Doctors' attire doesn't matter, study says

Dressing to impress apparently doesn't apply in health care, according to a recent study published in the American Journal of Obstetrics and Gynecology. Researchers from Cooper University Hospital in New Jersey followed 20 full-time physicians in a variety of dress (formal business attire with white lab coats, casual attire or surgical scrubs) and surveyed 1,116 patients after their visits with the physicians. To avoid bias from previous interactions, only patients who were meeting the doctor for the first time were surveyed. They were asked about the physician's competence and professionalism, their sense of comfort and confidence in the physician, and whether they would return to or recommend the doctor to others. No questions referred to the provider's clothing. Researchers found identical levels of patient satisfaction regardless of the attire of the physicians.

Income gap between primary care, specialists must be addressed

Between 1995 and 2004, median compensation for primary care physicians increased 21.4 percent to $161,816. (For family physicians, it increased 20.8 percent to $156,011.) However, during the same period, median compensation for specialists increased 37.5 percent to $297,000.

These statistics from the Medical Group Management Association are reported in a Feb. 20 Annals of Internal Medicine article that cites four reasons for the widening income gap between primary care and specialty physicians:

1. The volume of procedures is increasing more rapidly than the volume of office visits, and procedures are reimbursed more highly under the Resource-Based Relative Value Scale, which determines Medicare reimbursement levels.

2. Specialists are overrepresented on the Relative Value Scale Update Committee, which advises the Centers for Medicare & Medicaid Services on reimbursement matters.

3. Under Medicare's “sustainable growth rate” formula, when growth in physician expenditures exceeds economic growth, the difference must be subtracted from physician fees. Because most of the growth is due to procedures, primary care physicians experience fee reductions due to growth that did not benefit them.

4. Many private insurers exacerbate the income gap by reimbursing specialists at larger percentages over Medicare rates. On average, private insurers' reimbursement rates for primary care office visits were 104 percent of Medicare's fee, compared with 119 percent to 120 percent of Medicare fees for surgical, diagnostic procedure and imaging codes.

The authors concluded, “Payment reform to narrow the income gap is essential if the United States is to maintain a healthy primary care base to its health care system.”

Health plan contract bill gets a second chance

Colorado legislators are debating a bill (SB 79) that could make health plan contracts fairer and more transparent in the state. The bill would require health plans to disclose all the information necessary for a health care provider to make an informed business decision, such as fee schedules, and it would prohibit unfair contracting provisions, such as a health plan unilaterally amending a contract without prior notification or negotiation with the physician. It would also require third parties who rent a health plan's provider network to abide by all terms of the contract in order to enforce a discounted fee schedule.

At press time, the bill had passed the Colorado House. The Colorado legislature passed a previous version of the bill last year, but it was vetoed by the state's lame duck governor.

Judge allows antitrust suit against United to proceed

The latest victory in an ongoing legal battle between the AMA and United Healthcare has gone to the AMA.

In late December, a judge granted the AMA's motions to add several counts against United Healthcare based on the Racketeer Influenced and Corrupt Organizations Act (RICO) and federal and state antitrust laws.

The central claim of the case, which started in 2000 when the AMA filed suit against United Healthcare, is that the insurer uses unreliable or insufficient data when it calculates “usual, customary and reasonable” charges and underpays physicians and patients for out-of-network services.

Reminder: Are you ready for the revised CMS-1500 form?

We're less than one month from the April 2 deadline for submitting your claims with the new CMS-1500 claim form. The new form will incorporate the new National Provider Identifier (NPI) number, which you need to obtain if you haven't already. You can obtain your NPI online at https://nppes.cms.hhs.gov.

For more information on the new claim form, which will most likely require your billing system to be upgraded, read “Get Ready for the Revised CMS-1500 Claim Form” in FPM's October 2006 issue.

Consumer Reports asks patients about docs - and vice versa

A recent survey of patients and primary care physicians by Consumer Reports revealed the major compliments and complaints that both groups direct at the other.

The good news for physicians: The overwhelming majority of patients said they were “highly satisfied” with their doctor and that their health improved under their doctors' care. In addition, 77 percent said their doctors treated them with respect and 67 percent said they were patiently listened to and understood.

The bad news for physicians: The majority of patients said their doctors never talked to them about the cost of treatments and tests. In addition, patients had these complaints:

• 74 percent said their physicians had not asked about emotional stress.

• 24 percent said their physicians made them wait 30 minutes or more.

• 19 percent said they couldn't get an appointment within less than a week.

Patients weren't spared from the criticism, however. The most common complaint, shared by 59 percent of the physicians surveyed, was that patients don't follow prescribed treatments. Other physician gripes included the following:

• 41 percent said that patients wait too long before making an appointment.

• 32 percent said patients are too reluctant to talk about their symptoms.

• 31 percent said patients request unnecessary tests.

• 28 percent said patients request unnecessary prescriptions.

The Consumer Reports survey was conducted in three parts: Its annual questionnaire asked 25,184 adults about visiting the doctor for an illness; the magazine asked 13,906 online subscribers about their preventive-care visits; and it surveyed 335 primary care physicians.

Survey offers snapshot of office-based physicians

Data collected back in 2003 and 2004 by the National Center for Health Statistics paint a comprehensive picture of the life of an office-based family physician.

About three-fourths of office-based physicians were the owner or part owner of their practice, and about two-thirds worked in group practices with two or more physicians. Roughly 43 percent were in single-specialty group practices, and about 21 percent were in multispecialty group practices. About one-half were primary care physicians.

Physicians with 11 or more managed care contracts had 26 percent more office visits per week but averaged 18 percent less time with each patient compared with physicians who had one or two managed care contracts.

Office-based physicians reported an average of 73.7 office visits, 12.7 hospital visits and 11.1 telephone consultations per week. Primary care physicians averaged more encounters per week compared with other specialists.

About one in five reported using electronic health records.