Roughly half of adults receive recommended care

Only 55 percent of U.S. adults receive the recommended care for their medical conditions, says a RAND Corporation study published in the June 26 New England Journal of Medicine. Researchers based their findings on telephone interviews with a random sample of adults living in 12 metropolitan areas in the United States and on reviews of the individuals’ medical records for the most recent two-year period. For 30 acute and chronic conditions as well as preventive care, the researchers compared the individuals’ actual care received against the care that should have been provided.

Quality varied substantially across medical conditions, ranging from a high of 78.7 percent of eligible patients receiving recommended care for senile cataracts to a low of 10.5 percent receiving recommended care for alcohol dependence. Recommended hypertension care was provided 64.7 percent of the time. Recommended diabetes care was provided 45.4 percent of the time. Only 24 percent of participants who had diabetes received three or more glycosylated hemoglobin tests over a two-year period. Only 45 percent of persons presenting with a myocardial infarction received beta-blockers.

“The gap between what we know works and what is actually done is substantial enough to warrant attention,” said the study authors.

What can be done to correct these care deficits? “Given the complexity and diversity of the health care system, there will be no simple solution,” said the researchers. They suggested that a key component will be automating the entry and retrieval of patient care data to aid clinical decision making and improve performance measurement.

PRACTICE PEARLS from here and there

Understanding modifier -59

CPT modifier -59, “Distinct procedural service,” can be one of the more difficult modifiers to use correctly because its CPT description is long and confusing. According to Margaret Loftus, CPC, reimbursement specialist at Stanford Hospital and Clinics in Palo Alto, Calif., the key to understanding the modifier is to “focus on the essence.” Basically, the modifier should be used “only to unbundle an appropriately reported service that is normally part of a bundled code pair,” says Loftus.

– The secret to billing troublesome modifier -59: tips for proper use.

Part B News. July 21, 2003:3.

PRACTICE PEARLS from here and there

Faster, more accurate prescription writing

To save time handwriting frequently prescribed medications, use your computer to print the drug name, dosage and instructions on a sheet of labels to keep in your exam room drawer. “I’m always looking to maximize my efficiency,” says Chris Koman, MD. “Labels work especially well for common scripts that require detailed instructions, such as a prednisone taper.”

– Posting from the AAFP’s practice management listserv, June 9, 2003.

Study reveals FP income, malpractice premiums

Family physicians’ average income (after expenses but before taxes) reached $142,400 in 2002, according to the AAFP’s 2003 Practice Profile I survey. For the past several years, family physicians’ average income has hovered around $134,000.

For the first time, the annual survey also asked about family physicians’ medical malpractice premiums, which have reportedly been rising nationwide. According to the survey, FPs’ premiums averaged $12,300 for basic coverage in 2002, although policy types varied widely among respondents.

When asked “Are you planning to make any changes in your practice as a result of rising malpractice insurance premiums?” 7 percent of respondents said they plan to retire or leave practice, 4.5 percent said they plan to move to another location, 7.5 percent said they plan to stop delivering babies, 10.7 percent said they plan to stop performing certain procedures and 1.7 percent said they plan to drop their malpractice insurance coverage.

The majority of respondents (88.5 percent) had no malpractice claims filed against them during the last twelve months; 7.3 percent had one claim filed against them; 1 percent had more than one claim; and 3.1 percent did not respond.

R_xerrors increase for seniors

U.S. seniors are increasingly receiving prescription drugs that are inappropriate or that have incorrect dosage levels or dangerous interactions with other medications, according to a recent study by Medco Health Solutions, a pharmacy benefit manager. The study found that in 2002, 7.9 million “medication alerts,” including millions of cases of overdosing, were identified by the company’s senior drug utilization review system – more than double the number issued in 1999. The authors of the study attribute these errors to the complexity of seniors’ prescriptions and a lack of communication among physicians. The study found that one in four seniors sees four or more different physicians and one in three seniors uses four or more different pharmacies.

Managing diabetes online

Yahoo!, the popular Internet search site, and software developer iMetrikus have partnered to create an online diabetes management system now available to the public at health.yahoo.com/health/centers/diabetes/medicompass/index.html. For a small monthly fee, the secure system allows patients with diabetes to enter daily glucose measurements, track their blood-sugar levels over time and compare their health status to recommendations from the American Diabetes Association. Patients can also give their physicians online access to this information. Yahoo! Health and iMetrikus plan to introduce additional condition-specific programs throughout 2003.

Discussing uncovered treatments?

Ethically, physicians should discuss all appropriate medical options with their patients, but health plans’ coverage restrictions are making that task difficult. According to survey results published in the July/August issue of Health Affairs, 31 percent of physician respondents said they did not discuss useful treatments with their patients at least “sometimes” in the previous year because the services were not covered by the patient’s health plan. Physicians were most likely not to discuss useful but noncovered services if they had larger volumes of poor patients, had experienced a patient requesting that they deceive a health plan or had more than a quarter of their income at risk for the costs associated with patient care.

Final exams

The medical school class of 2005 will be required to take a new test created by the National Board of Medical Examiners to assess students’ bedside manner and clinical skills, such as how well they interview and listen to patients. To pass, students must successfully examine 10 people posing as patients with various illnesses, record their observations after each exam and report these observations to senior physicians. Although the test evaluates critical communication and decision-making skills, opponents question its high cost ($975 per student) and accuracy.

Insurers in hot water

Of 1,581 justified complaints against eight health insurers in Connecticut over a one-year period, 70 percent dealt with delayed payments and 10 percent dealt with denied payments, reports the Aug. 10 Hartford Courant. During the past three years, the insurers have faced fines approaching $500,000 for breaking state laws related to delays and denials of care, but physicians insist more stringent laws are needed. The Connecticut State Medical Society has joined a national class-action lawsuit against the insurance industry. The case is pending in U.S. District Court in Miami.

Immunization levels at all-time high

According to the CDC, immunization rates for children reached an all-time high in 2002, although wide variations continue to exist among states and some urban areas. Nationally, varicella immunization rates increased from 76.3 percent in 2001 to 80.6 percent in 2002. The coverage rate for pneumococcal conjugate vaccine, which was recorded for the first time in 2002, was 40.9 percent.

Sharing the same language

Taking the first step toward a national electronic health record (EHR), Health and Human Services Secretary Tommy G. Thompson recently announced a licensure agreement with the College of American Pathologists for public use of SNOMED, the college’s standardized medical vocabulary system. SNOMED is recognized as the world’s most comprehensive clinical terminology database and will be made available for free under the agreement.