Americans should be required to buy health insurance, bringing healthier people into plans that will help bring down costs, Ron Williams, chairman and CEO of Aetna, told a Detroit audience. Williams said he favors plans similar to those adopted by some states that require everyone to have health insurance: either through a workplace plan or through a plan consumers buy on their own, with help from state subsidies for those who can't afford it. A mandatory system would help bring down costs and end the problem of enrolling healthy applicants and rejecting those with prior medical problems because costs and risks would be spread over a larger group of people, Williams said.
Although far more Massachusetts residents have health insurance coverage than residents nationwide, a significant portion of state residents are still struggling to pay for needed healthcare, according to a new survey. Some are postponing treatments, and others are not filling prescriptions, because of high costs or an inability to pay bills from earlier procedures, according to the survey. A third of those surveyed said the cost of care is their biggest health concern, and 39% ranked it among their top two health concerns.
The Bexar County (TX) Medical Society and The Association of Physicians of India's Chennai Division plan to sign a Memorandum of Understanding to facilitate communication, ideas, education, and camaraderie. This is the latest development between San Antonio and Chennai after the two cities signed a Sister City earlier this year. "This exchange of information is pertinent to clinical practice and the healthcare delivery system in the two cities," said Kausi Subramaniam, president of the Alamo Asian American Chamber of Commerce.
The number of people in England infected by the hospital superbug C. diff has plunged by more than a third in a year. There were 10,866 cases reported in English hospitals between April and June 2008, down 35% on the same period in 2007, according to figures.
GlaxoSmithKline has become the latest drug maker to report their payments to physicians. In addition to publicly reporting what the company pays doctors, Glaxo will also cap payments at $150,000 per year.
The two presidential candidates take very different approaches to healthcare reform, but they both agree that Medicare needs a new system for physician reimbursement. Their advisers have suggested both would shift the system away from the current model, which gives doctors a financial incentive to do lots of high-end procedures, even if they are not entirely necessary, according to this blog posting in the Wall Street Journal.
Foiling the drug-seeking patient involves more than the physician. It's a collaborative effort that's a clinical and practice-management issue.
The following tips can help to create an office environment that discourages drug seekers:
Appearances matter. Run a clean, neat office that doesn't look like it's a place for drug seekers.
Have consequences. Too few practices terminate their relationship with patients who are trying to game the system. Termination may not always be the right approach, but there need to be consequences.
Ask questions. You want to have the reputation as a practice that asks questions. It's part of taking a thorough history. Among the questions to consider:
What other providers have you seen for this condition?
What drugs are you currently taking?
Which pharmacies do you use?
Are you being treated for drug or alcohol dependency?
Ask for picture ID. Ask for a driver's license or state ID and make a copy for your files so you can match a face to a name.
Spread the word. Putting a policy in place is essential. But you must also communicate it to patients. Develop an information brochure that describes the practice's policies, and be sure to include a section on controlled substances. Include information about samples to after-hours refills to drug testing in the brochure.
Practice due diligence. Securing drug samples is common sense, but lapses do occur. It may be time to review your procedures. Likewise, keep track of prescription sheets.
This article was adapted from one that originally appeared in the October issue ofThe Doctor's Office, a HealthLeaders Media publication.
The financial crisis—both within healthcare and in the world economy—was predictably a hot topic of conversation at the MGMA annual conference in San Diego this week, and the latest MGMA cost survey that was released at the event suggests the financial environment isn't getting any better for physicians.
At this point, you don't need me to tell you that operating costs increased faster than revenues for many medical groups last year. That trend has been firmly in place for so long that the relatively small difference this year—multispecialty groups reported a 5.5% increase in revenue and a 6.5% increase in costs—seems predictable and almost mundane.
But when you consider that this pattern has held for more than a decade, the daunting circumstances group practices now face become clear.
Since 2001, operating costs for multispecialty groups have increased an astounding 43.1%, while the Medicare conversion factor for reimbursement is exactly the same. Seeing that data graphed during a presentation this week was alarming—and the slope is only getting steeper.
The natural reaction to this dynamic is to improve efficiency and cut operating costs as much as possible. But any business can only trim fat so far, and most groups have reached the limits of these improvement efforts.
Many of the cost-centers with the biggest increases are crucial to practice operations and difficult to cut:
Drug supplies. Costs of drugs jumped 17% for multispecialty groups, compounding a 33% increase the previous year. Pediatrics was the single specialty hit the worst with a 56% single-year increase, creating an unbelievable 132% increase over the past three years.
