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

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From the November 1999 ACP-ASIM Observer, copyright 1999 by the American College of Physicians-American Society of Internal Medicine.

Doctors earning more, but only by working harder

Physician income continued to rise last year, but only because doctors are working harder and longer.

According to statistics from the Medical Group Management Association (MGMA), primary care physicians saw their income rise by 2.54% in 1998, while specialist pay rose 5.22%. Internists led primary care with an average income of $141,147. Family practice trailed closely with an average income of $138,277, and pediatricians earned an average of $135,000. Among the specialties, invasive cardiologists earned an average of $350,000, noninvasive cardiologists earned an average of $278,000, and hematologists/oncologists earned an average of $212,516.

Those gains were balanced by signs that physicians are working more hours and generating more charges to maintain their incomes. Primary care physicians increased gross charges by 4.67%, while specialists increased their gross charges by 6.51%. Over five years, charges for primary care physicians grew by 11.59% and 29.33% for specialists.

MGMA's statistics also noted that managed care appears to be hurting specialists more severely than generalists. When specialists receive 51% to 100% of their revenue from capitation, the data found, compensation drops $100,000. Generalists who receive more than 51% of their revenue from capitation, on the other hand, tend to see their revenue increase.

Humana changes its plan to review high level claims

Humana Inc. has backed down from a plan to aggressively review all high level claims from physicians.

Last summer, Humana implemented a program in which it reviewed all level 4 and level 5 claims. The insurer then gave many of the physicians filing those claims 14 days to provide supporting documentation. Physicians who did not respond adequately or in time had their claims downcoded one level.

Humana last month announced that it would review only high level claims from physicians whose claims coding patterns fell outside the norm. Officials apologized for imposing burdensome administrative requirements on physicians, but said that it was still concerned that many of its physicians were not following coding guidelines.

The insurer acted in response to complaints from physicians and state medical societies, and to increasing scrutiny from state regulators. The Kentucky General Assembly planned to hold a hearing examining how insurers handle claims payments. The Florida Department of Insurance also issued a bulletin warning health insurers not to automatically downcode physician claims, saying that such practices violate state laws.

HMOs expect to raise premiums by 10%

For the first time since the early 1990s, HMOs are expecting to ask for double digit increases in health care premiums.

According to a report from the Sherlock Company, a firm that specializes in analyzing managed care issues, HMOs across the country are expecting to raise health care premiums by 10.6% in the year 2000. Regional rate increases are expected to range from 8.3% in the West to 12.7% in the Southeast.

Rates have been rising steadily since the mid 1990s, when premiums increased by one or two percentage points. Analysts point to the rapidly rising costs of drug benefits, which last year grew by roughly 15%.

ABIM recertification exams to be offered twice a year

Beginning next year, the American Board of Internal Medicine (ABIM) will begin offering its final exams for physician recertification twice a year.

The final exam is the last of three steps in ABIM's recertification process. All internists who became board certified during or after 1990 will have to go through the process by the end of the year 2000 or lose their board certification.

ABIM will offer final exams in May and November of 2000. To sit for the May exam, physicians must complete the self-evaluation process by Feb. 1 and register for the exam by March 1. To sit for the November exam, physicians must complete the self-evaluation process by Aug. 1 and register for the exam by Sept. 1.

For more information about the recertification process, see ABIM's Web site at www.abim.org or call 800-441-2246.

NCQA to measure physicians

The National Committee for Quality Assurance (NCQA) is getting in the business of accrediting physician practices.

The NCQA plans to accredit physician group practices, independent practice associations (IPAs) and other physician entities in California by the end of the year. The voluntary accreditation program could be expanded to the rest of the nation sometime next year.

While details of the program have not been finalized, published reports have said that the organization plans to measure physician performance, not just the structure of physician organizations.

Wanted: student abstracts

The Society of Clinical Trials (SCT) is looking for medical students, residents and post-doctoral fellows to submit abstracts about issues related to clinical research trials. The abstracts are due Dec. 1, 1999.

Abstracts may focus on study design and data analysis; meta-analysis; medical, ethical and legal issues; data entry, management and computing as it relates to clinical trials; review of a class of trials; or scholarship in the history of clinical trials. Abstracts that are accepted will be displayed at the SCT's annual meeting, to be held April 16-19 in Toronto, Canada.

The three students who are selected to present their papers at the meeting will receive an all-expenses paid trip to the meeting. An additional $500 will be given to the student with the best paper.

For information, go to the SCT's Web site (www.sctweb.org) or e-mail Steve Goodman, MD, at sgoodman@jhmi.edu.

Two new products from AHA help fight heart disease

The American Heart Association (AHA) has created two new products to help educate patients about how to prevent heart disease.

The Physician's Tool Kit contains materials to help providers address compliance issues, including guidelines, posters and brochures for patients, tip sheets, diet suggestions and a sample patient education sheet.

A new patient brochure, Knock Out America's Hidden Health Threat, is designed to educate patients about the importance of compliance. It contains tools to help patients learn and adopt healthier behaviors, including a wallet-size card to track medications, weight, cholesterol and blood pressure.

For more information, or to order the Physician's Tool Kit, which contains a copy of the patient brochure, call 800-242-8721.

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