Chronic care guidelines prove impossible to follow

Many patients fail to receive the recommended chronic disease care as outlined in national practice guidelines. But according to a new study in the May/June issue of the Annals of Family Medicine, physicians aren't to blame. Instead, there simply isn't enough time to do what the guidelines suggest.

Researchers applied national guidelines for 10 common chronic diseases to a panel of 2,500 primary care patients and then estimated the minimum physician time required to deliver high-quality care. They found that proper chronic disease management for these patients would require 828 hours per year, or 3.5 hours per day, assuming the patients' conditions were stable and well-controlled. For uncontrolled disease, the time demands tripled, to 2,484 hours per year, or 10.6 hours per day.

Researchers concluded that “comprehensive high-quality management of 10 common chronic diseases requires more time than primary care physicians have available for all patient care.” Streamlined guidelines and alternative methods for delivering chronic disease services (such as self care and group visits) are needed if physicians are expected to follow national guidelines.

Bill would offer up to $15,000 for EHR implementation

Physicians could soon receive financial assistance for implementing or upgrading electronic health record systems (EHRs) if a bipartisan bill introduced in the Senate on June 10 makes it into law.

The Health Information Technology Act would establish tax incentives and roughly $4 billion in grants, with awards of up to $15,000 per physician. At least 20 percent of the funds would go to rural or underserved areas. The bill also would adjust Medicare payments to those who use EHRs to improve quality and patient safety and would require the development of national standards to promote the efficient exchange of data.

“The legislation recognizes that the main obstacles to widespread adoption of electronic health record systems are the significant upfront costs and the lack of general interoperability of many fragmented electronic systems,” said AAFP Board Chair Michael Fleming, MD, in a recent letter of support to the Senators who introduced the bill.

AMA, AAFP take note of reimbursement problems

The American Medical Association (AMA) and the American Academy of Family Physicians (AAFP) are taking steps to address physicians' reimbursement problems with health plans. In May, the AAFP Board of Directors established a strike force to explore these issues and report to the Congress of Delegates in September. And in June, the AMA presented the National Association of Insurance Commissioners (NAIC) with a set of standards it believes would improve the health insurance system.

Specifically, AMA Chair J. James Rohack, MD, asked the NAIC to stop health plans from concealing information on their fees. “There is a pervasive refusal by health plans to disclose information regarding what they pay and how they pay,” said Dr. Rohack.

“Can you imagine any other small business tolerating not knowing how much it was going to be paid for services it rendered?” asked Dr. Rohack. “Other industries have long recognized the need for transparency in business transactions.”

Dr. Rohack cited instances in which physicians have submitted claims for the same service under the same contract but received different payments. “This is a perfect example of how confusing the practice environment has become for physicians and how difficult it is for physicians to determine the actual payment for the provision of health care services.”

Malpractice award caps result in more physicians, better access

States that cap malpractice lawsuit awards have more physicians per capita than states without such caps, resulting in better access for patients, according to a report from the Agency for Healthcare Research and Quality (AHRQ) published May 31 on the Health Affairs Web site.

Researchers found that between 1970 and 2000, the number of physicians per 100,000 residents more than doubled in states that established caps on non-economic damages during the 1980s. In contrast, the physician growth rate in states that didn't cap malpractice awards was just 83 percent.

Currently, 27 states have caps on malpractice awards.

Rural physicians, surgeons and obstetrician/gynecologists were most likely to be affected by the caps.

“This study contributes to the growing foundation of evidence underpinning efforts to reform malpractice laws in this country,” said Carolyn M. Clancy, MD, director of AHRQ. “This research will help inform states as they work to balance the concerns of physicians and the need to ensure access to services for their citizens.”