Checking Up On Health: March 19, 2013

Benita Dodd  Vice President  Georgia Public Policy Foundation
Benita Dodd
Vice President
Georgia Public Policy Foundation

Health policy news and views
Compiled by Benita M. Dodd

Upcoming Foundation event on telehealth: Find out what’s happening around the nation and in Georgia – and what needs to happen – when it comes to innovative implementation of telehealth for greater efficiency, greater cost-effectiveness, better quality, better access and a better patient experience. Register now for, “Telehealth: Taking Health Care to the Next Level,” a Georgia Public Policy Foundation Leadership Breakfast at 8 a.m. on Tuesday, April 24, at Cobb County’s Georgian Club.

The panel discussion is moderated by Dr. Brenda Fitzgerald, Commissioner of the Georgia Department of Public Health, with panelists Dr. Jeffrey English of the Multiple Sclerosis Center of Atlanta, Dr. Jeffrey Grossman of Peachtree Spine and Paula Guy, CEO of the Georgia Partnership for Telehealth. The cost is $25 to attend; register online at Attire: business, business casual.

Seven hours of “urgent care:” I’m sharing a personal story about health care today. (We all have one, but I write the blog so I get to tell mine!) I was returning from an event in South Georgia on Friday night when I suddenly started feeling ill. My throat hurt and I warned the boss, who was driving, that I was unwell. After getting home past midnight, I spent a restless night and got up Saturday morning to head to the local doc-in-a-box (urgent care center). The parking lot was full, not a space to be found.

So I did what any self-respecting sick person would do. I Facebooked an appeal! A friend directed me to her GP, who she said was open until 1 p.m. on Saturdays. I called; they said turn up by 11 a.m. The doctor examined my throat, said, “Yes, you have a sore throat. Here’s a prescription for amoxicillin.” I guess there was no strep test, ear or nose exam because, as he told me in passing, he was trying to get home by noon to enjoy his weekend.

By Sunday, I was worse, wheezing and coughing up a storm. Monday, I went back to the urgent care center. Arrived at 1:30, signed in, was warned there was a two-hour wait. I had my iPad and phone, so I thought time would pass quickly. Three hours later, I was escorted to the exam room.  It helped (a little) that everyone was polite and apologetic about the delays. About a half hour, the doc came in, apologized for the delay, did a thorough exam, ordered X-rays and blood work. I ended up with beaucoup prescriptions and a painful steroid shot, which meant I had to stay 20 minutes for observation.

About 6:10 p.m. the tornado sirens sounded. Nurses, patients, admin and I sheltered in the X-ray room for 10 minutes. As I was dismissed and about to leave, the skies opened up, rain blew sideways, lightning flashed thunder exploded and everyone was ordered back into the X-ray room. I left at 6:25 p.m., stopped to fill prescriptions and got home after 7 p.m. I shudder to think of how long I would’ve waited for emergency care if the urgent care wait was that long. … On the bright side, I was so sick that none of the other ailing would sit near me, and I am now prepared for ObamaCare! At least it wasn’t the prospect of a group appointment.

And in related news: Amid sequestration and entitlement cuts there’s a boom in less costly urgent care centers opening across the country, Forbes magazine reports. Urgent care, also known as immediate care (pshaw, see above!), is similar to retail health clinics operated by Walgreen, CVS and Wal-Mart in that they are generally open in the evening and on weekends to treat routine maladies but also offer a board-certified physician and additional services such as on-site X-rays. More than 8,000 centers have opened with growth estimated at 8 to 10 percent annually, according to the Urgent Care Association of America, most of them run by nonprofit health systems. Forbes cites one system’s chief medical officer’s statement: “The best way to provide care for patients is by making health care accessible, through hours of operation, locations, quality medical services and affordable costs.” Forbes adds that those picking up the tab for health care welcome the moves toward less costly patient-care settings like urgent care, especially as Medicare and Medicaid programs move toward paying providers for coordinating care.

Get ready for group hugs in the waiting room: More doctors are holding group appointments, a trend some say may help ease a forecasted shortage of physicians, according to Kaiser Health News. According to a study published in December, meeting the country’s health-care needs will require nearly 52,000 additional primary-care physicians by 2025. More than 8,000 of that total will be needed for the more than 27 million people newly insured under the Affordable Care Act also known as ObamaCare. According to the American Academy of Family Physicians, 12.7 percent of family physicians conducted group visits in 2010, up from 5.7 percent in 2005. If you think this isn’t happening at a practice near you, read this response from a Facebook friend after I posted the article: “Seriously, my friend in Dallas (Ga.) is treated this way and she was quite uncomfortable with the doc sharing her info with a room of strangers. I had a nurse tell me that with the new regulations, your symptoms are put into a computer and it tells the doc what the acceptable treatment is. Cookie-cutter medicine.” Insurance typically covers a group appointment just as it would an individual appointment; there is no change in the co-pay amount. Oh, and typically, patients are asked to sign a non-disclosure agreement. I’m sure that makes a difference. (H/T to Randy Lewis for sharing the article on Facebook.)

