primary care physicians

Study: Primary care MDs don't understand consumer-driven health plans

Anne Zieger — Wed, 08 Oct 2008 11:27:05 -0400

While the number of patients with high-deductible consumer-driven health plans continues to climb, it seems that primary care physicians haven't caught up with this trend. A new study funded by the Robert Wood Johnson Clinical Scholars Program found that many aren't ready to discuss the financial ins and outs of these plans, though the adoption of them by employers has grown from 440,000 to 5.5 million over the last three years.

The study, which appears in this month's issue of the American Journal of Managed Care, was based on a mail-in survey of 528 physicians done between May and June of 2007. Of that group, less than half (48 percent) said they felt ready to discuss medical budgets with patients, and 43 percent said they had little knowledge of how consumer-driven health plans work. About one-third said they had scant understanding of how health savings accounts function.

Meanwhile, with physicians feeling on the defensive as consumers peruse online quality reports rating their performance, many don't feel as comfortable discussing tradeoffs between cost and quality, which makes these communications problems worse, researchers said.

To learn more about this study:
- read this Modern Healthcare piece (reg. req.)

Related Articles:
Consumer-driven healthcare shifts MD tech needs
Pediatrics group comes out against CDHPs
MA hospitals want insurers to collect high deductibles

Study: Retail clinic users don't have personal doctors

Anne Zieger — Thu, 25 Sep 2008 13:50:59 -0400

For years now, many primary care physicians have battled the rise of retail clinics, arguing that such clinics would interfere with their patient relationships. However, a new study suggests that their fears are misplaced--as the patients may never have been theirs in the first place.

Retail clinics are attracting patients who largely don't have a primary care relationship in the first place, according to a survey by Rand Corp. More than 40 percent of patients visiting retail clinics were ages 18 to 44. Meanwhile, 23 percent of that group had a primary care doctor relationship, said researchers, who looked at more than 1.3 million visits to retail clinics from 2000 to 2007.

Researchers speculate that such patients value the convenience of the clinics more than the continuity of care a private physician can offer. The study comes as the number of retail clinics in the U.S. surges past 1,000, driven largely by giants like pharmacy chains CVS and Walgreens.

To learn more about the study:
- read this Chicago Tribune article

Related Articles:
FTC slams IL physicians' retail clinic rules
AMA demands retail clinic regs, backs off ban
Doctors push law regulating retail clinics
Wal-Mart plans 2,000 retail clinics
Retail clinics mostly utilized for simple treatments
SLIDESHOW: Common retail-clinic locations

Wait to see primary care MDs growing in MA

Anne Zieger — Mon, 22 Sep 2008 14:01:52 -0400

Here's a look at the future of the U.S. health system: In the state of Massachusetts, the wait to see primary care doctors has grown to as long as 100 days as the number of practices accepting new patients has fallen. Worse, as the state's health insurance mandate has encouraged more patients to seek care, the shortage is likely to keep getting worse, policymakers say.

Aware of the problem, the state's legislature has approved a sweeping set of financial incentives for young physicians, as well as other measures designed to attract primary care doctors into the state. This includes $1.5 million to help the University of Massachusetts Medical School expand its class size, as well as waive tuition and fees for students who agree to work in community health centers. It would also provide $500,000 to pay off debt for physicians who work in primary care in undeserved areas for at least two years.

However, the state's healthcare leaders say that even if they pass, such measures will take several years to have a significant impact on the supply of primary care physicians. In the meantime, the state is still struggling with trends that are fueling national primary care shortages, including a lack of new graduates in the field. According to a survey published this month in the Journal of the American Medical Association, a mere 2 percent of students graduating from med school plan to practice primary care.

To learn more about this trend:
- read this piece from the Boston Globe

Related Articles:
Primary care doctor numbers headed in the wrong direction
Primary care shortage blocks healthcare reform
Congress under pressure to address MD shortage
Primary care MDs ask patients for extra dollars

Case study: Midwest physicians seek hospital ownership deals

Anne Zieger — Wed, 06 Aug 2008 11:25:52 -0400

Physicians are looking to make substantial investments in two financially-struggling Midwest hospitals, both of which will be majority-owned by doctors if the deals go through. In one case, an entrepreneurial family physician is hoping to restructure the ownership of Cincinnati-based Deaconess hospital as a for-profit joint venture with the hospital's not-for-profit parent. Meanwhile, another venture formed by a Rochester Hills, MI-based urologist is preparing to take over North Oakland Medical Center of Pontiac, MI.

