Should life and health insurers be investing in the stocks of fast-food companies? Researchers at the Cambridge Health Alliance, which is associated with Harvard Medical School, say no, citing the associations of fast food with obesity and other health problems, heavy marketing to kids, and the the chains' environmental impact. Insurers, however, say they have a responsibility to share or policyholders to maximize returns, and that may include investments in companies that do not share their health-promoting mission, the Wall Street Journal Health Blog reports.
During the last building boom, St. Vincent's Hospital Manhattan executives tried to pull out of financial trouble by making a deal with the Rudin Management Company, a prominent developer. Under the deal, Rudin was to buy most of the St. Vincent's campus for $300 million. It planned to renovate four hospital buildings and demolish four others and build luxury town homes and apartment buildings on their sites. Now St. Vincent's is closing, but officials are trying to preserve some medical operations, possibly an urgent-care center that could treat emergencies but would not admit patients. In a statement, William C. Rudin, chief executive of Rudin Management, said that he still wanted to develop the site and that a healthcare facility there would factor into his plans.
Senate Democrats are inching closer to approving an amendment that would finally reinstate physician Medicare payment rates to the March 31 level—at least until June 1.
An amendment proposed by Senate Finance Committee Chairman Max Baucus (D-MT) was approved in a 60-40 vote Wednesday night that would stop—at least temporarily—the 21% cut in physician reimbursements mandated by the sustainable growth rate (SGR) formula.
The amendment calls for exempting the payment provision from a Senate rule that says all spending legislation must be paid for under the Senate's "pay as you go" rule.
The full bill that is currently under debate calls for temporarily extending funding for several other federal programs that have expired, including unemployment benefits and COBRA benefits.
That bill is expected to be voted on by the Senate today or tomorrow.
Physicians have not encountered the cuts that went into effect April 1 because—for the second time this year—the Centers for Medicare and Medicaid Services (CMS) called for Medicare contractors to hold claims for performed services for the first 10 business days of the month (which expired yesterday).
J. James Rohack, MD, president of the American Medical Association, said Thursday that physicians remain in "limbo" waiting for Congress to act.
"This continued uncertainty coupled with the fact that Medicare payments, even without the 21% cut, have not kept up with the cost of providing care to seniors demonstrates the need for a permanent solution to this annual problem."
Rohack said 25% of Medicare beneficiaries are already having trouble finding a primary care physician. Cutting the payment will not help matters.
"Fixing the Medicare physician payment problem is essential to the stability of Medicare. If Congress fails to repeal the formula, the problem will continue to grow. Seven times in seven years, Congress voted not to impose cuts triggered by the flawed payment formula, putting off paying for it until another day," he said.
"Congress' inability to solve this problem has not only made it impossible for physicians to keep seeing all Medicare patients, it has more than quadrupled the price of a solution for taxpayers.
"It's irresponsible to continue short-term fixes just as baby boomers begin aging into Medicare next year. Congress needs to make the better fiscal decision and the better decision for seniors and repeal the formula now instead of putting it off again and increasing the price tag for America's taxpayers," he added.
Meanwhile, Ted Mazer, MD, a California Medical Association trustee, says he is frustrated about the issue.
"The failure of Congress, in particular the Senate, to act to correct this problem not only now but year after year highlights the inability of our legislators to deal with the real economic issues in access to medical care and is driving physicians away from continuing their participation in the Medicare program. The delay in this vote will result in increased costs to both Medicare and physician offices as payments are now made at 21% reduction since April 1, only later to be adjusted by retroactive payments, requiring two check cuts by carriers and double the work or more in physician offices across the nation to adjust payments and copayments a second time.
"It will also lead to confusion for patients and issues with secondary payers. And then the best we can hope for is just another delay in reaching a permanent fix of this horribly broken formula," he says.
On that topic, Joseph W. Stubbs, MD, FACP, president of the American College of Physicians (ACP), said, "There's the additional wrinkle that doctors may have to go back and re-bill patients for higher co-insurance once the payments are restored retroactively. If Congress then applies some short-term fix—be it for six weeks or six months—the added cost of rebilling will just add to the chaos."
"The only effective answer for patients and physicians, who operate small businesses, is a long-term solution to physician payments that provides predictable, positive and stable updates that keep pace with practice costs," said Stubbs.
Mazur says the doctor payment issue also causes some doctors to wonder about whether expanding government programs is the way to go.
"If nothing else, this repetitive politicization of needed payment reforms and corrections in the Medicare and related Tricare programs gives pause to physicians with respect to the future of expanded government payment programs and the reliability of the legislative process in maintaining and expanding access to care," says Mazur.
Depending on how well they are organized, board meetings can provide vital monthly or quarterly face-to-face time among the decision-makers to keep your physician practice running smoothly. Or they can devolve into a cat rodeo—a huge waste of time and energy where very well-educated, opinionated, highly trained professionals find themselves arguing over the everyday and trivial issues that should be solved on the middle-management level.
At Radiological Associates of Sacramento (RAS), the monthly practice board meeting is a model of efficiency. It is no small feat to get the 64 physician owners of the practice to sit down for two- to four-and-a-half hours every month to review critical governance issues. But the efficiencies built into the meetings, which might seem effortless to the casual observer, are actually the result of constant streamlining and review, says Fred Gaschen, executive vice president at RAS.
"I'm proud of the way they have organized this," Gaschen says. "I've been here more than 13 years, and I inherited a good structure. But I'd like to think that in that time, we have streamlined and improved the structure."
