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Fam Pract Manag. 1999;6(5):20-21

HCFA's Y2K hotline now available

To help Medicare providers prepare for 2000, HCFA has established a Y2K hotline (800–958–4232) to answer questions about preparing computer systems, medical equipment, facilities and business operations for the millennium. Hotline operators will also provide referrals for callers with specific Y2K billing questions.

Updates on HCFA's Y2K policies and general information about preparing computer systems for 2000 are available at

OIG finds providers lagging in Y2K preparation

According to a survey by the Department of Health and Human Services Office of Inspector General (OIG), about half the responding doctors, hospitals, nursing homes, home health agencies and medical equipment suppliers said their billing and medical records systems are Y2K compliant. However, more than two-thirds had yet to test their biomedical equipment, and fewer than 20 percent had tested whether their systems will function with external vendors. Less than half said they had a contingency plan for Y2K-related system failures.

In the March 25 Washington Post, the OIG cautioned against using the survey data to generalize about the health care industry because the data “were not verified for accuracy.”

AHCPR announces new prevention topics

The Agency for Health Care Policy and Research (AHCPR) recently announced an initial list of 12 prevention measures and screening tests that the U.S. Preventive Services Task Force (USPSTF) will be evaluating this year.

Four of the topics have not been previously reviewed by the USPSTF. They are chemoprophylaxis to prevent breast cancer, vitamin supplements to prevent cancer or coronary heart disease, screening for bacterial vaginosis in pregnancy and developmental screening in children. Eight other topics are being updated: postmenopausal hormone therapy, counseling to prevent unintended pregnancy, newborn hearing screening, diabetes mellitus screening, skin cancer screening, high cholesterol screening, depression screening and chlamydial infection screening.

“These initial topics selected by the USPSTF will help close the gap between what we know and what we do in preventive medicine,” said John M. Eisenberg, MD, AHCPR's administrator.

The USPSTF will publish its recommendations in the third edition of the Guide to Clinical Preventive Services.

Quote. Endquote.

“Training residents in hospitals for office-based practice is ‘like training people to be foresters by having them work in a lumber yard. Most programs, even the most prestigious, are training residents for a world of medical practice that no longer exists.’”

Gordon T. Moore, MD, Pew Charitable Trusts program director and Harvard Medical School professor, arguing for changes in resident training in the Feb. 2 Washington Post.

How salaried physicians are being paid

Family physicians employed by hospitals, HMOs or group practices earned an average total cash compensation of $142,700 last year, according to a new survey from William M. Mercer Inc. Physicians overall averaged $158,800. The survey of more than 800 organizations found that half pay physicians with a base salary plus variable compensation; 43 percent use salary only; and 7 percent use variable compensation only. More than 75 percent of the organizations that offer variable compensation base it on physician productivity.

Source: 1998 Integrated Health Networks Compensation Survey. New York: Willam M. Mercer Inc; 1999.

Charity care suffers in managed care

Two recent studies from the Center for Studying Health System Change report that financial and competitive pressures associated with managed care threaten the uninsured's access to care and affect the amount of charity care that physicians provide.

The first study, published in the March 24/31 issue of JAMA, found that physicians with a high proportion of patients in managed care provide 40 percent less uncompensated or reduced-cost care than do physicians with fewer patients in managed care. In addition, physicians who practice in areas highly penetrated by managed care provide less charity care regardless of their own level of involvement in managed care. The researchers theorize that the financial pressures of managed care may limit physicians' “ability to cross-subsidize care for the medically indigent by shifting the costs onto third-party payers.”

The second study, published in the April issue of Health Services Research, found that low-income people who lack insurance have more difficulty getting access to health care in communities with high Medicaid managed care penetration. “The research suggests that the holes in the safety net may be widening,” says Peter J. Cunningham, PhD, lead author of both studies.

QI brings improvements in Medicare

The first national report on Medicare peer-review organizations, also known as quality improvement organizations (QIOs), suggests that QI projects have decreased costs and improved the care provided to Medicare beneficiaries. QIOs are funded by HCFA to work with hospitals, health plans, employers and community coalitions to assess and improve quality in Medicare.

The report found that 87 percent of the almost 500 QI projects studied resulted in measurable improvements. Highlights include projects that reduced heart attacks by 10 percent among Medicare beneficiaries, prevented an estimated 1,285 strokes per year in 20 states, and saved an estimated $325 million through diabetesrelated initiatives.

The report, “A Pillar of Quality: The Medicare Peer Review Organization/Quality Improvement Organization Program,” was released by the American Health Quality Association.

Microchip enables precise drug delivery

Researchers at the Massachusetts Institute of Technology could be making the future of drug delivery a snap. Their creation, the first of its kind, is a dime-sized microchip that patients could swallow or have implanted under the skin and that could be programmed to deliver exact amounts of drugs at specific times. Although the prototype is wired to an external power source, the researchers say the chip could operate on its own if wired with a small battery and microprocessor.

The researchers' findings appeared in the Jan. 28 Nature.

Medical group acquisitions drop

The number of medical group mergers and acquisitions decreased 16 percent last year, the first drop since 1994, according to preliminary data from Irving Levin Associates Inc. The Physician Medical Group Acquisition Report, 4th Edition, shows that the number of deals fell from 310 in 1997 to 262 in 1998.

The number of physicians affected by the deals also fell, from 30,017 in 1997 to 23,889 in 1998; however, the 1998 number remains the second largest in the survey's history.

“The drop in the number of groups acquired, coupled with the relatively large number of physicians involved, indicates that buyers are now favoring larger groups such as IPAs,” says Sanford Steever, editor of the report.

The drop in merger and acquisition activity came during the last half of 1998 and can be attributed, in part, to the poor financial performance of physician practice management companies. Analysts say 1999 levels should resemble those at the end of 1998.

Source: The Physician Medical Group Acquisition Report, 4th edition. New Canaan, Conn: Irving Levin Associates Inc; 1998.

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