Posts Tagged ‘patients’

Why Aren’t Physicians Paid For Talking To Their Patients?

Tuesday, July 5th, 2011

One possible reason that more physicians do not choose family practice as their specialty could be the fact that an essential part of the job is spent talking with patients – an activity that pays less than does performing procedures.   According to a recent study published by the Journal of the American Medical Association, just two percent of medical students plan a career in general internal medicine, pediatrics or ob/gyn.

Writing on the KevinMD.com website, Jennifer Adaeze Anyaegbunam says that “Family doctors spend more time talking to patients than performing procedures, but these doctors don’t get paid much to chat.  According to Dr. Sameer Badlani, a professor at the University of Chicago School of Medicine, when physicians are paid on a fee-for-service basis, specialists have the opportunity to make four to five times as much as a family physician.  Given the increasing debt of medical students, it is no surprise that the overwhelming majority choose to specialize.  In order to increase the supply of primary-care providers and meet the anticipated demand, family physicians need to be reimbursed more for their services.  Congress is looking into legislation that includes provisions for loan forgiveness and increased Medicare/Medicaid payments to primary-care providers.  Additionally, there have been talks of expanding the National Health Service Corps, program that utilizes scholarships and loan repayment to recruit primary care professionals to work in underserved areas.”

Primary-care physicians spend more time talking to patients and helping them avoid health crises to cope with chronic and incurable diseases than they spend performing tests and procedures. These doctors ask relevant questions, about health and life circumstances, and listen carefully to their patients.  These are physicians who know their patients and the circumstances and beliefs that can make health problems worse or hamper effective treatment.  The problem is that reimbursements are dictated by Medicare and other insurers.  As a result, physicians are not compensated well for taking the time to talk to patients.  They are primarily paid for procedures – such as blood tests and surgery — and for the number of patients they see.  Most spend long hours doing paperwork and negotiating treatment options with insurers.  The payments they receive have not increased along with increases in the costs of running a modern medical practice.  To earn a reasonable income of $150,000 a year, many primary-care doctors squeeze more and more patients into the workday.  “If you have only six to eight minutes per patient, which is the average under managed care, you’re forced to concentrate on the acute problem and ignore all the rest,” said Dr. Byron M. Thomashow, medical director of the Center for Chest Diseases at New York-Presbyterian Columbia Medical Center.  In a study of more than 3,000 patients with chronic obstructive pulmonary disease, 50 to 60 percent had one or more other illnesses, and 20 percent had more than 11 other conditions that required medical attention.  “There just isn’t the time to address them all,” Thomashow said.

Dr. Alan J. Stein, an infectious disease specialist in private practice in Brooklyn who treats many patients with HIV, described his practice as “heavily cognitive.  I spend a lot of time talking to patients — listening to them, examining them, interpreting tests and figuring out what’s wrong,” he said.  “I don’t do procedures in the office.  Over the last 10 or 15 years, the income of procedure-based physicians like cardiologists has increased significantly, whereas for those in primary care it has remained the same.”

Despite this, many physicians are reluctant to talk to their patients via e-mail.  Suzanne Kreuziger, a Milwaukee registered nurse, said.  “It makes sense to me to have the words laid out, to be able to re-read, to go back to it at a convenient time,  If I were able to ask my physician questions this way, it would make my own health care much easier.”  Her experience is shared by the majority of Americans: They want the convenience of e-mail for non-urgent medical issues, but fewer than 33 percent of doctors use e-mail to communicate with patients, according to surveys.

“People are able to file their taxes online, buy and sell household goods, and manage their financial accounts,” said Susannah Fox of the Pew Internet & American Life Project.  “The health care industry seems to be lagging behind other industries.”  Physicians have good reasons for avoiding e-mail exchanges with their patients.  Some are concerned that it will increase their workload.  Others worry about hackers compromising patient privacy.

Illinois Should Improve Healthcare Delivery Quality: Study

Thursday, October 22nd, 2009

flu_seniors_480Illinois medical providers rank among the nation’s most ineffectual when it comes to providing cost-effective treatment and avoiding unnecessary hospitalizations.

