The Whitmore Lake Health Clinic near Detroit has provided care for 38 years to uninsured and underinsured residents of Washtenaw and Livingston counties but needs to raise $110,000 to resolve a dispute with the Internal Revenue Service that could force its closing. The clinic's problems mushroomed two years ago when it failed to send payroll taxes to the IRS.
Medical science has learned a great deal about the causes of pain and ways to relieve it, pain experts say, but for a host of reasons, the treatment of pain and suffering has improved hardly at all in recent years. Hospitals do a little better than that in managing pain for patients with all kinds of illnesses, according to a survey in the New England Journal of Medicine.The survey of hospitals in 40 metropolitan areas by the Harvard School of Public Health found that one-third of patients felt that their pain wasn't well controlled. The percentage of those who were satisfied by their pain care ranged from 72% in Birmingham, AL, to 57% in New York City hospitals.
As Americans are cutting back on healthcare costs, doctors are working to keep their offices full by adding reminder calls for appointments, extended office hours, last-minute appointments and same-day test results. According to a survey of 75 physician practices, revenues are down 3.5% this year, compared with a rise of 6% last year, Dow Jones Newswires columnist Victoria Knight reports.
Doctors from Beaumont Hospital in Troy, Michigan, looked at more than 2,000 patient-satisfaction surveys from the first part of 2007 and found that patients whose stays in the ER lasted up to three and a half hours had satisfaction scores in the 83rd percentile as compared with patients at comparable ERs around the country. But for those who spent between three and a half and four hours, satisfaction plunged to the 49th percentile. And those who spent more than four hours had an average satisfaction score in the 24th percentile.
Doctors Without Borders will leave Niger because the government unexpectedly terminated its medical and nutritional program in one of the country's drought-prone districts, an official announced.
The president of Doctors Without Borders told reporters the government of Niger had closed down its program in the district of Maradi in July. The French branch of the aid agency has been working in Niger since 2001 and also runs a smaller health center in the country's north. In protest, the French branch of the organization will leave Niger, resulting in the closure of the smaller center as well as the one in Maradi. The Swiss, Spanish and Belgian branches of the aid agency will continue to operate in Niger.
The e-mail subject line reads: "Pop song Stayin' Alive helps people perform chest compressions for CPR."
Skeptical, am I. Quality is a weighty matter, not one to be addressed with gimmick solutions. We have thousands dying from healthcare-associated infections every year. We have wrong-site surgeries, fatal drug errors. We have hospitals struggling with the costs of improving patient safety. In short, we have serious challenges. Someone is actually spending the time to study the effects of disco music?
My cynicism aside, the report is from a credible source—the American College of Emergency Physicians—so I read on. The Bee Gees' Saturday Night Fever anthem, I learn, has 103 beats per minute, which is almost exactly the rate at which compressions should be administered. Physicians and medical students at the University of Illinois College of Medicine who were trained to do chest compressions while listening to the song were able to maintain the ideal compression rhythm weeks after their training. Apparently the song creates a sort of mental metronome that sticks in the brain.
I reflect that maybe there's something to this. But then again, the study involves just 15 participants—10 physicians and five medical students. How can anyone expect to draw meaningful conclusions from that? Training caregivers with the Bee Gees? Come on.
A few days later, I read a New York Times piece about how teaching literature to medical residents can make them more empathetic, compassionate physicians who are more adept at evaluating patients. The story describes residents gathering to read short stories and poems together, then reflecting upon how the themes and situations detailed in the readings apply to their clinical experiences.
Again, I am leery. Using literature to supplement medical students' curricula is not a new phenomenon. But residents? They're extraordinarily busy, and the scope of their training is immense. Now we're going to squeeze "narrative medicine training" into their 80-hour weeks?
But then I read this quote from Benjamin Kaplan, MD, a second-year resident at Saint Barnabas Medical Center in Livingston, NJ, about the issue of committing time for such things amid a sea of priorities: "It does get pretty busy. But if you want to make time for it, you can," Kaplan told the Times. "Spending a half hour a day to remember that we are all human, not just doctors or pharmacists or nurses or patients, is important enough that I think you should do it."
And there it is. Kaplan is right. Time may be at a premium, but it's there. The trick, of course, is deciding which training, which initiative, which solution justifies the time. When it comes to improving the quality of care that healthcare organizations provide to patients, I'm still not convinced that every obscure study or program is time well spent. For the most part, we cannot nickel-and-dime our way through healthcare's minefield of enormous challenges, and the issue of quality is no exception. But we—and that we includes me—also shouldn't automatically dismiss nontraditional ideas as trivial. The industry push for quality demands legitimate solutions—and it also demands fresh thinking.
The Bee Gees and classic literature aren't exactly typical quality solutions. But we need all the solutions we can get.
Jay Moore is managing editor for HealthLeaders magazine. He can be reached at jmoore@healthleadersmedia.com.
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I received more e-mail from readers about my recent column covering the Obama and McCain healthcare reform plans than anything else I've written this year.
With less than a week until the election, I'd like to share some of that feedback so you have a fuller picture going into the voting booth (some of the e-mails have been edited for length):
A physician writes: "Do either of them have physician advisors? I am curious as to how they can revamp the system without input from physicians—primary care, surgeons, and specialists. They want us to give care but are not seeking our input.
