Resource spotlight
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Also available
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January 9, 2014 |
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In this issue: |
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Helping trainees "choose wisely" |
A recent blog post from the New England Journal of Medicine discusses the ABIM Choosing Wisely campaign and how a similar approach to financial diligence might be applied to interns and trainees. The author says both practitioners and interns share some of the blame when it comes to contributing to the high costs of medical care. According to the author, the expectations of the learning environment also contribute to the epidemic of excessive utilization of medical resources. He suggests five ways to help trainees make wiser decisions on the use of appropriate medical care. They are: - Deploy pre-clinical curricula that emphasize value-based medical decision-making.
- Include cost-conscious ordering and prescribing in our board examinations.
- Reward trainee restraint.
- Give trainees some sense of the cost and price of tests and treatments.
- Get leadership buy-in at academic centers.
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Most doctors still accepting Medicare patients |
Contrary to popular belief, there is no shortage of doctors willing to take Medicare patients, according to a new report from the Kaiser Family Foundation. The vast majority (96 percent) of Medicare beneficiaries reported having a usual source of care, primarily a doctor’s office or doctor’s clinic. Most beneficiaries also reported being able to schedule timely appointments (90 percent). Of those beneficiaries that looked for a new doctor over the past year, only 2 percent reported having problems, about the same as those age 50-64 in the general public who have private insurance. The report did find that some physicians are less likely than others to accept Medicare patients, but on the whole a majority still does so. For example, 87 percent of family medicine physicians are taking new Medicare patients, while among specialists, general surgeons (99 percent) and orthopedic surgeons (98 percent) reported taking new Medicare patients compared to only about 63 percent of psychiatrists. |
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Physicians open to receiving hospice themselves more likely to discuss it with patients |
Physicians who are open to receiving hospice care at the end of their life are more open to discussing such an option with their patients, according to a recent study (abstract only) from the Journal of the American Medical Association (JAMA). For the study, more than 4,300 physicians were survyed on their personal end-of-life care preferences, and asked if they would discuss hospice with a patient expected to live for another six months who currently didn’t show any symptoms of illness. Current medical guidelines suggest physicians discuss end-of-life care with their patients who have less than one year to live, but researchers found they rarely do. According to the study, roughly 65 percent of doctors strongly agreed they would receive hospice if they were terminally ill, but only about 27 percent said they would discuss hospice with a hypothetically dying patient "now.” An accompanying opinion piece (abstract only) in JAMA suggests the hesitation may be due to a number of factors including lack of physician training and preparedness, the patient or their family’s denial or wish to avoid painful news and attempts to maintain hope for a different outcome. |
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Report finds physician prescribing style and lack of consensus contribute to pediatric care variation |
A recent report from the Dartmouth Atlas Project suggests medical care received by children is often dictated by provider preference and not patient needs. Looking specifically at Maine, New Hampshire, and Vermont, researchers used claims from an all-payer data set from 2007 to 2010 for patients younger than 18 years old. Researchers noted the inconsistency in provided care for such things as tonsillectomy, the use of computed tomography scans, and emergency department visits in a short geographic radius. Influencing this variation in prescribing patterns is the lack of prescribing consensus and physicians’ own prescribing styles, according to the report. To improve this, the authors suggest more public reporting on quality measures. |
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Drug maker no longer to pay physicians to promote its drugs |
British drug maker GlaxoSmithKline, the sixth-largest drug maker in the world, recently announced it would no longer hire doctors to promote its drugs, according to an article from ProPublica. In addition, over the next two years the company will stop tying compensation for sales representatives to the number of prescriptions written for drugs they market. The announcement comes of the heels of a more than 80 percent decline for the company in spending on promotional speakers over the past three years. Under the Physician Payment Sunshine Act, a provision of the 2010 Affordable Care Act, every drug and medical device company will have to make payments to doctors public starting this year. Some experts have said that such transparency will discourage doctors from accepting payments, a contention supported by some doctors themselves. GlaxoSmithKline is best known for its drugs Advair (for asthma), Lovaza (for high triglyceride levels), Avodart (for prostate enlargement), and Avandia (for diabetes). |
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List offers view of issues facing physicians in 2014 |
Physicians will continue to face a number of challenges in 2014. To that end, the journal Medical Economics has released a top-ten list of issues facing physicians in 2014. They include: - Payment for medical services
- Government mandates
- Payer headaches, and the fine print
- Time for patients amidst growing administrative responsibilities
- Technology costs
- Staffing and training
- Putting control back in the hands of physicians
- Changing patient populations
- Primary care’s changing role
- Work-life balance
Although some of the issues may seem dauting, the author feels there is tremendous upside for physicians in leading health care delivery in the United States in 2014 and beyond. |
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The slow extinction of the doctor’s lounge |
Once a place to catch up with one another, talk hospital politics, and compare patient notes, the doctor’s lounge is slowly becoming extinct, according to an article from The Atlantic. The doctor’s lounge was arguably the most important hub of medical collegiality within the hospital, the author notes. But nowadays, with increasing workloads and the complexity of medical practice, many physicians simply don’t have the time to relax. The author feels the loss of collegiality and building of strong relationships with colleagues is one of the most unrecognized contributors to the high rates of dissatisfaction and burnout among physicians today. The author argues that medicine needs to catch up with other organizations that have recognized the importance of promoting interdisciplinary interaction by offering environments where more interaction among people from different departments takes place. |
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CHG webinar to focus on moving to care coordination |
The American Hospital Association’s Center for Healthcare Governance (CHG) will host a webinar titled, “The New Frontier in Health Care: Moving to Care Coordination,” taking place Wednesday, January 29 beginning at 1 p.m. ET. The live webinar and recording are free for CHG members and $195 (live) and $240 (recorded) for non-members. In this session, presenter Kevin C. "Casey" Nolan, Managing Director, Healthcare, Navigant Consulting, Inc., will help participants explore the concept of care coordination across the continuum: what is it, how to do it, and the benefits (and risks). Included in this session will be a discussion of the mechanisms, means, and methods associated with effective care coordination as well as the implications for and impact on governance, business models, strategies, revenue streams, organizational structures/reporting relationships, and physician relations. To check and see if your organization is a CHG member, contact Tracey Johnson at [email protected] or 312-422-3276. |
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