According to the nonprofit Commonwealth Fund’s report, Illinois ranks 49th among 50 states and the District of Columbia in terms of “avoidable hospital use and costs.” The study measures how often Medicare patients with chronic conditions such as heart disease are admitted to the hospital or how frequently nursing home patients shuttle in and out of hospitals.  New York came in 50th, with Louisiana occupying the last place.

Illinois also placed 44th in terms of how effectively hospitals deliver basic care that avoids complications.  Healthcare costs and volumes of tests and treatments were found to be unusually high, especially in metropolitan Chicago.

There was some good news for Illinois in the Commonwealth Fund’s study.  The state ranked 20th in access to care, quality in terms of income, race and ethnic background; 29th in quality-of-life measures such as infant mortality; and 32nd in death rates for colon and breast cancer.  The study places Illinois in 42nd place in terms of the quality of overall healthcare delivery.

Cathy Schoen, Senior Vice President of the Commonwealth Fund and a co-author of the study, noted that the findings underscore the need for wide-ranging healthcare reform.  “We need payment reforms with incentives to do well on outcomes and efficiency of care,” she said.

Physicians Line Up To Support A Public Option

Monday, September 21st, 2009

A random survey of 2,130 physicians found that 73 percent support a public option as one element of healthcare reform legislation.  That breaks down to 63 percent of physicians supporting both public and private options; 10 percent supporting a public option only; and 27 percent favoring private options only.  The poll was conducted by New York’s Mount Sinai School of Medicine internists and researchers Dr. Salomeh Keyhani and Dr. Alex Federman.nmrally20in20support20of20public20option20and20bingaman20july2015

The majority of physicians who favor giving their patients a choice of public or private insurance are in tune with President Barack Obama’s position and that of many congressional Democrats.  Polls of average Americans have found that between 50 and 70 percent support a public option.  In other words, physicians support the public option more strongly than the general population.  This contradicts one of the canards of the healthcare debate – that doctors will resist reform for fear of seeing their incomes erode.

“Whether they lived in southern regions of the United States or traditionally liberal parts of the country, we found that physicians – whether they were salaried or they were practice owners, regardless of whether they were specialists of primary care providers, regardless of where they lived – the support for the public option was broad and widespread,” Dr. Keyhani said.

The survey was published Monday, September 14, in the online New England Journal of Medicine. It was funded by the Robert Wood Johnson Foundation, a healthcare research organization that supports reform legislation.

Wanda Jones: Time to Reinvent Hospitals and Medical Office Buildings

Wednesday, September 9th, 2009

great_ormond_st_readyHospitals and medical office buildings must undergo a complete rethinking to move them functionally and architecturally from the 1970s to models that make sense for the 21st-century.  Wanda Jones, healthcare futurist and president of the New Century Healthcare Institute, believes that we need to reinvent hospital design and construct linear-spine facilities that provide patients with more personalized medicine.  This anticipates expansions, contractions, removal and replacement of patient towers by dividing the number of patient beds into two, three or four towers.  This way, they can be incrementally changed without interrupting the others and are readily adaptable to specific programs.

In a recent interview for the Alter+Care Podcasts on Healthcare, Wanda Jones discusses the paradigm shift in terms of new technologies that will make obsolete the knowledge base on which healthcare systems, hospitals and physicians have made money up until now.  Every surgical specialty will use robotics, and cures for cancer will be based on technology that has arisen out of the human genome project.  The New Century Healthcare Institute is a research-and-development and educational foundation devoted to population-based planning and adaptation of the healthcare system to future conditions.

Medicare: The Free Market Option

Tuesday, September 8th, 2009

Medicare gives patients more choice, and a greater range of free-market options than does private insurance.  While Medicare has had its financial challenges, it is an example of a government-run program that gives patients choice.  Sometimes, private insurers refuse to include physicians in their plans; Medicare does not exclude physicians.

