Posts Tagged ‘American Medical Association’

The Doctor Will Tweet You Now

Monday, July 9th, 2012

Physicians are often pigeonholed as technophobes because they fear that using technology might threaten patient privacy and their own incomes.  But, an increasing number of physicians are texting health messages to patients, tracking disease trends on Twitter, and communicating with patients via email.  Kansas City pediatrician Natasha Burgert is one of this new breed, offering child-rearing advice on her blog,  Facebook and Twitter pages, and answering patients’ questions by email and text messages.  According to Burgert, she sends messages between checkups and it’s easier than calling a lot of people back at the end of the day.

These tools are embedded in my work day,” Burgert said. “It’s much easier for me to shoot you an email and show you a blog post than it is to phone you back.  That’s what old-school physicians are going to be doing, spending an hour at the end of the day” returning patients’ phone calls, she said.  Burgert doesn’t charge for virtual communication, although some physicians do.  She believes that it augments but doesn’t replace office visits or other personal contact with patients.  Colleagues “look at me and kind of shake their heads when I tell them what I do. They don’t have an understanding of the tools,” Burgert said.  “For the next generation that’s coming behind me, I think this will be much more common.”

Sarah Hartley, whose daughters are Dr. Burgert’s patients, loves having e-access to her pediatrician and says that even emails late in the evening typically are responded to quickly.  “It’s so useful,” Hartley said.  “Sometimes parents get concerned about a lot of things that maybe aren’t necessarily big deals” and getting after-hours reassurance is comforting.

Writing for the Associated Press, Lindsey Tanner says that “So far, those numbers are small.  Many doctors still cling to pen and paper, and are most comfortable using e-technology to communicate with each other — not with patients.  But from the nation’s top public health agency, to medical clinics in the heartland, some physicians realize patients want more than a 15-minute office visit and callback at the end of the day.”

Dr. Steven Nissen, who is in his 60s, is experimenting with e-technology.  A cardiologist at the Cleveland Clinic, Nissen insists that he’s not a member of “the Twitterati.”  With technical assistance from clinic staffers, he recently led a live Twitter chat about things like heart failure and cholesterol problems, and found the process “in some ways maybe a little exhilarating.  This was an opportunity to use a different communication channel to find an audience to talk about heart health,” Nissen said.  “The downside is that we dumb it down,” he said.  “It’s very challenging for physicians, primarily because the messages that we have are not conducive to 140 characters.  If you ask me a question, you’re likely to get a five-minute answer.”

Some physicians are still technology averse.  Dr. Raoul Wolf, a pediatrics professor at the University of Chicago, doesn’t use social media sites in his personal or profession life and is concerned about the permanence of online communication.  “With anything on the Internet, it’s there forever. There’s no calling it back,” Wolf said.  “Ask any politician.”

A survey of 501 randomly selected doctors found that more than 20 percent sent emails to patients over secure networks.  Another six percent communicated with patients through other social media.

The American Medical Association recognizes the benefits of using social media, but also cautions doctors to protect patient privacy and “maintain appropriate boundaries” with patients.  In a case of technology use gone bad, a Rhode island state disciplinary board last year reprimanded an emergency medicine physician for “unprofessional conduct” and fined her $500 after she posted on Facebook about a patient’s injury.  Even though she didn’t post the patients names, others figured out the identity.  Hard numbers are scarce on exactly how many of the nation’s nearly one million physician communicate virtually with their patients, but anecdotal evidence suggests the numbers are on the rise.

New York Controversy Emerges Over Food Portion Size Campaign

Monday, February 20th, 2012

The New York City Department of Health recently launched a campaign to get New Yorkers to make their waistlines smaller by controlling their portion sizes when ordering food and beverages. “Consuming too many calories can lead to weight gain,” said city Health Commissioner Thomas Farley.  “If New Yorkers cut their portions, they can cut their risk.”  The “Cut your portions. Cut your risk” campaign is billed as “hard-hitting” and has the purpose of making certain that people understand that large meals cause obesity.  Even worse, obesity can cause diseases like diabetes.  In one city poster, a man whose leg has been amputated because of Type 2 diabetes sits behind a graphic showing how soft drink portions have grown over the years.

Over the last 40 years, according to the Health Department, serving sizes for sugary soft drinks have grown four times, and the amount of French fries in a single order has tripled.  As a result, “a single meal could balloon to contain many more calories than the amount an adult needs for an entire day” – roughly 2,000.

Writing on the friendseat.com blog, Spence Cooper takes a more cynical attitude. “The number of New Yorkers motivated to make healthier choices and forgo that next order of large fries because of ad nauseam public service ads is equal to the number of New York smokers who pay attention to the warnings on cigarette packs. You can count them on one hand.”

