Tuesday, April 22, 2014

Short Office Visits Strain Patient-Physician Relationship

An unfortunate trend is emerging in health care that’s leaving both patients and their physicians frustrated ― the 15-minute office visit. Buckling under financial pressure from declining payment rates, many doctor’s offices are scheduling patient visits at ever-shrinking intervals. The result is a more harried visit with time focused chiefly on the patient’s complaint and less on overall health.

Kaiser Health News reports:
“By all accounts, short visits take a toll on the doctor-patient relationship, which is considered a key ingredient of good care, and may represent a missed opportunity for getting patients more actively involved in their own health. There is less of a dialogue between patient and doctor, studies show, increasing the odds patients will leave the office frustrated.”
It is a widespread problem, and one that could get worse as more Americans get health insurance through the Affordable Care Act. Kaiser reports the 15-minute appointments started after “Medicare’s 1992 adoption of a byzantine formula that relies on ‘relative value units,’ to calculate doctors’ fees.” Read more.

Monday, April 21, 2014

Putting the Medicare Data in Context

By Todd Pollock, MD
President, Dallas County Medical Society

In a stated effort to be “more transparent” and “help patients make informed decisions about the care they receive,” the Center for Medicare & Medicaid Services (CMS) has released information on its payments to physicians. This made the headlines of every news show and newspaper last week. Headlines reveal staggering dollar amounts paid out to the physicians who serve the elderly and disabled, and highlighted a handful of physicians who collected millions. Conventional wisdom among physicians is to avoid the topic of compensation, but this information release and the headlines that followed necessitate a response to inject some balance and perspective.

Is this raw payment data helpful to the public in making informed health care decisions? It is highly unlikely and is more likely to deceive and inflame the public. To start, the number of physicians who collected millions of dollars from Medicare — the focus of the headlines — is represents less than 0.4% of physicians in the U.S., with a similar percentage in Texas. And, the dollar amount a physician collects tells nothing about that physician’s net income, quality of the care they provide, or whether there is any waste, fraud or abuse associated with those payments. The vast majority of physicians collects much smaller amounts and is in fact poorly compensated for the work they do by these government insurance programs.

The reality is that payments from Medicare are meager and barely cover expenses. On average, 61 percent of Medicare’s payment goes towards the treatments’ overall cost —expensive drugs, medical supplies and other expenses of running a business. The problem starts with how Medicare payments are determined. In medicine, unlike other businesses, charges don't reflect what physicians are ultimately paid for the services they provide. The amount physicians are paid by CMS for a service they perform is derived by a formula adapted by congress in 1997 with the express purpose of controlling costs. These fees have not been increased, despite inflation and increasing medical costs, since its inception. In fact, using this formula, Medicare payments to physicians would have been cut 24.1 percent this year had Congress not stepped in to avert it. This unfair payment formula has been slated for overhaul for over a decade, but instead it was kicked down the road for the 17th time with a short-term patch. The unwillingness to permanently address this important payment issue has caused great concern among physicians, further limiting patient access as physicians often limit the number of new Medicare patients they accept into their practices.

CMS admits that this data has limitations as it acknowledges that the information has not been verified, does not account for the disease severity of patients being treated, does not account for overhead costs of the treatments, and cannot possibly asses the quality or, more importantly, the value of care. In fact, due to the potential for inaccuracies and lack of context, this raw data is more likely to mislead the public rather than aid them in making an informed decision about their health care.

Despite this poor reimbursement, most physicians continue to treat the Medicare community out of a deep feeling of commitment to serve their patients. There is almost certainly waste, fraud, and abuse in any system as large and with as much money in play as Medicare. As a taxpayer, when waste is found, I absolutely want CMS to root it out and develop ways to avoid it. When fraud and premeditated abuse are uncovered, I expect it to be prosecuted to highest degree allowed by the law. But, this raw data — unverified and lacking in perspective — has garnered headlines and unfairly portrays the physician as at best, excessively compensated, and at worst, criminal. Rather than focus on the few who collect large sums, this information release should shed light on how inadequately most physicians are compensated under Medicare. Only a more detailed analysis of the typical physician’s Medicare compensation will provide patients and policy makers with a more accurate picture.

Friday, April 18, 2014

Historic Texas City Explosion Featured in TMA Exhibit

The deadliest industrial accident in U.S. history 67 years ago this week in Texas City — one that changed the state’s emergency response system — is chronicled in a Texas Medical Association (TMA) exhibit.

