Ilovebenefits’s Blog

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The Value of Retail Clinics

Time, money are factors in decision to use retail clinics
A survey found that people would rather see their primary care provider but if that is not possible they are likely to use a retail-based clinic. People were willing to see a nurse practitioner at a retail clinic if they could save at least $31.42 and would wait a day or more to do so if they could save at least $82.12. Los Angeles Times/Booster Shots blog (3/8)


March 10, 2010 Posted by | healthcare, innovation | , , , , | Leave a comment

From Fee for Service to Fee for Care

Support grows for move to bundled payments
Many health policy experts say it is time to dump fee-for-service physician reimbursement and move to a bundled payment model that could save money without reducing quality of care. Pilot programs have shown that the model can offer high-quality care, greater patient satisfaction and lower costs. The Washington Post (3/9)

Group appointments are a growing trend
Health care providers say patients like group appointments because they cut down on wait times, give them more face time with physicians and allow them to share experiences with other patients. The Future of Family Medicine Project named group visits one of 10 trends to be taken seriously. The Washington Post (3/9)

March 9, 2010 Posted by | healthcare, quality, Reimbursement | , , , , | Leave a comment

Is the Work Ethic of Physicians Changing

Editor’s note: As physicians retire and as younger physicians take their place they are seeking a work/life balance.

According to a recent report, the average hours worked by U.S. physicians dropped from 55 per week in 1996 to 51 in 2008, coinciding with a nationwide 25% decrease in physician fees between 1995 and 2006, after adjusting for inflation.

Source: “Trends in the Work Hours of Physicians in the United States,” Journal of the American Medical Association, Vol. 303 No. 8, February 24, 2010,

March 3, 2010 Posted by | physicians, Reimbursement | , , | Leave a comment

Study: 26% of referrals for imaging scans were inappropriate

A study of the medical records of 459 patients referred by their primary care physicians for diagnostic CT, MRI or PET scans found that 26% of the referrals weren’t appropriate because they didn’t follow guidelines that closely resemble those created by the American College of Radiology. The study results “suggest a need for tools to help primary-care physicians improve the quality of their imaging decision requests,” the lead author of the study said. Modern Healthcare (free registration) (3/2)

March 3, 2010 Posted by | Cost, healthcare, Overuse, physicians, quality | , , , , , , | Leave a comment

Extension of the Medicare Physician Payment Update

President Signs Into Law Temporary Extension of COBRA Premium Subsidy, Unemployment Insurance, and Medicare Physician Payment Update

President Obama signed into law on March 2, 2010 a bill to temporarily extend emergency unemployment benefits, the COBRA premium subsidy program, and a Medicare physician payment update, along with other programs, all of which had expired on February 28. The “Temporary Extension Act of 2010” (H.R. 4691), which was passed by the Senate on March 2 and the House on February 25, continues the emergency unemployment compensation program through April 5, 2010. It also extends the 65% COBRA premium subsidy included in the American Recovery and Reinvestment Act (ARRA) (P.L. 111-5) through March 31, 2010. In addition, the law expands eligibility for the COBRA premium subsidy to certain individuals who are involuntarily terminated after they experience a qualifying event of reduction in hours. Also included in the law is an extension of the Medicare physician payment update, which sustains current Medicare payment rates for physicians (preventing a 21% payment reduction) through March 31, 2010.

The full text of H.R. 4691 is available here.

March 3, 2010 Posted by | Federal Government, healthcare, Medicare, physicians | , , , , , | Leave a comment

Where are the Health Care Dollars Going


While the high cost of private health insurance has drawn plenty of attention in the health reform debate, an underlying driver of higher insurance premiums–the growing market power of hospitals and physicians to negotiate higher payment rates–has gone largely unexamined, according to a Center for Studying Health System Change (HSC) study published online Feb. 25 by Health Affairs.

