American College of Physicians: Internal Medicine — Doctors for Adults ®

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From the February 1997 ACP Observer, copyright 1997 by the American College of Physicians.

Registration for ABIM specialty exams ends April 1

Internists who want to sit for the American Board of Internal Medicine's (ABIM) 1997 specialty certification exams must register by April 1.

Exams will be held Nov. 19, 1997, in critical care medicine; endocrinology, diabetes and metabolism; gastroenterology; hematology; infectious disease; medical oncology; nephrology; pulmonary disease; and rheumatology. The two-day cardiovascular disease exam will be held Nov. 19 and 20, and the exam for added qualifications in adolescent medicine will be held Nov. 18.

For more information, contact ABIM's registration section at 215-243-1590.

Patients often forget physician's diagnosis

In a recent study of patient-physician communication, more than 550 patients surveyed after their general exam could not remember 68% of the medical problems their physicians diagnosed, including 54% of the most important problems diagnosed such as colorectal polyps, obesity, tobacco use and hypothyroidism.

The article, published in the December issue of Mayo Clinic Proceedings, said patients:

  • misunderstand doctor's medical terminology;
  • practice selective listening, especially if preoccupied with test results or other concerns;
  • deny health conditions, such as tobacco use or obesity; and
  • don't always agree with their physician on the importance of a health problem.

The survey found that patients who traveled far to their doctor's office, who received a new diagnosis or a diagnosis of a major health problem were more likely to remember what their doctors told them.

The authors suggested that doctors should consider giving patients problem lists or summary letters of diagnosed health problems.

IOM makes Medicare recommendations

The Institute of Medicine (IOM) has developed recommendations to guide future Medicare policy and ensure the program provides adequate information to beneficiaries about their options when purchasing a plan. The recommendations include the following:

  • Don't limit the number of health plan options despite concern that too many options confuse or intimidate beneficiaries. All plans should meet benchmark conditions of participation and all coverage options must be offered during open-enrollment periods.
  • Keep traditional Medicare as an option, even though it might mean additional costs to government.
  • Build unbiased, comparable and understandable information for Medicare members. For example, one suggestion was to create customer service centers that would give Medicare recipients telephone access to representatives, complemented by regional and local information and ombudsman programs.
  • Prohibit gag clauses because they hinder the relationship between the physician and patient.

More Medicare is managed care

In just a few years, Medicare risk enrollment has grown dramatically and now reaches a majority of Medicare beneficiaries, according to the Physician Payment Review Commission (PPRC).

By the summer of 1996, almost two-thirds of Medicare beneficiaries had at least one Medicare managed care plan available in their zip code, and the PPRC predicted rapid growth will continue.

All Medicare beneficiaries living in major urban centers now can join a Medicare HMO, and 59% have at least five plans available. However, 79% of Medicare beneficiaries living near urban areas and 92% in rural areas lack access to Medicare risk programs.

They study found no correlation between the presence of Medicare risk plans and enrollment rates.

Federal workers get HMO accreditation info

For the first time, federal employees are getting accreditation information on the managed care plans offered to them. The Federal Employees Health Benefits Program Guide now gives members access to information from the National Committee for Quality Assessment so that consumers will better assess the quality of the program's plans.

The government's FEHBP covers more than 2 million employees and 8 million dependents and retirees.

Columbia accepts productivity measures

Columbia University College of Physicians and Surgeons has become the first academic center to agree to productivity measures as part of a new contract agreement between the medical school and the public hospital agency of New York City.

The agreement mandates that productivity and accountability standards determine physician pay. Columbia, which will provide services at Harlem Hospital, could be fined if it fails to meet the standards. For example, the institution could be fined $10,000 if its doctors do not conduct Pap tests on a certain percentage of its female patients.

The New York City hospital agency has long worked with the medical schools in the area to staff the city's public hospital system. But the flat fee agreement has proved too expensive as insurers have cut reimbursement rates.

Cardiologists unhappy with managed care

Cardiologists report that managed care organizations have adversely affected their relationship with patients and decreased their salaries, according to a survey in the December 1996 Journal of the American College of Cardiology.

The survey also found that, despite these concerns, cardiologists are entering into more managed care contracts and attempting to adapt their practices to the managed care environment. On average, the survey found, about 15% of cardiologists' income comes from managed care.

Many of the 1,200 respondents also reported that their practices had recently spent money on quality improvement, outcomes monitoring, clinical data collection and clinical pathway development to adapt to the managed care environment.

