Pa.'s chronic care management project

Implementation of a respected model of chronic disease care and management is being promoted by the state and supported financially by health plans.

 
Paula Bussard

Medicaid stops payment for preventable medical errors

Preventable, serious adverse events are not medically necessary and therefore, for inpatient services at acute general hospitals, these events will not be paid for under the Medicaid fee-for-service program.

Moving medical malpractice out of the courts

A liability by contract proposal to get medical malpractice out of the courts.

Rick Bloxdorf

Ambulatory surgery centers proliferate in Pa.

Rapid and profitable proliferation of ambulatory surgery centers have important impacts on physicians and hospitals.

Prescription for Pennsylvania progress report

Of the dozens of proposals to enhance access, quality and affordability, some have passed legislatively, some are being implemented administratively, and others continue to face hurdles.

Richard A. Bankowitz, M.D. M.B.A.

Premier launches expanded hospital quality initiative

New hospital quality incentive project expands beyond Medicare and looks at appropriateness of care, clinical outcomes, patient satisfaction, harm avoidance and efficiency.

Appraising CMS's new hospital reimbursement methodology

Historically significant changes to Medicare’s hospital reimbursement methodology, and their anticipated impacts.

 
HAP's Melissa Speck

Impact of Pa.'s new infection reporting law

Reports will now go directly into a CDC database, while hospitals must demonstrate measurable improvement or face penalties.

Physician home visit Medicare patient demonstration

IBC pilot project uses physicians instead of nurses to expedite in-home preventive care to the frail eldery.

Pa. eHealth Initiative issues recommendations

What needs to be done to allow physicians to share electronic medical records across Pennsylvania.

The Joint Commission's health literacy initiative

Joint Commission recommendations on how to: make effective communication an organizational priority to protect the safety of patients, address patients’ communication needs across the continuum of care, and pursue policy changes that promote improved practitioner-patient communication.

Anticipating impacts of a Blue Cross merger

Seeking to have questions answered regarding a merger’s impact on physicians and patients.

Free electronic prescribing available to all physicians

Every physician with an Internet connection can now use electronic prescribing at no charge.

Improving end-of-life care in Pennsylvania

Report recommends a public awareness campaign, improved professional education and training, and reimbursement changes in order to improve end-of-life care.

Launching the 5 Million Lives Campaign

The campaign seeks to continue to save lives, raise awareness about the problem of variability in the quality of health care, and expand the national infrastructure for supporting hospitals in making improvements.

Parameters for Medicare pay-for-performance

Appraising which performance measures should be used and how they should be updated; which payment policy should be used to reward performance; and which key implementation issues need to be addressed, such as data and information technology requirements.

AHRQ offers prevention 
guidelines electronically

The federal government is making 110 recommendations covering 59 different preventive service topics even more useful and accessible.

Practicing patient-centered collaborative care

What physicians need to render “exactly the care that patients want exactly when and how they want and need it.”

Plans for a new medical school in Scranton 

Rationale and expectations for the state’s ninth medical school.

Turning physician stress into physician empowerment 

It is well recognized that medicine is a high stress profession. What is less well known is that chronic stress may be punctuated by episodes of terror, even acute stress reaction and post traumatic stress disorder when a mistake is discovered or a lawsuit ensues.

Hospitals collaborate to reduce diagnostic errors 

Efforts to define and identify pathology lab diagnostic testing errors, and to design and test interventions to reduce them.

Moving from evidence-based to value-based medicine 

Value assessment gives more complete information that includes quality-of-life metrics as judged by patients.

Internal medicine board adds practice improvement modules 

Practice Improvement Module program modifies and enhances the American Board of Internal Medicine’s maintenance of certification program.

Board certification offered in disaster medicine 

A description of the core competencies and testing process for this new board certification, which is available to all physician specialties.

Bringing community resources into care management 

An online repository of community organizations helps care managers link patients to needed resources, increasing the odds that they will follow through with the care for which they are covered.

Report card grades emergency medicine in Pa. 

Pa.’s grades in four areas reveal weakness in malpractice climate and strength in health care access. But strong grades mask other important weaknesses.