The insurance companies insist the idea of healthcare reform to include a public option – such as Medicare – but it’s important to look at the facts that includes a government-run plan.  According to a recent article in Mother Jones magazine, “Survey results demonstrate that Medicare beneficiaries are less likely than those with private coverage to High healthcare cost, advanced healthcare directivereport negative experiences with their insurance plans – including having expensive medical bills for non-covered services, being charged a lot more than insurance would pay, and physicians not taking their insurance.”

According to a study by the Commonwealth Fund, 37 percent of Medicare patients are completely satisfied with their coverage and report few problems accessing and paying for healthcare.  Only 20 percent of people with employer provided plans reported the same level of satisfaction.

One argument often used against the public health plan option is the following: I want to choose my own doctor, and I don’t want a government bureaucrat making that decision.  That’s wrong.  Under private healthcare plans, your only choice is to pick a doctor who has negotiated costs with your insurance company.  Doctors unwilling to negotiate are excluded.

In seeing the way the healthcare debate has been framed, perhaps the administration would have been better off describing the proposed reform as the extension of Medicare to the entire population.

A public health plan option will not introduce a bureaucracy into healthcare; that bureaucracy already exists.

Healthcare Industry Offers Cost Savings

Thursday, July 16th, 2009

Healthcare providers will slash up to $1.7 trillion in costs over the next 10 years by enhancing the care of chronic diseases, reorganizing administrative procedures and eliminating unnecessary treatments.medical_bill

This is a sneak peak at how healthcare systems, physicians, pharmaceutical companies, insurers, medical device manufacturers and other stakeholders plan to respond to President Barack Obama’s request that the industry find ways to control patient costs.  Among the American Medical Association’s (AMA) suggestions are cutting overused – and often unnecessary — procedures, such as Caesarean sections.  The savings are crucial to funding the Obama administration’s proposed health system overhaul.

A new White House study states that reforming healthcare will increase the nation’s GDP by two percent in 2020 and eight percent in 2030, cut unemployment and save families an average of $2,600 a year by 2020.  Without healthcare reform, the number of uninsured Americans will rise to 72 million by 2040, compared with 46 million today.

Christina Romer, chair of the president’s Council of Economic Advisers, said “The one thing that’s happened relative to the 1990s is the nightmare scenario is getting closer.”  Other recommendations include reducing medical errors, using common insurance forms, improving physician performance standards, readmitting fewer patients to hospitals, improving drug development efficiency and expanding in-home care for patients with long-term illnesses.

Stimulus Bill Boosts Healthcare for the Uninsured and Underserved

Thursday, July 2nd, 2009

Tucked into the Obama Administration’s stimulus bill is $200 million to support student loan repayments for primary-care physicians, dentists and mental health specialists who devote two years to working at National Health Service Corps sites.  Approximately 3,300 awards are being made to individuals serving in health centers, rural health clinics and healthcare facilities that treat the uninsured and people living in under served areas.23285

Department of Health and Human Services Secretary Kathleen Sebelius, notes that the American Recovery and Reinvestment Act “has laid the foundation for health reform and is supporting our effort to give more people access to the quality, affordable healthcare they need.  National Health Service Corps has helped protect the health and well-being of millions of Americans.  Now, we are doubling the Corps and putting doctors and clinicians in the communities where they are desperately needed.”

The additional funding should double the number of corps members “and the number of patients they care for, and spark economic growth in communities hard hit by the economic turndown,” according to Mary Wakefield, administrator of the Health Resources and Services Administration, which manages the corps.

“Positive Deviants” Will Revitalize the Healthcare System

Tuesday, June 30th, 2009

The solution to America’s healthcare crisis might just lie in deviant thinking.  This is the message of Dr. Atul Gawande, this year’s commencement speaker at the University of Chicago’s Pritzker School of Medicine.  Gawande is a general and endocrine surgeon at Brigham and Women’s Hospital in Boston, an associate director of their Center for Surgery and Public Health, an associate professor at the Harvard School of Public Health and at Harvard Medical School.