We are adversely affected also by the poor economy because we cannot get loans and our patients are increasingly unable to pay us, and of course our reimbursements continue to plummet. Is either candidate going to do something about plummeting reimbursements? If not, the physician shortage will get worse. Are they even aware of the impending physician shortage? There should be arrangements made for all physician specialties, not just primary care."
A cardiovascular business consultant writes: "The one factor that everyone keeps silent on is the funding of Obama's plan. You may have greater access for all citizens up to 25 years of age like you mentioned, and the physicians will be paid for their services, but your take-home pay as a physician will be stagnant at current levels or may actually decrease through all the taxes required to fund such a program as well as his other initiatives.
As with the financial crisis—the money has to come from somewhere. Physicians are interested in the bottom line, not just that they will get reimbursed—and you failed to mention at what level the reimbursement will be for the services provided. Reimbursement doesn't directly translate into higher take-home pay."
Betty Via, who has worked in healthcare since 1983, writes: "After trying to become acquainted with both the Obama and McCain proposals, I know they both have challenges. As of this writing I tend to believe that Obama's plan is better for numerous reasons.
Providers have difficulty now when a patient has an out-of-state plan because the local carriers can't answer questions and because the computer systems don't integrate and read each other. Imagine not being able to get benefit and claims information routinely. The McCain plan has not been thought out. The Obama plan may need some work and definition, but I believe that it will be easier for providers and also the patients.
Health insurance may not be a right, and it absolutely should not be a privilege, but it should be a "shared' responsibility. By that I mean individuals and government alike should share in creating plans that insure people at reasonable rates and "pre-existing" and people termed "uninsurable"(survivors of a terrible illness) should be language that disappears from the American vocabulary.
Ronald T. Libby, professor of political science at the University of North Florida writes: "The larger issue has to do with the out-of-control costs of healthcare in the country. We cannot afford what is currently mandated for Medicare and Medicaid let alone future expansion of these programs.
Inevitably, there are only two solutions. One is to ration healthcare, which is what the Canadian and European social democracies do, or we must transfer some of the costs onto patients. We simply cannot provide unlimited, free healthcare to everyone without destroying what is widely acknowledged as the best healthcare system in the world."
An anonymous reader writes: "Neither candidate has a clue how to fix healthcare. It is too big a problem to fit in a sound bite. The country cannot afford to simply insure everyone without a dramatic change in how healthcare dollars are spent. Not every headache needs a CT scan, not every backache needs an MRI. Evidence-based medicine would lower costs quickly.
Doctors should be incentivized to do procedures in their office rather than the hospital or surgery center. There are also many examples of routine testing which I will bet are not cost effective. Teaching kids how and what to eat would help a lot. Stressing normal weight with healthy eating would lower blood pressure and cholesterol, decrease back problems, enhance self esteem, decrease sleep apnea, and decrease heart disease, cancer, and other illnesses. Kids don't even take Phys Ed anymore. Anyway, it's a large, complex problem. The politicians do not want Americans to think they cannot have it all when it comes to healthcare, but that is the truth."
One final note: I came across a study a while back suggesting physicians have lower voter turnout rates than the general public. That, to me, is mind-boggling considering physicians' livelihoods are so heavily influenced by state and federal government decisions. Even if you don't agree with either presidential candidate, there are a lot of down-ticket positions and ballot issues being decided next week as well.
So vote.
Elyas Bakhtiari is a managing editor with HealthLeaders Media. He can be reached at ebakhtiari@healthleadersmedia.com.
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The most common way of determining medical directorship compensation is to develop fair market value (FMV) benchmarks for the agreement in question. Benchmark data typically includes publicly available survey results for the specific specialty and generally are at or below the compensation level paid to clinicians for equivalent work effort.
In some situations, there may not be enough publicly available data to develop a specialty-specific benchmark; therefore, it is possible to extrapolate the available data to develop a valid benchmark.
In these cases, it is important to rely on an independent, third-party, industry expert in hospital/physician relationships who has knowledge of the healthcare industry and laws to develop a benchmark that is appropriate and indisputable.
Once an appropriate benchmark is determined, a range of appropriate payments can be established based on the benchmark. In general, a proposed payment should satisfy FMV if the payment is within the range of the identified benchmark, which is generally considered to be less than the 75th percentile of the survey data. Special circumstances might exist at the hospital or within the specific market that might warrant a payment that is higher than the benchmark.
Remember that medical directorship agreements must adhere to the anti-kickback statute, Stark laws, and §501(c)(3) of the Internal Revenue Code.
Physicians at Greensboro, NC-baed Carolina Pediatrics are part of a movement toward electronic health records. Members of the movement say such systems will reduce costs, improve efficiency, and reduce medical errors. But change has been slow in coming because some physicians, particularly those in small practices, say the systems are too expensive.
Key elements of Medicare's Physician Quality Reporting Initiative must be improved so that physicians can successfully participate and use the information to increase the quality of patient care, according to an American Medical Association's survey of physicians who participated in the PQRI during its first year of implementation. More than six out of 10 physicians surveyed rated the program difficult, and only 22% were able to download the PQRI feedback report for their practice.
