Docs sue six health plans

Two Connecticut physicians’ groups, collectively representing 7,000 physicians, have filed 11 separate lawsuits against six of the nation’s largest health plans, saying they “systematically harmed” patients by denying medically necessary treatments and by illegally withholding millions of dollars in payments to doctors, the Feb. 15 New York Times reports. The lawsuits are being called “one of the broadest legal challenges to the health insurance industry.”

Timothy B. Norbeck, executive director of the Connecticut State Medical Society, which filed six of the suits, says the action is an attempt to force the health plans into making fundamental changes in the way they operate. “These suits take direct aim at health plan policies and practices that place critical medical care decisions in the hands of insurance company bureaucrats instead of physicians, where they belong,” he said.

Keith Stover, a lobbyist for the Connecticut Association of Health Plans, expressed disappointment over the lawsuits, saying, “The claims are, at best, hyperbolic, and at worst they’re just disingenuous.”

The American Medical Association is supporting the litigation and has said it hopes physician groups in other states will join the suits. “Physicians throughout the country have been pushed to the breaking point,” said D. Ted Lewers, MD, chair of the AMA’s board of trustees.

National outcomes database in the works

The Agency for Healthcare Research and Quality (AHRQ) and the private, nonprofit Kanter Family Foundation have pledged to improve treatment decisions by developing a national health outcomes database. The joint venture, referred to as the Health Legacy Partnership (HELP), will engage groups already involved with specific diseases to gather existing treatment data into a comprehensive database that patients and physicians can access for statistically reliable information on what works best.

The proposed database would allow a subscriber to type in a particular disease and retrieve a list of outcomes for various treatments. For example, a patient could type in “prostate cancer” and compare the success rates and side effects of radiation versus surgery. The patient can then make a decision based on the outcomes he or she considers most important.

According to AHRQ director John M. Eisenberg, MD, such a database would be an immensely useful tool not only for patients and physicians but also for researchers aiming to improve health care quality. At the same time, he acknowledges that a “radical change” must occur in the way Americans think about medical information. Referring to concerns about privacy and misuse of personal data, he added, “We’re so concerned about the confidentiality of our information that we’re not willing to share it for the common good.”

HELP is currently seeking partners to gather health outcomes information. For more information, visit their Web site at www.healthlegacy.org.

PRACTICE PEARLS from here and there

Reducing errors in primary care

Preliminary findings from a study on medical errors in primary care, sponsored by The Robert Graham Center, the AAFP’s policy center in Washington, D.C., show that errors in communication and processes, not poor clinical decisions, are usually to blame. To reduce office-based errors, try one or more of the following tips:

• Follow a “blame-free” policy and make it clear that physicians and support staff can disclose errors or close calls without fear of recrimination.

• Ask patients to bring in every medication they take, and review the records during every office visit.

• Use a hand-held computer and download a free electronic drug reference guide such as ePocrates qRx (www.epocrates.com) so that the information you need is available to you at the point of care. Fifty percent of ePocrates qRx users recently surveyed reported that it helped them avoid at least one adverse reaction per week.

• Prevent future medication errors from occurring by reporting mistakes to the Medication Errors Reporting Program of the U.S. Pharmacopeial Convention Inc., at 800–23-ERROR or www.usp.org.

– Lippman H. Preventing errors in your practice. Hippocrates. January 2001:38–43.

PRACTICE PEARLS from here and there

Better doctor-patient relationships

Research has suggested that a good doctor-patient relationship may actually decrease a patient’s likelihood to sue when something goes wrong. To improve your relationships, try these tips:

• Offer at least some information to your patients. Even if they don’t understand all the clinical terms, they’ll appreciate being told.

• Avoid sounding critical or disapproving when you talk with your patients. Consider recording your voice and listening to it to find out what your patients hear.

• Share a comment or two about your own life. This can increase your patients’ trust in you.

– Boschert S. Eleven ways to build doctor-patient relationship. Fam Pract News. Feb. 1, 2001:36.

PRACTICE PEARLS from here and there

Making a grand departure

If you are laid off or fired from your job, regardless of the reason, leave your employer with positive feedback and appreciation. Give your boss a letter of resignation that speaks positively of your accomplishments and the things you have enjoyed about the organization. Personally thank individuals who helped you and follow up with a handwritten note. What you say will be remembered and could improve your severance package.

– Kennedy MM. Fired? Here’s an exit strategy. Phys Exec. July–August 2000:34–37.

Average salary offerings

The average first-year annual income offered to family physicians in 1999–2000 was $135,000, a slight drop from the previous average of $136,000, according to Merritt, Hawkins & Associates’ 2000 Review of Physician Recruitment Incentives. The survey, which includes data from 1,901 searches conducted by the firm, found that salary offerings for all primary care specialties remained flat or dropped slightly while most other specialists saw “significant” gains.

Group visits

The group-visit model, developed almost a decade ago at Kaiser Permanente, is starting to catch on. Medical organizations such as Stanford Medical School and the Mayo Clinic have started teaching the model to their doctors, according to the Jan. 16 Denver Rocky Mountain News. At Kaiser Permanente, group visits not only allow time for patient socialization and education; they also save more than $12 per month for each participating patient.

Oh, Canada

U.S. residents are saving as much as 20 percent to 50 percent on prescription drugs by ordering them through Canadian online pharmacies, according to the Jan. 18 Wall Street Journal. Although this practice is “technically illegal,” the FDA says it has only enough manpower to police large commercial prescription drug shipments. Pharmaceutical companies have warned that there is no guarantee of the quality of such drugs and say the practice underscores the need for prescription drug coverage for seniors.

I just work here

Forty percent of nurses say they would not feel comfortable having their family or close friends treated at the facility where they work, according to a survey conducted by the American Nurses Association. A marked decrease in quality over the past two years was noted by 75 percent of responding nurses, 70 percent of whom felt inadequate staffing was the primary reason for the decline.

Illness prediction

Some insurers and employers are taking disease prevention one step further – too far, say some – by predicting patients’ near-term health care needs, based on a specialized risk assessment, and directing them toward preventive services. While critics say the approach could lead to discrimination, proponents view it as an effective way to reduce health care costs. The Haelen Group, which offers one such program, boasts of a “near 70 percent” rate of accuracy and a 50-percent reduction in costs.

Costly noncompliance

Two years after performing a ground-breaking, 13-hour, hand-transplant operation, “infuriated” surgeons were recently forced to amputate the patient’s transplanted hand, reports the Associated Press. According to the patient’s medical team, the patient’s body had rejected the hand because he did not keep in contact with them and failed to follow his drug therapy regimen.

Spending spree

Pharmaceutical companies spent a record $1.3 billion in direct-to-consumer advertising in the first half of 2000, $883 million of which was spent on television advertisements, according to a report by IMS Health. In the first half of 1999, direct-to-consumer advertising expenditures were just $907 million.

You gotta have faith

If medical school and residency training curriculums are any indication, the role of spirituality in healing is a hot topic. More than half of all U.S. medical schools now offer coursework or lectures on spirituality, up from just four schools in 1992.