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Primary care doctors growing scarce
Roughly 4 million additional Californians are expected to obtain health insurance by 2014 through the federal health law, an expansion that will likely exacerbate the state’s doctor shortage and could even squeeze primary care access in the Bay area, experts say.
Even without the Affordable Care Act, a worsening doctor shortage had been forecast as the state’s and nation’s population ages and grows, and as a generation of older doctors retires. But by mandating that individuals have insurance and expanding Medicaid, the law will extend coverage to an additional 30 million Americans and place a greater strain on the physician workforce, especially for primary care.
See on www.sfgate.com
BMJ Group — “Stop the silent misdiagnosis: patients’ preferences matter”
The BMJ Group is owned by the British medical Association, and it provides research, medical information, and resources to improve outcomes for patients and the provision of healthcare worldwide.
In recent decades, rapid advances in the biosciences have delivered an explosion of treatment options. This is good news for patients, but it makes medical decision making more complicated. Most critically, an accurate medical diagnosis is no longer sufficient to identify the proper treatment. Just as important is an accurate preference diagnosis.1 Every option for treatment (a term that we use broadly here, to include procedures, tests, and even watchful waiting) has a unique profile of risks, benefits, and side effects. Doctors, generalists as well as specialists, cannot recommend the right treatment without understanding how the patient values the trade-offs. Regrettably, patients’ preferences are often misdiagnosed.
The article’s authors provide a method for making better preference diagnoses:
- Adopt a mindset of scientific detachment
- Formulate a data based provisional diagnosis
- Engage the patient in conversation and deliberation
- Team talk
- Option talk
- Decision talk
The result should be better care, not necessarily more care, but more cost effective care and better patient satisfaction.
This study was also commented on by The Dartmouth Center for Health Care Delivery Science in a press release, in which it stated that “Standard & Poor’s has warned a number of countries, including the US and UK, could see their credit ratings downgraded within the next decade if they fail to cut health care costs.”
Federal health care law is just one part of changes in medical care
Now that the election is over, healthcare experts are focusing on how to make healthcare reform work for patients and providers. It was never supposed to be easy. Obamacare presents a paradigm shift in how healthcare is being thought about in this country. Unfortunately, this process of intelligently implementing the law is three years late, but finally it’s starting.
One example of how people are beginning to think was reported in LiveWell Nebraska (Omaha World Herald):
American medical care is changing for a variety of reasons, and the results in many cases are unpredictable, University of Nebraska Medical Center experts said Thursday at a forum.
The changes are occurring because of the federal health care law, which is now secure with President Barack Obama’s re-election, federal budget constraints and a general acceptance that the American health care system is inefficient.
The experts’ comments ranged from optimism that care will improve with teamwork to concern that there will be too few doctors and nurses in an underfunded system.
Pew Research — Mobile Health 2012
According to Pew Research:
One in three cell phone owners (31%) have used their phone to look for health information. In a comparable, national survey conducted two years ago, 17% of cell phone owners had used their phones to look for health advice.
The study shows that there is still a long way to go. Nevertheless, this is what electronic health records and health care reform are all about. If patients and their healthcare providers can have better access to patient medical information, then patients and providers can improve patient care and keep patients healthier.
Health Care Law Delivers Higher Payments to Primary Care Physicians
CMS, in a press release on Thursday, November 1, announced the adoption of the final rule implementing the part of the Affordable Care Act that primary care physicians be paid 100% of the Medicare rate when they treat Medicaid beneficiaries. The final rule is over 100 pages long and provides —
Under this provision, certain physicians who provide eligible primary care services will be paid the Medicare rates in effect in calendar years (CY) 2013 and 2014 instead of their usual state-established Medicaid rates, which may be lower than federally established Medicare rates. The payment increase applies to primary care services delivered by a physician with a specialty designation of family medicine, general internal medicine, or pediatric medicine or related subspecialists. States will receive 100 percent federal financial participation (FFP) for the difference between the Medicaid state plan payment amount as of July 1, 2009, and the applicable Medicare rate.
The rule provides information about how CMS and states will work together to make the increased payments operational. More information can be found in the CMS Fact Sheets.
USDOJ S.D. Florida: Owner of Miami Home Health Company Sentenced to 37 Months in Prison for $60 Million Health Care Fraud Scheme
The owner of a Miami health care agency was sentenced today to 37 months in prison for his participation in a $60 million home health Medicare fraud scheme, announced U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida; Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; Michael B. Steinbach, Acting Special Agent in Charge of the FBI’s Miami Field Office; and Special Agent in Charge Christopher B. Dennis of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), Office of Investigations Miami office.
Rodolfo Nieto Jr., 40, of Miami, was sentenced today by U.S. District Judge Cecilia M. Altonaga in the Southern District of Florida. In addition to his prison term, Nieto was sentenced to serve three years of supervised release and ordered to pay $1.1 million in restitution.
On Aug. 14, 2012, Nieto pleaded guilty in the Southern District of Florida to one count of conspiracy to defraud the United States and to receive health care kickbacks.
Nieto was the owner and operator of Ronat Home Health Care Inc. According to court documents, during the time of the conspiracy, Ronat was a Florida home health “staffing agency” that purported to provide home health care and physical therapy services to eligible Medicare beneficiaries. Ronat subsequently became a home health agency.
