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Online Update


Don't forget about follow-up

When asked to select one of five things that would most improve their next appointment, aside from more face time with their physician, patients said they wanted more attention and follow-up after the visit. The nationwide survey of 1,000 adults found that nearly one in three (31 percent) prefers follow-up interaction to knowing more about what to expect in terms of the doctor's expertise, procedures to be performed, and costs (26 percent) or to being able to arrange an appointment without having to call during office hours (24 percent). Remarkably, patients cared far less about having fewer papers to fill out in the waiting room (13 percent) and conveniences like heated exam tables (6 percent). Market researcher Synovate conducted the survey for DoctorsDirect.com, which allows patients to research physicians in their area and, in some cases, book appointments online.

What a difference a year makes

When evaluating mutual funds, it's wise to ignore one-year returns and focus on longer periods. But until recently the five-year records of many funds—especially growth and technology funds—have stunk up the joint, to put it mildly. Now, with the recent bear market well behind us (the bottom was in late 2002), many funds that were once looking like dogs show five-year records that have vastly improved, according to an analysis conducted by The Wall Street Journal using data from Morningstar. For instance, the five-year average annualized return of Fidelity Aggressive Growth was -13.2 percent through 2005. However, through 2006, the five-year number crept into the black, at 0.4 percent. Likewise, Putnam New Opportunities, a large-growth fund, saw its five-year average annualized return improve from -4.9 percent to 3.9 percent.

Pay for value instead of P4P?

Two executives of the Mayo Clinic are calling for a reimbursement system based on achieving good outcomes at lower costs as an alternative to "piecemeal" pay-for-performance plans that encourage adherence to evidence-based standards. The "Pay for Value" model would increase insurance payments to healthcare providers whose patient mortality and satisfaction—as measured by whether the patient would recommend the provider to a friend—are better than average, and whose costs over time are below average. Physicians and hospitals with worse outcomes, less-satisfied patients, and higher costs would have their reimbursements slightly reduced. "Pay for Value looks at both sides of the equation, quality and cost, and defines quality in a way that's meaningful to patients," says Robert K. Smoldt, the Mayo Clinic's chief administrative officer, who co-authored his commentary with President and CEO Denis A. Cortese, MD, in the February issue of Mayo Clinic Proceedings. For the full text, go to www.mayoclinicproceedings.com.

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