time for the appropriate steps, even as Medicare pay incentives for meaningful use of technology are scheduled to begin in 2011.

Rushing into adoption solely for the sake of earning incentive money is not only a bad business move but also one that could be dangerous to patients, experts warn.

Meaningful use, and physicians' attempts to satisfy the requirements to meet it, was a major topic of discussion at the annual Healthcare Information and Management Systems Society conference, held in March in Atlanta. Physicians, consultants and others described their implementation success stories, most of which involved slow and deliberate processes toward adoption, and warned of failures if that slow and deliberate process is not followed.
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Online Physician Rankings Can Boost, Harm a Practice
Date: April 9, 2010

National report — Love or loathe them, public Web sites that let patients rate their physicians aren't going away, experts say.

Making these sites work for you rather than against you requires ongoing vigilance, broad-based patient participation and — for some physicians — patient contracts, they add.

"The biggest problem with these sites is that you're not sure who is evaluating you: a real patient, a competitor, a disgruntled employee or other anonymous source," says Vic Narurkar, M.D., associate clinical professor of dermatology, University of California, Davis. Most physicians are uncomfortable with online rating sites, says Jeffrey Segal, M.D., J.D., CEO of Medical Justice, a company that helps physicians fight online defamation. Such sites can represent "the dark side of the Internet," he says.

Currently, he says, "There are more than 40 sites, mostly anonymous. And most sites have zero to three ratings — they're not particularly useful to anyone yet."

"The good sites are good; the bad ones are really bad," adds Beth Santmyire-Rosenberger, M.D., a Fairmont, W.V., private practitioner whose patients have used such sites.
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A new federal rule has expanded the scope of the National Practitioner Data Bank to include disciplinary information not just on physicians but on all licensed health care professionals.

In an effort to promote patient safety, the confidential reporting system was established under the federal Health Care Quality and Improvement Act of 1986 to give hospitals a snapshot of any issues with a doctor's competence or conduct before credentialing.

A final rule published Jan. 28 by the Dept. of Health and Human Services expanded the data reported to the Health Resources and Services Administration, which administers the data bank, to include adverse actions taken against licensed health care professionals. That includes nurses, chiropractors, podiatrists and physician assistants. The rule, published in the Federal Register, is available online: Click Here
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10 EHR Lessons from 10 Practices
Date: February 19, 2010

Getting an EHR is like getting married," says Jonathan Hager, MD, an internist with Alexander Medical Group in Rochester, New York. "Once you are in one of these systems, you are in it. You've got to take the time and make sure you know what you're doing."

We asked 10 practices to reveal the best lessons they learned from their electronic health record (EHR) adoption experiences. Although the lessons are different, the physicians and practice managers with whom we spoke echoed Hager's comments: do your research. Take time to investigate the systems and what each would mean for your practice.

The $44,000-per-physician incentive from the Centers for Medicare and Medicaid Services for proving "meaningful use" of an EHR has many practices considering adoption this year.
The incentive was courtesy of the federal economic stimulus package announced in February 2009, specifically a measure called the Health Information Technology for Economic and Clinical Health Act. A 2009 report by the Congressional Budget Office predicted that 90 percent of physicians would have an EHR system by 2019, in part due to the incentive.

In the later months of 2009, EHR vendors began to offer money-back guarantees that physicians would achieve "meaningful use" with their systems, putting even greater pressure on practices to make the jump.

But with a potential $14,500 to $63,600 in software, hardware, and training costs per physician, as well as $7,500 a year for maintenance, according to a 2006 report in the Journal of the American Health Information Management Association, practices understandably are cautious of the project.

To help bolster your research, we asked physicians and practice managers how they selected a vendor, prepared their staff, implemented the system, and endured the first few months in the new digital world.
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Privacy issues are made more challenging by a tougher HIPAA, growing cyber risks
Date: February 4, 2010

With today's more rigid regulatory environment, privacy and security challenges are on the rise in healthcare. Cyber crime continues, and patient information is becoming more difficult to secure.

As part of the stimulus package, physicians can receive up to $44,000 in Medicare incentives for adopting electronic health records ($65,000 under Medicaid), but the federal government is also mandating tighter controls over data and information. Failure to comply with a strengthened HIPAA, starting in February, plus a new Red Flag Rule that goes into effect in June, and many other regulations can mean stiffened penalties, lawsuits, audits, fines, loss of reputation and other costly consequences.

Commissioned by Managed Healthcare Executive and including expert commentary, this package of articles, checklists and links to other sources can help you navigate the thicket of new information and changes while protecting your patients and yourself.
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HITECH ratchets up HIPAA accountability
Date: January 11, 2010

In the current risk climate, the loss of confidential patient data to unauthorized third parties presents a daunting challenge for health care professionals. In this context, the introduction of large networks of computerized health information has caused the number of individuals with access to patient medical records to expand exponentially.

Physicians make widespread use of laptops, home-computer links, smart phones, smart cards, USB flash drives and PDAs. E-prescribing systems link physicians and others directly to pharmacies. A contemporary physician's Blackberry typically contains far more patient information than the locked filing cabinets of previous years.

Unfortunately, all of this health care data—ranging from medical diagnosis and treatment codes, to names, addresses, birthdates, social security numbers, bank and credit card accounts—has enormous value to identity thieves who exploit open networks and Wi-Fi systems.

Within the context of the Health Insurance Portability and Accountability Act (HIPAA) of 1996 all "covered entities" that collect private health information must comply with specific administrative, technical and physical security standards and procedures for "electronic protected health information." Most health care entities are familiar with the federal HIPAA privacy rules. They constitute an extensive and detailed attempt by the federal government to protect the privacy of personal medical information in electronic form. The rules seek a pragmatic balance between the need to protect personal health information and the growing need to disclose personal health information for treatment, payment, public health, research, and other socially beneficial purposes. It is important, however, to also note that HIPAA is a "floor" and does not pre-empt a growing patchwork of currently existing state confidentiality and notification requirements.
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It is hard to imagine a more uncertain time for the healthcare industry in the United States.

The recession has brought an increase in charity and unreimbursed care as millions of Americans join the ranks of the unemployed and lose their healthcare benefits. Recruiting in the midst of a severe physician shortage is only going to get tougher as more doctors retire and competition intensifies for the too-small candidate pool to replace them.

And hanging over everything is healthcare reform. Just about everyone agrees that President Obama will sign some sort of healthcare reform bill this year. However, few would venture to guarantee what those reforms will contain beyond an expected expansion of health insurance coverage to some of the 46 million uninsured people in the United States.

So physicians and other healthcare professionals are looking at a very distinct possibility that they will soon be asked to work harder for more people and probably not make as much money. A little anxiety and outright crankiness is to be expected.

"It's a very trying time for physicians. There are changes going on in the entire context of the healthcare delivery system, and the fact that the economy is down, and so their practices are down," says Jeff Peters, president and CEO of Surgical Directions, LLC, a physician-led consulting firm in Chicago.
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