A physician's assistant pleaded guilty yesterday to aiding in a $119 million Medicare fraud ring in Miami and Cuba that involved doctors, administrators, and immigrants. Ten other defendants have also pleaded guilty to similar charges.
The United States has the world's only healthcare system where everyone plays by his or her own rulebook. Essentially there is no American healthcare system. Also, healthcare costs have risen about 2.4 percentage points faster than the economy every year since 1970.
Federal investigators arrested 18 people Thursday on charges of allegedly participating in schemes to defraud Medicare. Among those arrested were Donald Noyola, president, secretary, and chief financial officer for Sycamore Medical Supply Co. in Los Angeles, along with clinic owners and other medical professionals.
UT Southwestern Medical Center plans to build a biotech park to develop and make money from medical discoveries. To be called BioCenter at Southwestern Medical District, the complex will include four buildings, the first of which is slated to be constructed by next year.
Aetna officials are now assessing the health insurer's risk to investments in Lehman Brothers and AIG. Its investment in Lehman debt securities is estimated at $132 million, in addition to the $102 million in AIG. Aetna said it's now determining how much of those investments it will be able to recover.
BlueCross BlueShield of Tennessee is now online with a new system that will provide its members with cost and quality information about physicians in the health insurer's move toward more transparency. The online resource will offer information such as doctor records and what they have billed for specific procedures.
A study released Thursday by the Commonwealth Fund, a nonprofit research group in New York, shows that the U.S. spends significantly more for healthcare than other countries. It has also found, however, that the quality of this nation's healthcare system is lacking.
Patients hate waiting to get an appointment, and in many practices the wait for an appointment is, from their viewpoint, outlandish. In recent years many practices have successfully reduced patient frustration through "open access" scheduling, which makes it possible for a medical practice to provide appointments immediately or on the same day.
The results: No long waits or delays in care, no triage, no deflecting patients to another-day appointment or another provider, and no stress from dealing with upset patients. The model has been proven time and time again to allow for faster attention to people's health issues, increased efficiency, and dramatic improvements in the patient experience, as patients no longer endure frustration about waiting for an appointment.
Sound like a panacea? In a way, it is, but note that there is no easy recipe for converting to open-access scheduling. Practice leaders need to tailor this kind of system to their unique circumstances.
The key is to ground your plan in a set of tested principles:
Measure, analyze, and understand your supply and demand. These need to be balanced; you will not be able to sustain open access scheduling if demand for appointments typically exceeds supply. If you accept more patients than you can handle in a timely fashion, you must turn down appointments, which plays havoc with the patient experience.
Develop a short-term strategy to reduce your backlog to zero, so you can begin your new scheduling system on a date certain. There's no getting around the fact that you will have to work harder than usual in the short-run to make the transition to your new system on your conversion date. But of course, after that, both patients and physicians reap ongoing benefits.
Decrease the number of queues by shrinking the variety of appointment types and durations available. A single appointment length works best. It's easier for staff to manage, simpler for patients, and physicians find themselves getting into a rhythm that helps them stay on time. Also, staff who schedule appointments don't have to say no to patients who need a certain appointment type because the right-size slots are full. When longer appointments are critical, staff can combine two of the generic appointment slots.
Develop contingency plans for those occasions when you have more demand than expected or less capacity than anticipated.
Fine-tune the demand by matching patients to their own physician, maximizing what is accomplished in a single visit, and adjusting the interval between visit and return visits.
Allow some prescheduling of appointments for clinical follow-up. That way, you keep control of the follow-up appointment instead of risking that the patient will not follow through. You can also load these appointments into the lower-volume times of the day and week, so there will be less demand for such appointment times.
Address the bottlenecks and constraints that tie up physician time. For instance, shift as much work as possible from the physician to other members of the team.
Develop an education strategy for patients and staff. Clarify the approach, emphasizing its benefits for them. If some patients still insist (and few do) on prescheduling an appointment, honor the patient's preference, selecting time slots in the early morning or latter part of the week-whenever your volume tends to be lowest.
This article was adapted from Physician Entrepreneurs: The Quality Patient Experience, a new book published by HealthLeaders Media. For more information or to order a copy, visit HealthLeaders Media online.
The traditional voluntary medical staff model that characterized hospital-physician relations for decades is now fading. That much we know. What's less clear, however, is what the new relationship between physicians and hospitals will look like when the dust settles.
A quick scan of news reports and our own coverage may give the impression that the hospital and physician are now more at odds than ever—doctors are increasingly refusing to take ED call without compensation and are frequently opening facilities that directly compete with the hospitals they used to partner with.
But it wouldn't take much digging to come up with a similar number of news reports that paint the opposite picture. Physicians are more willing these days to work directly for a hospital or health system as an employee, sacrificing autonomy for the security of full integration.
So which is it? Are hospitals and physicians becoming more separate and competitive or more integrated?
The answer is both, according to a new study by the Center for Studying Health System Change. The relationship is becoming polarized as fewer doctors choose the "middle ground" of voluntary medical staff coverage. Doctors are forking in one direction or the other—employment or competition.
Most markets have seen an increase both in the number of physicians—specialists and primary care doctors—employed by hospitals as well as the number of new competing physician-owned facilities, such as ambulatory surgery centers and in-office imaging.
The trend toward employment is in part a defensive move—hospitals "employ specialists to preempt competition from specialist-owned ASCs, specialty hospitals, or imaging facilities," according to the HSC report.
Hospitals and physicians have often faced very different incentives, and employment is a necessary step to get both parties on the same page, says self-proclaimed healthcare futurist Jeff Bauer, partner with ACS Healthcare Solutions. "The clear path to success for the hospital of the future is employed medical staff."
But the trend is also driven by the changing physician culture. Tired of clawing through the bureaucracy of today's healthcare system just to break even, many physicians are opting to enter a hospital's fold so they can focus on medicine and maintain some semblance of work-life balance.
Yet despite the culture shift, others still choose entrepreneurialism over employment. It is a path with higher risk, but also higher reward. And technological advancements that have opened doors for additional revenue in outpatient settings have made the rewards more worthwhile for those willing to take the chance.
There are strong incentives for physicians to pick either option. Not that there aren't opportunities for collaboration that don't belong solidly in either track—hospitals and physicians can align through joint ventures, service line management, and physician-hospital organizations.
But in most markets, physician-hospital relations will continue to split along these two disparate paths.
Doctors will not, however, return to the voluntary model anytime soon.
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Dr. Barry Silbaugh has been chosen to replace longtime American College of Physician Executives Chief Executive Roger Schenke. Schenke is retiring this year after founding the organization 30 years ago; Silbaugh has previously served as executive vice president for ACPE.