Buy now, pay later: The 73 percent (average) pay raise for primary care physicians who treat Medicaid patients under the Patient Protection and Affordable Care Act will be delayed, according to an article in Forbes magazine. The payments were scheduled for Jan. 1, 2013, but are now three months behind. According to the report, Medicaid directors warn it could take another three months before the raise begins, but the Obama administration maintains the checks will be sent to physicians retroactive to the Jan. 1 date. Whenever. As I recall, “Under Georgia law an insurer must pay a penalty at the rate of 18% per annum on the amount of the unpaid claim beginning on the 16th working day up until the claim is paid.” Guess there’s no sauce for the gander.

Medicare makes mistakes? Unbelievable! Is this called a readmission? For the second time in six months, Medicare has erred in calculating penalties for more than 1,000 of the nation’s hospitals as it tries to crack down on repeat hospitalizations. As a result, Medicare has slightly lessened its readmissions penalties for 1,246 hospitals as part of its new program pressuring hospitals to ensure patients stay healthy health after they leave, according to Kaiser Health News, which reported on the data that Medicare published on its Web site.

Reworked Medicare payments need not involve taxpayers: Medicare needs $138 billion over the next decade to avoid steep cuts in physician pay, according to the National Commission on Physician Payment Reform, composed mainly of doctors, which says additional outside funding is unnecessary. Avoiding the pay cuts has become an annual scramble in Congress known as the “doc fix.” In a report released Monday, the panel concludes that Medicare can eliminate “marginal, harmful, ineffective, or unnecessary” services. The panel also said Medicare could save money on payments that vary based on where they are performed: Medicare pays $450 for an echocardiogram in a hospital, but only $180 when the procedure is performed in a doctor’s office. “There’s no reason for that whatsoever,” said one panel member. Overall, the panel called for speedy changes in Medicare’s fee-for-service payment system so that within five years doctors are rewarded for value, not volume. Source: Kaiser Health News 

Who’s hiring? More than half of the nation’s hospitals plan to acquire physician practices this year, according to a survey conducted by Atlanta-based Jackson Healthcare. In a survey of 118 hospital participants, 52 percent have acquisitions planned for this year, up from the 44 percent that acquired physician practices in 2012. The breakdown by specialty:
Family practice: 31 percent
Internal medicine: 22 percent
Primary care: 13 percent
Cardiology: 10 percent
Orthopedic surgery: 10 percent
Gastroenterology: 8 percent
General surgery: 8 percent
Urology: 8 percent
Obstetrics/gynecology: 7 percent
Oncology: 7 percent
Otolaryngology: 6 percent
Neurology: 5 percent
Nurse practitioner: 5 percent
Pulmonary medicine: 5 percent. Source: Becker’s Hospital Review

Too big to fail? The phrase “Big Medicine” was propelled by Atul Gawande, MD, in a New Yorker op-ed in which he drew analogies between American health care and The Cheesecake Factory restaurant chain. “Big chains thrive because they provide goods and services of greater variety, better quality and lower cost than would otherwise be available,” he wrote. “Size is the key. It gives them buying power, lets them centralize common functions and allows them to adopt and diffuse innovations faster than they could if they were a bunch of small, independent operations.” Data show that 2011, the latest year available, brought 86 hospital merger or acquisition deals — the highest number in the past decade. And more are on track, according to an article in Becker’s Hospital Review, which cautions, “But Big Medicine and mega-mergers involve an entirely new set of organizational challenges, too.” Read more here.

Quotes of Note

In this age of technology, I feel justified in getting Quotes of Note from YouTube! Here’s a link to a great YouTube precautionary tale in song: “Dumb Ways to Die:”

“The best six doctors anywhere
And no one can deny it
Are sunshine, water, rest, and air
Exercise and diet.
These six will gladly you attend
If only you are willing
Your mind they’ll ease
Your will they’ll mend A
nd charge you not a shilling.” – Nursery rhyme quoted by Wayne Fields, “What the River Knows”

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