In the Deaconess case, a group of about 100 physicians would buy a 40 percent stake in the hospital, with the remaining 60 percent staying in the hands of hospital operator Deaconess Associations. The idea is to build a model that appeals to individual primary-care physicians and specialists, which should compensate for admissions the hospital has lost as the area's largest groups have been acquired by competitors. Right now, Deaconess Associations showed an operating loss of $5.5 million, a result that incorporates its 24 nursing homes. The hospital lost $5.2 million in 2006.

In Michigan, meanwhile, North Oakland Medical Centers has been underwater financially, suffering an operating loss of $13.4 million in 2007. It had only 18 days' cash on hand at the end of the year, according to Standard & Poor's, and missed a payment earlier this year on $38 million in bonds issued under a lease agreement with the city of Pontiac. The Pontiac City Council has now agreed to sell the hospital property to Oakland Physicians Medical Center, an LLC formed by a consortium of physicians. The physicians expect to invest as much as $6 million toward the $11-odd million deal, and the hospital's owner, McLaren Healthcare Corp., will need to kick in $5 million.

To find out more about these deals:
- read this Modern Healthcare article (reg. req.)

City of Boston creates primary care referral service

Anne Zieger — Fri, 01 Aug 2008 11:09:50 -0400

In one of several steps it's taking to improve access to primary care, the city of Boston's health department is starting a telephone referral service that will direct residents to primary care physicians who are accepting new patients. The referral service is one of the first initiatives kicked off by a task force, chaired by Mayor Thomas Menino, established to look at how primary care options can be improved within the city. The mayor is also looking at whether medical institutions could provide subsidized housing for primary care doctors in new research buildings.

This seems like a well-timed initiative, given that Boston--and the state of Massachusetts as a whole--may face worse primary care shortages than some other states. With the state's universal health insurance initiative bringing more patients into the fold, primary care access is particularly difficult there.

Menino formed the current panel, in part, due to his resistance to the encroachment of retail clinics in the city. (The mayor seems to dislike intensely retail clinics intensely, for reasons that he hasn't articulated well.) Originally, he'd hoped to drive them out of Boston, but he's switched his focus to primary care access outside of clinics.

To learn more about this initiative:
- read this article from The Boston Globe

Related Articles:
Doctor shortage slows Massachusetts health reform
Shortage of primary care docs in MA
Boston's mayor objects to retail clinic approval

Study: Primary care MDs don't know when to recommend defibrillators

Anne Zieger — Tue, 22 Jul 2008 13:05:19 -0400

A new study suggests that one of the key reasons few patients who need implantable defibrillators get them is that primary care doctors often don't know when to recommend them. Right now, between 300,000 and 400,000 Americans per year suffer a sudden cardiac attack, most of which are caused by an electrical disturbance. However, some studies have shown that as many as 80 percent of patients who meet guidelines for having an ICD implanted aren't getting them.

To figure out why this is the case, researchers at Cleveland's MetroHealth Medical Center sent out surveys to primary-care physicians in nine northeast Ohio counties, asking them when they might refer a patient for an ICD. The questions were based on CMS's guidelines for ICD use from 2005. When she tallied the responses, researcher Dr. Kara Quan found that only one-quarter to one-third of PCPs responding were aware of referral guidelines for ICDs.

Another factor that emerged--surprisingly--was that 80 percent of PCPs said that patients refused to be referred for ICDs. She suspects that patients' refusals may be linked to doctors' lack of knowledge of the guidelines, and poor understanding of the benefits of such a device.

To learn more about the study:
- read this New Orleans Times-Picayune article

Related Articles:
Defibrillator use delays common, harmful
FDA releases new defibrillator safety data

Case study: Cinci hospital joint ventures with doctors

Anne Zieger — Mon, 21 Jul 2008 15:18:19 -0400

Convinced that the deal offers something that benefits everybody, officials at Cincinnati's Deaconess Hospital are transforming the hospital from a traditional acute-care facility to a joint venture with doctors. Going forward, doctors will own 40 percent of the hospital, and its parent organization will own 60 percent.

