• Industry Watch •
America to Lose Primary Care Physicians
Large numbers of caregivers plan to slash their workload or quit the profession altogether, so says a recent survey mailed to 270,000 primary care physicians and 50,000 specialists. The Physicians’ Foundation conducted the survey, which featured more than 4,000 written physician’s comments and included more than 800,000 data points. Of the 11,950 responses, 78 percent cite a marked shortage of primary care doctors in America, and more than 49 percent (statistically representing more than 150,000 practicing primary care doctors) indicated their intention to reduce or eliminate their practices.
According to 94 percent of the respondents, non-clinical paperwork has increased in the past few years, and 63 percent say that the increased paperwork causes them to spend less time with patients. Eighty-two percent said declining Medicare reimbursement rates will cause their practices to become “unsustainable”; Thirty-three percent have stopped taking Medicaid patients and 12 percent have stopped taking Medicare patients. Sixty percent said they would not recommend a career in medicine.
In a Nov. 18 press release, Lou Goodman, Ph.D., president of The Physicians’ Foundation, expressed surprise and concern. “Going into this project we generally knew about the shortage of physicians; what we didn’t know is how much worse it could get over the next few years,” he said. “The bottom line is that the person you’ve known as your family doctor could be getting ready to disappear and there might not be a replacement.”
CMS Saves Money: Issues Improper Payment Rates
According to the recently released U.S. Department of Health and Human Services (HHS) fiscal year (FY) 2008 financial report, the Centers for Medicare & Medicaid Services (CMS) reduced its rate of improper Medicare fee-for-service (FFS) payments from 3.9 percent in 2007 to 3.6 percent in 2008, a savings of $400 million. According to CMS’ Nov. 17 press release, CMS defines improper payments as “those payments that may have been paid incorrectly and do not necessarily reflect fraud.” In FY 2008, those improper FFS payments amounted to $10.4 billion.
CMS also released its FY 2006 Medicare Advantage improper payment rate, which was 10.6 percent ($6.8 billion), as well as their FY 2007 national composite Medicaid and SCHIP improper payment rates, which were 10.5 percent ($32.7 billion) and 14.7 percent ($1.2 billion), respectively, for which the federal share is $18.6 billion and $0.8 billion, respectively. The total amount of improper payments exceeded $50 billion.
Reasons for the improper payments include: “Claims for services that were medically unnecessary or incorrectly coded that contained inadequate documentation; or where the correct amount of information was not included or not provided when requested by CMS; or where services were provided to Medicaid or SCHIP beneficiaries who were not eligible for either program, or for the services received.” Nevertheless, CMS made the payments anyway.
Stark Laws Initiator Blasts CMS
Rep. Pete Stark, chairman of the House Ways and Means Health Subcommittee, wrote to Acting Administrator Kerry Weems of Centers for Medicare & Medicaid Services (CMS) admonishing the agency’s inadequate oversight of Plan D bids and other issues.
In his letter, Stark decries “rampant abuse by plan sponsors and an inexcusable lack of oversight or accountability by CMS, in dereliction of its statutorily-mandated duty.” Stark is the original sponsor of the Medicare & Medicaid payment rules and their subsequent exceptions that came to bear his name.
The Congressman’s comments follow the release of a series of reports by the Health and Human Services
Office of the Inspector General, which state that required audits for Part D plan bids are of “limited value.” He also cited a 2007 GAO report, criticized CMS for its “consistency of inaction” and accused the agency of running out the clock on the current presidential administration “without ever complying with the minimal oversight requirements Congress put in place to check private plans.”
Stark also chastised the agency for several cost-sharing components of Part D plan formularies it approved for the 2009 plan year, such as specialty drug cost sharing requirements and penalties for brand name drug purchases where generics are available.
Microsoft Tests Homecare Devices
A pilot underway at the Cleveland Clinic is testing the patient-controlled data exchange between
Microsoft’s HealthVault, a suite of widely-used digital medical devices, and eCleveland Clinic MyChart,
Cleveland Clinic’s personal health record (PHR) system. The short-term pilot, which began on Nov. 3, is the first in the country to follow multiple diseases in the clinical delivery setting using multiple at-home devices such as glucometers, heart rate monitors, weight scales and blood pressure monitors.
Cleveland Clinic plans to enroll approximately 400 patients and aims to demonstrate that the program will enable patients to better manage and track chronic diseases from home using the patient’s own computer. The pilot is a physician-driven, invitation-only opportunity offered to a group of Cleveland Clinic PHR users in the areas of diabetes, hypertension and heart failure.
Patients are provided HealthVault-enabled digital devices, such as blood pressure monitors and glucometers and asked to perform regular health monitoring. By connecting the devices to their home computers, the health information gets uploaded, with their consent, to a personal HealthVault account controlled by the patient, and then sent to their Cleveland Clinic MyChart account. This data populates an online log of the readings accessible to the patient’s physician. Data sent from a patient’s HealthVault account to MyChart cannot be changed or altered in any way.
Health Information Sources of The Young
An online survey of 1,600 teens and young adults aged 13 to 24 asking how they are accessing health information online reveals that young people frequently turn to the Web for reliable, easily understood information on health and wellness. Anastasia Goodstein, author of
Totally Wired: What Teens and Tweens Are Really Doing Online, led the study by collaborating with ISIS, a nonprofit organization that works locally, nationally and internationally to “develop innovative sexual health resources through technology,” as well as with YouthNoise, an online community of young people “dedicated to creating lasting positive change around the world.”
The study finds more than half of those surveyed are searching the Internet for health and wellness information. Of those who do so, 15.1 percent cited WebMD as their primary source and 11.83 percent named Google, followed by Wikipedia. The study also finds young people acknowledge the important role of professionals in providing accurate information, but they also pay particular attention to the advice of peers online.
Survey respondents said they wanted health information that was “comprehensive and accurate” but also “not too technical.” The ideal site was identified as one that would present information in a “fun and interactive way.”
Publicity of online health resources is also important. Sites that offer health and wellness information must go beyond the traditional search engines and engage in creative solutions to push resources to social networks or in viral marketing applications, widgets, or videos to deliver their information.
Social Security Seeking Help With EHRs
The Social Security Administration (SSA) sought input last month for developing a system that automatically pulls data from electronic health records (EHR) to increase disability claims processing efficiency. The SSA requested suggestions for streamlining the processes from EHR and PHR vendors, health providers and payers. The agency is currently piloting records retrieval processes with Beth Israel Deaconess Medical Center in Boston and the Cleveland Clinic. It is demonstrating similar capability with other participants in the Nationwide Health Information Network (NHIN) prototype program.
Two regional health information exchanges,
MedVirginia and the North Carolina Healthcare Information and Communications Alliance have been working with SSA on the NHIN project. Electronically transmitting authorizations between the records repository and third parties such as SSA, which would obtain information on the patient’s behalf, is an element of the larger prototype. The system will employ Healthcare Information Technology Standards Panel (HITSP) standards, as much as possible, including the Continuity of Care Document that summarizes the patient’s health conditions, medications and allergies.
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