physician practices

Physicians struggle to keep their practices afloat

Anne Zieger — Fri, 31 Oct 2008 11:17:58 -0400

Physicians' practices are seeing revenue falling this year instead of rising like last year, no doubt because of the slowing economy. So what are they doing to try to stay afloat?

A survey of 75 physician practices reveals that most doctors are trying to make themselves more accessible and convenient. Some of the ways they are doing this include working longer hours, allowing last-minute appointments, even offering hot and cold beverages in their waiting rooms.

And in a nod to the troubled economic times, they are also being more open about financial costs, and more accommodating of uninsured patients. Many are even offering payment plans for patients who can't afford their care up front, but need to be seen by a doctor.

To learn more about the survey:
- Read this Wall Street Journal blog

Retail clinic firm agrees to support MD group standards

Fri, 22 Feb 2008 06:59:54 -0500

The Little Clinic--based out of Brentwood, TN--which runs more than 40 retail clinics inside of Kroger and Publix supermarkets, has agreed to formally adopt proposed clinic standards established by the American Academy of Family Physicians. The standards, which the AAFP tags as "desired attributes," include that the retail clinic should have a limited scope of clinical services, practice evidence-based medicine, have connections with local physician practices, have a referral system for care outside its scope, and use electronic medical records to gather accurate and comprehensive data for use by the primary physician.

While none of these standards are likely to change the way Little Clinics work too much, you could still call this effort an olive branch to the medical community, some of which still violently opposes the existence of such clinics. Now, one is left to ponder whether the retail chain's peers will make similar good-will gestures toward leading physician groups. Wonder if Wal-Mart has any such plans?

To learn more about the agreement:
- read this press release from The Little Clinic

Related Articles:
Wal-Mart plans its own in-store clinics. Report
AMA demands retail clinic regs, backs off ban. Report
Doctors push law regulating retail clinics. Report
Retail clinics: thousands on the way? Analysis
Retail clinics: our resource center.

ALSO NOTED: Metro Boston practices, hospitals form new system; Officials dispute PA cancer link; and much more...

Mon, 10 Dec 2007 06:59:50 -0500

> A group of suburban Boston medical centers and physician practices have come together to form a new health system. Article

> It's government versus researchers in Pennsylvania, where officials dispute that conditions in two counties have led to a rise in rare blood cancers. Article

> The California Nurses Association/National Nurses Organizing Committee has convinced hospitals at a Nevada hospital to come on board. Article

> Longs Drug Stores is opening retail clinics in two Hawaii locations, the first such clinics to open in the state. Article

And Finally... Even Bill Gates would think twice before serving this scotch to dinner guests. Article

Study: Number of small practices decreasing

Fri, 17 Aug 2007 06:59:57 -0400

Physicians are increasingly practicing in single-specialty groups of six to 50 physicians, rather than the old-school groups of one or two physicians, according to new research.

A report by the Center for Studying Health System Change says the proportion of physicians in solo- and two-physician practices fell from 40.7 percent in 1996-97 to 32.5 percent in 2004-05. That's a big structural change for the industry. Another important structural change is that a growing number of physicians are giving up ownership stakes in their practices, suggesting that changes in physician pay are afoot.

Meanwhile, the study also notes that physicians aren't moving into multi-specialty practices, and that the proportion of physicians in such practices actually fell, from 30.9 percent to 27.5 percent between 1998-99 and 2004-05. That's contrary to conventional wisdom that managed care would fuel development of large multi-specialty groups to manage risk-sharing and coordination with specialists.

For more data on this trend:
- read this CSHSC press release

Related Article:
Smart ways PCPs can avoid closing their practice. Report

EMRs show promise in easing malpractice cost

Thu, 09 Aug 2007 06:59:56 -0400

After years of hope and speculation, healthcare providers finally are seeing some evidence electronic medical records can ease the risk of malpractice suits and the burden of liability insurance costs. In a survey from the Boston-based Medical Records Institute, 45% of physician practices said EMRs reduce their vulnerability to malpractice suits, and nearly one in five reported that their malpractice insurer offers a discount for EHR usage.

Likewise, close to 20% of respondents said they have been involved in a malpractice case in which an EMR provided documentation, and 55% of this group believed the EMR was helpful in fighting the suit.

The results may not be indicative of all physician practices, since 62% of survey takers said they have an EMR, while most credible estimates put non-hospital physician adoption rates at far less than 20%.

For details:
- Check out this Health Data Management story. Article
- See the Medical Records Institute press release.

Related Articles:
GPS-enabled PDAs aid the fight against malaria. Press release
Lack of education slows EMR rollouts. Column
Small practice EMR use to rise slowly. Report

After big losses, Henry Ford prospers

Sun, 22 Apr 2007 20:01:34 -0400

It's a good time for the Henry Ford Health System, which is coming back strong after suffering major losses a few years ago. The nonprofit system has done well again this year, reporting a 2006 net income of $134.9 million on revenues of $3.25 billion. Revenues are up 6.6 percent from 2005, and net income a whopping 20 percent. Revenue sources included $1.5 billion from the system's Health Alliance Plan and $1 billion from its 920-bed Detroit hospital, physician practices and behavioral health program. These numbers are a huge turnaround for the Ford system, which had lost $87.7 million in 2001. Now it's on a winning streak; in fact, this is the fourth year in which the health system has improved earnings. Buoyed by its new success, the system is building a $310 million hospital and has acquired another health system. In addition, it plans to spend $1 billion on projects between 2006 and 2010. What's more, the system is hiring, having added 947 staffers last year alone. It also paid $22.4 million in bonuses last year, which ranged from $400 to $1,200 depending on employee status.