The new posters, available in both English and Spanish, bear the message “Cut your portions. Cut your risk,” providing New Yorkers with a clear strategy for preventing obesity and its health penalties.  While the City has made strides in combating the nationwide trend of growing obesity, the majority of adult New Yorkers (nearly 57 percent) and two out of every five New York City elementary school children remain overweight or obese and the health consequences are dire, ranging from hypertension to type 2 diabetes.  Nearly 10 percent of New Yorkers have been told they have type 2 diabetes, which can lead to blindness, kidney failure and amputations. In 2006, nearly 3,000 New Yorkers with diabetes were hospitalized for amputations. Obese children and adolescents also are more likely to become obese adults. Even while young, they are more likely to develop obesity-related conditions such as high cholesterol, high blood pressure, and type 2 diabetes.”

Not all are in agreement with Farley’s campaign. The New York ads create an “inaccurate picture” of the impact of soft drinks, argues Stefan Friedman, a spokesman for the American Beverage Association.  “Portion control is indeed an important piece of the solution to obesity,” he said. “Instead of utilizing scare tactics, the beverage industry is offering real solutions like smaller portioned containers and new calorie labels that show the number of calories in the full container, right up front, to help people chose products and sizes that are right for them and their families,” he said.

The posters are appearing on subway stops around the city for the next three months. Mayor Bloomberg dismissed his critics who claim that the ads were too graphic and disturbing:  “What do you want to do? Do you want to have people lose their legs or do you want to show them what happens so that they won’t lose their legs? Take your poison. Which do you want?” said Bloomberg.

Many healthcare experts agree with Bloomberg. “Obesity rates in adults rose to 35.7 percent from 30.5 percent between 1999 and 2010, compared with rates that nearly doubled in the two previous decades, the Centers for Disease Control and Prevention (CDC) reported . The rate among boys climbed 29 percent, surpassing girls for the first time, according to the CDC.

More than 78 million American adults — as much as  one third of the population, and about 12.5 million children were considered obese in 2009- 2010, according to a series of studies reported in the Journal of the American Medical Association. The studies are part of a continuing CDC effort to track obesity rates with new numbers every two years.

Some of America’s Doctors Are Going Broke

Wednesday, January 18th, 2012

Many of America’s physicians have an embarrassing secret — they are going broke. This quandary is claiming a wide range of casualties, including family physicians, cardiologists and oncologists.

Industry insiders are concerned about the trend.  Approximately 50 percent of all doctors operate a private practice. If a cash crunch forces the closure of an independent practice, it robs a community of a vital healthcare resource.  “A lot of independent practices are starting to see serious financial issues,” said Marc Lion, CEO of Lion & Company CPAs, LLC, which advises independent physician practices about their finances.  Doctors say that smaller insurance reimbursements, changing regulations, soaring business and drug costs take away from their practices’ profitability. Some experts counter that doctors’ lack of business sense shares the blame.

Recent steep 35 percent to 40 percent cuts in Medicare reimbursements for key cardiovascular services, such as stress tests and echocardiograms, have taken a substantial toll on revenue for cardiologists, as an example.  Federal law requires that Medicare reimbursement rates be adjusted every year based on a formula tied to the economy’s health. That law says rates need to be cut every year to keep Medicare financially sound.

Although Congress has blocked those cuts 13 times over the 10 years, most recently on December with a two-month temporary “patch,” this dilemma haunts doctors every year.

Beau Donegan, senior executive with a hospital cancer center in Newport Beach, CA, is well aware of physicians’ financial woes.  “Many are too proud to admit that they are on the verge of bankruptcy,” she said. “These physicians see no way out of the downward spiral of reimbursement, escalating costs of treating patients and insurance companies deciding when and how much they will pay them.

“This is a very timely and truthful story for doctors and hospitals in America. This is also a 911 call for U.S. healthcare security.  More importantly, when a doctor is ‘$3.2 million in debt’ or has to force 6,000 cancer patients to look for a new doctor”, as reported by CNN Money, “our healthcare system infrastructure earthquake is coming,” says Dr. Jin Zhou, president of ERISAclaim.com, a national expert on PPACA and ERISA appeals and compliance.  This 2012 CNN Money report is consistent with an AMA report on March 4, 2011 that 51 percent of doctors in Texas are going broke: “51 percent of Texas doctors dug into personal funds to keep practices afloat in 2010,” Dr. Zhou said.

Writing in Forbes, Rick Ungar counters that “While there is considerable truth to be found in the CNN Money piece, a deeper analysis is in order given the knee-jerk reaction by the many who are too quick to place the problem and the blame at the feet of the federal government.  First off, it is important to recognize that not all physicians in the healthcare system are facing financial crisis. About 50 percent of the nation’s doctors are employed, typically by hospitals, and receive a salary in exchange for their service. So far, these practitioners do not appear to be in any significant financial danger.”