RAS has been around since 1917, and Gaschen says the physicians in the practice know enough to let the business people they've hired to run the business, run the business. The business side takes care of the minutia and helps the physicians organize the subcommittee and board meetings.
"We support the decision-making process by the physicians at the board level through our infrastructure," Gaschen says.
This all seems perfectly logical and simple: Don't waste everybody's time squabbling for hours about lower-level management issues that prolong meetings, force you to skim through more important issues, and leave practice partners irritated by the sense that important issues are not being addressed. But it's surprising how many physician practices run their meetings exactly that way, says Kenneth T. Hertz, CMPE, principal consultant at the Medical Group Management Association Health Care Consulting Group in Alexandria, LA.
What's on the agenda?
"I don't think you want to spend a half hour at a board meeting deciding what kind of chairs you are going to put in the reception area. I don't think you want to spend a half hour at the board meeting or partner meeting deciding whether Dr. Jones' nurse Mary should get a bigger raise than the other nurses because she has been here longer and, after all, she does three times the work everybody else does," Hertz says.
Instead, he says, the board should focus on governance. "We are talking about strategic issues—mergers, acquisitions, integration, recruitment, strategic decisions to develop a marketing plan," Hertz says. "Sitting at the board meeting is not where you read the copy for the ads and Dr. Jones says, ‘I don't like the way that paragraph is written.' It is your right to question, but there are certain things you need to entrust to a manager or a subcommittee."
To run an efficient meeting, Gaschen says, what is not on the agenda is almost as important as what is on the agenda.
"Small operational issues are not discussed at the board level. The board is responsible for overseeing the corporation setting policy and directions. That is their role," he says. "The day-to-day operations are handled by the respective administrative staff hired in each division. "
For example, RAS has several subcommittees that meet weekly to vet and prepare issues for the larger board to act upon.
"It is at the divisional level they will look at new offices, new equipment, new services, or new medical ways of doing things, and there will be a lot more debate at the division level and the subgroupings that happen between the monthly board meetings," Gaschen says. "So the division will arrive at a consensus within its membership and that division will take it forward to the executive committee for informational purposes and the board of directors for final approval.
By the time it gets to the board of directors, it has been vetted in multiple stages along the way. Rarely do we bring something up to the board level and there is a big brouhaha."
Meeting parameters
The agenda, the structure, the frequency, and length of the meeting may vary from practice to practice, depending on what works for the practice, Hertz says, but there are also some fundamental commonsense rules that should apply, regardless of whether you've got two or 200 physicians in your practice. For example:
"Meetings need to start and end on time," Hertz says. "The people who show up on time shouldn't be penalized for the people who don't. It's disrespectful not to start on time and end on time. The more you don't start on time, the more people say, ‘Why should I show up on time?' and then it becomes a downward spiral."
Meetings need to have a structured agenda and a facilitator to ensure that the agenda advances. "What we really want is the meeting to move forward. I've sat through many meetings where nobody moves. Somebody introduces a topic and it just meanders. There has to be some leadership," Hertz says.
In most physician practices, the president of the board or a managing partner should lead the meeting. "I've seen a lot of practices where the administrator or manager chairs the meeting, but I'm not a big fan of that," Hertz says. "They are an employee. It's your practice. You're the governance. The manager can meet with the chair or the president, re- view the agenda and the material, point out any land mines or other things they need to be aware of, but, ultimately, a board needs to do the board's work."
Physicians need time to prepare for the meeting. Hertz says one of the most common complaints he hears from physicians is that they aren't given a chance to plan for the meeting. He recommends publishing agendas as far in advance as possible.
"You come to the meeting and somebody gives you a 15-page report and expects you to comment on it. That is not right," Hertz says. "I also hear, ‘I came to the meeting and all I heard was reports and I left.' Well then, why have a meeting? Put it in writing and e-mail it to me."
Hertz says some practices don't issue the agenda because they say their physicians won't bother to read it. "I say, ‘I don't really care.' The right thing to do is give it to the docs in advance and they read it or they don't. It's their choice, but that is the proper way to do it."
Don't rehash the same issue in meeting after meeting. "Some practices allow that. Some practices say, ‘We made the decision. We are moving on.' If it is a major decision that the board is going to make and the board isn't made up of all the partners in the group, it is incumbent on the part of the board to get the shareholders' input before the meeting and before the decision is made." In the end, the board can't allow itself to get bogged down on one issue. Make a decision. It all comes back to leadership.
This story first appeared in an edition ofThe Doctor's Office, a HealthLeaders Media publication.
Massachusetts hospital executives are reviewing state Senate President Therese Murray's call for providers to contribute $100 million to help reduce soaring healthcare costs paid by small businesses, the Boston Globe reports. But they made no commitment to follow the lead of Partners HealthCare, which has pledged $40 million this year. Gary Gottlieb, MD, president of Partners, whose Boston teaching hospitals have been blamed for helping to drive up medical spending, said that the organization decided to make the one-time commitment because it "wanted people to understand that we wanted to become part of the solution."
As Jackson Health System plans to cut expenses, Miami-Dade County executives want bigger pay cuts than union members agreed to. At a meeting of a Public Health Trust committee, Assistant County Manager Alena Tejada Hudak said the mayor and manager had mentioned this issue to Jackson executives 10 days ago and were surprised nothing had apparently been done. Jackson is counting on quick approval on pay cuts to save it $23 million for the remainder of this fiscal year as it works to reduce a $230 million deficit, the Miami Herald reports.