Category Archives: Doctors

End of Medicare bonus will cut primary care doc pay


Doctor at deskBy Michelle Andrews

Many primary care practitioners will be a little poorer next year because of the expiration of a health law program that has been paying them a 10 percent bonus for caring for Medicare patients.

Some say the loss may trickle down to the patients, who could have a harder time finding a doctor or have to wait longer for appointments.

But others say the program has had little impact on their practices, if they were aware of it at all.

The incentive program began in 2011 and was designed to address disparities in Medicare reimbursements between primary care physicians and specialists.

It distributed $664 million in bonuses in 2012, the most recent year that figures are available, to roughly 170,000 primary care practitioners, awarding each an average of $3,938, according to a 2014 report by the Medicare Payment Advisory Commission.

Although that may sound like a small adjustment, it can be important to a primary care practice, says Dr. Wanda Filer, president of the American Academy of Family Physicians.

“It’s not so much about the salary as it’s about the practice expense,” she explains. “Family medicine runs on very small margins, and sometimes on negative margins if they’re paying for electronic health records, for example. Every few thousand makes a difference.

Doctors who specialize in family medicine, internal medicine and geriatrics are eligible for the bonuses, as are nurse practitioners and physician assistants. Continue reading


When things go wrong at the hospital, who pays?


Physician and Nurse Pushing Gurney

By Shefali Luthra
KHN/Washington Post

When Charles Thompson checked into the hospital one July morning in 2011, he expected a standard colonoscopy.

He never anticipated how wrong things would go.

Partway through, the doctor emerged and said there were complications, remembered Ann, Charles’ wife. Charles’ colon may have been punctured. He needed emergency surgery to repair it.

Charles, now 61, from Greenville, S.C., almost died on the operating table after experiencing cardiac distress. His right coronary artery required multiple stents. He also relies on a pacemaker.

If treatment makes things worse – meaning patients need more care – who pays? The answer, it seems, is that it depends.

“He’s not the same as before,” said Ann, 62. “Our whole lifestyle changed – now all we do is sit at home and go to church. And that’s because he’s scared of dying.”

When things like this happen in the hospital, questions arise: Who’s responsible? If treatment makes things worse – meaning patients need more care – who pays?

The answer, it seems, is that it depends. Continue reading


Fewer black men applying to medical school than in 1978


Jeffrey Okonye, left, and Oviea Akpotaire are both fourth-year medical students at the University of Texas, Southwestern. (Photo by Lauren Silverman/KERA)

By Lauren Silverman

Oviea Akpotaire and Jeffrey Okonye put in long days working with patients at the veterans’ hospital in south Dallas as fourth-year medical students at the University of Texas Southwestern.

542 black male students enrolled in 1978, compared to 515 in med school in 2014.

In a class of 237 people, they are two of only five black men.

“I knew the ones above us, below us,” Okonye says. “We all kind of know each other. It’s comforting to see another person that looks like you.”

While more black men than before have graduated from college over the past few decades, the number applying to med school has dropped: From 1,410 in 1978 to 1,337 in 2014.

Enrollment statistics are similar:  542 black male students enrolled in 1978, compared to 515 in med school in 2014. Continue reading


Nursing home residents face health risks from antibiotic misuse


Three red and white capsulesBy Lisa Gillespie

Antibiotics are prescribed incorrectly to ailing nursing home residents up to 75 percent of the time, the nation’s public health watchdog says.

The reasons vary — wrong drug, wrong dose, wrong duration or just unnecessarily – but the consequences are scary, warns the Centers for Disease Control and Prevention.

Overused antibiotics over time lose their effectiveness against the infections they were designed to treat. Some already have. And some antibiotics actually cause life-threatening illnesses on their own.

Studies have estimated antibiotics are prescribed inappropriately 40 percent to 75 percent of the time in nursing homes.The CDC last month advised all nursing homes to do more – immediately – to protect more than 4 million residents from hard-to-treat superbugs that are growing in number and resist antibiotics.

Antibiotic-resistant infections threaten everyone, but elderly people in nursing homes are especially at risk because their bodies don’t fight infections as well. Continue reading


Humana and Northwest Physicians Network form accountable care partnership


Screen Shot 2015-10-14 at 8.44.31 AMNorthwest Physicians Network and the insurer Humana have signed an accountable care agreement that will provide Humana Medicare Advantage members access to the network’s physicians.

Northwest Physicians Network (NPN) is an independent physicians association with more than 500 providers and 200 ancillary facilities located throughout the Puget Sound region.