The financial problems are typically experienced by a portion of the remaining 50 percent who wish to operate their own private practices and, as a result, find themselves suffering from the financial stresses faced by so many small businesses in these difficult times.  Yet, even among this 50 percent, not all private practices areas are in trouble. For example, surgeons and dermatologists seem to be doing just fine while cardiologists and oncologists, whose business models necessarily make them more susceptible to trouble, are feeling the pain.

Why oncology and cardiology?

Part of the blame does rest with changes in Medicare and Medicaid payment policies. Certainly, cardiologists and oncologists, whose practices naturally bring them into contact with more senior citizens, are the most likely to feel the pain when it comes to reduced government payments. Last year, the Centers for Medicare & Medicaid Services (CMS) took a hatchet to what is paid to cardiologists for performing important tests such as echocardiograms, stress tests and other “machine” based testing. But what you may not know is that these reductions were based on a survey conducted by the American Medical Association, at the request of the CMS, that seemed to go out of its way to omit cardiologists in private practice from the survey participants. Why? Because private practice cardiologists have, by and large, dropped out of the AMA and the AMA’s interest was in getting more money set aside for those medical practitioners in other areas of medicine who remain members.

Time to Resolve the “Doc Fix”

Wednesday, December 21st, 2011

Congress’ end of year to-do list inevitably includes the “doc fix” – billions of dollars to avoid deep rate cuts for physicians who treat Medicare’s 48 million patients.  Congressmen and Senators always defer the cuts demanded by a 1997 reimbursement formula — known as the sustainable growth rate (SGR) and which most believe needs to be entirely rewritten.  The deferrals are temporary, and the doc fix has become increasingly difficult to pass through a divided and deficit-wary Congress.  In 2010, Congress put off scheduled cuts five times, with the longest delay lasting one year.

The story is the same heading into 2012.  If lawmakers are unable to agree before returning home for the holidays, 500,000 physicians will face a stiff 27 percent cut beginning January 1.  Although Congressional leaders have vowed to prevent that, they disagree over how to pay for the fix.  There is little doubt some agreement will be reached, but that deal could be delayed until early next year.

The cost of congressional intervention, not surprisingly, has grown: Delaying the cuts — the solution Congress has chosen since 2003 — will cost $21 billion for a one-year delay and $38.6 billion for two years.  Repealing the formula would add approximately $300 billion to the deficit, according to the Congressional Budget Office.

No one imagined that the SGR would cause so much trouble when it was passed as a minor element of the Balanced Budget Act of 1997.  Nearly 15 years ago, Medicare physician spending, which accounts for a small share of the program’s overall outlay, was growing slowly.  The law included other restraints that have since been repealed.  Analysts predicted that, at most, the SGR formula would curb physician payments minimally.  “It wasn’t viewed as a big deal at the time,” said Paul Van de Water, an economist specializing in Medicare with the research group Center on Budget and Policy Priorities.  “They needed a few more billion dollars in savings (for the Balanced Budget Act), so they just tacked on the SGR arrangement.”

Kaiser Health News wonders why Congress doesn’t just scrap the SGR formula.  “Money is the biggest problem.  It would cost about $300 billion to stop the doc fix cuts over the next decade and Congress can’t agree on where to find that kind of cash.  Some lawmakers, including Senator Jon Kyl (R-AZ), have proposed using money saved from winding down the wars in Iraq and Afghanistan to finance a permanent fix.  While the idea has found favor among some Democrats, other Republicans oppose it.  For physicians, the prospect of facing big payment cuts is a source of mounting frustration.  Some say the uncertainty led them to quit the program, while others are threatening to do so.  Still, defections have not been significant to date, according to MedPAC.  Physician groups continue to lobby Congress to enact a permanent payment fix.”

Dr. Florence C. Barnett recently decided to quit seeing Medicare patients.  She said the plan covered approximately 33 percent of what it cost her to see patients — and found herself facing a growing Medicare patient population after other local neurosurgeons left the program in 2010.  “This is the way the government will ration healthcare,” Barnett said.  “The people who can afford it will have healthcare, and the people who are only on government support — they will not be able to find a doctor or they will have a very long wait.  It’s happening now.”

A survey conducted by the Medicare Payment Advisory Commission found that among patients looking for a new primary-care physician in 2010, 79 percent experienced no problems finding one.  According to the American Medical Association (AMA), which generally resists limits in reimbursements, nearly 33 percent of primary-care physicians already restrict how many Medicare patients they accept in their practices.

Physicians are once again relying on Congress to put off the impending cut.  It’s a scenario that Glen Stream, M.D. and president of the American Academy of Family Physicians, calls a “Lucy and Charlie Brown and the football thing.”  In other words, physicians have become numb to the whole situation.  This year, that numbness could be risky.  “Doctors are sort of numb from this,” Stream said.  “It’s concerning because I think there’s a very serious chance that this cut could go into place and yet many practicing physicians have heard this years and years in a row and it always seems to get averted at the last minute.  I think that they may not understand the gravity of the situation this time.”

