Practice Beat

Joan R. Rose

The RN Shortage: Florida's solution: Train doctors to do the job

Facing an unprecedented nursing shortage, four South Florida hospitals will help fund a program to enable foreign-trained physicians to obtain bachelor of science degrees in nursing at Florida International University. The BSN program—which will be able to accommodate 40 physicians annually—requires students to pay one-third of their tuition, while the hospitals pick up the other two-thirds and underwrite the cost of faculty and support staff. In return, the doctors must promise to work as nurses at the sponsoring hospitals for three years following graduation.

In addition to helping relieve the burgeoning nursing shortage—the state is projected to need 34,000 additional nurses by 2006—sponsors say the program will provide a way for these doctors to make better use of their clinical education and skills. The program has already drawn 425 physician applicants, many of whom had been working as medical technicians and assistants.

Collective Bargaining: Will this Denver IPA rewrite antitrust rules?

The Federal Trade Commission has approved a proposal by MedSouth, a 432-physician IPA in Denver, to negotiate fee-for-service rates for its physician members—at least for now. Antitrust rules usually require that groups of otherwise competing physicians share financial risk through capitation or other means.

The IPA plans to develop a Web-based clinical data record system that would enable its primary care physicians and specialists to share patient information, practice protocols, and physician performance and utilization benchmarks. MedSouth successfully argued that its plan will lower costs while increasing quality and efficiency. An FTC analysis concluded that the improvements couldn't be achieved without joint pricing.

The Feds warned, however, that they will closely monitor MedSouth's activities and will recommend that the Commission take appropriate action if the group's conduct later appears to be anticompetitive.

Medicare: The reimbursement sieve is still leaking millions

Last year, Medicare carriers and fiscal intermediaries paid $12.1 billion in fee-for-service claims that should have been disallowed, according to a report from the HHS Office of Inspector General. That's up slightly from $11.9 billion the previous year, but IG Janet Rehnquist notes that the Feds' vigilance in taking steps to lower the rate of noncompliance has borne fruit. The portion of improper payments declined from 6.8 percent in 2000 to 6.3 percent in 2001—the lowest in six years.

As in past years, questionable claims most frequently involved medically unnecessary services, insufficient documentation, and miscoding. Of those, documentation errors represented the largest category in three of the last six years. In 2001, they accounted for an estimated $5.1 billion in improper payments—an increase of almost 20 percent over the preceding year.

Medicare's Improper Payments

Managed Care: Texas goes after millions in unpaid claims

In the ongoing battle to force health care plans to pay claims promptly, Texas Attorney General John Cornyn is suing PacifiCare of Texas. Three of the delegated networks that contracted with the HMO have failed, leaving behind an estimated tens of millions of dollars in unpaid claims. Although these failures resulted in turn from PacifiCare's own failure to monitor and manage those networks, Cornyn says, the insurer refuses to pay physicians and hospitals in those networks for services already rendered. In addition to seeking an injunction requiring PacifiCare to comply with state laws, the AG is asking the court to hold PacifiCare liable for actual damages, civil penalties, and restitution to those harmed by the health plan's actions.

The Texas Medical Association, which has repeatedly brought the issue of prompt pay to legislators and state agencies, is pleased to have "the state's top lawyer" on its side. But the group remains "deeply concerned about the entire pattern of misconduct by health plans across the state."

Our Web Poll

We asked physicians who visited our Web site (www.memag.com ) to tell us whom they trust more to prepare their tax returns.

Tax software

The paid preparer, but I'll use software to check his work

HIPAA Regs: HHS does an about face on privacy rules

In a stunning alteration of a proposed rule first issued in the waning days of the Clinton administration, HHS on March 21 announced that HIPAA would not require doctors and hospitals, among others, to obtain written consent before using or disclosing patient data for the purposes of treatment, payment, or health care operations.

The revised rules still require doctors to notify patients of their privacy rights, but patients needn't "acknowledge" or consent to those rights for treatment to move forward. The revision, HHS Secretary Tommy Thompson said, would eliminate "obstacles" to care "while continuing to protect patients' privacy." Reacting to the change, the AMA said it's for "modifying" patient consent, not dropping it altogether, while ACP-ASIM wants to see it retained. Consumer groups are still united in their support of the written consent requirement.

The final rule will be published pending a 30-day comment period, which began March 27.

Inpatient Care: How hospitalists are living up to their promise

Despite the skepticism that greeted their arrival in 1996, hospitalists are on their way to becoming the dominant model of inpatient care, according to a new study. Most physicians now accept the idea, researchers say, and 12 of the top 15 hospitals (as defined by US News & World Report) have hospitalist programs. Ultimately, the number of inpatient physicians is expected to nearly quadruple, from 5,000 today to 19,000.

The study found, moreover, that hospitalists reduce costs without adversely affecting quality of care. Researchers reviewed 19 published studies on the impact of hospitalist programs on financial and clinical outcomes. In 15 of them, hospitals using physicians who focus on inpatient care enjoyed significantly reduced costs (13.4 percent, on average) and lengths of stay (an average of 16.6 percent). How does that translate into dollars and cents? Researchers hypothesize that if the 5,000 American hospitalists care for an average of 600 inpatients yearly and generate a 10 percent savings over the average medical inpatient cost of $8,000, hospitalists are safely reducing inpatient costs by approximately $2.4 billion per year.

Robert Wachter (the physician who first coined the term hospitalist) is lead author of the study, published in the Journal of the American Medical Association.

The author is a Contributing Writer.

 

Joan Rose. Practice Beat. Medical Economics 2002;7:21.