Cooperating for better care.


Tag Archives

AMA moves further to address physician-burnout issue


MedPage Today reports that the “American Medical Association wants physician work-life balance added to provider-experience measures for evaluating how well alternative payment models function” address what is seen as the growing  incidence of physician burnout under the stress of ever more complicated work, including vast quantities of red tape and record-keeping.
The new AMA policy, approved following the annual meeting of its House of Delegates, also changed  its support of the “Triple Aim” to  support of the “Quadruple Aim”. As originally conceived in the development of healthcare reform in recent years, the Triple Aim seeks to improve patient experience and the health of populations and to cut per-capita costs.

The AMA will ask the Centers for Medicare & Medicaid Services to use the Quadruple Aim when evaluating Accountable Care Organizations and other practice

Fearing ageism against physicians


Fears that many physicians will soon retire because 26 percent of them are 60 or over, creating  a physician shortage, compete with fears that too many older physicians could create a quality-performance gap.

But Joel Kupfer, M.D., a professor at the University of Illinois College of Medicine in Peoria. asserts hat  there’s  little evidence that older physicians are more likely than younger ones to see their skills deteriorate or avoid learning the latest techniques.

Dr. Kupfer says any national guidelines should “be applied to all physicians, regardless of age, wherever and whenever they work.”

Cost-consciousness shakes up medical education


This Washington Post article discusses how the cost-consciousness revolution in U.S. healthcare “is starting to shake up one of the most conservative parts of medicine: Its antiquated model for training doctors.”

“Once paid {only} a la carte for the procedures and services they perform, physicians are beginning to be reimbursed for keeping their patients healthy. Doctors trained in the science of medicine, the diagnosis and treatment of the sick person in front of them, are increasingly responsible for helping to keep their patients out of the hospital.

“Those changes have been rippling through the health-care system for years in an attempt to address rising costs but were powerfully accelerated by the Affordable Care Act. That has left medical schools scrambling to catch up.”

Among the signs of change:

“Penn State is making its first-year students patient navigators. The University of Texas at Austin is building a medical school from scratch, with an explicit focus on areas beyond the doctor-patient interaction, such as health-care delivery and population health. The AMA {American Medical Association} is worried enough about the problem that it has been giving out millions of dollars to prod new kinds of teaching, in the hope that doctors’ training can adapt as quickly as the system they will soon join.”

Why doctor opposes hospitals hiring physicians


Broward Health Medical Center (Photo by Rytyho usa via Wikimedia Commons)

By JAY HANCOCK, for Kaiser Health News

There is a good chance that your once-independent doctor is now employed by a hospital. Michael Reilly, M.D., a Fort Lauderdale, Fla., orthopedic surgeon, does not believe this is good for physicians, patients or society.

For years he watched Broward Health, a nonprofit Florida hospital system, hire community doctors, pay them millions and minutely track the revenue they generated from admissions, procedures and tests.

“We are making money off these guys,” Broward Health’s CEO told Reilly, according to a federal whistleblower lawsuit filed against the system by Reilly and the U.S. Justice Department.

Last month Broward Health agreed to pay $70 million to settle allegations that it engaged in “improper financial relationships” with doctors under laws prohibiting kickbacks in return for patient referrals.

Giving doctors incentives to generate medical revenue is widely deemed unethical because it tempts them to order unneeded treatment or send patients to lower-quality providers. Physicians with a financial interest in a medical facility tend to prescribe more procedures than those who don’t, studies show.

Lawmakers have repeatedly tried to ban or limit such behavior at least since the 1970s. What happened at Broward Health and numerous other hospitals suggests they haven’t succeeded. Now that hospitals everywhere have gone on their own physician acquisition sprees, Reilly worries the same thing will keep occurring.

“We have got to get hospitals out of the business of hiring doctors,” he said in an interview. “It’s potentially detrimental to the patient, and it’s terrible for health care.”

Hospitals, burdened with large, fixed costs and anxious to ensure patient referrals and revenue in a changing industry, are doing the opposite.

“Doc binge buying rolls on” was the June headline in Modern Healthcare, an industry magazine. A third of doctors now work directly for hospitals or for practices with at least partial hospital ownership, estimates the American Medical Association.

Broward Health is a taxpayer-supported system with five hospitals and a publicly appointed board.

More than a decade ago it launched an expansion drive that included hiring previously independent physicians and paying CEO Frank Nask and other executives large bonuses if the institution increased revenue and the bottom line.

It agreed to hire orthopedists and cardiologists for more than $1 million a year — far more than average for such specialties. It paid orthopedic surgeon Dr. Erol Yoldas, also team doctor for the Florida Marlins baseball team, nearly $1.6 million in 2009.

Reilly rejected an employment deal with Broward Health after his lawyer told him it was illegal, he said. His whistleblower complaint, originally filed in 2010, was unsealed last month.