Humana executives said the accountable care model, which focuses on chronic disease management and wellness and which rewards providers for improved performance, is designed to control costs, improve quality and enhance the patient experience.

“Humana is excited to work with NPN to continue delivering value-based health care to our Medicare Advantage members in the Puget Sound region,” said Catherine Field, Intermountain Vice President for Senior Products at Humana. “This model is designed to foster high-quality healthcare, lower costs and provide a more patient-centric healthcare system.”


Medical prices higher where large doctor groups dominate


Sign for an emergency room.By Michelle Andrews

Prices for many common medical procedures are higher in areas where physicians are concentrated into larger practice groups, according to a new study.

The October Health Affairs study examined the average county prices paid by preferred provider insurance organizations in 2010.

It focused on 15 high-volume, high-cost medical procedures across a variety of specialties, including vasectomy, laparoscopic appendectomy, colonoscopy with lesion removal, nasal septum repair, cataract removal and knee replacement.

The prices studied reflected the negotiated prices between the PPOs and the physician groups, including payments made by both the plan and the patient. The average price ranged from $2,301 for a total knee replacement to $576 for a vasectomy.

The researchers also used an index to measure competition among physician practices at the county level that is based on the number and size of practices. They then examined the association between procedure prices and the concentration of physicians in larger practices.

In 12 of the 15 procedures, prices were 8 to 26 percent higher in counties with the highest average physician concentration compared to counties with the lowest average concentration, the study found.

The three procedures where there was no significant relationship between physician competition and price were intensity-modulated radiation therapy, shoulder arthroscopy and kidney stone fragmentation. Continue reading


Whistleblower warns about hospitals hiring physicians



By Jay Hancock

There is a good chance that your once-independent doctor is now employed by a hospital. Dr. Michael Reilly, a Fort Lauderdale, Fla., orthopedic surgeon, does not believe this is good for physicians, patients or society.

For years he watched Broward Health, a nonprofit Florida hospital system, hire community doctors, pay them millions and minutely track the revenue they generated from admissions, procedures and tests.

“We are making money off these guys,” Broward Health’s CEO told Reilly, according to a federal whistleblower lawsuit filed against the system by Reilly and the U.S. Justice Department.

Last month Broward Health agreed to pay $70 million to settle allegations that it engaged in “improper financial relationships” with doctors under laws prohibiting kickbacks in return for patient referrals. Continue reading


Seniors tell medical students what they need from doctors


Belle Likover, a 95-year-old retired social worker, told Case Western Reserve medical students that growing old gracefully is all about being able to adapt to one’s changing life situation, including health challenges. (Photo by Lynn Ischay for Kaiser Health News)

By Susan Jaffe

CLEVELAND – When doctors told Robert Madison his wife had dementia, they didn’t explain very much. His successful career as an architect hardly prepared him for what came next.

“A week before she passed away her behavior was different, and I was angry because I thought she was deliberately not doing things,” Madison, now 92, told a group of nearly 200 students at Case Western Reserve School of Medicine here. “You are knowledgeable in treating patients, but I’m the patient, too, and if someone had said she can’t control anything, I would have been better able to understand what was taking place.”

Belle Likover recounted for the students how she insisted when her husband was dying of lymphoma that doctors in the hospital not make decisions without involving his oncologist.

“When someone is in the hospital, they need an advocate with them at all times,” said Likover, who turns 96 next month. “But to expect that from families when they are in crisis is expecting too much. The medical profession has to address that.”

Madison and Likover were among six people all over the age of 90 invited to talk to the second-year medical students this month. The annual panel discussion, called “Life Over 90,” is aimed at nudging students toward choosing geriatric medicine, the primary care field that focuses on the elderly. It is among the lowest-paid specialties, and geriatricians must contend with complex cases that are time consuming and are often not reimbursed adequately by Medicare or private insurance. And their patients can have diseases that can only be managed but never cured. Continue reading


Teamwork key to reducing diagnostic errors, report


By Julie Appleby

Almost every American will experience a medical diagnostic error, but the problem has taken a back seat to other patient safety concerns, an influential panel said in a report out today calling for widespread changes.

Diagnostic errors — defined as inaccurate or delayed diagnoses — account for an estimated 10 percent of patient deaths, hundreds of thousands of adverse events in hospitals each year and are a leading cause of paid medical malpractice claims, a blue ribbon panel of the Institute of Medicine (IOM) said in its report.

Photo courtesy of Sanja Gjenero
Continue reading


Pay up, but not equal for women anesthesiologists


hospital-02By Shefali Luthra

In anesthesiology, it pays – literally – to be a man.