050102_Gawande_Atul_3.jpgHis concept of positive deviants identifies those communities and physicians who discover innovative ways to reduce costs and improve care  to deliver better outcomes.

Gawande cites a nutritionist who spent his career attempting to reduce hunger in Vietnamese villages.  This man asked villagers to identify which families had the best-nourished children to determine a “positive deviance” from the norm.  The answer was that those children’s mothers did not act in accordance with accepted village wisdom had the best outcomes.  Rather, they fed their children even when they had diarrhea; fed them several small meals daily rather than one or two large ones; and fed their children foods that others considered low class but were nutritious such as sweet potato greens.

In the American healthcare system, the positive deviants resist the tendency to view patients primarily as revenue streams – but as human beings.  Rather, these physicians deliver high-value healthcare without focusing too strongly on their practices’ bottom lines; they neither over-treat nor under-treat their patients with extraneous but profitable tests and procedures.

To quote Gawande, “Look for those in your community who are making healthcare better, safer and less costly.  Pay attention to them.  Learn how they do it.  And join with them.”

Recession Makes Access to Quality Healthcare Less Accessible for the Poor

Tuesday, June 2nd, 2009

Thousands of poor women on Chicago’s South Side have lost what may have been their single lifeline to decent healthcare with the University of Chicago’s recent announcement that it is closing its storefront Women’s Medical Center on 47th Street near Woodlawn Avenue. This move is the latest in a pullback by the University of Chicago on some of the healthcare services it delivers to the city’s poor and indigent.47001667

According to University of Chicago Medical Center executives, the clinic’s June closing is a victim of the deep recession that has forced the hospital to cut $100 million from its budget.  The Women’s Medical Center, which treated women whose only healthcare insurance is Medicaid, consistently lost money.  The tax-exempt hospital insists that it isn’t hurting the poor, saying that most of the clinic’s patients will be sent to other neighborhood clinics.  The move will let the hospital focus on the more complex illnesses of the patients who utilized the clinic.

“We can’t do everything for everyone in the community,” says John Easton, the medical center’s spokesman.  “Our goal is to use our scarce resources to provide complex care and let our partners in the community provide primary care, which they do very well.”

The clinic’s closure is a highly controversial move.  As a non-profit hospital, the Medical Center is perceived as having a responsibility to give back to its community in exchange for the enormous tax breaks it receives.  It’s a tremendous loss for the women who visited the clinic to keep up with their annual pap smears and mammograms.

Walk-In Clinic A Good Fit With the Healthcare Village

Thursday, May 28th, 2009

Urgent care centers (Illinois law mandates that they be called immediate or convenient care centers) are gaining ground nationwide as an alternative for families with minor medical emergencies that require quick treatment.  Although the walk-in clinic concept has been around for more than 20 years, the trend is picking up steam in an increasingly cost-conscious healthcare environment.  emergency_roomApproximately 8,000 such facilities currently are open for business in the United States.

A 2008 survey by the Urgent Care Association of America found that most centers are owned by physicians, and approximately 15 percent are hospital affiliated.  More than 55 percent are located in suburbs, where well-off patients with private insurance are unwilling to spend hours waiting in an emergency room.  The survey found that of an average of five employees, 1.7 are physicians; 0.4 are nurse practitioners; 0.7 are registered nurses; and 2.3 are clinical staff or medical assistants.  Sixty percent of patients are seen by a physician, nurse practitioner or physician’s assistant in just 30 minutes.

Alter+Care sees immediate care centers as a great fit with Alter+Care’s Healthcare Village concept (our concept of a wellness/preventive-focused outpatient campus, see www.healthcarevillage.net, because the village becomes a healthcare destination while generating visibility and visits for all services located in the village such as diagnostics/imaging, specialty clinics, physician practices, retail healthcare, laboratory and the wellness center.  For patients, the centers provide easy access and reasonably priced care because they typically charge far less than an emergency room visit.  Insurers who want to control costs are encouraging people to use urgent care facilities as an alternative, especially during after hours and on weekends.