Writing on the MDNews.com website, Maggie Behringer says that “Last year the battle to fund the Medicare deficit — $19 billion for the fiscal year — ended in a one-year measure.  The summer saw a hands-off stance from the Center for Medicare and Medicaid Services when the administration instructed providers to temporarily cease filing claims until Congress resolved a standstill over stimulus spending and unemployment benefits.  The cut projected for January, 2012, should Congress fail to enact the customary doc-fix, totals to 27.4 percent.  The core conflict for legislators — 19 of whom are physicians, themselves — emerges in the inability of the SGR to adapt in today’s economic environment.  The formula was originally developed to bind spending to the economy’s growth.  Despite initial success, the exponential climb in healthcare costs quickly surpassed the overall market.  The subsequent deficits to fund Medicare were further compounded by the recent depression and ongoing recession.  Even if Congress is able to act in time with a temporary doc-fix over the holidays, the fundamental dilemma will remain a question of funding just as the patient population eligible for Medicare benefits enters a major boom.”

Super Committee’s Failure Raises Questions About Healthcare Funding

Wednesday, December 7th, 2011

Now that the Super Committee has failed to identify $1.2 trillion in cuts from the federal budget, automatic cuts totaling billions for everything from Medicare to biomedical research, start in 2013.  Some healthcare sectors will fare better than others.  The primary health entitlement programs, Medicare and Medicaid, are protected under the law that created the Super Committee.  Automatic cuts will not impact Medicaid, the joint federal-state health program for the poor.  Medicare would be cut by two percent – all from payments to hospitals and other providers.

The bad news is that unless Congress reworks the legislation mandating the automatic cuts, a series of across-the-board reductions will begin in 2013.  The House and Senate appropriations committees must decide how to spread the cuts among various programs.  And some of the larger, better-financed lobbies may be able to influence what is cut and what is kept.

Even though the Medicare cuts are limited to hospitals and other medical providers and would not exceed two percent, they argue that is too much and that they sacrificed plenty in the Patient Protection and Affordable Care Act (ACA).  Rich Umbdenstock, president and CEO of the American Hospital Association, said sweeping cuts would hurt Medicare beneficiaries and their families and “also have an impact on the ability of hospitals to provide essential public services to the communities they serve given the impact that Medicare has on the entire healthcare system.”

Officially known as the Joint Select Committee on Deficit Reduction, the Super Committee was unable to meet its deadline to come up with $1.2 trillion of deficit reduction required by the law that created it, much less the $4 trillion that deficit hawks said was necessary to stabilize the finances of the U.S. government, whose debt has topped $15 trillion.  The failure ensures that the fiscal debate between Democrats who want to protect social programs and increase revenue by raising taxes on the wealthy; and Republicans who want smaller government and have pledged to reject tax increases will be a fundamental choice confronting voters in 2012.

“After months of hard work and intense deliberations, we have come to the conclusion today that it will not be possible to make any bipartisan agreement available to the public before the committee’s deadline,” Representative Jeb Hensarling,(R-TX), and Senator Patty Murray, (D-WA) said.  The co-chairs thanked committee members, staffers and “the American people for sharing thoughts and ideas and for providing support and good will as we worked to accomplish this difficult task.”

Writing for Politico, David Nather speculates on whether the Super Committee’s failure has harmed efforts to reform Medicare and Medicaid.  It would be easy to conclude that the Super Committee’s failure means the big, expensive health care entitlement programs — Medicare and Medicaid — are untouchable.  It also would be wrong.  The timing was off, coming too close to a presidential election.  The co-chairs weren’t powerful enough.  The work came too soon after a summer debt deal that Democrats hated.  Republicans couldn’t give the kind of concessions on taxes that Democrats needed.  And the alternative to a Super Committee deal on healthcare entitlements — the two percent automatic cuts in healthcare payments and defense funding that will now take place in 2013 — wasn’t harsh enough to force a deal on Medicare and Medicaid. In fact, it might even have been the easier way out.  All of which means Medicare and Medicaid are not off the table forever.”

The Hill’s Sam Baker offers a different perspective. “The Super Committee’s demise is a mixed bag for the American Medical Association and other groups that wanted the 12-member panel to tackle Medicare’s payment formula, known as the sustainable growth rate (SGR).  The AMA — with bipartisan support in Congress — pushed hard for the supercommittee to include in its deficit-cutting package a long-term fix to the SGR.  The formula calls for automatic annual cuts in doctors’ payments, which add up as Congress consistently delays each cut from taking effect.  Aspirations of a long-term SGR patch should be put to rest, healthcare lobbyists said. But they questioned whether the supercommittee push was ever realistic, because an SGR fix would add to the deficit.”

“I never once believed that the Joint Select Committee would be the one to do that,” said Julius Hobson, a senior adviser at the Washington, D.C.-based law firm Polsinelli Shughart and a former AMA official.

Can Marilyn Tavenner Save Medicare?

