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Issue Date: December 2007

Are Health Plan Ratings Unfair to Physicians?
A number of physicians are unhappy about health plan efforts to rate physicians so they can place them in tiers according to how well they deliver care to plan members. The problem is that health plans rate physicians according to algorithms they apply to claims data. Then, plans place those physicians who have the best quality and cost scores in the upper tiers. Those physicians who have lower scores are placed in lower tiers. Plans then publish lists of these doctors and some are steering patients to higher-scoring physicians. For physicians, a particularly onerous aspect of this system involves the plans’ use of proprietary software to rate physicians. Since the data are unavailable to physicians, physician associations in Connecticut, Washington State, New York, and elsewhere have complained that the process is unfair.

Physicians Join the Blogosphere
Benjamin Kruskal, MD, PhD, misses the days when he had time to sit with his colleagues over a cup of coffee to discuss clinical and practice-related concerns. A pediatrician, Kruskal has joined several physician-only online communities and started his own blog to interact with physicians and
others in health care. In March, Kruskal launched his blog (at http://drbensblog.com) to add his voice to the debate about how “to improve our health care system from the micro to the macro level.”
A blog (short for “web log”) is an online journal or personal diary that can be updated regularly with easy-to-use content management software. Typically, blogs include a front, or home page, with dated posts starting with the most recent, a list of topic categories, a dated archive, and links to other related online content. Most blogs allow visitors to post comments in response to the blogger, often leading to an ongoing dialogue about issues.

EBM: Often Admired, Seldom Practiced
Evidence-based medicine is often admired but seldom practiced. It is rarely practiced because few physicians have the time to appraise the medical literature critically. This reality is unfortunate considering the astounding improvements they could make in quality if they did have the time. Three published estimates suggest that physicians are directing 80% of the spending in our $2 trillion health care market. Yet if one considers the lack of information that physicians bring to these spending decisions, frankly, it is primitive and pathetic. Imagine physicians as purchasing agents with $2 million annual budgetary authority. Studies show that as physicians we don’t know how much the drugs and diagnostic tests cost that we order, and that we lack comparative information about their effectiveness and adverse effects. Furthermore, our compensation is largely disconnected from the quality and cost-effectiveness of our performance. Is it any wonder that the United States has the most expensive health care system in the world, while perennially ranking near the bottom of industrialized countries in such metrics as healthy life expectancy?
Evidence-based medicine (EBM) is often promoted as the solution to much of what ails our health care system. It promises to displace authority-based medicine, wherein practicing clinicians simply follow the recommendations of experts in the health care community. These so-called experts usually are affiliated with distinguished academic medical centers with successful college football programs. The actual practice of EBM requires clinicians to formulate carefully structured questions about clinical problems in specific patients and then to perform searches of the medical literature to find valid randomized controlled clinical trials that contained patients representative of the particular patient being treated. This process usually takes the better part of an hour per question. If the true practice of EBM takes too long and is not compatible with having a financially viable medical practice, and if most physicians lack expertise in critical analysis of sophisticated medical studies, then what can dedicated physicians do to improve the quality and cost-effectiveness of their care? The answer is advanced tools and economic incentives to optimize health care outcomes for patients. The state-of-the-art in evidence-based medical practice involves the integration of context-specific rules-based clinical decision support messages into electronic health records, according to an article last year in Evidence-Based Medicine (2006;11;162-164) by R. Brian Haynes.

Speech Recognition Speeds Data Entry
For many physicians, electronic medical record (EMR) systems offer the potential to improve the quality of health care they deliver and reduce costs as well. However, many factors inhibit widespread adoption of EMRs, and one of the most significant roadblocks for physicians is the high installation and operating costs of these systems. EMR systems also can be inflexible and have other limitations that often prevent physicians from using them. Many physicians find that EMR systems are more effective with the help of enabling technologies. For the physicians at the Lifetime Health Medical Group, an example of enabling technology is speech recognition software to assist with transcription. We installed speech recognition technology shortly before implementing EMR systems in our offices in Buffalo and Rochester, N.Y., and experienced a smooth integration of the two technologies. The Rochester offices began EMR implementation in late 2006, while Buffalo began implementation early this year. In both places, speech recognition technology was implemented prior to EMR, and then integrated into the system. In both cases, the results were pleasantly surprising.

Sell Your Practice With a Buyout Fund
Physicians often fear they will not be able to sell their practices for any significant value. Many financial and practice advisors say there is no white knight coming along to buy practices for seven-figure sums, especially if the selling physicians will be retiring in the same year or in the near future. In fact, few physicians have built a solid plan for a lucrative buyout based on their existing advisers’ help. But there are ways to sell a practice for millions of dollars and they require planning and preparation. It is not necessarily true that an outside party such as a management company or insiders such as younger doctors will cut you a seven-figure check as you are about to retire. If the physician’s buyout plan is to see patients with no forethought about how to sell the practice upon retirement, it is highly likely that the physician will get virtually nothing for the practice. On the other hand, if a physician begins when he or she starts a practice to fund a buyout vehicle for the practice, the physician can almost be assured of getting a multi-million dollar check upon retirement.

Broker Sees Positive Trends for CDHPs
In this interview, Jeffrey Hogan, the New England/New York/New Jersey regional manager in Farmington, Conn., for Rogers Benefit Group Insurance Brokerage, Inc., discusses what physicians should know about high deductible health plans and health savings accounts (HSAs). There is a groundswell toward consumerism in health care, and the pace is picking up, said. About 95% of the companies that Rogers Benefit Group quotes are installing some aspect of consumer directed health care plans in their strategies to contain health costs, he added. "By moving toward consumer directed care, these companies are now requiring employees to be educated about cost and quality," he explained. "That means doctors will be seeing patients who feel empowered to evaluate cost and quality and who have done their homework. In this new marketplace, physicians who are on the top of their game, who can show tangible evidence of value and quality, and who treat patients in a consumer-friendly way, will be the most successful."