The system carefully tracked the return on its investment in the other doctors, recording the value of referrals and pressuring them to increase volume if they lagged, the lawsuit said.

Although Broward Health paid an enormous sum to settle allegations of wrongdoing, it did not admit those allegations, which is typical in such cases. CEO Nask retired last year. Nobody in the system has been charged with criminal wrongdoing.

Yoldas did not respond to requests for interviews. Nask did not respond to messages left at a number listed in his name.

Thanks to an uncoordinated system that pays for procedures instead of keeping people healthy, 30 percent of U.S. health care dollars spent in 2009 were wasted on unnecessary treatment, excessive administrative costs or fraud, calculates the authoritative Institute of Medicine.

Reilly responds carefully when asked whether doctors employed by Broward Health were ordering unneeded procedures. He’s concerned about possibly getting sued by a system with “deep coffers,” he said.

“I wasn’t allowed to review medical records,” he said. But when he sometimes saw patients who had been recommended for surgery by those doctors, he added, “I never agreed with the previous opinions.”

Reilly preferred working as an independent — on staff at hospitals but not employed by them. He didn’t feel compelled to generate revenue by ordering procedures, he said.

If Broward Health pushed a brand of artificial knee he felt was wrong for a patient, he could do the operation elsewhere. If he had concerns about the system’s radiology department — as some doctors did, according to the lawsuit — he could refer people to a different facility.

Fewer and fewer doctors have the same freedom, Reilly worries.

Some believe the AMA underestimates the portion of physicians employed by hospitals. Hospitals have been especially keen to hire primary-care doctors, the specialty that generated the highest referral profits for Broward Health, according to the lawsuit.

Not only does hospital employment “dramatically” boost chances that a doctor will refer to that hospital, but it also raises odds that patients will end up at a higher-cost, lower-quality facility, finds a recent study from Stanford University researchers. Like Broward Health CEO Nask, many hospital bosses get bonuses for increasing revenue and profits.

In the last two years the Justice Department has settled more than a dozen cases under the Stark Law, which prohibits improper financial inducements to doctors in return for patient referrals.

“My wish would be that the hospital-physician employee contract would go away,” said Reilly, now retired and entitled to $12 million of the whistleblower settlement. “You could pick just about any hospital, and I will tell you there is a component where that contract is driven by referrals.”

He is skeptical that accountable care organizations — collaborative groups of doctors and hospitals that are supposed to focus on keeping patients healthy and not on maximizing revenue — will change the dynamic.

Hospital hiring of physicians “not only fosters an environment to motivate physician referrals, but also blunts physician innovation, discovery and ingenuity,” he said.

What should patients do? Ask their doctor who he or she works for, Reilly added. If the doctor is employed by the hospital and recommends surgery or some other expensive treatment, he said, “research the indications for the procedure” and “consider a second opinion” from an independent practitioner.

AMA denounces insurance firms’ merger plans


Goya Giant I

One of Goya’s “Titan” paintings.

Two proposed mergers of U.S. health insurers  would hurt competition in the  health-insurance sector,  the American Medical Association, the  largest U.S. group representing physicians, said.

The AMA denounced Aetna’s plan to buy Humana and Anthem’s plan to buy Cigna as anti-competitive. Many physicians worry that the new, even bigger insurance companies that would be formed by these mergers would have the ability to force down U.S. physicians’ compensation — the  world’s highest compensation by far for doctors.

The insurers, for their part, assert that  that the deals would let them offer  cheaper insurance by using their increased size to negotiate better prices with physicians and hospitals.

The AMA said that the Anthem-Cigna behemoth  would increase market power in 13 states where the behemoth would sell individual insurance plans and competition would decrease in all 14 states where Anthem currently operates Blue Cross Blue Shield plans.

The Aetna-Humana combination, the AMA said, would raise anti-competitive issues in 14 states overall.

The American Hospital Association recently said that its analysis of the deals found that they would cut competition.

How about it, Dr. McAneny? What’s your SGR cure?


Rep. Larry Bucshon, M.D. (R.-Ind.), a cardiac surgeon and member of the House Energy and Commerce Health Subcommittee, asked Barbara McAneny, M.D., chair of the American Medical Association’s board of trustees, if the AMA could offer “substantial possible pay-fors” to cover the cost  of repealing the sustainable growth rate (SGR), which the Congressional Budget Office estimates as costing about $140 billion over 10 years.

MedPage Today reported that she said: “The AMA stands ready to assist and help by weighing in on any specific suggestions; we don’t really have the ability to give you specific pay-fors, because the devil is in the details.”

Dr. Bucshon, responded with frustration:  “I would implore you for the AMA to reconsider and maybe help us. If someone is going to offer an opinion at the end, you should be part of offering solutions on the front side …. If you are just going to wait and be a critic and not offer solutions yourself, to me it’s not very helpful.”



Contact Info

(617) 230-4965

Wellesley, Mass