AHCPR funds referral studies

New research funded by the Agency for Health Care Policy and Research (AHCPR) will investigate the quality and cost effects of referring primary care patients to specialists.

AHCPR funded eight studies with nearly $5 million. One study, "Managed Care and the Primary-Specialty Care Interface," will analyze how managed care organizations' financial incentives and organization controls influence referral patterns. Other research topics include, "Nephrologist Care and Outcomes in Renal Insufficiency," "Specialty Care in Closed Versus Open Access HMOs," "Referrals in Primary Care" and "Specialty Referrals Among California Physician Groups."

Physician volunteer program to begin

Physicians in 15 areas of the country are scheduled to expand volunteer care in their community as part of a Robert Wood Johnson Foundation program.

The $3 million program, "Reach Out: Physicians' Initiative to Expand Care to Underserved Americans," awarded nearly $3 million to health care organizations from Los Angeles to Miami to Baltimore.

Although two-thirds of physicians already provide some volunteer care to patients, foundation officials say that it's a small part of practice, in part because physicians fear being overwhelmed by indigent patients. The Reach Out program aims to offer physicians an organized way to volunteer care to underserved people.

For more information about Reach Out and for a list of program locations, call 401-729-3284 or visit the foundation's home page at www.rwjf.org.

Research fellowship for minority physicians

A postdoctoral research fellowship is available to minority physicians interested in a career in academic medicine.

The four-year program from the Robert Wood Johnson Foundation aims to increase the number of senior minority medical faculty. Currently, minority faculty compose just 4.3% of the nation's full-time medical faculty members.

The program includes an annual stipend of up to $50,000 and a $25,000 annual grant to support research. Fellows pursue advanced research under the guidance of a faculty mentor.

The application deadline is March 28. Information: Lois F. Lipsett, PhD, at 301-913-0210.

AGS expands geriatrics program

The American Geriatrics Society (AGS) has released a new, more inclusive edition of its core curriculum for geriatric medicine.

Participants can earn 70 CME credits for completing the Geriatrics Review Syllabus, which ACP has endorsed.

The program is divided into three volumes, with the first containing a five-part text focusing on the general principles of aging, approaches to the patient, geriatric syndromes, geriatric psychiatry, common diseases, disorders and health concerns. The second and third volumes contain questions and answers, along with detailed explanations and references.

The self-study course costs $255 for AGS members and $330 for nonmembers; CME credits cost an extra $30. Information: Kendall/Hunt Publishing, 800-228-0810.

JCAHO launches PPO accreditation

Preferred provider organizations (PPOs) can now earn accreditation through the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).

The new accreditation process, which will begin in early 1997, after the Accreditation Manual for Preferred Provider Organizations is published, offers PPOs a way to distinguish themselves when seeking contracts with employers and insurers.

The manual offers performance standards for PPOs to demonstrate effective management. The accreditation process also focuses on how PPOs credential their practitioners and improve quality of care and includes sections on ethical business practices and customer satisfaction.

The manual costs $125. Information: 630-792-5800.

Gatekeeper policy cuts outpatient costs

The cost of outpatient care falls by more than half when patients contact their primary care physicians first--instead of a specialist or the emergency room--with new medical problems, according to a recent study in The Journal of Family Practice.

The researchers estimated that the U.S. health care system would save about $1.1 billion annually if this first-contact approach increased by just 10%.

Primary care physicians save money, in part, because they receive lower payments for services and because they practice less resource-intensive care than specialists.

National Medical Association says no to California

To protest political efforts in California to disband affirmative action and other minority preference programs in education and employment, the National Medical Association (NMA) has decided to move its 1998 annual convention and scientific assembly out of state. The meeting, which was scheduled for San Diego, will instead take place in New Orleans.

The move by the House of Delegates of the nation's oldest African-American medical professional organization came after California Gov. Pete Wilson, who supports an anti-affirmative action amendment to the state's constitution, instructed state agencies to revoke affirmative action programs. The University of California system state also eliminated preference programs this year.

"The effect [of these decisions] will be culturally and economically devastating to us as medical providers, our children and the patients we serve," said NMA President Yvonnecris Smith Veal, MD, in announcing the boycott.

The NMA joins other national African-American organizations that have decided to move their conventions out of California, including the National Urban League, the National Bar Association and the National Black Nurses.

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