FPs call for change after families experience suboptimal care

Family physicians who observe the care of a seriously ill family member have a unique perspective on the shortcomings of the current health care system, concludes a study by Frederick M. Chen, MD, MPH, Lorna A. Rhodes, PhD, Larry A. Green, MD, and the Robert Graham Center for Policy Studies in Family Practice and Primary Care, published in the September 2001 issue of the Journal of Family Practice.

The interview-based study of family physicians who observed their fathers’ care by other physicians found that in each case there were significant quality concerns. These included a lack of responsiveness by physicians and other providers, poor communication, a loss of continuity of care and medical mistakes. As a result, many of the physicians felt compelled to intervene in their fathers’ care.

One physician, whose father was hospitalized for treatment of a peri-cardial hemorrhage following aortic valve replacement, said, “A variety of specialties were consulted, and there were plans for a thoracentesis – this, that and the other thing going on. Finally I couldn’t stand things much longer and I wrote two pages of orders. I essentially discharged him from the hospital and got him back involved with his family physician. Nobody was looking at the whole picture, and it was clear to me that I had to get him out of there.”

Researchers concluded that health care systems should “affirm the continued presence of one physician who is in charge of the patient’s care and accountable to the patient and the patient’s family. Payment systems and health plan rules should not force discontinuity across different care settings. Physicians who have a relationship and previous experience with patients should be encouraged to remain involved in their care during hospitalizations. Health care begs to be rebalanced to emphasize the importance of knowing the patient at least as well as the disease process and medical technology.”

Clinical guidelines need updating

The clinical practice guidelines published by the Agency for Healthcare Research and Quality (AHRQ) are widely believed to represent state-of-the art management for a broad range of conditions. Yet a recent study published in the Sept. 26 Journal of the American Medical Association found that more than three quarters of the AHRQ guidelines still in circulation are outdated.

The study, done at the request of and with support from AHRQ, used a combination of focused literature searches and assistance from members of the original AHRQ clinical practice guideline panels to evaluate the current validity of the guidelines and to determine the rate at which they become outdated.

Seven of the 17 AHRQ guidelines developed between 1990 and 1996 were determined to need “major updating” due to new evidence; six required minor updates; three were current; and one was inconclusive. Approximately half of the guidelines had become outdated 5.8 years after they were completed. Based on their findings, the study authors recommend that developers of clinical guidelines review them for validity every three years on average – more often if the guideline’s topic area is evolving quickly, less often if the topic area is relatively stable.

PRACTICE PEARLS from here and there

Protecting patients’ information

Although physicians still have almost two years to comply with the privacy and security rules of the Health Insurance Portability and Accountability Act, HIPAA experts are urging that you start your compliance efforts now. One approach is to conduct a self-audit of your practice’s HIPAA readiness by answering three questions:

1. What information do we need to protect? Identify any sensitive patient information that you or your staff may handle in each area of your practice.

2. What do we need to protect it from? Identify potential threats to paper-based and electronic data, including data in storage and in transit.

3. How do we protect it? Identify policies, procedures, physical safeguards and technical safeguards that you have in place or may need to implement in order to protect patient information.

– How to find information-security threats in your office. The Physician’s Advisory newsletter. September 2001:5.

PRACTICE PEARLS from here and there

Mystery patients

To find out what kind of service your practice is really providing to your patients, consider hiring a “mystery patient.” Mystery patients are either specialized consultants or real patients trained by consultants who are hired to go through an entire visit and assess a practice’s customer service skills. You can ask your mystery patients to focus on key areas that concern you, such as scheduling, waiting time, physician demeanor and paying the bill. But before hiring a mystery patient, be sure your practice is prepared to handle any serious problems that are uncovered.

– Darves B. Patients incognito. Physicians Practice Digest. September/October 2001:33–38.

Demand for FPs steady

Recruitment rates for family physicians remained steady this year, with the average income rising slightly to $136,000 from $135,000 in 2000, according to the 2001 Review of Physician Recruitment Incentives by Merritt, Hawkins & Associates. Meanwhile, for many non-primary-care specialties, demand and income rose significantly, due in part to an aging population and easier access to specialists.

Don’t mess with Texas

Health plan payment policies are under scrutiny throughout the nation but perhaps nowhere more than in Texas. After receiving a deluge of complaints, the Texas attorney general is now investigating the payment practices of nine of the state’s largest managed care organizations. The allegations include that the plans deny payments for pre-authorized services, bundle services under one fee and provide lower reimbursement than promised in physicians’ contracts.

Credentialing made easier

Minnesota has become the first state to develop a uniform credentialing application for use by all hospitals, health plans and physicians in the state. The application is expected to streamline the cumbersome credentialing process, which requires physicians to complete separate applications and gather supporting documents for, on average, three hospitals and five health plans every two years, according to Credential One, the credentials verification organization selected to oversee the state’s new process.

Lamictal 25 mg or Lamisil 250 mg?

Forty-one percent of fatal medication errors are caused by administering the wrong drug dosage, according to a retrospective analysis of the FDA’s Adverse Event Reporting System, a database containing case reports of medication errors. The second most common cause of fatal medication errors was administering the wrong drug (16 percent). Of the 469 fatal medication errors reported, half occurred in patients over the age of 60. The study appeared in the Oct. 1 American Journal of Health System Pharmacists.

Don’t ask the expert

Eighty-five percent of the billing and coding answers given by Medicare carriers were either incorrect or incomplete in a recent study by the General Accounting Office (GAO). The GAO made 60 calls to five carriers, asking questions the carriers listed on their own Web sites as frequently asked questions. Fifty-three percent of the answers given were incomplete, 32 percent were incorrect and only 15 percent were complete and correct.

HIPAA tramples the constitution

The Association of American Physicians and Surgeons recently filed a lawsuit to halt implementation of the Health Insurance Portability and Accountability Act (HIPAA) privacy rule on the basis that it is unconstitutional. The lawsuit is the first filed by a national organization and argues, among other things, that the privacy rule is in violation of the First and Fourth Amendments because it allows government access to personal medical records without a warrant or patient consent and subjects patient-physician communication to government review.

Medicare relief

Congress is looking at a number of ways to provide Medicare regulatory relief to physicians and other health care providers, according to Reuters Health. For example, the House Energy and Commerce Committee is considering a bill that would require Medicare to issue most new rules only once a month and would give providers 30 days to comply. A bill in the House Ways and Means Committee also proposes less burdensome Medicare regulations, such as allowing providers to repay Medicare overpayments over five years instead of three.

Computerized by 2003

Of the 93 percent of practices that currently use paper prescriptions, 82 percent expect to use a computerized prescription-writing system by 2003, according to a June 2001 report from For-rester Research Inc. In addition, of the 89 percent of practices using paper charts today, 80 percent anticipate switching to an electronic system by 2003.

Top 5 medical innovations

What would you say are the most important medical innovations of the last 30 years? According to a recent survey of physicians, the top five were as follows:

• MRI and CT scanning (75.6 percent),

• ACE inhibitors (54.2 percent),

• Balloon angioplasty (53.8 percent),

• Statins (48 percent),

• Mammography (47.6 percent).

–Fuchs VR, Sox HC. Physicians’ views of the relative importance of thirty medical innovations. Health Affairs. 2001;20:30–42.