Appraisal of Attorney General's Health Care Unit 

Former head describes the Unit’s accomplishments and decries its limitations, which he says derive from a lack of political will.

Highmark's physician grants for electronic prescribing 

The grants are available to any Pa. physician who purchases a system with certain specifications.

Pa. launches academic drug detailing 

Pa. is sending trained staff, not unlike detailers for the pharmaceutical manufacturers, to call on physicians who have a high number of PACE enrollees and educate them with respect to prescribing in six different therapeutic classes.

Navigating the PACE and Medicare Part D program 

How will you answer your elderly patients’ questions about Medicare Part D’s impact on PACE and PACENET?

Insurance Dept. maintains MCARE Fund coverage level

MCARE Fund coverage will continue at the status quo level for the near future. What are the implications for physicians?

Pa. Medicaid budget partially restored

Restored items benefit patients and providers, while some cuts stand firm.

IBM forming health information technology ventures

IBM health care technology experts discusses area’s promising expansion, obstacles impeding implementation, and innovation ventures with hospital systems.

Creating a practice in holistic medicine

Appraising different business models, treatment protocols, and benefits to patients and physicians.

Systems approach to health care quality improvement

Value Capture, co-founded by Paul O’Neill, seeks out health care organizations that are not content with a slow pace of quality improvement and error reduction.

Fighting frivolous malpractice lawsuits with countersuits

Even frivolous lawsuits cost insurers money to defend against and can raise liability insurance premiums. Countersuits attempt to recoup those losses, while sending a message to the tort community.

Effects of medical error disclosure & apology

Research suggests that physicians should apologize, and that doing so does not increase malpractice costs.

Government addresses health care competition

Why the feds suggest abolishing Certificate of Need requirements, oppose collective bargaining by physicians, are skeptical that health insurers have monopsony power, and more.

William H. Lamb, Esq.

Pa. Supreme Court changes rules affecting malpractice

Real tort reform from the judiciary, explained by one who was there.

Championing physician causes with political activism

Activist for physician causes describes why she got involved and how her activities have grown.

Paula Bussard

HAP issues charity care guidelines for Pa. hospitals

HAP describes rationale and details of the guidelines and responds to charity care lawsuit allegations.

Wide scope of priorities for cancer control in Pa.

An organization comprising over 100 organizations is addressing eight areas: screening and diagnostic follow-up, quality of life, tobacco prevention and cessation, research, treatment and care delivery, access to services, healthy lifestyles, and information management and dissemination.

Frank A. Sloan, Ph.D

State-Sponsored Medical Malpractice Insurance

Pew Grant researcher appraises roles of MCARE Fund, JUA, Guaranty Fund and No-Fault payment systems.

James Martin, M.D.

Transforming family medicine on multiple fronts

Family Physician organization announces findings of reform project advocating far-reaching proposals.

Forming a national society for concierge physicians

President of new national organization explains conditions that make conversion to retainer-based medicine attractive or difficult, including legal and regulatory issues, and describes how the model fits in to the health care delivery spectrum.

Stephen Foreman, Ph.D., J.D., M.P.A.

Demand spike will cause severe MD shortage

Mostly driven by demand, there will be a substantial shortage of physicians by 2020 that cuts across most specialties and urges a look at the physician supply situation.

Challenging the surpluses of Pa.'s Blue Cross plans

Outspoken Pa. legislator details push to rein in Blues’ surpluses in light of recent Insurance Department restrictions.

John C. Nelson, M.D., M.P.H.

Physicians gain from new Medicare law

AMA’s president-elect outlines reimbursement changes and other implications of the new Medicare law.

Expertise-enhancing reform of malpractice litigation

Latest Pew grant study recommends minor changes to the present tort system to improve the performance of juries and judges.

John J. Skiendzielewski, M.D

New federal rule could degrade emergency care

Relaxed rules for on-call specialists could seriously increase burdens on emergency physicians and emergency patients.

Universal health care on ballot in Pa.

Former Philadelphia Health Commissioner describes universal health insurance ballot initiative and physician support for a single payor health care system.