TMA’s History of Medicine Gallery exhibit, “Bugs, Bones, and Blood,” features artifacts from the April 16, 1947, tragedy in the harbor town southeast of Houston. Dental records used to identify victims, telegraphs reporting victims, photos, and medical equipment and supplies used to treat patients now are on display at TMA.

The Texas City event began with a fire on the Grandcamp, a U.S. Liberty ship built to deliver cargo during World War II. As firefighters battled the blaze, the ship exploded, killing nearly 500 people and leaving another 100 people missing. Within 24 hours, the High Flyer ship also exploded, killing two more people.

The aftermath of the explosions and fires underscored the importance of direction and coordination in emergency response. This led Texas to establish a state emergency management office to coordinate and quickly direct the help needed.

The Texas City scene was chaotic.

“We started operating ... one patient after another, too numerous to count, and didn’t stop through all of Wednesday afternoon, Wednesday night, Thursday morning, and afternoon, and Thursday night,” described the late John M. Thiel, MD, a faculty member in the Department of Surgery at The University of Texas Medical Branch (UTMB) the day of the Texas City disaster. “Finally at 7 o’clock in the morning on Friday, I was able to stop, along with members of my operating team, to obtain some rest.”

He described the scene as being in a “war theater and attending to casualties of a war conflict … .”

The TMA display also features a letter from the late Sam Nixon, MD, describing his experiences during the tragedy, and his personal resolve as a result. “I decided the medical profession is the only thing for me. I have had my ups and downs on it ... . But not anymore,” wrote the first-year UTMB medical student in a letter to his parents. The young Mr. Nixon later became a physician and served as TMA president in 1991-92.

Bugs, Bones, and Blood” examines the history of forensic medicine, which began when a forensic pathologist and other experts searched for a cause when death was sudden or mysterious. The Kennedy assassination is among the events featured in the exhibit, which traces forensic medicine back to its roots some 5,000 years ago.

The exhibit includes images and artifacts from the TMA archives, as well as contributions from the Blocker History of Medicine collections, Moody Medical Library, and The University of Texas (UT) Medical Branch, Galveston; Moore Memorial Library, Texas City; The Sherlock Holmes Society of Austin, Texas Department of Public Safety, and Historical Museum, Austin; and the UT Southwestern Library Archives, Dallas.

Thursday, April 17, 2014

Cancer. The Big C.

By Rep. Ruth Jones McClendon (D-San Antonio)

Cancer. The Big C.

For anyone who has heard this chilling diagnosis from your doctor, my heart goes out to you. I have been there.

The Big C is also The Big Scare. And for me, having been diagnosed with Stage 4 cancer in 2009, it is also The Big Fight.

I fought and beat the odds against cancer. I am blessed and grateful, and I am a woman on a mission. Now my fight is to do as much as I can to keep my fellow Texans from losing to The Big C.

The solution is The Big P. Prevention is by far the best path.

Three years ago, I authored a state law declaring April as Minority Cancer Awareness Month in Texas.

On April 3, I hosted a legislative briefing at the Capitol, along with my good friend and colleague Rep. Myra Crownover, R-Lake Dallas, herself a champion for smoke-free public places. Over and over, we heard that the best defense is a good offense: prevention, prevention, prevention.

Dr. David Lakey, commissioner of the Department of State Health Services, explained that this year alone, more than 119,000 Texans will likely be diagnosed with cancer and more than 44,000 Texans will die from cancer. Malignant cancers are the second-leading cause of deaths in Texas, after heart disease. African-American males are the single most vulnerable group. Compared with white non-Hispanics, minority groups (African-American, Hispanic and Asian/Pacific Islander) show a greater incidence of all cancer sites.

During Minority Cancer Awareness Month, I urge my fellow elected officials, religious and community leaders, and residents to make prevention a priority. Sadly, cancer does not bypass any group based on social or economic status, religious affiliation, race or ethnicity. According to the Texas Cancer Registry, the hazard of cancer affects minority populations more than others. That's why prevention is crucial. Through cancer education, screenings and cancer prevention policies, we can significantly reduce the number of cancer fatalities among people of all ethnicities.

Dr. Debra Patt, past chairwoman of the Texas Medical Association Committee on Cancer, knows how to reduce cancer and its mortality rates in minorities.

“Screening for cancers to the cervix, lung, colon, breast, and prostate exist,” she says. “We need to reduce barriers to access to screening. We need to reduce barriers to access to care. Primarily, we can prevent tobacco-related cancers by supporting reduced exposure to tobacco and policies that promote cessation and reduced exposure.”