To find out more about the system's turnaround:
- read this Detroit Free Press piece

Related Article:
Henry Ford bans pharma perks, vendor drop-ins. Report

ALSO NOTED: PA health reforms held up; FL hospital succeeds with "bloodless" surgery; and much more...

Sun, 22 Apr 2007 20:01:30 -0400

> A Pennsylvania health reform plan backed aggressively by Gov. Ed Rendell (D) may not pass this year. Article

> Following peers elsewhere, a Jacksonville, FL hospital has developed a bloodless medicine and surgery program aimed at patients who reject transfusions. Article

> Dallas-area hospitals have decided to cut trans fats from their menus. Article

> A California nonprofit focused on quality improvement is working to get doctors on board with EMRs and other health IT tools. It's dangling Medicare pay-for-performance options as an incentive. Article

> A new federal bill is now under consideration which would help physician practices afford the cost of implementing more sophisticated health IT tools. Article

> New York City plans to distribute EMR software at no cost to physicians with large Medicaid caseloads. Article

> CMS has put its stamp of approval on three e-prescribing standards for use in Medicare Part D transactions, after testing them jointly with the Agency for Healthcare Research and Quality. Article

> Promoting PHR use: Is it a good idea? One critic offers a resounding "no." Article

> Red Hat strikes a healthcare research deal with the University of North Carolina. Article

And Finally... A physician critique in rhyming couplets. Blog

Editor's Corner

Thu, 29 Mar 2007 20:01:39 -0400

Like it or not, retail clinics are gradually becoming a mainstream concept. As this market gathers steam--and it is, despite some initial problems--it's going to change consumer perception of what outpatient care should be. The question is whether traditional healthcare systems are going to be nimble enough to make their own plays.

Some are giving it a try. For example, northern California's Sutter Health is opening a string of Sutter Express Care clinics in several Sacramento-area Rite Aid drug stores. Another example is Atlantic City-based health system AtlantiCare, which is opening retail clinics in several ShopRite grocery stores in its region.

However, many other systems are holding their peace. After all, setting up quickie clinics could be seen as creating competition for existing doctors, fostering a wave of mistrust which could have a nasty effect on relationships. AtlantiCare execs have stressed to physicians that their new clinics don't handle ongoing care, and that they will refer patients into physician practices, but they admit it's a delicate negotiation nonetheless.

It could also be that the systems don't want to divert their talent pool of nurse practitioners--who usually staff such clinics--away from their core business into a still-unproven niche. What's more, with demand for NPs usually outstripping supply by a wide margin, recruiting new ones for retail clinic sites could be a challenge.

Then there are the administrative issues involved. After all, nurse practitioners will still have to work as part of a team supervised by a physician. Clinics will have to establish efficient methods for communicating with primary care doctors, specialists and hospitals. Clinics will also have to develop clear standards for what treatments they will provide, and when a patient is too sick be treated there. Health systems can doubtless handle all of this, but there's definitely a learning curve involved.

However, all that being said, it seems certain that retail settings are going to become another important touch point within the next few years, so providers should get on board. Now's the time to develop standards and systems, hire and train staff, get supervising doctors in place, put together appropriate technologies, and iron out kinks in the business model. Sure, entering this market may be tricky, but putting it off is just procrastination. Better to figure things out now than stumble around later when the stakes are higher. - Anne

OIG plans extensive 2007 payment reviews

Sun, 19 Nov 2006 19:01:38 -0500

The federal Office of the Inspector General has released a work plan for 2007--among the most detailed in recent years--that targets a wide range of activities and reimbursement areas important to hospitals, home care services, laboratories, rehab providers and psych facilities. Two important issues to be studied include:

Supplemental payments to hospitals: The OIG is taking a closer look at adjustments for graduate medical education permits, nursing and allied health education, permits, inpatient hospital payments for new technology and organ procurement organizations.
Hospital classification: The OIG is reconsidering a myriad of hospital classification issues, including inpatient rehab facility classification criteria, the Medicare dependent hospital program, inpatient rehab facility compliance with Medicare requirements, late assessment for inpatient rehab payments, PPS payments for inpatient psych facilities, long-term care hospital payments and classification, cost-based reimbursement for critical access hospitals and several aspects of outpatient PPS payments.

The OIG is also looking at several reimbursement issues in home care, skilled nursing facility and physician practices, Medicare Part D drug pricing, and a range of issues related to FDA and NIH-funded researcher accountability.

For more information on the work plan:
- read this summary from Foley & Lardner
- review the OIG work plan (.pdf)

ALSO NOTED: Health systems failing worldwide; Schering CEO touts managed care scorecard; and much more...

Sun, 12 Nov 2006 19:01:30 -0500

> An IBM-backed study suggests that most of the world's health systems will begin to fall apart by the year 2015. Release

> In a speech to a cardiology group, Schering-Plough's CEO puts forth his own set of cost-busting criteria for a managed care scorecard. (Sure, it's health plan mismanagement, not drug prices, which is driving up healthcare costs). Release

> A Georgia workforce study has concluded that the state must invest in medical education if it hopes to reverse physician shortages. The state's physician supply currently ranks in the bottom half of U.S. states. Article

> An in-your-face anti-HIV campaign tells HIV positive people that smart behavior is the "cure" for the spread of the disease. Release

> Hospitals worldwide can cut infection rates if doctors and nurses wash their hands after each patient encounter, according to the World Health Organization. Article

> Minority medical students are less satisfied with their personal lives and have less of a sense of accomplishment than their non-minority peers. Article

> HHS, IRS rules on EMR donations clash. Report

> Smaller physician practices are still behind in IT adoption. Report

> Pharmaceutical industry vendors are suing to get a New Hampshire law thrown out which they claim unconstitutionally restricts their use of physician-identifiable prescription information. Report

And Finally... A physician consultant offers doctors her ten rules for entrepreneurial success. Blog