Monday, December 5th, 2011

President Barack Obama’s choice of Marilyn Tavenner as administrator of the Centers for Medicare and Medicaid Services — to replace Dr. Donald Berwick, whose recess appointment was set to expire at the end of the year – is more likely to survive the Senate confirmation process relatively unscathed.

A Harvard-educated pediatrician, Berwick won praise and the backing of major healthcare groups for his academic work, which focused on cutting the cost of care while improving quality and patient experience.  Republicans took exception to his praise of Britain’s National Health Service as an “example” for the United States to emulate.  Others accused him of supporting “rationing” healthcare services, a claim Berwick rejects.  “Every bone in my body, as a physician, even as a person, is to get everything (patients) want and need and to help them at every step,” he said.  “I have gone to the mat to get a last-ditch bone marrow transplant for a child with leukemia…and they are telling me I’m rationing?  They haven’t met me.”

White House officials said, “Before entering government services, Tavenner spent nearly 35 years working with health care providers in significantly increasing levels of responsibility, including almost 20 years in nursing, three years as a hospital CEO, and 10 years in various senior executive-level positions for Hospital Corporation of America.”

According to Ezra Klein, “Tavenner’s healthcare experience lies much more in management than policy.  Former colleagues describe her as a patient-centered manager, a hands-on medical professional equally comfortable in the board room and the emergency room.  And in contrast to Berwick, Tavenner isn’t associated with a grand vision for health reform, or a particular policy agenda for Medicare and Medicaid.  ‘With Marilyn, you present the information, then she makes a decision, and you move on,’ said Patrick Finnerty, who served as Virginia’s Medicaid director under Tavenner.  ‘She doesn’t make promises she can’t keep.  There are differences of opinions, and she would try to work through those.  She’s straight with folks but always respectful.’”

Tavenner started her career as a nurse at Virginia hospitals owned by the Hospital Corporation of America (HCA).  Tavenner met with success, rising from chief nursing officer to CEO.  In 2004, she was again promoted to HCA’s president of outpatient services, her first national position with the firm.  She resigned two years later, when then-Virginia Governor Tim Kaine tapped her to head the state’s Health and Human Resources department.

Tavenner has already won the American Medical Association’s (AMA) backing. “We have worked extensively with her in her role as deputy administrator, and she has been fair, knowledgeable and open to dialogue,” AMA President Peter Carmel said.  “With all the changes and challenges facing the Medicare and Medicaid programs, CMS needs stable leadership, and Marilyn Tavenner has the skills and experience to provide it.”

Senator Orrin Hatch (R-UT), the ranking Republican on the Senate Finance Committee, said that the panel would thoroughly scrutinize Tavenner, but did not say he opposes her nomination.  Despite Hatch’s mild comment, Tavenner is expected to face some difficult questioning because Senate Republicans have not overtly endorsed her.  According to a Republican healthcare lobbyist, “I can’t imagine a lot of support for her,” noting that the high-profile CMS role “always gets sucked into the controversy of the day.”  Ultimately, Tavenner is likely to be confirmed for the CMS post.

Tavenner is widely seen as a pragmatic administrator who will not rock the CMS boat. “The only way to stabilize costs without cutting benefits or provider fees is to improve care to those with the highest health care costs,” she said.  Tavenner also said she opposed Republican efforts to turn Medicaid into a block grant that would limit the amount of federal funding states can receive for the program.  “That approach would simply dump the problem on states and force them to dump patients, benefits or make provider cuts or all the above,” she said.  Tavenner “brings continuity in terms of implementing the mission,” said Len Nichols, director of George Mason University’s Center for Health Policy Research and Ethics.

Medical School Enrollment on the Rise

Tuesday, November 1st, 2011

More young Americans are deciding to become physicians during a tough jobs market, even though they tend not to choose the high-demand primary care.  American medical schools were pleased when they received a record number of applications in 2011.  Applicants increased by 1,178, or 2.8 percent, according to the Association of American Medical Colleges (AAMC).  Fully 43,919 men and women applied to U.S. medical schools this year, including 32,654 first-time applicants, according to the Washington, D.C.-based AAMC.  First-year enrollment increased by three percent to 19,230, a rise of 18,665 when compared with 2010.

A vital highlight is the larger number of African-American applicants, following a 0.2 percent decline in 2010.  Those numbers grew by 4.7 percent to 3,640 in 2011, while enrollees rose by 1.9 percent to 1,375.  The number of Hispanic/Latino applicants also grew by 5.7 percent to 3,459, with enrollment rising by 6.1 percent to 1,633.  Asians comprised 22.7 percent of the total applicant pool; applicants who identified themselves as white made up 62.3 percent of the total.

