pcps

Study: Legal risk for prescribing painkillers not significant

Anne Zieger — Thu, 04 Sep 2008 05:08:33 -0400

Lately, legislatures and regulatory authorities have been paying a lot of attention to the prescription of painkillers, noting that some can kill if prescribed irresponsibly and that other opioid may be diverted for addictive use. Not surprisingly, such has made some physicians afraid to prescribe opioids at all. In fact, primary care doctors say the biggest obstacle they face in prescribing opioids to treat chronic pain is scrutiny from regulators and law enforcement officials, a recent survey found.

The thing is, PCPs' fears are misguided, according to a new study appearing this month in the journal Pain Medicine. Researchers, who reviewed nine years of medical board and local, state and federal law enforcement charges against doctors for improperly prescribing opioids, found that very few resulted in any real problems for physicians. In fact, only 725 doctors--or one-tenth of one percent of practicing physicians--were accused of criminal or administrative offenses during the period studied, 1998 to 2006.

It's worth noting, however, that the study has some harsh critics. They contend that the number of doctors who get investigated is much larger than the number who are actually charged. They note that fear of being investigated, even if that investigation is unlikely to lead to charges, is enough to chill physicians' use of painkillers anyway. And that, say pain management specialists, means that physicians may refuse to treat patients that have severe chronic pain with the high doses they need to get relief.

To learn more about the study:
- read this AMNews piece

Related Articles:
DEA eases painkiller prescription rules
A victory for pain management MDs?
Off-label use of narcotic raises questions
FDA may urge training to dispense narcotics

MA gov. signs pharma gift reporting law

Anne Zieger — Mon, 11 Aug 2008 12:27:33 -0400

Massachusetts governor Deval Patrick (D) has signed legislation that, in addition to promoting electronic medical records and boosting primary care training, imposes one of the country's toughest limits on gifts to clinicians. The new measure, which not too surprisingly drew strong opposition from the pharmaceutical companies, bans certain types of gifts (such as sports tickets and free travel) while requiring pharmaceutical companies and medical devicemakers to publicly disclose any gifts worth over $50. As controversial as the gift restrictions and reporting were, they actually weren't tough enough for some critics, who had hoped to see drugmaker and devicemaker gifts banned entirely.

In addition to banning some gifts to clinicians, the new law directs the University of Massachusetts Medical School to grow its class size to allow for training of primary care doctors, as well as helping some PCPs repay med school loans. What's more, it allocates $25 million to help award grants to doctors and hospitals who want to boost their use of health IT, particularly electronic medical records. On top of all of this, the law gives the state greater power over health plan rates than regulators have had in more than a decade, observers say. Despite the importance of these changes, the drug gift ban has gotten by far the most attention, according to Massachusetts pols. This is almost certainly because drugmakers, with their deep pockets, have stirred the pot vigorously on this issue, hoping not to see such a law enacted in other states.

To learn more about the new law:
- read this article from The Boston Globe

Related Articles:
NJ mulls pharma, devicemaker gift reporting
Psychiatrists getting largest pharma gifts
Doctors weigh in on pros and cons of accepting drug/device freebies
NY bill would require pharmas to report MD gifts

Trend: Young PCPs see dozens of job offers

Mon, 03 Dec 2007 06:59:55 -0500

Given mushrooming primary care shortages, young PCPs in training shouldn't be surprised if they feel like they have a bullseye on their head. According to one survey, almost 80 percent of primary care residents got 26 job solicitations before they even completed their training, according to the Association of American Medical Colleges.

Not only is the demand for primary care patient management growing, physician aging is playing a role. In California, which has the highest number of active doctors aged 60 and older, it's a particularly acute problem. But several factors that continue to hold primary care levels at below-replacement rates, including relatively low pay and unpredictable schedules.

Particularly in superheated markets like California, the shortage is pressuring providers to acquire practices and nail down physician relationships. Of course, the shortage is pushing up PCP salaries as well, but not necessarily among smaller practices whose margins don't allow for big increases. All in all, there's quite a market imbalance here. It will be interesting to see what aspect of the system gives in 2008.

