Anthony Aquilina, D.O., MBA

Physician “report cards” – ratings of physician quality and efficiency made publicly available by health plans and other entities – are undergoing major transformation, as key developments are spurring improvements in substantive validity and methodological transparency.

Online physician communication  

Concerns about time, cost and liability persist, while use of electronic communication raises issues including privacy and security regulations under HIPAA, efficiency, efficacy, care coordination, care documentation, practice marketing potential, and the patient-physician relationship.

 
Medem CEO Edward Fotsch, M.D.

 
Rusty Holman, M.D.

While the hospitalist model has gained widespread acceptance within the health care delivery system, research remains surprisingly inconclusive as to whether it has improved the efficiency and quality of patient care, or lowered costs; while concerns remain about its potential erosion of continuity of care, the physician-patient relationship, and the supply of office-based general internists.

Physician websites evolve  

While these Web 2.0 technologies facilitate rapid access and exchange of medical information, democratizing the promulgation of that information requires more vigilance to vet its credibility and potential bias, as sources may be anonymous and/or have commercial ties to industry that are not immediately apparent.

Daniel Palestrant, M.D.

Sharon Buttress, M.D.

As the number of uninsured grows, the strain on the health care safety net intensifies. Inherent weaknesses of that safety net – maintaining adequate resources and coordinating patients’ specialty care needs – may be reaching a critical point.

Reducing health care disparities

Definitive causes of persistent health disparities remain elusive, but recent research from key agencies sheds new light on the issue, as well as which models of intervention may hold the most promise for closing the health status gap, and those models are being applied at the state and local level.

Aline Holmes, RN

Amy Waterman, Ph.D.

The problem is more prevalent than one would expect, while adequate support services for physicians are often unavailable, and physicians do not use available services for a variety of personal and professional reasons.

Physician-insurer relations evolve   

Although still defined partly by acrimonious confrontation over reimbursement issues, the relationship has seemingly taken on a more cooperative style, as illustrated by several recent developments affecting Pennsylvania and New Jersey physicians.

MSNJ President-Elect 
Richard J. Scott, M.D.

The health court concept is being treated with a new level of seriousness, enjoys growing support from new quarters, and now occupies a conspicuous place in medical liability reform policymaking.

Physician pay-for-reporting launched   

Many physicians may find the PQRI appealing, as they stand to gain extra reimbursement for reporting data that they may already capture in their patients’ clinical charts, although participation will likely entail workflow changes, and few expect the 1.5 percent bonus to cover a practice’s additional cost for capturing and reporting the data.

The popularity of bariatric surgery as a treatment for obesity has spiked tremendously in New Jersey – with the number of cases increasing nearly 850 percent between 1998 and 2003 – sparking important economic and quality-of-care implications as the state tries to respond to rapid growth with appropriate policy.

Physician-hospital gainsharing   

A practice that violates the federal anti-kickback statute, the Stark physician self-referral law and the civil monetary penalties provision of the Social Security Act is gaining legitimacy as a catalyst for physician-hospital collaboration and clinical quality improvement.

There appears to be a consensus among stakeholders and analysts that the current reimbursement mechanism is ineffective at holding down costs, incapable of improving quality of care, inequitable to physicians, and injurious to Medicare’s balance sheet.

Implementing a medical home

A wholesale change in the way that primary care is organized, delivered and reimbursed is being promoted by three primary care specialty societies, being tested in Pennsylvania and New Jersey, and gaining clout in the form of a federal demonstration project.

AtlantiCare's Don Parker

Convenient care clinic expansion 

This curious market phenomenon will have increasingly important implications for primary care physicians and their relationship with patients; as well as quality, cost and continuity of care.

Malpractice insurance changes in NJ 

Signs of a freshly competitive market may present a glimmer of hope for some physicians, while at the same time worrying others that excessive exuberance could lead to another cycle of price competition that brought carrier insolvencies and market crisis the last time around.

Three major, statewide programs to control the spread of hospital-acquired infections are showing promise in New Jersey , while important challenges remain.

