News Roundup: Doc Pay, Quality Reporting, and a Tough New Law

Three things to know this week: How much a physician earns is largely dependent on practice size and geographic location, quality reporting is expanding, and a new Tennessee law is tough on drug addicted mothers.

This week I've rounded up some news items that caught my eye because they illustrate some of the the quality reporting, financial, and legislative forces affecting physicians and their practices.

Hospital System Issues Texas-sized Quality Report—On Itself
In addition the new safety scores announced by the Leapfrog Group this week, Texas Health Resources, the nonprofit, faith-based hospital system in north Texas has unveiled a quality and safety report that it says will show both the good and the bad at each of its wholly-owned hospitals.

The public report includes clinical outcomes on more than two dozen indicators, including cancer, pneumonia, patient satisfaction, and heart failure, among others. Under the heading of each condition, Texas Health Resources lists quality indicators from third-party organizations such as the CDC, CMS, the Joint Commission, and others.

Hospital Rankings: The More, the Murkier

"We never have really had a comprehensive stewardship report for the community around how we perform our work," Dan Varga, MD, chief clinical officers and senior executive vice president told me.

"The report will be somewhere between 300 and 400 indicators, all of them are national consensus indicators that are owned by some other indicator developer. All of them have transparent, non-proprietary rules for the gathering and collection reporting of the indicators. We'll aggregate those into a single report and put them out on the web for the public to have access to."

Now public, the report is modeled after a similar one used by Louisville, KY-based Norton Healthcare, one of the state's largest healthcare systems with five hospitals and 90 physician practice locations. It's also where Varga was CMO in 2005 when the system developed its quality report.

With nearly a decade of data and practice at developing quality reports, Norton's includes information on 23 indicators, and is interactive. Texas Health Resources says it anticipates having the same interactive functionality for its report by October.

Even though the aim of the public quality report is to be transparent to the public, Varga says Texas Health Resources is also a big beneficiary of the information. "We are as big an audience for this report as the community is," he says.

Leapfrog's CEO and President Leah Binder told me reports like the ones produced by Norton and now Texas Health Resources are a good step toward being more transparent, but she still considers them "ads."

On-call Doc Pay Depends on Size
A new survey of 2,513 providers shows that compensation for physicians who are on-call varies depending on the location and the size of the practice. Medical Group Management Association (MGMA) issued its findings this week. Primary care physicians and nonsurgical specialists earn the highest daily rate in the western region of the U.S. PCPs earn $1,103/day in that region; nonsurgical specialists earn $750. Surgical specialists report earning the highest daily rate of $838 in south. All three earn the least in the Midwest.

The size of the practice also affects the on-call rate paid to physicians and specialists. MGMA's survey shows surgical specialists get paid more if they're providing coverage in a practice with 75 or more full-time physicians while the opposite is true of nonsurgical specialists.

Another key finding of the survey, which looked at data from 2013, is that 37% of those who responded reported not getting paid for their on-call coverage, and of those who aren't paid, a little over one-third are given additional time off instead of pay (33%).

New TN Law Puts Addicted Moms in Legal Peril
Let's start in Tennessee, where Republican Governor Bill Haslam has signed into law a controversial bill that gives prosecutors the option of pursuing jail time for mothers who give birth to babies while withdrawing from drugs ingested during pregnancy.

The bill has drawn strong criticism from several groups including Planned Parenthood, the ACLU, and a U.S. drug official, Michael Botticelli, acting director of the White House Office of National Drug Control Policy. A petition with more than 10,000 signatures did not sway Haslam, who waited until the last day available to sign the bill into law.

At issue is the desire to drive down the number of babies born in Tennessee with neonatal abstinence syndrome (NAS), essentially drug withdrawal as a result of the mother using drugs during pregnancy. In 2013, the first year the state's health departments began requiring hospitals to report of cases of NAS, there were 921 cases of NAS. So far in 2014, there have been 253.

Opponents fear the law will prevent drug-addicted mothers from seeking treatment while advocates cite the need for a tougher alternative. Previously, mothers could be charged with a misdemeanor, which triggered treatment through the state's drug courts.

The new law, which goes into effect July 1, allows mothers who give birth to babies with NAS to be prosecuted for homicide if the baby dies because of the drugs taken during pregnancy, or for assault if a baby is born addicted or is harmed. Mothers who get into treatment can avoid criminal charges.

In a statement, Governor Haslam emphasized the bill was aimed at ultimately getting mothers into treatment programs. The state's health commissioner, John Dreyzehner, MD, MPH wants physicians to be more cautious of the medications prescribed to pregnant women. According to 2013 state health data, in 63% of NAS cases, at least one of the medications was prescribed by a healthcare provider.