Meanwhile, first-time female applicants grew 3.3 percent to 15,953, while female enrollment increased by 3.2 percent to 9,037.  The number of first-time male applicants increased by 1.9 percent for a total of 16,698 applications with 10,193 enrollees, a 2.9 percent increase when compared with 2010.  AAMC said medical schools attract well-qualified applicants, noting their academic profiles included an average grade-point average of 3.5 and an MCAT score of 29.

“We are very pleased that medicine continues to be an attractive career choice at a time when our healthcare system faces many challenges, including a growing need for doctors coupled with a serious physician shortage in the near future,” said Darrell G. Kirch, M.D., AAMC president and CEO.  “At the same time the number of applicants is on the rise, we also are encouraged that the pool of medical school applicants and enrollees continues to be more diverse.  This diversity will be important as these new doctors go out into communities across the country to meet the health care needs of all Americans.

“U.S. medical schools have been responding to the nation’s health challenges by finding ways not only to select the right individuals for medicine, but also to educate and train more doctors for the future.  However, to increase the nation’s supply of physicians, the number of residency training positions at teaching hospitals must also increase to accommodate the growth in the number of students in U.S. medical schools.  We are very concerned that proposals to decrease federal support of graduate medical education will exacerbate the physician shortage, which is expected to reach 90,000 by 2020,” Kirch said.

Wait a minute!  The Council on Physician and Nurse Supply disagrees, noting that the U.S. will be short 200,000 physicians by 2020. “According to recent data, physician demand seems to be a real crisis,” said Onyx M.D. CEO and Chairman Robert Moghim, M.D.  “Not only is the overall physician shortage a major problem but certain specialties will be hit harder than others, especially primary-care specialists.”

In fact, the AMA announced that the number of primary-care physicians (PCPs) could decrease by 35,000 to 40,000 by 2025.  Apparently PCPs are becoming increasingly frustrated in many areas of their practice.  “Dealing with third-party payers, governmental red tape, slowness in receiving reimbursement and increased time spent with non-clinical paperwork seems to be driving this discontent,” said Monty McKentry, VP of Client Services & Recruitment at Onyx M.D.  He notes that, “These factors may be the cause of the newly reported data from the Journal of the American Medical Association that only two percent of current medical students intend to go into primary care.”

To make this situation even worse, there is a growing concern that one new physician entering the work force may not equal the productivity of a retiring physician.  This can be attributed to a cultural shift to a better work-life balance, shorter working hours and increased demand for more part-time work.  With the anticipated shortage in primary-care physicians, demand will increase for short-term coverage or locum tenens (a place-holder).  “We anticipate a wide variety of new opportunities as primary care physicians look for other alternatives such as locum tenens, Moghim said.”

Finally, Kirch highlighted programs that provide scholarships and loan forgiveness in exchange for working as general practitioners in the nation’s underserved areas.  According to Kirch, more funding is needed for these programs, and payments to primary-care physicians for services should be increased.

AMA: Lack of Competition Among Healthcare Insurers

Monday, October 31st, 2011

More than four out of five metropolitan areas do not have a competitive commercial health insurance market because mergers and acquisitions have allowed some insurers to increase their market share, according to a report issued by the American Medical Association.

The report studied 368 metropolitan markets and 48 states, and determined that 83 percent had minimal competition among health insurers.  In approximately 50 percent of markets, at least one insurer maintained a majority market share of 50 percent or more.  In half of the states studied, the two largest health insurers had a combined market share of 70 percent or more.  The data shows “the degree of anti-competitive market clout” that some insurers have accrued through mergers and acquisitions, which decreases competition for patients, physicians and employers, said AMA President Peter W. Carmel.  Alabama occupied the last place, followed by Alaska, Delaware and Michigan.

According to Carmel, “Our new report is intended to help regulators, lawmakers, researchers and policymakers identify markets where mergers among health insurers may cause competitive harm to patients, physicians and employers.”

This latest edition of Competition in Health Insurance: A Comprehensive Study of U.S. Markets is the most comprehensive analysis to date, reporting commercial health insurance market shares and federal concentration measures for all 48 states.  The scope of the analysis provides a comprehensive snapshot of fully-insured and self-insured enrollments for both health maintenance organizations (HMOs) and preferred provider organizations (PPOs).

One conclusion is “A significant absence of health insurer competition exists in 83 percent of metropolitan markets studied by the AMA.  These markets rated ‘highly concentrated’, based on the newly revised Horizontal Merger Guidelines issued last year by the U.S. Department of Justice and Federal Trade Commission.

“The market power of health insurers places physicians and patients at a significant disadvantage,” Carmel said.  “When insurers dominate a market, people pay higher health insurance premiums than they should, and physicians are pressured to accept unfair contract terms and corporate policies, which undermines the physician role as patient advocate.”

Physicians are the least concentrated segment of the healthcare sector with 78 percent of office-based doctors working in practices with nine physicians or less.  The majority of those are in either solo practices or offices with between two and four physicians.