Angioplasty waiver controversy 

New Jersey ’s nine waiver hospitals have begun to perform elective PCIs without open heart surgery programs according to CPORT trial protocols designed to track safety and quality via outcomes. Although public acrimony may have quieted, tensions remain among the competing imperatives of safety, quality, access and economics.

 
U.S. Sen. Robert Menendez

Candidates square off on health care - Part 1 

The Democratic candidate for U.S. Senate from New Jersey answers our questions.

Candidates square off on health care - Part 2

The Republican candidate for U.S. Senate from New Jersey answers our questions.

N.J. Sen. Thomas H. Kean, Jr.

Small gifts, modest meals and drug samples from pharmaceutical reps still get physicians to prescribe the newest and often most expensive drugs, according to a recent critique that some hospitals are taking seriously.

Physician-patient communication 

Recent developments are driving a paradigm shift in medical education: training medical students, residents and practicing physicians in “best practice” communication skills, restoring the value of empathy and rapport-building between physicians and patients.

IOM's Steven A. Schroeder, M.D.

There is scant evidence that QIO interventions drive quality improvement, and QIOs appear to meet their beneficiary complaint review obligations poorly. Those findings were affirmed by an Institute of Medicine investigation, which will guide government reforms.

Malpractice crisis erodes access 

Recent studies found that "high-risk" patients may be not be getting the care they need because of defensive medicine and other physician practice changes induced by the threat of liability.

William M. Sage, M.D., J.D.

Surveyed companies remained pessimistic about the market softening in the near future and expected more rate increases to be in the offing.

Payors expand quality incentives  

Expansion of pay-for-quality incentive programs takes clinical guidelines to a new level and raises questions about how they may transform the medical profession and patient care.

CMS' Stuart Guterman

Three health insurance companies have come forth with lawsuit settlement proposals promising more favorable reimbursement practices and significant changes in their reimbursement policies and procedures, which physicians had tried to get them to implement, without success, through contract negotiations and through legislative channels.

Bush to push sweeping health reform  

The reforms seek to substantially redesign America’s health care delivery and financing system—from changing the way primary care is delivered and records are kept, to covering the uninsured, to shifting medical liability burdens off the shoulders of physicians.

Gail Warden

In the wake of a massive financial shake-up of the disability insurance industry a few years ago, the industry has undergone significant consolidation, policy benefits for physicians have eroded and physicians are experiencing benefit delays and denials, with some resorting to costly and protracted litigation against their insurers.

Aetna attempts policy transformation  

Aetna’s intentions, if actualized, would signify a remarkable transformation in the managed care industry. Those intentions appear to have been partially realized, although physician experience has been mixed. Nevertheless, Aetna’s changes would seem to be dictated by current marketplace trends and may offer a glimpse of how managed care will be shaped in the years to come.

Aetna CEO John W. Rowe, M.D.

Barbara E. Barnes, M.D., M.S.

While some defend the importance and appropriateness of traditional CME program formats, a variety of innovative CME programming, some involving the latest web-based technology, is increasingly being made available to physicians.

Fate of joint negotiation legislation  

While the future of antitrust waiver legislation is unclear, movement at the federal and state levels indicates that the campaign is not over, although it will take some time to achieve the momentum that was lost last year.

J. Scot Chadwick

OIG compliance guidance  

HHS' Office of Inspector General has issued its final "Compliance Program Guidance for Individual and Small Group Physician Practices" to help protect doctors from Medicare Fraud & Abuse prosecution. We offer some guidance on the guidance, in five easy pieces.

Candidates' health care proposals  

Gore’s focus is on spending more to expand existing government programs, while Bush favors spending less and relying more on market-based reforms. Issues include the Campbell bill, tort reform, medical research finding, HMO patient bill of rights, expanding health care access to the uninsured and Medicare reform.

Congressman Tom Campbell

M.D. joint negotiation bills advance 

Legislation that would allow independent physicians to negotiate collectively with health plans is enjoying a groundswell of support, both at the federal and state levels, and appears to indicate a sea change in the politics of medicine.