Funded by the California HealthCare Foundation, the study examines the growing market power of many California hospitals and physicians, finding that providers are using various strategies, such as tighter alignment of hospitals and physician groups, to negotiate significantly higher payment rates from private insurers. The authors point out that California offers a cautionary tale for reform proposals that encourage hospitals and physicians to form tighter relationships through accountable care organizations.

“Health insurers have been squarely in the crosshairs and blamed for the high cost of private insurance, while the role of growing hospital and physician market power has escaped scrutiny,” said HSC Senior Consulting Researcher Robert A. Berenson of the Urban Institute, a coauthor of the study with HSC President Paul B. Ginsburg and Nicole Kemper, a former HSC research analyst.

March 1, 2010 Posted by | healthcare, hospitals, insurance, physicians | , , , , | Leave a comment

Physician Hours Declining

Editor’s note: It is likely a more complex root cause. It is more than simply payments. Values, cultural changes and other interests are likely to play a role.


Physician work week hours drop, study says
The average number of hours worked by U.S. physicians dropped from 55 per week in 1996 to 51 in 2008, a report said. The reduction was linked to lower physician payments, which decreased 25% from 1995 to 2006, data showed. Bloomberg (2/23)

February 24, 2010 Posted by | healthcare, physicians, Reimbursement | , , , | Leave a comment

Accountable Care Organizations (ACO)

Boldly going where few health care systems have gone before, Baylor is exploring the universe of accountable care. The 13-hospital, 4,500-physican health care system based in Dallas is placing itself front and center of insurance companies, employers, and patients themselves as it takes on the role of accountable care organization, a concept still not fully baked. It aims to convert itself to an ACO by 2015.

Generally speaking, an ACO is a local health care organization plus such providers as physicians, hospitals, therapists and home care workers. Collectively, they are accountable to each other for the cost and quality of care relative to established metrics. When they meet or exceed cost and care objectives, they receive a bonus. For most in the health care industry, the ACO concept presumes that doctors or hospitals will fill the role, stands in contrast to earlier reform efforts that tapped insurers as cost guardian.

February 22, 2010 Posted by | Accountability, healthcare, hospitals, physicians | , , , | 1 Comment

Patient Compliance With Doctor’s Orders

UnitedHealthcare’s cancer treatment non-compliance rates for selected diseases

Disease Non- Compliance Rate Rule
Breast Cancer 17% Patients with a genetic marker indicating a favorable response to the drug Herceptin should receive that drug.
Colon Cancer 61% Patients should receive ultrasound prior to treatment in order to determine how far the tumor has spread and to plan for treatment
Colon Cancer 31% Patients with early-stage colon cancer should receive chemotherapy or radiation after surgery.
Lung Cancer 31% Patients should receive pulmonary-function testing before treatment
Lung Cancer 24% Patients should be given Avastin only if they meet the following criteria: Non-squamous cancers only and no history of coughing up blood.


Data Source: UnitedHealthcare

Publication: The Wall Street Journal, February 9, 2010. “Insurer Plays Judge on Cancer Care: UnitedHealthcare Sends Doctors Individualized Reports; a Complaint on Email.”

Related Article for reference: “UnitedHealthcare Creates Adult National Cancer Care Registry With Data and Analysis to Support Oncologists in the Fight Against Cancer.” UnitedHealthcare, February 9, 2010


February 16, 2010 Posted by | healthcare, physicians, Prevention and Wellness, quality | , , , , | Leave a comment

Health Care Supply and Demand

Editor’s note: Of particular positive interest is the comment that there will be a focus on training primary care physicians.


More U.S. medical schools open to answer demand
Almost two dozen medical schools have opened recently or plan to open soon, a trend that could help to correct an enrollment imbalance of students going abroad for medical training while U.S. hospitals bring in foreign-trained and foreign-born physicians to fill medical residencies. Some of the new schools plan to focus on training doctors to serve primary care needs in immigrant and disadvantaged communities. The New York Times (2/14)

February 15, 2010 Posted by | healthcare, physicians | , , , | Leave a comment