Some clear trends have emerged over the past 20 to 30 years. Dr. Lorna McNeill, associate professor of the M.D. Anderson Department of Health Disparities Research, explained how a healthier diet and better exercise habits will help decrease the incidence of cancer and improve the prospect of early diagnosis.

She emphasized most Texans lead sedentary lives and practice physical activities less than in 1990. We rely on cars, use electronic entertainment and computer-centered workplaces, and eat more fast foods and larger portions. In lower income areas, there is often poor access to healthier foods and fewer low-cost or no-cost options to exercise in safe areas; reversing that would help lower the incidence of cancer. The city of San Antonio is making smart changes to the infrastructure and the habits of its residents through the Mayor's Fitness Council and as part of SA2020. Other cities should follow its lead.

Cigarette smoking is the No. 1 risk factor for lung cancer, causing about 90 percent of all U.S. lung cancers. Between 2007 and 2011, both the cancer rate and mortality rate of lung cancer was higher among African-American males than any other group. In Texas, 273 municipalities have banned cigarette smoking in public places, and we need to take that further.

We can change the effects of The Big C in our communities and our state by making prevention a priority. Exercise regularly. Eat healthy foods. Promote healthy habits at school and at work. Get regular checkups. Quit smoking.* Spread the word and do your part during Minority Cancer Awareness Month.

*Texas Quitline: 1-877-YES-QUIT

Representative McClendon serves on the House Committee on Appropriations and the 
House Committee on Transportation. She also serves as Chair of the House Committee on Rules & Resolutions.  

Wednesday, April 16, 2014

Physicians Help Create a Healthy Texas Economy

New study demonstrates physicians generate $78.6 billion in economic activity

Physician practices add value to Texas’ economy by producing tens of billions of dollars in revenue each year and providing hundreds of thousands of jobs. “The National Economic Impact of Physicians,” a new study conducted for the American Medical Association (AMA) and state medical societies, found Texas’ 47,000-plus practicing physicians boost the state’s economy by supporting 522,619 jobs and generating $78.6 billion in economic activity.

Texas Medical Association (TMA) President Stephen L. Brotherton, MD, says, “Unlike last week’s Medicare payment data dump, these numbers are supported by solid analysis and reported in rich context. The bottom line is that Texas’ physician practices, without a doubt, are good for the economic health of our communities and our state.”

The economic benefit of doctors’ offices goes beyond the hundreds of thousands of direct jobs they support, including the quite-quantifiable ripple effect of those jobs and tax dollars through the local economy.

“Physicians carry tremendous responsibility as skilled healers charged with safeguarding healthy communities, but their positive impact isn’t confined to the exam room,” said AMA President Ardis Dee Hoven, MD. “The new study illustrates that physicians are strong economic drivers that are woven into their local communities by the economic growth, opportunity, and prosperity they generate.”

The findings in Texas cover these four key economic barometers:

  • Jobs: Each physician supported an average of 10.8 jobs and contributed to a total of 522,619 jobs statewide.
  • Output: Each physician generated an average of $1,627,498 in economic output and contributed to a total of $78.6 billion statewide.
  • Wages and Benefits: Each physician supported an average of $890,990 in total wages and benefits and contributed to a total of $43 billion statewide.
  • Tax Revenues: Each physician supported $52,618 in local and state tax revenues and contributed to a total of $2.5 billion statewide.

The report found that Texas physicians generate significantly more economic output (i.e., medical and nonmedical sales revenues) than the legal industry; produce more jobs than colleges, universities, and nursing homes combined; and pay more in wages and benefits than all Texas hospitals.

Across the country, the nation’s 720,000 practicing physicians support 9.9 million jobs, generate $1.6 trillion in economic activity, support $775 billion in wages and benefits, and generate $65.2 billion in state and local tax revenue. To view the full national report and an interactive map of the United States, visit www.ama-assn.org/go/eis.

“The National Economic Impact of Physicians” was prepared for the AMA by IMS Health.

Tuesday, April 15, 2014

What the Medicare Numbers Reveal ― and What They Don’t

By Bradford W. Holland, MD
Waco Otolaryngologist  

On Wednesday, April 9, the Centers for Medicare & Medicaid Services (CMS) did something they have never done before. They released information detailing how the $77 billion that Medicare spent to pay physicians for their services in 2012 was distributed among the 880,000 providers in the U.S. This caused a small uproar in the media (which is already dying down) about how much certain physicians were paid in that year. However, it quickly became clear there were a lot of misconceptions about what the numbers mean. So, here's a few thoughts on what we learned from this new information.