According to court documents, from approximately January 2006 to approximately November 2009, Nieto accepted kickbacks in return for recruiting Medicare beneficiaries to be placed at Nany Home Health Inc., a Miami home health agency that purported to provide home health care and physical therapy services to eligible Medicare beneficiaries. The owners and operators of Nany paid Nieto kickbacks in return for allowing Nany to bill the Medicare program on behalf of the patients Nieto had recruited through Ronat. Specifically, as part of the scheme, Nany billed Medicare for home health services purportedly provided by Ronat.
See on www.justice.gov
USDOJ E.D. California: Third Physician Sentenced To Lengthy Prison Sentence In Medicare Fraud Case
Dr. Ramanathan Prakash, 65, of Northridge, CA, was sentenced today by United States District Judge Morrison C. England, Jr. to a statutory maximum 10 year prison sentence. The defendant had been found guilty of Conspiring to Commit healthcare fraud, and three counts of healthcare fraud by a jury on July 8, 2011. Judge England also imposed a $75,000 fine and ordered Prakash to pay $607,456.80 in restitution.
According to testimony presented at trial, from February 2006 through August 2008, Vardges Egiazarian, 63, of Panorama City, owned and controlled three health care clinics in Sacramento, Richmond, and Carmichael. Egiazarian and others recruited doctors to submit applications to Medicare for billing numbers. Prakash participated in the establishment of a clinic in Sacramento, although he lived in the Los Angeles area. He established the Medicare provider number for the clinic, signed the lease and established a bank account for the clinic. He only visited the clinic twice.According to evidence at trial, Prakash never treated a single patient at the clinic. Clinic patients, almost all of whom were elderly and non-English speaking, were recruited and transported to the clinics by individuals who were paid according to the number of patients they brought to the facilities. Rather than being charged a co-payment, the patients were paid for their time and the use of their Medicare eligibility, generally $100 per visit. False charts were created stating that each patient received comprehensive exams and a broad array of diagnostic tests. Few of these tests were ever performed, none were performed based on any medical need, and clinic employees filled out other portions of the charts using preprinted templates. Some clinic employees admitted to performing various tests on themselves, and placing the results in patient files.
Patient files were then transported to Los Angeles where Prakash signed them indicating he provided or approved the treatments. In all, the three clinics submitted more than $5 million worth of fraudulent claims to Medicare, $1.7 million of which was actually paid. In return for their roles, Prakash and the other physicians received 20 percent of the billings paid under their provider numbers.
See on www.justice.gov
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
OIG Work Plan Will Examine Hospital-Based Physician Practice Billing
The OIG 2013 Work Plan will focus on many topics to make sure health care providers are dotting i’s and crossing t’s.
One topic is will be to determine the effects of nonhospital-owned physician practices billing Medicare as hospital-based physician practices.
[This is very timely given the renewed wave of hospital acquisitions and employment of physicians.]
See on www.bna.com
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
WSJ CIO Journal: One Stanford Doctor Wants to Focus on Real Patients, Not iPatients
Electronic medical records don’t always reflect what really happens during an examination. Physicians are so busy checking off boxes and keying in vital signs that sometimes they spend more time with the virtual patient than the real one.
“Many of us recognized that there was a gap between what the medical record claimed was done on the patient, in a sense, and the actual execution of the task,” Dr. Abraham Verghese, a professor at Stanford University’s School of Medicine and best-selling novelist, said in a Thursday Wall Street Journal article. “It reflects an increasing dependence on technology and paying lip-service to the actual examination of the patient,” he said.
Creators of electronic medical records never envisioned that the technology might actually decrease the quality of patient care. Instead, they saw a world where medical errors would drop because charts could be easily accessed and read. They also hoped that electronic records would result in fewer duplicated tests and lower costs. Yet, the difficulty of using many of these systems means that, in some cases, it’s encroaching upon the quality of patient care. It’s a lesson for CIOs — the very technology they implement to solve a problem can actually make that problem worse if they don’t think carefully about the people using it.
See on blogs.wsj.com
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
Poking Fun at My Patients to create an environment that feels at least a little normal
“I joke around with my patients to create an environment that feels at least a little normal in the craziness of their disease, so they can focus on living, not dying.”
Certain aspects of medical school, like learning the basics of normal and abnormal organ function, or rotating onto specialty services as mini-apprenticeships to recognize disease and treat it, haven’t changed much in 100 years of medical education.
What has changed is the emphasis on communicating with patients, which includes understanding how social and cultural factors and life circumstances can influence everything from disease occurrence to medication compliance. This is a good thing.
Leukemia doesn’t read a person’s tax returns, and my patients run the gamut. In the same morning recently, I saw a Russian oligarch who comes for visits in his private jet and a 20-year-old whose leukemia diagnosis kept him from serving jail time, and who catches the Regional Transit Authority bus for his appointments. I need to have insight into their lives outside my stark exam room to appreciate how their environments will affect the care plans we develop.
We also learn how patients react to illness, and how a diagnosis like cancer can dramatically alter a family’s landscape, or how a person defines herself.
See on well.blogs.nytimes.com
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
Joseph Rugg's Health Law Blog 