physician groups

CMS says doctors earned $16.7M on P4P demo

Anne Zieger — Fri, 15 Aug 2008 10:43:11 -0400

You've gotta love it when CMS gives out money above and beyond the usual reimbursement rates--and it's even better when the bonuses involved work out for pretty much everyone involved. That's the cheery outcome for the second year of CMS's pay-for-performance demonstration project, under which 10 physician groups earned a total of $16.7 million in incentive payments. Under the terms of the demonstration project, which addresses the quality of care for heart patients and diabetics, physician groups were asked not only to improve outcomes for Medicare patients, but also to coordinate their care.

The groups involved were strikingly successful at meeting CMS's goals. All of the groups involved in the Physician Group Practice Demonstration met performance goals on at least 25 of 27 quality markers for patients with diabetes, coronary artery disease and congestive heart failure. Five of the groups, including Forsyth Medical Group, Geisinger Clinic, Marshfield Clinic, St. John's Health System and the University of Michigan Faculty Group Practice--achieved all 27 performance goals.

To learn more about the P4P payouts:
- read this Modern Healthcare piece (reg. req.)

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Medical testing board to offer doctor of nursing certification

Wed, 11 Jun 2008 06:59:55 -0400

Starting in the fall, doctor of nursing practice graduates will be able to take a certification test that proponents predict should become the standard for DNPs. The test, which is being developed by the National Board of Medical Examiners, is based on the physician licensing exam. Such DNPs are comparable to primary care doctors in their diagnostic and disease management skills, proponents say. Physician groups, meanwhile, have suggested that while such certifications are good, DNPs should still be part of a team under physician supervision.
The certification drive comes as DNP graduation rates have started to climb. About 200 nursing schools are expected to offer a two-year DNP degree by 2015, or more than double the programs now in operation.

To learn more about the certification:
- read this AMNews article

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CT restricts use of 'silent PPOs'

Mon, 02 Jun 2008 06:59:54 -0400

Connecticut's legislature has joined a growing trend by adopting measures setting limits on insurers' practices of renting access to physician networks, taking a fee from the renting party while turning over none of the benefits to physicians. Typically, the primary insurer doing the renting offers the lowest rates that physician agreed to with any insurer.

The network rentals, known as "silent PPOs," have stirred up vigorous opposition among physician groups, who argue that such arrangements unfairly extend discounts on their services to companies who never approach or negotiate with them directly. Thanks in part to physician activism, more than a dozen states currently have laws on the books restricting or prohibiting the use of these arrangements.

The measure requires insurers to let contracting doctors know if they plan to sell or rent access to network discounts. It also requires insurers to maintain a list of all secondary parties who sign network rental agreements. In addition, the bill requires secondary silent PPO renters to pay on the same terms as the primary contract, and cancels the second party's contract if the first is canceled. What's more, it requires that remittance notices state clearly which entity is going to pay a bill.

To learn more about this law:
- read this AMNews piece

Related Article:
Ohio law makes health plans disclose contract terms

Louisiana MDs win legal battle over patient record disclosure

Fri, 18 Apr 2008 06:59:56 -0400

A group of Louisiana physicians have won their battle to keep their patients' records out of the hands of a pharmaceutical company--though they may face future challenges on the issue. The dispute comes as part of the Louisiana attorney general's suit against Janssen Pharmaceutic, which the state says has been illegally promoting off-label uses of Risperdal. The AG also is arguing that in so doing, Janssen defrauded the state's Medicaid program. Though no doctors or patients are parties to the suit, Janssen got a court order allowing it to subpoena physicians for the medical records of up to 6,000 Medicaid beneficiaries who received Risperdal prescriptions. The order also allowed the pharma to depose individual doctors on their Risperdal prescription decisions. However, the state's physicians contested the order, with judges concluding that Louisiana's laws governing medical privacy would invalidate the request.

To learn more about the case:
- read this AMNews article

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Lack of PA reform bill leads to higher med mal costs

Mon, 31 Mar 2008 07:59:55 -0400

Pennsylvania Gov. Ed Rendell (D) is taking a unique tack on healthcare reform--one which, in essence, holds doctors hostage. He's telling the state's physicians that until there's an agreement on legislation to provide healthcare to the uninsured, they'll have to pay more for their medical malpractice insurance. Rendell says he won't approve another round of the state's MCare malpractice insurance abatement program until there's legislation in place helping to provide affordable health insurance. For doctors in high-risk specialties like neurosurgery, orthopedic surgery and obstetrics, this means an additional $15,000 payment for medical malpractice insurance, while doctors in lower-risk specialties would pay an average of about $1,500 more.