“The market power of health insurers continues to prompt anti-competitive concerns among physicians,” Carmel said.  “To help restore a competitive balance to health insurance markets, the AMA urges the federal and state agencies to prohibit harmful insurance company mergers and adopt policies that would level the playing field between small physician practices and large insurers.”

Writing in the Washington Post,  Ezra Klein points out that one of the major goals of the Patient Protection and Affordable Care Act (ACA) is to create a competitive insurance market.  “This is the bill’s first, and most important, step.  Right now, the insurance market’s version of competition is pretty brutal.  Companies compete to avoid the sickest people and sign up the healthiest people.  Offering the best coverage for the lowest cost isn’t much of a priority, because most consumers don’t know whose coverage is best, and the ones who really do know are probably sick customers who spend their days researching this stuff.

“Outlawing the bad kind of competition while enabling the good kind, which the bill does, is more than just a humanitarian measure.  It’s a cost control.  The insurance ‘exchanges’ imitate the market in which federal employees (including congressmen) purchase their health insurance. In the exchanges, insurance products have to be above a minimum level of comprehensiveness (no more insurance that doesn’t cover anything) and their benefits have to be presented in a standard, comprehensible way.  The insurers themselves can’t discriminate based on pre-existing conditions, will have to answer to regulators if they attempt to jack up premiums, and will be rated by their customers — a rating that everyone else will see when shopping for their insurance,” according to Klein.

“If all goes well, consumers will be able to log onto the exchange’s website, compare insurance plans and choose their favorite.  That means insurers will have to compete for customers in a more transparent market, where shoppers have more information, and where the relationship between price and quality is more obvious.  As any free-market conservative will tell you, that should drive prices down and quality up.  If it doesn’t, insurers will have some annoyed legislators to answer to: The bill says congressmen and their staff members need to buy their insurance from these exchanges, too.”

Medicare ACOs Receive Mixed Reviews

Tuesday, August 16th, 2011

A Medicare pilot program started in 2005 chose 10 groups for an experiment in improving quality and controlling costs. This foreshadowed some of the cost-control rules in the Patient Protection and Affordable Care Act (ACA) , with groups given bonuses for meeting approximately 15 quality measures, and for spending at least two percent less than conventional Medicare.  This program is a forerunner to the Accountable Care Organization (ACO) model that is one of the prime means by which the ACA’s supporters expect it to control costs.  Now that the results are in, the quality issues were met, but the issue of cost proved to be far more difficult to achieve.

Writing in The Atlantic, Megan McArdle says that Donald Berwick, the head of the Centers for Medicare and Medicaid Services (CMS), says “he is optimistic about the potential of ACOs to lower costs by coordinating care, although he acknowledged that savings from the experiment ‘were unevenly distributed, and they were modest…if care is correctly coordinated, costs fall and quality rises.  To me, it’s a matter of how fast we will get there, not whether we will get there.’  He may be right; sometimes you just haven’t done a program correctly.  On the other hand, sometimes programs don’t work, were never going to work, and can’t be made to work.  Even in the latter case, you still hear the sort of thing that Berwick is saying from the proponents of said programs: we need more time, more money, more staff, more rules.  People have usually spent years, even decades, investing in their ideas; when contrary evidence comes in, their first instinct is rarely to say, ‘Well, that’s too bad–it sure seemed like it was going to work, but I guess it didn’t!’.  No, what they want to do is double down.”

Started in 2005 by the George W. Bush administration, the experiment offered “performance payments” to participants that met most of 32 measures of quality — half as many as in the proposed rule — and spent at least two percent less for Medicare patients.  Despite their spotty financial progress, all 10 medical groups in the experiment met the quality requirements.  Additionally the program promoted care innovations, according to administration officials, outside health policy experts and leaders of the groups.

The Obama administration recently announced new options for Medicare ACOs.  The new shared savings components complement the proposed rules that will be finalized this year, Dr. Berwick said.  This pioneering model has been in process for months and that the latest announcement was not in response to skepticism about the proposed rules.  “This is responsive to some of the concerns on how to get started faster,” Dr. Berwick said.  “That’s what we’re getting asked about a lot. The criticism is comment we’re welcoming.”

CMS’ announcement represents a step in the right direction, although additional changes to the shared savings program need to be included to assure physician involvement, said American Medical Association’s (AMA) Immediate Past President J. James Rohack, MD.  “The AMA is pleased that (the innovation center) is working to assist physicians at varying stages of readiness who want to participate in Medicare ACOs,” Dr. Rohack said.  “The benefits of this new care delivery model cannot be fully realized unless physicians in all practice sizes can be involved.”

The CEO of the Cleveland Clinic hates proposed federal rules for accountable care organizations, saying they create “significant barriers” and would discourage hospitals from adopting the new model of care.  Toby Cosgrove made the comments in an eight-page letter addressed to Donald Berwick, though Cosgrove stressed that the Clinic supports the concept of accountable care organizations (ACOs).

