Your Business

Your Doctor’s Business Is Your Business | WSJ | 11.20.07

“There should be a discussion between physicians and patients about financial involvements,” says Dr. Zuckerman, chairman of orthopedic surgery at NYU Hospital for Joint Diseases. “As time goes on, patients will add this to the list of questions they have.”

In the end, patients shouldn’t be put in the position of having to quiz their doctor on his or her business practices, says David Blumenthal, a Massachusetts General Hospital researcher who studies conflict-of-interest issues. He says the onus should be on doctors, insurers and hospitals to inform patients of any stake they have in a treatment.

What Experts Recommend:

• Ask if your doctor has any financial connection to the recommended treatment.
• If the answer is yes, seek a second opinion.
• If unwilling to ask the doctor, do research on the Web

Valid Criticism: Mascot

Emergency Medicine’s mascot? Shouldn’t be!

Concierge Medicine

Concierge medicine: Rx for stressed health care system? | AJC | 11.8.07

Concierge medicine — the name itself implying highly personalized services — has sprouted as a rebellion against what’s perceived as assembly-line medicine. The doctors flee the frenetic pace and hassles of traditional practices, and limit their practice loads. Patients, in exchange for $1,500 or more a year, get 24/7 convenience and added face time with a doctor.

In the past five years, concierge practices have gained a small foothold in major cities. But these arrangements — also known as boutique practices — raise tough ethical questions:

• In a system that already has a shortage of primary care doctors, does concierge medicine siphon off valuable resources?
• Does it create a two-tiered medical system, one for the well-off and one for everyone else?

We have this in the ER, except for the $1,500/year and the wait…

e-Carrots

Medicare docs can get bonuses for using EHRs and e-prescribing in 2008 | GHIT | 11.5.07

For the first time, the Medicare program will pay bonuses to doctors and other health care providers for using electronic health records and e-prescribing in 2008.

Use of the two technologies are among 119 quality measures that the Centers for Medicare and Medicaid Services listed in an official notice of its payment rules for the coming year.

To qualify for a bonus of as much as 1.5 percent of their Medicare fees, doctors can report their compliance with as many as three of the 119 measures. A pool of $1.35 billion will be available to pay incentives next year.

Too Aggressive?

Army’s Aggressive Surgeon Is Too Aggressive for Some | NYT | 11.6.07

Under his watch, Army surgeons have become aggressive users of a controversial drug called Factor VII, which promotes clotting in cases of severe bleeding. He has also guided a redesign of the transport system for wounded soldiers, encouraging helicopter pilots to take the severely injured to the hospitals best able to treat them, even if they are not the closest.

Too aggressive? I think not.

Professional Spam

You’ve got to love the AMA, I can always tell when they sell my name (again) to some marketing firm. The AMA is the only professional organization that spells my name in a unique manner. This un–professional spam sleaze arrvied in the mail today:

“Connotes respect and credibility?” Check out their website: SLD Industries — contending for The Worst of the Web.

Let me get this straight, “excellence” is determined by the Consumers’ Research Council of America? And a “top emergency medicine physician” is an “FACS” that specializes in “emergency general surgery?”

Kudos to AMA marketing — they wonder why their membership continues to decline.

Micturitions of a Dinosaur

“…if we’re going to start a series of whines about inappropriate calls and silly treatments I’ve got a box full…”

Think much bigger — a dinosaur’s carsass full…

Citation Styles

Citation styles — not exhaustive…

NLM style:

Pho K. How to cite a blog in a paper [Internet]. Nashua, New Hampshire: Kevin Pho. 2004 May - [cited 2007 Oct 12]. Available from: http://www.kevinmd.com/blog/2007/10/how-to-cite-blog-in-paper.html.

ALWD (Rule 40.3) style:

Kevin Pho, Kevin, M.D. Medical Weblog, How to cite a blog in a paper, http://www.kevinmd.com/blog/2007/10/how-to-cite-blog-in-paper.html (Oct. 12, 2007).

Bluebook (Rule 18.2.3) style:

Kevin Pho, How to cite a blog in a paper, Kevin, M.D. Medical Weblog, Oct. 12, 2007, http://www.kevinmd.com/blog/2007/10/how-to-cite-blog-in-paper.html.

Aside, with the legal profession’s recent interest in medical weblogs, it is more likely that formal citations will be in the ALWD or Bluebook style…

Kidney Notes, Kevin, M.D., medGadget

ED is Not Emergency Dentistry

Boom Times for Dentists, but Not for Teeth | NYT | 10.11.07

With dentists’ fees rising far faster than inflation and more than 100 million people lacking dental insurance, the percentage of Americans with untreated cavities began rising this decade, reversing a half-century trend of improvement in dental health.

“Most dentists consider themselves to be in the business of dentistry rather than the practice of dentistry,” said Dr. David A. Nash, a professor of pediatric dentistry at the University of Kentucky. “I’m a cynic about my profession, but the data are there. It’s embarrassing.”

Dentists, of course, are no more obligated to serve the poor than are lawyers or accountants. But the issue from a public health standpoint, the critics say, is that even as so many patients go untreated, business is booming for most dentists. They are making more money while working shorter hours, on average, even as the nation’s number of dentists, per person, has declined.

Dentists’ incomes have grown faster than that of the typical American and the incomes of medical doctors. Formerly poor relations to physicians, American dentists in general practice made an average salary of $185,000 in 2004, the most recent data available. That figure is similar to what non-specialist doctors make, but dentists work far fewer hours. Dental surgeons and orthodontists average more than $300,000 annually.

I’m always amazed at how many dentists and oral surgeons seeing (or taking a call on) dental pain due to a dental abscess send them to the Emergency Department for the antibiotic and pain medicine prescriptions. We are not dentist — see the patient and treat the patient — the patient needs a dentist not a delay. Sorry, we’re already taking all those disenfranchised from medicine, we can’t do those disenfranchised from dentistry as well. Ranks right up there with “I just had my chiropractor do a manipulation and now I really hurt.”

Physician Herding

Lawyers To Docs: Lump It. Insurers Can Rate You | WSJ Health Blog | 10.9.07

[T]hree George Washington University public-health professors and attorneys have put together a legal analysis of the practice. Their conclusion: Get used to the rating game, docs. Nothing in the law prevents insurers from publicly ranking doctors — provided they do it right, the three say. That means applying clear criteria transparently, with an established process for fixing any problems that crop up.

[I]t is not classification based on quality that is illegal,” the George Washington lawyers write, “nor is it publication of information regarding health care quality that is illegal: it is undertaking these efforts in an opaque manner that tends to lead to legal backlash.

An Assessment of Legal Issues Raised in “High Performing” Health Plan Quality and Efficiency Tiering Arrangements | RWJF | 10.9.07

A legal analysis released by The George Washington University School of Public Health and Health Services and the Robert Wood Johnson Foundation affirms the legality under federal and state law of physician ranking systems used by health plan provider networks.

Key findings:

• Successful transparency efforts include an open process>that outlines clear development of standards and methods to identify and correct errors.
• All affected groups should be involved in developing the transparency process from the start and weigh in on key governance issues, including approved uses and access to data, disclosure issues and due process rights to challenge data, and performance evaluations.
• Government entities (i.e., state insurance regulators, the Centers for Medicare and Medicaid Services or the United States Department of Labor) could assist the process by developing common standards to establish scientific methodology of tiering.

How are physicians to be herded? Ratings, tierings, “best practices,” reimbursements, satisfactions, etc. — ah yes, performances — the other-side of the P4P coin…. And lawyers are grousing over Avvo.

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