To get more information on the physician shortage:
- read this Sacramento Business Journal article

PLUS: Here's a look at the physician recruiting challenges faced by Memphis-based recruiters. Article

Related Articles:
MA faces primary care shortage. Report
The problem with primary care. Report
Primary care MDs ask patients for extra dollars. Report
Study: Primary care costs, reimbursement low. Report

Employer group backs higher pay for primary care

Wed, 07 Nov 2007 06:59:58 -0500

A powerful healthcare standards group plans today to launch an initiative promoting a new model for primary care which would help employers and health plans identify high-performing primary care physicians. The plan, backed by National Committee for Quality Assurance (NCQA), mirrors pay-for-performance plans already in force among some health insurers.

Under its proposal, participating health plans would pay high-ranked primary care physicians more for office visits, and would also offer a system for paying physicians and nurse coordinators for communicating with patients by phone and e-mail outside of their usual office hours. In addition, it would compensate PCPs for managing chronic conditions effectively and using e-prescribing.

While NCQA's proposals may not be in and of themselves unusual, the fact that the group is throwing its weight behind this proposal is significant, as large employers take its recommendations very seriously. IBM, for example, has come out in support of these proposed payment changes. "We are empowering doctors once again to have a doctor-patient relationship," said Dr. Paul Grundy, IBM's director for Health Care Technology and Strategic Initiatives. "We don't want to buy the kind of care we're getting any more."

To learn more about employer P4P initiatives:
- read this piece from The New York Times

Related Articles:
Primary care MDs ask patients for extra dollars. Report
Study: Primary care costs, reimbursement low. Report
White paper: Building Teams in Primary Care: Lessons from 15 Case Studies. Report
SPOTLIGHT: Upping pay for primary care. Report
Trend: Primary care doctors create own prepaid plans. Report

Trend: Primary care doctors create own prepaid plans

Mon, 22 Oct 2007 06:59:58 -0400

As FierceHealthcare readers know, hard-pressed primary care physicians are trying a wide range of strategies to keep afloat, including offering cosmetic procedures, setting up a high-priced concierge practice, creating one-person "micropractices" with low overhead and even charging monthly administrative fees.

Another emerging practice model, meanwhile, is one in which PCPs charge a flat monthly fee for a fixed bundle of services. For example, after struggling to make the numbers work under a traditional, insurance-based model, Wheeling, West Virginia-based PCP Dr. Vic Wood was recently kicked off a program under which he offers unlimited primary and urgent care for a monthly fee of $83 per individual or $125 per family. He's also offering lab work, X-rays and a selection of generic drugs. Dr. Wood chose his price by assuming that the average adult needs about 20 itemized services per year. To date, Dr. Wood has signed up 100 patients to this plan; he projects that he'll need 1,200 enrollees to support his entire clinic.

Not long after Dr. Wood kicked off his plan in 2003, he heard from the state insurance commissioner, who said he was operating as an unlicensed insurer. (Other states have issued similar challenges to physicians attempting to roll out this model.) Since that day, however, Dr. Wood has lobbied the state legislature to get his approach approved. Eventually, the legislature approved a three-year pilot program testing the prepaid primary care approach, with Dr. Wood as one of the first participants.

To find out more about this approach:
- read this Wall Street Journal piece

Trend: PCPs offering cosmetic procedures

Thu, 04 Oct 2007 06:59:56 -0400

If you're a primary care physician, and you're sick of getting your clock cleaned on procedures with narrow profit margins, what do you do? Well, for some, the answer is to begin offering higher-margin cosmetic procedures that don't involve insurance companies at all.

While laser treatments, liposuction and Botox may not have been why a PCP went to school, they do generate good cash flow, without anyone's having to file a claim. And it's a change of pace for harried physicians tired of the pace they're keeping these days. What's more, the demand for such procedures is high.

While there's no firm numbers on how many PCPs are taking this step, it's clear many are interested. The American Academy of Family Physicians, for example, is offering 10 continuing ED courses on cosmetic procedures. The courses are thronged, and some have waiting lists, AAFP officials say.