Impacts of error reduction initiatives 

In addition to actually reducing adverse events, error reduction initiatives could have impact on the way health care systems are organized and care is delivered, on physicians’ clinical decision-making authority, on patient choice of physicians and hospitals, and on medical malpractice rates and lawsuits.

David M. Lawrence, M.D.

• Washington State statute allows self-employed physicians to negotiate jointly with health plans over contractual issues not including fees.

• Texas law allows joint physician negotiation with health plans over fees and other contractual issues, while prohibiting strikes.

• Congressional bill would grant antitrust exemptions to self-employed health care professionals to negotiate collectively with health plans, while prohibiting strikes.

• Three physician joint negotiation bills introduced in the Pennsylvania General Assembly, with two others expected to be introduced shortly.

Physician antitrust waivers gain momentum 

Existing state laws that permit private physicians to negotiate jointly with health plans over contract issues free of antitrust obstacles are beginning to bear fruit, while a federal bill offering even more negotiating latitude for physicians seems likely to be amended and moved for a vote. In Pennsylvania alone, three antitrust waiver bills for health care professionals have been introduced in the state Legislature, while two more are expected to be introduced shortly.

Collective bargaining vote challenges AMA leadership

A great deal has been made about the AMA’s vote, ranging from those who view the decision as marking the zenith of physicians’ resolve to those who believe that the ethos of the medical profession is imperiled by associating itself with the working-class interest politics of labor unions.

Annals of Internal Medicine
Editor Frank Davidoff, M.D.

Serious reform proposals emerge 

While incremental solutions have been adopted or are under consideration for a variety of problems in the current health financing system, a surprising convergence between critics has emerged on the point that nothing short of fundamental change will significantly improve the situation.

Physicians seek antitrust waiver 

A radical and little-known approach to redress the problem of monopolistic health plan behavior has quietly been in effect in Washington state since 1995, has just passed the Texas legislature and is seriously being considered for introduction in Pennsylvania as early as this fall.

Legislative Initiatives

• Washington state measure implemented in 1995 allows competing physicians to negotiate jointly with health plans over contractual issues not including fees.

• Texas Legislature passed measure last month to allow physicians to negotiate jointly with health plans over contractual issues including fees.

• Pennsylvania Medical Society is drafting legislation similar to the Texas bill for possible introduction this fall.

Stanley Pomarantz, M.D.

Managed care showdown in Texas; 

After years of escalating hostility and mistrust, two large integrated physician organizations have terminated their HMO contracts with Aetna U.S. Healthcare.

Documentation and coding tools

Given ample reason to be concerned about their documentation and coding habits, physicians need to examine the strengths and weaknesses of various products and services available to expedite those tasks. Documentation efficiency aside, one might also contemplate how useful these systems are to actual patient care.

Does standardization equal quality?

Some view practice guidelines as merely attempts to legitimate cost cutting measures, while others see them as attempts to improve outcomes and reduce costs. Is physician resistance based on professional integrity or professional arrogance?

Physicians slam market-driven medicine

A physician-drafted Call to Action is intended to spark a revolt against market-driven health care. Ad Hoc committees in Philadelphia and Pittsburgh will pursue the manifesto proscribing for-profit takeovers of health care institutions.

Physician unions gain steam

While the debate continues over whether it is prudent for physicians to join unions, recent developments indicate that a growing number of physicians are choosing to muster down that path with the hope of protecting their professional autonomy from policy dictates of hospital networks and health insurance companies. Local and national developments are examined.

HMO liability: boon or bane?

Recent events, both in Pennsylvania and nationally, indicate a trend toward increased HMO risk of being sued for medical malpractice. That may not be good news for physicians, however, as HMOs go on the offensive. A recent case illustrates the potential dangers.

As employment becomes a more dominant setting for physicians, what will become the dominant image for what it means to be a physician in our society? Two competing visions are analyzed in the face of some sobering trend data.

Oxford Health Plans’ initiatives to manage patient populations by specialty teams and nurse practitioners challenge the traditional primary care physician gatekeeper model of managed care. One of the experiments is being tried in Pennsylvania; the other may not be far behind.