Walter Tsou, M.D., M.P.H.

Charles W. Bailey Jr., M.D

The story behind tort reform success in Texas

TMA president narrates what it took to get malpractice caps signed into law. Some strategies and tactics may be exportable to Pennsylvania.

Leading Pa.'s new Office of Health Care Reform

With a charge to lead and coordinate the administration's health care reform agenda among and between several state departments, the new office is advising the governor on projects related to medical malpractice insurance, accessibility to emergency room care, the continued operation of trauma centers and long term care.

Rosemarie B. Greco

Nancy Udell, Esq.

Advocating a new system of medical justice

Why the current tort system – and the typical remedies being debated – are inadequate compared to a new, alternative system to adjudicate medical malpractice cases.

Tort replacement solution to malpractice crisis

Penetrating analysis of causes contributing to Pa.’s malpractice crisis, and of possible solutions, and why tort reform is a misguided approach compared to a systems approach that removes the fixation on individual blame.

Randall R. Bovbjerg, J.D.

Rick Campanelli

Enforcing the patient privacy component of HIPAA

The director of the Office for Civil Rights, U.S. Department of Health and Human Services, tells what he will be looking for as he gears up for the  enforcement of  HIPAA

Report card for Pa. Health Department

Interviews with over 40 persons from inside the department and outside culminate in a reckoning of the department’s strengths and weaknesses, as well as an agenda for improvement.

Karen Wolk Feinstein, Ph.D

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

Researching solutions to Pa.'s malpractice crisis

Principal investigator on the The Pew Charitable Trusts Project on Medical Liability in Pennsylvania offers an expert insider’s view of what dynamics drive medical malpractice crises and what approaches might stop them

Inside the governor's malpractice task force

Inside look at who is on the task force, how it functions, what proposals it has considered and what impact the proposals have on physicians.

Roger F. Mecum

Geisinger sees success in disease management

Geisinger Health Plan devotes millions of dollars to multiple areas of disease management and sees return, both financial and improved patient outcome.

Rural community hospital turnaround

Pocono Health System taps patient population growth and geographic strengths to move from a deficit to a multi-pronged expansion plan.

Eugene Leblond

HealthAmerica confronts dominance of the Blues

HealthAmerica describes its strategy in various Pa. markets and explains how it intends to sustain and grow its business in the face of health plans with as much as two-thirds market share.

Francis S. Soistman, Jr.

New health coverage for uninsured adults

New health plan for uninsured adult Pennsylvanians is funded from the state’s national tobacco settlement money. Here’s how it works

Patricia Stromberg

Health Dept's report on minority health care

A blueprint to help communities take stock of health care disparities and to engineer efforts to redress them

Pa. Sec. of Health 
Robert S. Zimmerman, Jr., MPH

Angelo S. Agro, M.D.

NJ passes physician joint negotiation law

New Jersey has become only the third state in the U.S. to pass a law granting antitrust exemption to private physicians who wish to negotiate jointly with health plans over fees and other contractual issues under state supervision. This version of the legislation may be the strongest yet for physicians wishing to garner bargaining clout through their numbers.

Highmark unveils practice guideline program

Clinical software-based program offers real-time best practices resources while compiling practice pattern data to feed back to physicians for quality analysis.

Keith Morgenlander

Sec. of Aging Richard Browdie

Mending Pa.'s senior Rx coverage crisis

Secretary of the Pa. Dept. of Aging proposes short- and long-term fixes for the state’s cash-strapped program for low-income seniors

Raising the malpractice crisis ante

Orthopedic surgeon from Delaware County explains how the medical liability situation has prompted his 18-physician group to drop surgery next year, and outlines the likely impact on patient care and the goals his group hopes to achieve with such a move.

Nicholas A. DiNubile, M.D.

Joel M. Blau, CFP

Changing your practice situation

Many physicians are working longer hours for less pay and some may want to consider transitioning into another way of practicing medicine. Co-author of Medical Practice Divorce discusses legal, financial and personal considerations.

