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Fam Pract Manag. 2001;8(1):25-27

Is quality of care getting more difficult to provide?

More than half of U.S. physicians believe their ability to provide quality health care has weakened over the past five years, according to a new international survey of doctors by the Harvard School of Public Health and The Commonwealth Fund.

In the five countries surveyed, physicians’ primary concerns were struggles to keep abreast of new medical developments, nursing shortages and a lack of time with patients. In addition, U.S. physicians reported significant concerns about patients being able to afford care.

“In areas such as system responsiveness, including access to the latest technology and waiting times, the United States leads many other countries,” said Karen Davis, president of The Commonwealth Fund. “However, the United States does poorly on financial burdens on patients, inequality across population groups, and a variety of health outcomes. That is why we rank so low — number 37 — in the World Health Organization overall health system ratings.”

Concerning how quality might be improved, a substantial percentage of physicians in all five countries endorsed electronic prescribing and electronic patient medical records as “very useful.” Profiles comparing physicians’ practices to their peers were rated less useful.

Electronic prescribing of drugs55%35%57%90%42%
Electronic patient medical records43%43%49%68%48%
Comparisons of medical outcomes of selected procedures36%42%37%37%42%
Treatment guidelines or protocols45%51%32%30%35%
Reports from patients and families about satisfaction with care36%35%37%34%44%
Profiles comparing doctors’ practices relative to peers25%25%31%26%27%

Inflation returns to health care; workers less concerned

Health care costs rose 6.6 percent in 1999, up from an average increase of 2.4 percent annually from 1993 to 1997, according to a study from the Center for Studying Health System Change (HSC) published in the November/December 2000 issue of Health Affairs. Forty-four percent of the increase is attributable to higher prescription drug prices and new drug development.

Health care premiums also rose sharply — up 8.3 percent in 2000 compared with 4.8 percent in 1999 — and they’re projected to continue rising. However, while health care costs remain a top priority for U.S. employers, who bear much of the costs of health insurance, American workers are more concerned with retirement-related issues, according to a survey sponsored by the International Society of Certified Employee Benefits Specialists and Deloitte & Touche, LLP.

Practice Pearls from here and there

Retained earnings

While many medical practices distribute all profits among shareholders at year end, there may be good reason to retain earnings within the practice, says Barbara J. Grant, CPA. Retained earnings can help fund practice improvements, such as new medical equipment, which can bring a high return on investment. However, because corporate income is taxed at a higher rate than individual income, don’t hold cash in the practice at year end “just in case.” Do so only if you have a strategic plan. — Good reasons to keep cash in the company. The Physician’s Advisory newsletter. Conshohocken, Penn: Advisory Publications; November 2000:1–3.

Overwhelmed by medical literature?

To find the best clinical information in that pile of medical journals sitting on your desk, skim the table of contents looking for POEMs (patient-oriented evidence that matters). You can distinguish POEMs from disease-oriented evidence by asking three key questions:

  1. Did the authors study an outcome my patients will care about?

  2. Is the problem common in my practice?

  3. Will the study change my practice?

You can usually answer these questions by reading the conclusion of the abstract first. Then, if the article seems relevant, assess its validity by reading the rest of the abstract, focusing on the methods section to see how well the study was done. If the results seem credible and easily generalized, read the article in its entirety. — Brunk D. Looking for evidence on clinical practice. Fam Pract News. Nov. 1, 2000:38.

The job-shopping employee

If you suspect one of your employees is looking for a new job and you’d like to keep the employee on staff, there are two things you shouldn't do:

  1. Don’t waste time. Ask your employee outright — in a thoughtful, not accusatory manner — whether he or she is job hunting. If you talk to your employee, you may be able to change his or her mind about leaving.

  2. Don’t drag things out. If the employee is determined to leave, don’t present ultimatums or counteroffers. Even if the employee accepts your offer, he or she will probably leave soon anyway. — Sachs L. Managing the employee in crisis. J Med Pract Manage. March/April 2000:242–244.