Support staff. Some specialties struggled more with support staff costs than others. Family practice, OB/GYN, and pediatric groups all saw double-digit increases in employee-related expenses in 2007, for example.
Professional liability. Cardiology saw the biggest increase in malpractice insurance premiums, 8%—bringing the total increase since 2000 to 132%. However, there was some good news. OB/GYN and orthopedic groups reported a decrease in malpractice costs.
The most troubling aspect of the situation is that there is little relief in sight. It has been a struggle to just keep reimbursement stagnant, rather than sharply dropping, and cost controls aren't doing the job.
Despite the seemingly endless barrage of bad news for medical groups these days, though, the overall attitude at the conference was positive. Hard times tend to spur innovation and change. It may not always be the ideal change—many physicians feel pressure to sell to a hospital or seek employment—but in each problem also lies opportunity, and physician practices are rapidly discovering new practice structures and leadership approaches for the current environment.
Most medical groups are getting by, and don't let the numbers fool you—the most adaptive continue to do very well.
For more information, see some of the reports I filed this week from MGMA:
Elyas Bakhtiari is a managing editor with HealthLeaders Media. He can be reached at ebakhtiari@healthleadersmedia.com.
Note: You can sign up to receive HealthLeaders Media PhysicianLeaders, a free weekly e-newsletter that features the top physician business headlines of the week from leading news sources.
The American public is savvier than ever before when it comes to making healthcare choices. Everybody knows that, right? The days of the passive patient who blindly seeks care at whichever hospital his or her primary care physician recommends are fast disappearing. Today's patients are increasingly scouring Web sites for quality data before they make their choices. They're analyzing outcomes and realizing the distinction between Hospital A and Hospital B. In short, quality has become a critical differentiator, and provider organizations that don't make their data transparent to the public will soon be left wondering what happened to their patient base.
That's what I read. And hear. Constantly. Our organization is developing this online comparison tool, our hospital is reporting that new measure, our system is committed to quality transparency. And for the most part, I believe them. I believe that quality—both improving it and reporting it—is rising to the top of more and more healthcare leaders' priority lists.
So explain these figures from the Kaiser Family Foundation's 2008 Update on Consumers' Views of Patient Safety and Quality Information:
Roughly 30% of Americans say they've seen healthcare quality comparisons of health insurance plans, hospitals, or physicians in the past year—down from 36% in 2006 and 35% in 2004.
Roughly 14% of Americans say they've both seen and used healthcare quality comparisons in the past year—again, down from surveys in 2006 (20%) and 2004 (19%).
Fewer people today say there are "big" differences in care quality among providers than in 2000.
The list of organizations making quality data available to the public keeps growing, yet fewer people say they've seen such data, use such data to make decisions, or even believe there's that big of a difference from hospital to hospital, anyway. How is this possible? Are provider organizations not making the strides in transparency that they think they're making? Is this notion of savvy consumers just hogwash?
No. For one thing, not everyone faces a healthcare decision that requires a quality comparison in a given year. Just because fewer people say they've seen and used quality data compared to two years ago doesn't mean the information isn't available to them. If you need the information, you look for it. If you don't, you don't. And when people say there's not that much quality difference among providers, maybe they just mean that quality in general has improved and they've perceived once-mediocre organizations to have closed the gap.
Still, this new research reinforces two significant points. First, quality data is of little use in a vacuum. The study said fewer people reported seeing information comparing quality, not seeing quality data of any kind in any context. If infection rates or Press Ganey scores or any number of indicators are made available without a sufficient frame of reference, many people will gloss right over it no matter how detailed or illuminating it might be.
And second, the industry still hasn't figured out how to make quality data useful to the average consumer or even let people know it's there in the first place. When more healthcare organizations are publishing information on myriad indicators and the government creates a Web site specifically designed to let consumers compare hospitals, yet fewer people say they're using or even seeing quality comparison data, that tells me the message is too complicated or isn't getting out there at all. Accumulating and posting information about the quality of care an organization provides is only part of the transparency equation—when it comes to actually reaching the consumer, we still have a long way to go.
Jay Moore is managing editor for HealthLeaders magazine. He can be reached at jmoore@healthleadersmedia.com.
Note: You can sign up to receive HealthLeaders Media QualityLeaders, a free weekly e-newsletter that reports on the top quality issues facing healthcare leaders.
New York Presbyterian Hospital's John Flanagan discusses how to engage patients and staff in the Planetree's model of patient-centered care through gift giving.