At least, that’s what’s suggested by a study examining this specialty’s demographics and salaries in 2007 and again in 2013.

The study, by the RAND Corp., a nonpartisan research institute, was published Thursday in the journal Anesthesiology.

The researchers concluded that women are closing anesthesiology’s gender gap in terms of sheer representation, especially in younger age groups. A quarter of all anesthesiologists were female by 2013, compared with 22 percent in 2007. Of women younger than age 36, 38 percent were female, compared with 26 percent six years before.

Despite those gains, women in 2012 earned about $313,000 on average, while men earned about $404,000 – a difference of close to 30 percent. That broke down to $151 per hour for male anesthesiologists, compared with $131 for females. Part of the difference could stem from the fact that older, more experienced doctors often are male.

A detailed analysis of anesthesiologists younger than 36 who worked in group practices found wage disparities existed in 2012, even when taking into account age, experience, hours worked and type of employer. Controlling for those, women earned 7 percent less than did their male counterparts – $114 per hour worked, compared with $122. Continue reading


Washington clinics to receive $8.5 million to expand services


Washington state health centers will receive more than $8.5 million in federal funds to expand their primary care services, the US Department of Health and Human Services announced Tuesday.

In addition, seven centers in the state will receive $1 million each to to expand or renovate existing facilities or build new facilities to increase their service capacity. Continue reading


Accountable Care Organizations, explained


Question Q&ABy Jenny Gold

One of the main ways the Affordable Care Act seeks to reduce health care costs is by encouraging doctors, hospitals and other health care providers to form networks that coordinate patient care and become eligible for bonuses when they deliver that care more efficiently.

The law takes a carrot-and-stick approach by encouraging the formation of accountable care organizations (ACOs) in the Medicare program. Providers make more if they keep their patients healthy.

About 6 million Medicare beneficiaries are now in an ACO, and, combined with the private sector, at least 744 organizations have become ACOs since 2011. An estimated 23.5 million Americans are now being served by an ACO. You may even be in one and not know it. Continue reading


New heart procedure boon to patients and hospitals

Dr. Josh Rovin, left, and Dr. Douglas Spriggs, right, perform TAVR procedure at Morton Plant Hospital in Clearwater, Florida (Photo by Phil Galewitz/KHN)

Dr. Josh Rovin, left, and Dr. Douglas Spriggs, right, perform TAVR procedure at Morton Plant Hospital in Clearwater, Florida (Photo by Phil Galewitz/KHN)

New Hope Beats For Heart Patients And Hospitals

By Phil Galewitz

CLEARWATER, Fla. – Inch by inch, two doctors working side by side in an operating room guide a long narrow tube through a patient’s femoral artery, from his groin into his beating heart. They often look intently, not down at the 81-year-old patient, but up at a 60-inch monitor above him that’s streaming pictures of his heart made from X-rays and sound waves.

As with other new medical technology, TAVR draws concerns about possible overuse or adoption by hospitals lacking proficiency, which could harm patients and increase health care costs.

The big moment comes 40 minutes into the procedure at Morton Plant Hospital. Dr. Joshua Rovin unfurls from the catheter a metal stent containing a new aortic valve that is made partly out of a pig’s heart and expands to the width of a quarter outside the catheter. The monitor shows it fits well over the old one. Blood flow is normal again.  “This is pretty glorious,” Rovin said.

The surgeon has performed one of the fastest-growing procedures in U.S. heart care known as a transcatheter aortic valve replacement, or TAVR. The operation was approved in the U.S. in late 2011 to help patients too ill or frail for traditional “open-heart” valve surgery. The procedure has rapidly gained doctors’ acceptance, particularly for patients in their 80s and 90s. Continue reading


When the hospital is your doctor’s boss, that’s where you go


Sign for an emergency room.By Jay Hancock

Why did hospitals binge-buy doctor practices in recent years?

To improve care coordination, lower costs and upgrade patient experiences, say hospitals.

To raise costs, gain pricing power and steer patient referrals, say skeptics.

Ownership by a hospital “dramatically increases” odds that a doctor will admit patients there instead of another, nearby hospital.

Researchers at Stanford University tested those opposing arguments by comparing referral patterns between independent doctors and those working for hospitals.

Ownership by a hospital “dramatically increases” odds that a doctor will admit patients there instead of another, nearby hospital, they found.

Worse, from the viewpoint of reformers, it boosts chances that patients will go to higher-cost, lower-quality hospitals. Continue reading