The deal will make Deaconess the only acute-care hospital in the state that is structured as a joint venture. Senior officials hope that the deal will develop the hospital's referral base. And it needs the help, particularly given that it's losing money--it reported 2007 revenue of $59.3 million and expenses of $69.8 million.

Once the joint venture deal is consummated, the 273-bed facility will probably be the Doctors' Hospital at Deaconess. Officials with Deaconess believe that the new structure will appeal to doctors who are sick of competing with health systems staffed by employed primary-care physicians. The new structure will also give physicians who want to do so the chance to take on management roles.

To learn more about the joint venture:
- read this Business Courier of Cincinnati article

Trend: Medical home funding sources grow

Anne Zieger — Mon, 21 Jul 2008 14:35:22 -0400

While the notion of a "medical home" has been bubbling up through the healthcare industry for some time, it's still something of a new idea for many consumers, who've never lived in an era when primary care physicians had the time for leisurely visits. However, with the passage of the new Medicare bill--which authorizes funding for a three-year medical home project--and a growing list of state and federal projects fostering this approach, consumers may yet find out.

One example of the coming changes can be found in Philadelphia's metro, where 100 physicians are getting extra payments from some of the region's largest insurers to work more closely with 8,400 patients. (Participating health plans include Independence Blue Cross, Aetna and Cigna.) That includes not only traditional visits, but also e-mail and telephone care. Insurers are running similar pilot programs in several states, in programs impacting nearly 2 million patients and thousands of doctors.

What's more, many other health plans expect to roll out similar programs in the future. For example, Blue Cross Blue Shield of Michigan, which has 4.7 million members, will spend $30 million this year to help PCPs offer medical home-style services. The program should impact about 4,900 primary care physicians.

Government health organizations are playing with this concept too. In one example, a Medicaid-based medical home project under way in North Carolina saved about $162 million in 2006, 11 percent less than the state would have previously spent. And, of course, there's the Medicare medical home program, which has $100 million in funding.

To learn more about this trend:
- read this article from The New York Times

Related Articles:
Case study: NY health plan, group test 'medical home' model
Health plans, MD groups plan 'medical home' project
New Orleans creates medical home for poor residents
Study: Medical homes cut racial care disparities

MGMA: Specialty, PCP compensation grows slowly in 2007

Anne Zieger — Wed, 16 Jul 2008 13:48:50 -0400

According to a new study, it appears that while some specialists did well in 2007, most physician pay increases weren't anything to write home about. According to data from the Medical Group Management Association, inflation-adjusted specialty pay grew 0.31 percent to a median of $332,450. Meanwhile, inflation-adjusted primary care pay rose 3.35 percent to a median of $182,322.

Despite relatively pallid increases in specialist pay overall, there were a few winners: for example, noninvasive cardiologists' compensation grew 11.72 percent before inflation. Also, anesthesiologists saw a 6.43 percent inflation-adjusted pay increase and urologists saw a 5.5 percent gain, following a similar increase in 2006.

Meanwhile, primary care physicians essentially lost ground, if you consider that they generated an overall 7.59 percent increase in production in 2007. Looked at another way, they did more than 7 percent more work but got paid for less than 4 percent of it. This seems like a trend that can't continue; either smart providers will compensate physicians for the work they actually do, physicians will find a way to cut back, or the shortage will get so painful that pay jumps.

To learn more about the study:
- read this MGMA press release

Related Articles:
MGMA: MD groups limit Medicare patient access
MGMA: MI group wins at pay-for-performance

Hospitals, practices using locum tenens physicians more often

Wed, 04 Jun 2008 06:59:56 -0400

In what some deem a troubling sign that the primary care physician shortage is getting worse, a growing number of hospitals and practices are working through temp agencies to get their staffing needs met. As has always been the case, physicians are choosing the locum tenens option for their own reasons, including the flexibility of not having to maintain their own office, the ability to experiment with different regions and facilities, and the ability to limit how many hours they work.

However, hospitals and medical practices seem to be facing a new squeeze forcing them to change their habits. According to a survey by doctor temp-agency Staff Care, spending on temp doctors across the U.S. has more than doubled since 2001, and the number of days worked by physicians as temps has grown by 20 percent between 2006 and 2007 alone. Observers say a growing demand for primary care physicians is helping to fuel this boom.

To learn more about this trend:
- read this Chicago Tribune piece