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.

Physician practices making changes for managed care

In efforts to survive the cost-cutting measures of managed care, physician practices have tried everything from increasing education and staffing to decreasing the number of tests performed, according to the results of a recent survey.

Since they started participating in managed care, more than half of the 120 practices of different sizes and specialties surveyed had increased patient education and a fourth had hired additional administrative staff, nurses or physician extenders. A third of all practices instituted cost management training for all staff.

Nearly 40% of the practices had installed a new computer system. Almost as many had adopted outcomes record keeping. And nearly 20% of those surveyed increased their over-the-phone treatment while 15% increased triage nursing.

The survey, conducted by the Health Care Advisors Association, found that almost half of the practices that have managed care contracts have reported lower profits and a third have seen increased profits since they began participating in managed care. Profit increase or decrease did not correlate with length of participation in managed care.

Hospitals trying to attract PCPs

Sign-on bonuses, reimbursement for moving expenses, malpractice insurance payment, loan forgiveness and compensation guarantees: they're all tactics hospitals have revived to woo scarce primary care physicians.

More than 90% of 269 hospitals surveyed are in the market for physicians, according to a 1996 report sponsored by Cejka & Co. and Modern Healthcare magazine. About 70% plan to recruit family practitioners and about 50% plan to recruit internists.

In the same 1995 survey, 41% of hospitals had scaled down recruitment in reaction to the Herman Hospital Ruling, in which a hospital was ruled guilty of breaching inurement and private benefit prohibitions with its recruitment practices. In the 1996 survey, only 5% cited the case.

In the 1996 survey, most hospitals said their medical staff consisted of 40% primary care physicians and 60% specialists, a ratio some hospitals said was too heavy on specialists. However, few chose to retrain specialists as a recruitment practice.

How to avoid prescription errors ...

Because illegible, misleading or incomplete medication orders account for about 15% of medication errors reported, the National Coordinating Council for Medication Error Reporting and Prevention has created recommendations for minimizing prescription errors:

  • Move to a direct, computerized order system.
  • Note the purpose of the prescription (e.g., for cough), unless inappropriate for maintaining confidentiality.
  • Use the metric system except for therapies that use standard units. Spell out units.
  • Include age and weight of patient when appropriate to help pharmacists check appropriate drug dose.
  • Include drug name, exact metric weight or concentration and dosage form.
  • Leading zero should precede a decimal expression of less than one and a trailing zero should never be used after a decimal.
  • Avoid abbreviations.
  • Write specific instruction for use.

... And encourage compliance

The makers of Trental, Hoechst Marion Roussel, have created new compliance materials and support tools to educate patients about intermittent claudication and its treatment.

Since the condition is chronic and requires a lifelong medication program, physicians may have patients who have become lax with compliance. The Campaign for Healthy Circulation reinforces physician advice to patients about lifestyle changes and medical therapy. Information: 800-848-1223.

Physicians rank the drug companies

In a survey of drug companies, more than 5,000 physicians gave Merck the highest rating on the basis of credibility, commitment to research and development, sensitivity to pricing concerns and educational orientation.

The physicians from 25 specialties also gave the following drug companies high scores: Pfizer, Glaxo Wellcome, Eli Lilly, Johnson & Johnson and Abbott Labs.

The "Pharmaceutical Company Image 1996" survey, conducted by Scott-Levin, also found that doctors primarily consider medical journals the most reliable source of information. Drug company sales representatives ranked second.

Besides the doctors, Scott-Levin also surveyed 1,500 consumers. Only 39% could name a specific drug company and only 5% had ever asked for a drug made by a particular manufacturer. But Scott-Levin analysts surmise that as drug companies focus more attention on direct-to-consumer advertisements, consumers may soon identify specific products more with the manufacturer's names.

Patient literacy and medicine

Patient illiteracy is a liability not just to patients in their daily life but also to physicians in their practice of medicine, according to a new book, Literacy, Health and the Law.

Literacy, Health and the Law, which costs $20, says nearly half of Americans possess only marginal reading skills. A physician may be at risk for liability if a patient misreads a prescription label and takes a wrong dose or if a patient does not read a consent form because it is too difficult. Information: 215-546-1276.

JCAHO: new accreditation project, videos offer tips on compliance

Integrated delivery systems (IDS) can now receive accreditation from the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).

JCAHO's new Charter Network Project is designed as an integrated survey process tailored to the characteristics of a complex IDS.

The first accreditation has gone to Lovelace Health Systems, a fully integrated health insurance and health care system owned by CIGNA HealthCare in Albuquerque, N.M.

In other news, the JCAHO has produced several videotapes designed to help health care organizations prepare for accreditation surveys and comply with quality standards. For information about any of the following titles, call 708-916-5800:

  • "Competence Assessment in Home Care." Cost: $195.
  • "How to Prepare for Your Home Care Accreditation Survey." Cost: $195.
  • "Home Care Performance Improvement: A Practical Guide." Cost: $195.
  • "Your Video Guide to the Hospital Survey Process." Cost: $780 for six videos.
  • "How to Prepare for Joint Commission Accreditation: Long Term Care, Subacute and Dementia Special Care Units." Cost: $195.
  • "Long Term Care Improvement: Safety, Equipment Management and Preventive Maintenance." Cost: $195.
  • "Using Data to Improve Performance in the Long Term Care, Dementia and Subacute Care Settings." Cost: $195.

Information about JCAHO programs, surveys and standards is also available on the commission's Internet World Wide Web page (http://www.jcaho.org).

Survey: internists' care costlier

Women between 18 and 65 years old who see their internist for care had more visits and incurred higher outpatient expenditures than those who typically saw a family or physician identified as a general practitioner or an ob/gyn, according to a study published in the Winter issue of Health Affairs. After the age of 65, the cost difference balanced.

The data for the study did not indicate whether higher use and spending by internists reflected "relative overtreatment by internists, undertreatment by other primary care specialists or appropriate differences related to patients' needs."

The study was based on data from the National Medical Expenditure Survey, the only source of U.S. ambulatory health care use and spending information. The data for the study came from the population-based survey of 92.3 million civilian noninstitutionalized Americans; 65.5 million identified a particular doctor as their usual source of care. Of these women, 90.6% identified the doctor as a general practitioner, family physician, internist or ob/gyn. Data were collected in 1987 before the expansion of managed care.

Decrease Medicare errors

Coders can learn better methods for coding medical and surgical procedures in the CPT Coding Made Easy, from Aspen Publishers. The book, to be used in conjunction with Physicians' Current Procedural Terminology (CPT), can preserve losses from errors in coding. It is updated annually to reflect changes in CPT and costs $220. Information: 800-638-8437.

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