Gregg S. Meyers, M.D

Evidenced-based patient safety recommendation

Director of the Center for Quality Improvement and Patient Safety at the AHRQ discusses an analysis that the agency commissioned of evidence-based, best safety practices to disseminate to health care provider organizations, and advises that implementation criteria be sensitive to local priorities and resources.

Online reporting of MD disciplinary actions

A new state website currently reports a limited amount of physician disciplinary information, while the Pa. Bureau of Professional and Occupational Affairs considers adding to the scope of that information available to the public with the click of a button.

Bureau of Professional and Occupational Affairs Commissioner Albert H. Masland

Pa. Health Secretary Robert S. Zimmerman 

Name-based HIV reporting proposed for Pa.

Pa. Health Secretary describes reasons to require confidential name reporting of HIV-positive patients, while retaining access to anonymous testing facilities.

IOM's call for systemic change in health care

Former AMA president outlines IOM’s latest report indicating that problems of health care quality persist in the U.S., that substantial improvement cannot come merely through harder work by health care providers, and that a systemic reorganization is needed in the way that various factors are integrated to improve health care.

Lonnie Bristow, M.D.

Robert A. Auclair, Esq.

Antitrust primer for physicians

Physician practices need to be concerned about how they're affected by antitrust and how their conduct can affect others. Any conduct that reduces or eliminates competition is generally prohibited under antitrust laws, and there are four problem areas for physicians: relationships with payors, IPAs, practice mergers and staff privilege

MDs address malpractice reform at the grassroots

Private orthopedic surgeon discusses how he hopes to bring widespread attention to the region’s medical malpractice liability crisis, possibly resulting in widespread stoppage of surgeries, without running afoul of antitrust law.

Frank Giammattei, M.D.

Kenneth Melani, M.D.

Highmark's Internet portal for medical practices

Highmark Blue Cross Blue Shield is offering an Internet interface with physician offices, which is being made available to other health plans, designed to allow electronic practice transactions such as referral authorizations, claims submissions and patient eligibility and benefit inquiries, with possible future applications such as pharmaceutical ordering, physician-patient communication and physician profilin

Melinda Jenkins, Ph.D., CRNP

Nurse prescribing regulations, Part I:
Regulations need to be less restrictive

The Alliance for Advanced Practice Nurses seeks more flexibility in collaborative agreements between CRNPs and physicians as well as in advanced pharmacology course work.

Nurse prescribing regulations, Part II
Medical society ready to compromise

The Pennsylvania Medical Society is willing to increase the number of CRNPs each physician can have collaborative agreements with and allow alternatives to the 45-hour pharmacology course requirement.

Carol E. Rose, M.D.

Using medical information on the Internet

Executive vice president and editor-in-chief of Medicalogic/Medscape and former editor-in-chief of JAMA advises how physicians can maximize the Internet’s utility for patient encounters and speaks to the credibility of Internet--and print--medical journal.

George D. Lundberg, M.D.

Lawrence Otter, Esq.

Pa. attorney general opens health care unit

Attorney General’s enforcement powers applied to consumer health care complaints parallel protections offered by Act 68.

Market power of Pa.'s Blue Cross plans

Health care economist commissioned by the PMS to study Pa.’s insurance markets offers evidence that Independence Blue Cross and Highmark Blue Cross Blue Shield are using their market power to stifle competition, restrict patient choice, raise premiums and reduce payments to provider.

Stephen Foreman, Ph.D., J.D., M.P.A.

Responding to systematic reimbursement downcoding

Pennsylvania Blue Shield is automatically downcoding certain levels of critical care reimbursement, raising questions of how widespread the practice is, what impacts it may have on physicians and patients, and what recourse is available

John Hansen-Flaschen, M.D.

Ellison C. Pierce, Jr., M.D.

Improving anesthesia safety

Executive director of the Anesthesia Patient Safety Foundation describes how information dissemination and research grants have led to safer technological devices for anesthesia, better anesthesia drugs, expanded training in anesthesia residency programs and nursing schools, and a significant drop in anesthesia-related malpractice claims and insurance premiums

Implementing a new physician reimbursement paradigm

President of Pennsylvania Orthopaedic Society describes a risk sharing model, soon to be implemented in Pa., that establishes a single reimbursement price covering all costs associated with a given surgical procedure over a defined time interval from trigger event to conclusion event.