To find out more about this trend:
- read this piece from The Times-Picayune

Related Articles:
Primary care MDs ask patients for extra dollars. Report
Study: Primary care costs, reimbursement low. Report
White paper: Building Teams in Primary Care: Lessons from 15 Case Studies. Report
SPOTLIGHT: Upping pay for primary care. Report

Medicare increases preventive care, screening coverage

Wed, 29 Aug 2007 06:59:57 -0400

It's well documented that preventive care has significant wellness benefits, not to mention cost-saving advantages. However, at present, less than 10 percent of Medicare beneficiaries are getting all recommended health screenings and immunizations. Hoping to turn this trend around, CMS has begun authorizing more spending on screenings and immunizations.

Over the past five years, Medicare began covering glaucoma screenings, medical-nutrition therapy, cardiovascular and diabetic screenings, along with smoking- and tobacco-cessation counseling. This year, it has begun covering a wide range of new screening services and procedures, including ultrasound screenings for aortic aneurysms for those at risk, vaccines for flu, pneumonia and hep B, mammograms and diabetes self-management training.

To find out more about this trend:
- read this Kaiser Daily Health Policy Report piece

Related Articles:

HHS offers preventive care tool for PCPs. Report
Hospitals offer free preventative care. Report

Heart disease controls often skipped in diabetes care

Tue, 21 Aug 2007 06:59:56 -0400

While patients well understand high blood glucose can lead to ugly complications like blindness and kidney failure, few recognize that keeping cholesterol and blood pressure low are equally critical steps in avoiding deadly heart attacks. And their providers aren't getting the job done either, it seems. In fact, the CDC says only 7 percent of patients are getting all of the treatments they need.

Why the gap? In part, it's because many primary care doctors aren't adequately trained in diabetes care, getting only a few hours of instruction on the condition when in medical school. These PCPs, in turn, often spend no more than 10 minutes with such patients. Not only that, critics say, pharma advertising often encourage them to focus on blood sugar rather than heart attack risks. Unfortunately, that often leads to needless heart-attack deaths.

To learn more about the diabetes care gap:
- read this piece from The New York Times

Related Articles:
Glaxo: Avandia's safe as other diabetes drugs. Report
Avandia controversy sparks FDA criticism. Report
CMS P4P project shows diabetes care savings. Report
CMS to post hospital heart attack care data. Report

SPOTLIGHT: Upping pay for primary care

Wed, 25 Jul 2007 06:59:52 -0400

It's no surprise presidential hopefuls are giving us an earful on their healthcare reform proposals. The thing is, unless they acknowledge one critical issue--the growing scarcity of primary-care physicians--their proposals may be dead in the water, says Debra Geihsler, president and CEO of Harvard Vanguard Medical Associates. Aspiring primary care doctors face high educational costs and low reimbursement, a deadly combination which pushes them into other specialties. One solution to this problem, however, would be to put an emphasis on paying PCPs to coordinate care and improve health quality, she says. Article

Physician retail clinic protests miss the point

Thu, 28 Jun 2007 20:01:39 -0400

Physician retail clinic protests miss the point
Wow, the AMA is steamed about retail clinics. In my nearly 20 years of healthcare reporting, I can't think of an issue which has gotten members more worked up and ready to fight.

And the protests are all over the map. Apparently, retail clinics endanger patients. No, they endanger pediatric patients. They're not regulated enough. They have a conflict of interest in writing scripts their host retailer may fill. And so on. Why don't they just come out and say "It should be illegal to offer services we can't, at a price we can't?"

That being said, however, primary care practices are in an extremely unfair position. How many businesses have to contend with revenue streams which are as difficult to navigate, changeable and at risk for shrinkage as physicians? Given the challenges in coping with health plans--and limits on what plans will pay for--I'd argue that few practices are in a position to offer what retail clinics offer in terms of hours, convenience and flexibility. And it's just not their fault.

Here's an alternative. What if physician groups like the AMA stopped fighting the inevitable growth of the retail clinic sector and fought harder to foster financial situations that would allow PCPs to offer retail-clinic like options?

I'm thinking they could target government grants and loans at first, then probably, later, changes in reimbursement that explicitly acknowledge it's cheaper over the long term to pay for giving patients more access. (This way, a wheeze on Sunday won't turn into a hospitalized asthma patient on Monday.)

What do you think, folks? Is there any chance the primary care market could win support for building out its alternative to retail clinics? Or are the retail clinic operators serving a niche they'll never really be able to touch?- Anne