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Issue Date: September 2007

Treatment of Chronic Illness Offers Lessons
Health care experts are seeking ways to improve the care of patients with chronic illness, such as arthritis, cardiovascular disease, cancer, and diabetes. Chronic illnesses are among the most prevalent, costly, and preventable of all health problems. The federal Centers for Disease Control and Prevention says chronic illnesses account for 70% of all deaths in the United States and more than 75% of the nation’s medical care costs.
What health care experts are learning about treating patients with chronic illness is somewhat heartening. For example, having patients participate in regular physical activity is associated with needing fewer medications and having fewer hospitalizations and physician visits, the CDC says.

MDs Making Changes in Mid-Career
An orthopedic surgeon worked for 17 years before realizing he wanted another area of medicine. Another surgeon started a training business. A third started writing an advice column. Each of these physicians offers an example of how it is possible to make a mid-career change and inject more excitement into one’s career. “In the business world, people change jobs 12 times in their work lives,” reports Robert Mestas, MD, medical director of Physicians Career Practice LLC, an assessment and counseling firm in Denver (at www.pcpllc.org). “But physicians never used to do so. They would stay in one job whether they were satisfied or not.” Dissatisfied with his work, the orthopedic surgeon met with Mestas to discuss his options. “During counseling, we found he thought more like an internist,” Mestas explains. “He made the switch, and loves it. And he didn’t even take much of a pay cut.” Mestas had another client, a successful cardiologist earning over $1 million annually, who was unhappy after 10 years in cardiology. Instead of leaving the profession, he cut back to part-time work. “He’s removed some of the stress, and is sorting out what he might like to do,” Mestas explains.

Leasing Offers Several Benefits
Hospitals are seeking new and innovative ways to affiliate with physician group practices that are much different than the affiliations hospitals used in the 1990s. These new relationships could involve some form of physician employment, meaning both the hospital and physicians would have a more formal business relationship than they have had in the past. In addition, these arrangements could reflect lessons both parties have learned over the years through relationships that were somewhat less than satisfactory. Every hospital has a physician integration strategy as a part of its overall strategic long range plan, and hospitals are physician-driven organizations. Therefore, hospitals and health systems must explore alternatives to physician affiliation aside from the traditional employment model. For both parties, hospitals and physicians could develop much more meaningful relationships than they have had in the past and these arrangements could go beyond the traditional physician employment and professional services arrangements that were popular years ago. For strategic reasons, many large hospitals and health care systems and even many small and rural hospitals are likely to be interested in developing new and various affiliation models. The large hospitals are seeking to increase their reach in the communities in which they operate and the small rural hospitals are interested in developing these arrangements in part because they have had so much trouble in recent years recruiting physicians.

E-Systems Solve Specialists’ Problems
Two years ago, Grand Valley Medical Specialists, PLC, had a problem. The company that made the DOS-based practice management system we were using to help us shift to paperless documentation decided it would no longer support the system. Our group of 20 physicians and 3 nurse practitioners was facing the prospect of having to invest in a new Microsoft-based system that could easily be integrated with our other systems, and most important, maintain the high quality standards on which our practice was founded.
Physicians and staff at GVMS knew that as a specialty practice, we had certain needs that not all systems could address appropriately. A few of our concerns were managing referrals from multiple groups, managing appointments, complying with the federal Health Insurance Portability and Accountability Act (HIPAA), communicating with patients, and writing prescriptions electronically. We wanted to take all of these factors into consideration while searching for a practice management system to complement our electronic health records system. We needed a system that had state-of-the-art technology, comprehensive functionality, and scalability.

Is Your 3rd-Party Biller an Asset?
As physicians running busy medical practices seek to become as efficient as possible, many often consider outsourcing billing and coding. When considering a third-party billing company, the practice should ask a number of probing questions such as: What goal is the practice trying to reach? Is the practice seeking greater efficiency? Is it seeking to be better organized? Does it want more credibility with patients and payers? Or is it simply seeking accurate billing and reimbursement? After a physician group asks itself these questions, it will be well on its way to making a sensible decision about hiring a company that will help it meet its goals. But before the billing company is engaged, there are a number of questions the practice should answer (see sidebar) and the practice should have its attorney review any contracts the practice signs with the billing company.

P4P Project Helps Boost Outcomes
All 10 medical groups participating in the Medicare Physician Group Practice Demonstration Project significantly improved the clinical management of patients with diabetes over the first year of the pay for performance (P4P) project, according to the Centers for Medicare & Medicaid Services. The three-year project, which began April 1, 2005, rewards providers for managing costs and improving outcomes of fee-for-service Medicare patients with chronic conditions. Performance during the first project year was based on 10 measures developed from evidence-based guidelines for patients with diabetes, including HbA1c management, HbA1c control, blood pressure management, lipid measurement, LDL cholesterol level, urine protein testing, eye examination, foot examination, influenza vaccination, and pneumonia vaccination. Evidence-based measures addressing congestive heart failure and coronary artery disease were added in year two, and measures addressing hypertension and cancer screening were added in year three. Demonstration project participants have the opportunity to share in savings generated from improvements in care.