February 2001 Table of Contents
Monitor
Got a minute?
Despite the perception that managed care has intruded on patients' time with their physicians, the average length of office visits has actually increased by one to two minutes over the last 10 years, according to a study published in the Jan. 18 New England Journal of Medicine. Office-visit duration increased to 17.9 minutes for managed care patients and 18.5 minutes for patients with traditional insurance.
Go solo within your group To improve physician performance and morale, you might want to restructure your medical group so that each physician operates as an independent practice contracting with the group for management services, such as accounting, billing and scheduling. One year after implementing this model, Peachtree Orthopaedic Clinic in Atlanta saw its bottom line improve 23 percent without the addition of new income sources, and its physician and staff retention increased as well. -- Pulaski MJ. Interdependent physician practice. Group Pract J. 2000;49(8):18-20. E-mail precautions How can physicians best protect themselves against potential litigation when communicating with patients via e-mail? Begin with an understanding of the appropriate topics for e-mail communication, says Todd Dicus, JD, the AAFP's general counsel. These topics include prescription refills, making appointments, nonurgent medical follow-up, nonurgent medical correspondence, billing and insurance questions, and test results. Topics you shouldn't discuss via e-mail include urgent medical problems, mental health issues, HIV, STDs and work-related injuries. In addition, Dicus recommends the following:
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Utilization increase
Between 1994 and 1998, the average number of ambulatory visits per patient per year rose to 2.0 for commercial HMO members, 3.3 for Medicare HMO members and 1.8 for Medicaid HMO members, from 1.7, 2.7 and 1.6, respectively, according to the Managed Care Trends Digest 2000.
Hate managed care; love my plan
Public hostility toward managed care is not based on personal experience but is media- and physician-driven, concludes a recent Harris Poll of almost 1,000 insured adults. Despite previous surveys showing a sharp deterioration in the public's attitude toward managed care, 69 percent of those surveyed graded their own health plan an "A" or a "B"; only 2 percent gave their plans an "F."
$4.17 per month
A new poll conducted for the Robert Wood Johnson Foundation has found that 70 percent of Americans would be willing to pay up to $50 per year (or $4.17 per month) in additional taxes to ensure that all Americans have health care coverage. This figure is up from 65 percent in 1992.
ER: not just entertainment
ER, a prime-time television drama popular even among physicians, according to a survey by Medical Economics, is doing double duty for patients. Over half of regular viewers said the show not only entertained them but also informed them about important health issues, according to a study in the January/February 2001 Health Affairs. One in seven viewers said they were prompted by ER to contact a health care provider.
Doogie, Jr.
An Alexandria, Va., teen was recently charged in juvenile court with prescription fraud and practicing without a license after allegedly intercepting telephone pages intended for physicians and issuing medical orders to nurses at an area hospital, reports the Jan. 4 Washington Post. The teen's orders, which included drawing blood and prescribing blood-thinning drugs, were all medically appropriate, said hospital officials, and the investigation has turned up no evidence that patients were harmed.
Why doctors RSVP
In 1999, 280,000 pharmaceutical-company-sponsored meetings and events
were held for physicians, a 25 percent jump over the previous year, according
to a survey by Scott-Levin. Of all invitations they received, physicians
accepted nearly half, with 74 percent of
doctors citing "interest in the
topic" as a
main reason for attending. Meeting location and honoraria were
also important factors.
The root of primary care errors
While the subject of medical errors has been capturing the public's attention, thanks in part to the November 1999 Institute of Medicine report on the subject, virtually all data have been focused on hospital settings, not primary care -- until now. Preliminary findings from a study sponsored by The Robert Graham Center, the AAFP's policy center in Washington, D.C., have shed some light on primary care errors, suggesting they are mostly the result of process and communication problems rather than poor clinical decisions. (See graph.)
Although primary care errors "often appear trivial," say the researchers, they can significantly impact patients' well-being. "Approximately 5 percent of primary care errors directly precipitate a hospital admission, where patients are exposed to more risks of medical errors, with potentially more damaging consequences. Even when hospital admissions do not occur, care is often delayed and many patients suffer needlessly from worsening physical illness and/or mental anxiety."
Causes of primary care errors |
To protect patients, the researchers are calling for improved chart management efficiency, more effective communication within the primary care team, and more effective communication between the primary care team and other health care providers.
The full study is expected to be completed and published later this year.
Stark II final rule issued
IIn early January, the U.S. Department of Health and Human Services issued a final rule on the Stark II physician self-referral law. The law prohibits physicians from referring Medicare patients for certain health care services to entities with which the physicians or their immediate family members have a financial relationship.
However, the new regulations include some exceptions. For example, the final rule generally permits physicians to refer to entities with which they have a compensation relationship as long as their compensation is not more than what would be paid to someone providing the same services but not in a position to generate business for the entity. The final rule also expands the law's exceptions for services provided in a physician's office and for services provided by managed care plans, and it provides guidance about how to structure financial relationships to comply with the exceptions.
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STAFF SALARIES The 2001 Staff Salary Survey from the Health Care Group, Plymouth Meeting, Pa., lists the following average salaries for staff members who have been in their positions for two to five years. Note that actual salaries will vary by region and years of experience.
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The bulk of the final rule is available in the Jan. 4 Federal Register. Implementation has been delayed until Jan. 4, 2002, in order to give physicians time to restructure their financial arrangements.
Making physicians better observers
As part of a movement to "re-emphasize the human aspect of medicine," Weill Medical College of Cornell University is offering students the opportunity to study portraiture at New York City's Frick Collection. "The Art of Observation," a non-credit course, was designed to increase medical students' awareness of visual cues in the human face and body. After studying portraits, class participants then view photographs of actual patients and are asked to assess the patients' "health and happiness."
Not only has the experimental course proved popular (30 students vied for eight spots in the class), but it also seems to work. "Already I've had students tell me that when they walk into a hospital room they don't go right to the chart," said Amy Herman, the Frick's director of education and a creator of the pilot program, in the Jan. 2 New York Times.
Similar courses have been offered at Yale University Medical School and The University of Texas Medical Branch at Galveston. The Yale course is now required of all first-year medical students.
This is a corrected version of the article that appeared in print.
Copyright © 2001 by the American Academy of Family Physicians.
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