“Rather than providing a broad framework that focuses on results as the key criteria for success, the proposed rule is replete with (1) prescriptive requirements that have little to do with outcomes; and (2) many detailed governance and reporting requirements that create significant administrative burdens,” according to Cosgrove.

To be considered an ACO, organizations must agree to manage all of the health needs of a minimum of 5,000 Medicare beneficiaries for at least three years.  ACOs are appealing to hospitals because organizations that save Medicare money will be eligible to share in some of that savings themselves.  CMS is accepting public comments on its proposed ACO rules and will issue final rules later this year.  Like the Clinic, other leading hospitals have criticized the rules as being too burdensome and providing too little possibility of financial gain.

Healthcare Claims Errors Cost $17 Billion a Year

Monday, July 11th, 2011

A recent American Medical Association (AMA) survey has determined that claims-processing errors by healthcare insurance companies cost the nation $17 billion a year in pointless administrative costs.  The AMA’s study is based on a random sampling of approximately 2.4 million electronic claims submitted in February and March of this year to Aetna, Anthem Blue Cross Blue Shield, CIGNA, Health Care Service Corporation, Humana, the Regence Group, United Healthcare and Medicare.  The claims were filed for more than 400 physician groups in 80 medical specialties in 42 states.

The typical claims-processing error rate was 19.3 percent, a rise of two percent over 2010 and is expected to add $1.5 billion in administrative costs this year.  “A 20 percent error rate among health insurers represents an intolerable level of inefficiency that wastes an estimated $17 billion annually,” said AMA Board Member Barbara L. McAneny, M.D.  “Health insurers must put more effort into paying claims correctly the first time to save precious healthcare dollars and reduce unnecessary administrative tasks that take time and resources away from patient care.”  To promote a more efficient claims payment system, the AMA’s National Health Insurer Report Card provides a yearly check-up for the largest health insurers and benchmarks the systems they use to manage, process and pay claims.

America’s Health Insurance Plan’s (AHIP) spokesman Robert Zirkelbach said insurers and providers must share the responsibility for improving accurate and efficient claims payment.  “According to Zirkelbach, “Health plans are doing their part by collaborating with providers and investing in new technologies to improve the process for submitting claims electronically and receiving payments quickly.  At the same time, more work needs to be done to reduce the number of claims submitted to health plans that are duplicative, inaccurate or delayed.”

Medicare came out ahead of the commercial insurers, with a 96 percent accuracy rate.  The lowest rated firm was Anthem Blue Cross, at 61 percent.  Anthem’s parent company, WellPoint Inc., is expanding electronic claims processing operation to improve accuracy.

The National Health Insurer Report Card is the basis of the AMA’s Heal the Claims Process campaign. Launched in June 2008, the campaign’s goal is to encourage improvements in the industry’s billing process so physicians and patients are no longer at the mercy of a chaotic payment system.  “In spite of notable improvements by insurers in the four years since the AMA introduced the National Health Insurer Report Card, precious healthcare resources are wasted because each insurer uses different rules for processing and paying medical claims, Dr. McAneny said.  “This variability adds no value to the healthcare system and only increases unnecessary administrative costs.”

To help physicians enhance their management of each insurer’s claims-submission requirements, the AMA’s Practice Management Center offers user-friendly online resources for preparing claims, following their progress and appealing them when necessary.  The Practice Management Center’s educational materials and practical tools are available online at www.ama-assn.org/go/pmc.

Another of the report’s findings is that physicians were not reimbursed by healthcare insurance companies on almost 23 percent of submitted claims.  The reason usually provided for non-payment are deductible requirements that shift payment responsibility to the patient until a dollar limit is met.

According to AHIP president Karen Ignani,“Administrative simplification that benefits consumers and the physicians who serve them is a top priority for our community.  Recent data from PricewaterhouseCoopers indicate administrative costs have been stable for four decades.  As a result of the move to electronic processing, the cost for each claim has actually declined, enabling insurers to provide value added services to consumers, such as disease management programs, without contributing to rising healthcare costs.  AHIP data indicate that virtually all ‘clean’ claims are processed within 30 days.

“AHIP members have worked collaboratively with physicians to make improvements in processes to promote efficiency and move to real-time payment.  In order for claims to be processed as efficiency and promptly as possible, both insurers and physicians need to strive for accuracy and timeliness.  For example, data show there is often a significant lag time between when services are provided and physician claims are submitted.  Data also indicate that there are a significant number of incomplete and duplicate claims filed.  Reports released last week decried ‘no questions asked’ reimbursement in Medicare and emphasized the need to scrutinize claims to prevent fraud.  In addition, research shows more than $200 billion is spent annually on services that are not in sync with the rigors of medical science, the result of wide variations in practice, overuse, underuse, and misuse of services.  Our view is that discussions of efficiency are important, but that they should be broad discussions of opportunities for improvement by all the responsible stakeholders.”