Managing your stress

Whether at work or home, keep your stress level in check by trying these tips:

  • Say no sometimes.

  • Get rid of the clutter around you.

  • Discuss your worries with someone.

  • Don’t let others determine your mood.

  • Take 30 minutes of “quiet time” every day.

  • Don’t worry about things you cannot change.

  • Don’t schedule everything.

  • Exercise.

  • Laugh. — McGullicuddy J. De-Stress for success. On Managing newsletter. Plymouth Meeting, Pa: Health Care Publishing; 2000;10(4):5.

More work, not much more pay

Physicians are working “longer, harder or just plain smarter” and are not receiving comparable increases in compensation, reports the Medical Group Management Association in its 2000 Physician Compensation and Production Survey. For family physicians, gross charges rose nearly 16 percent between 1998 and 1999, while compensation rose 2.3 percent.

National database flawed

Information contained in the National Practitioner Data Bank, a database of physician disciplinary actions and malpractice cases, “may not be as accurate, complete or timely as it should be,” according to a November report by the General Accounting Office (GAO). In particular, the GAO is concerned about the underreporting of clinical privilege restrictions, which it views as a better indicator of professional competence than malpractice settlements or judgments. The GAO report comes after legislation was introduced in Congress to open the database to the public.

Can insurers sue patients?

The U.S. Supreme Court has agreed to decide whether an insurer may sue a customer for reimbursement of medical expenses after that customer has received money through a lawsuit or settlement, reports the Nov. 28 Wall Street Journal. The case involves an employee of Reynolds Metals Co. who, after suffering significant injuries from an auto accident, sued the driver of the other vehicle and settled the case out of court. Reynolds is seeking reimbursement on behalf of its insurance plan, which paid more than $560,000 of the employee’s medical expenses.

Healing the healer

A surprising number of physicians leave their health to chance rather than to health professionals. Thirty-five percent of physicians have no regular source of care, according to a study published in the Nov. 27 Archives of Internal Medicine. The study also showed that physicians without a regular source of care were much less likely to seek preventive services.

Surfing for health

Fifty-five percent of Internet users (or 52 million American adults) surf the Web for health information, outranking online shopping (47 percent), looking up stock quotes (44 percent) and checking on sports scores (36 percent), according to a study by the Pew Internet & American Life Project. However, 86 percent of those who use the Web for health information indicated they were concerned about online source credibility.

The cost of unhealthy habits

Nearly $250 billion a year, or 25 percent of the United States’ total health care costs, is spent on treating the effects of modifiable health risks such as smoking, stress and obesity, according to a recent study by The Medstat Group, Washington, D.C. The study found that former smokers cost $4.5 million per year in health care claims, current smokers cost $2 million and overweight employees cost $3.2 million. Published in the September/October issue of the American Journal of Health Promotion, the study looked at more than 46,000 employees over a six-year period.

Privacy, please

Americans rank the privacy of their medical records almost as important as the privacy of their finances, according to a recent telephone survey conducted by the Gallup Organization for the Institute for Healthcare Freedom. The survey, conducted in August, revealed that more than 90 percent of Americans oppose giving government agencies access to their medical records. Eighty-eight percent oppose keeping medical records in a national database, and 71 percent say they would not want doctors to have access to their medical records without their permission.

Physician assistant census

According to the 2000 Physician Assistant Census, 51 percent of physician assistants (PAs) work in one of the primary care fields, including 37 percent in family practice. On average, PAs earn $68,757 per year, work 45 hours per week and see 99 outpatients per week.

Fitness pays…

Physicians already know that exercise brings rewards, but now gamblers at the Tropicana Casino Resort in Atlantic City are literally betting on it. “It” is the “Pedal ‘n Play,” a stationary bike with a 25-cent slot machine attached. Buttons on the bike’s handlebars control the amount of the bet and the spin of the wheel. Cheapskates looking for a free workout are out of luck. The bike only works when the rider is gambling.

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Copyright © 2001 by the American Academy of Family Physicians.

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