Gov. Rendell is pushing to see state legislators take action on a bill, approved by the state House last week, which would provide subsidized coverage to adults earning up to 200 percent of the poverty level, as well as giving grants to small employers who already offer health insurance to low income workers.

To learn more about the legislative dispute:
- read this Pittsburgh Post-Gazette piece

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Errors force BCBS of TN to postpone doctor ratings

Tue, 11 Mar 2008 07:59:55 -0400

Dogged by complaints that its data was inaccurate, BlueCross BlueShield of Tennessee has put its planned doctor rating program on hold. During a 60-day review period BCBS gave doctors, the physicians came back with many complaints about inaccuracies. For example, the data sometimes suggested that they didn't perform certain tests, even though the doctors had such tests documented in their own records. In such cases, the health plan has been allowing doctors to submit their records to supplement the claims data it uses for ratings. After it responds to doctors' questions and concerns, BCBS of Tennessee still expects to publish physician quality and cost data, which will be available to privately-insured members through a secure web connection.

Unlike its health plan brethren in New York, BCBS of Tennessee doesn't have to live up to any regulatory or legislative standards in compiling the data. It will be interesting to see whether this furor raises calls to create standards such as those proposed by New York Attorney General Andrew Cuomo and the New York state legislature. My bet is that such state-driven guidelines are likely to pop up in other states soon, and I'm betting Tennessee will be no exception.

To learn more about this controversy:
- read this article from The Tennessean

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Stark case proceeds against SC hospital

Fri, 29 Feb 2008 06:59:56 -0500

A judge has given the U.S. Department of Justice the go-ahead to pursue a pending whistle-blower lawsuit against a South Carolina health system. A surgeon filed the whistleblower suit against Sumter, SC-based Tuomey Healthcare System in 2005, and the DOJ picked up the suit late last year. The suit accuses Tuomey of overpaying physicians, through its specialty group subsidiaries, in exchange for their exclusively referring patients to its hospital. It apparently did so because it feared losing surgical income to a competing surgery center, the suit contends. Not only did the hospital pursue such contracts, it did so despite receiving explicit legal advice that the contracts in question weren't kosher, according to the DOJ complaint. The whistleblower suit was filed by Dr. Michael Drakeford, a physician who was approached to sign one of the contracts.

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

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Trend: Lack of surgeons squeezes hospitals

Tue, 26 Feb 2008 06:59:54 -0500

In previous decades, medical schools put a cap on student enrollment, believing that controls imposed by managed care plans would reduce demand for physicians. Instead, what's happened is that such limitations have created a mushrooming physician shortage, particularly among primary care doctors and surgeons. While pay climbs rapidly over the first five years of practice, surgeons make less than other specialties in their first year, about $165,000--a big number by non-medical standards, but not huge for young physicians with $150,000 to $250,000 in educational debt.

The lack of surgeons is a particular problem for 54 million Americans who live in rural areas, where these specialists are retiring or leaving the community far more quickly than they can be replaced. Right now, only 9,334 of 211,908 physicians serving rural America are general surgeons, according to AMA data. To address these gaps, medical groups are recommending that schools expand the approximately 1,000 spots a year available for surgical training. They're also suggesting that medical schools look for students who want to practice in rural areas, rather than other standard qualifications such as their clinical research history.

To find out more about this trend:
- read this USA Today piece

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

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MD groups struggle with Medicare incentive goals

Tue, 19 Feb 2008 06:59:58 -0500

It looks like the initial stages of a new CMS demonstration project have turned out to be something of a disappointment. In April 2005, CMS began offering annual bonuses to 10 physician groups if they met cost savings and quality targets. While all 10 implemented care-coordination programs during the first performance year, only two of the groups met CMS bonus criteria, according to a new report from the Government Accountability Office. However, that's not solely the groups' fault. The GAO report said that part of the reason physician groups had trouble meeting the goals was the design of the demonstration project, including the fact that CMS gave no feedback to the groups until after the third year had begun. Along the way, the GAO report suggested that it might be difficult to broaden enrollment in the demonstration project--even without design challenges--given that all of this round's participants were larger than the average medical group size for the United States.

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

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