Lewis S. Sharps, M.D.

Rep. Patricia H. Vance

Advancing the battle for nursing autonomy

Sponsor of HB 50 explains how it would affect drug prescription authority of certified registered nurse practitioners and offers her views on how it is likely to impact on other nursing scope of practice issues.

Re-evaluating physician career paths

Expert in physician career assessment describes creative options for physicians who have become disenchanted with their present practice environments

Kent Bottles, M.D.

Coalition tackles tort reform

A coalition representing medical, business and public sector interests is pushing a broad set of tort reform measures in the Pa. General Assembly and the Pa. Supreme Court.

Physician general nominee outlines priorities

Robert S. Muscalus, D.O., sketches his priorities, offers his view on the role and authority of the Pa. Physician General, as well as on health care regulation, non-physician scope of practice and other issues.

Robert S. Muscalus, D.O.

HMO medical director becomes critic

Linda Peeno, M.D., uses her experience as an HMO medical director to expose what she regards as deep systemic defects in managed care operations.

Linda Peeno, M.D.

Owen Montgomery, M.D.

Coalition seeks to hold HealthChoices accountable

A coalition of 14 medical and lay advocacy groups seeks reforms of Pennsylvania’s Medicaid managed care program before its startup in western Pennsylvania.

William H. Mahood, M.D.

Shifting insurance from employers to individuals

AMA trustee outlines the AMA’s health reform plan and its impact on physicians and health insurers, as well as on cost, quality and access to health care.

PSIM works for ACP merger, against Blues merger

Physician leader talks of the Pennsylvania College of Internal Medicine’s structure and agenda, as well as ongoing challenges to the merger that created Highmark Blue Cross Blue Shield.

PSIM President Robert B. Sklaroff

Pennsylvania HC4's new executive director

PHC4’s incoming executive director reflects on the Council’s past performance and assesses ways to improve its future services.

Marc P. Volavka 

Former physician general's prescription for PA

Pennsylvania’s first physician general, who recently resigned, offers her assessment of how the position needs to be modified and the way it must be supported by, while being independent of, politics if it is to promote public health issues successfully.

Kenneth Melani, M.D.

Highmark's vision of managed care's fate

Highmark Blue Cross Blue Shield’s Kenneth Melani, M.D., projects the next wave of changes in managed care and reveals Highmark’s adaptation plan for its physician and hospital networks

Competing for clinical trials funding

Clinical trials funding is seriously threatened. The head of the new Coalition of National Cancer Cooperative Groups discusses proactive ways to redress those threats, including looking to industry and the private sector for competitive bids.

Robert L. Comis, M.D.

Nancy W. Dickey, M.D.

AMA launches program for collective bargaining

The AMA’s president-elect discusses their alternative to physician unions.

Secretary Daniel Hoffmann describes the Department’s approach to regulating managed care and discusses his views on competition, the prospects of direct contracting, grievance resolution and legislative initiatives affecting managed care companies.

Michael P. Hirsh, M.D., discusses the recent report, "Building Zero Tolerance for Violence Communities," addressing why physicians should regard violence as a medical problem, what roles they can play to intervene and what kind of data can be collected to study the problem.

Abraham J. Twerski, M.D., internationally renowned expert on physician addiction and treatment, advises what to do for a colleague who may need help. Approaches to detection and treatment, privacy and medical licensure issues.

Recently appointed PA Physician General Wanda D. Filer, M.D., discusses the purpose of the new post, its scope and authority, her policy priorities and role as physician representative.

Attorney General passes on Blues merger

The consolidation of Pennsylvania Blue Shield and Blue Cross of Western Pennsylvania has been approved. James A. Donahue III, Esq., assistant chief deputy attorney general of the antitrust section, explains how the Blues satisfied social mission and anticompetitive concerns which delayed the merger.