The information released is good information. It is accurate and reflects data points the public and watchdog agencies ought to be monitoring. The government, as a massive (and unfortunately, growing) payer in the health care market should be transparent in reporting its payments. The data may, as expected, help all of us weed out those bad seeds who fraudulently bill the government for services they don't provide. Believe me, doctors join patients in wanting to end Medicare fraud completely.

But one thing the data do not show is how much your doctor earned. Consider a standard corner gas station, which might sell $4 million worth of gas in a year. Does that mean the owner is a millionaire? Well, considering that the owner probably paid at least $3.75 million for the gas — then has to pay rent, electricity, wages for staff, etc. You can see that such a number really doesn't tell you anything about how much the gas station made in net dollars.

The same holds true when trying to interpret what these dollar figures mean about your physician's pay. While you can see how much your doctor was paid by CMS, it really has nothing to do with how much your doctor actually brought home in the form of a paycheck.

There is one more thing you can see from this data, and that's how poorly Medicare pays physicians for their services. My practice charges $122 for a comprehensive hearing test, performed by a master or doctor of audiology, and takes 15-30 minutes. On average, Medicare paid us $22 for the test. We charge $361 to perform a laryngoscopy (inserting a camera through the nose to look at the voice box), but Medicare paid $83. And when we perform a swallowing test with an x-ray machine and barium, we charge $338 but only get $63. Numbers like this show why senior citizens are having a hard time finding doctors. Medicare doesn't pay enough to even cover the overhead of these and most other procedures. That's a real problem, not only for physicians, but for the patients on Medicare whom we are trying to treat.

Truth be told, the data show that Medicare paid, on average, and across the entire United States, about $57 to the physician for every office visit. $57. Now you can't even have a stopped up toilet inspected by a plumber for that much, let alone have any plumbing really fixed. Do senior citizens on Medicare really expect that their doctor is paid less to listen, examine, diagnose, and treat their health problems than a plumber charges for a simple toilet clog? Most Medicare patients are aware of these discrepancies, and are generally sympathetic to their physician's plight, but really can't do anything about it. Senior citizens are being caught between a rock and a hard place in this federal Medicare system, and one thing is for sure: It is not their fault.

Let me say that I, like most physicians, greatly enjoy taking care of seniors, despite having to deal with Medicare. They are some of my favorite patients, and I feel a debt of gratitude to their generation to see them, treat them with compassion, and yes, learn from them. Caring for seniors is one of the most rewarding parts of being a doctor. I don't want that to end, but the predicament I'm in as a private practice physician is making caring for Medicare patients more and more difficult. And so, as something else that will perhaps come of this new data released last week —we need to ensure the health of our nation's seniors is not further jeopardized by the Medicare payment system currently opened to scrutiny by the public. I hope a better future for Medicare awaits us all.

Monday, April 14, 2014

Challenging Ethnic Disparities in Cancer Care

Dr. Patt speaks at the Minority Cancer Awareness Month press conference
By Debra Patt, MD, MPH
Austin Oncologist

April is minority cancer awareness month.

As a physician in Texas, I often see disparities in disease that vary by ethnicity.  I know that due largely to barriers to access to care, minority patients are less likely to get screened for cancer then are more likely to develop advanced-stage cancers.  Advanced-stage cancers are more aggressive to treat (often requiring chemotherapy) and harder to cure. Debilitation and death become more likely when cancer is more advanced.

Recently, I had an opportunity to speak at an event hosted by Rep. Ruth Jones-McClendon (D- San Antonio) to commemorate Minority Cancer Awareness Month. I appreciate Representative Jones-McClendon's efforts to heighten awareness of cancers among minorities and for hosting this event at the Capitol. She is an amazing woman, a champion of this cause, and a voice of inspiration in cancer survivorship. Being a five-year survivor of metastatic lung cancer, she shares in our passion to eradicate this disease.

As doctors in Texas, we have an opportunity to educate our patients and help facilitate appropriate cancer screening, access to appropriate and timely cancer care, and most important, cancer prevention with encouraging healthy behaviors. Encouraging smoking cessation, referring for smoking cessation resources, supporting smoke-free policy, and encouraging healthy eating and physical activity would all help make our patients healthier and reduce the risk of death from cancer.

Cancer death remains a leading cause of death for all Texans. It is a risk that is higher among minorities. Lung cancer, by far, remains the greatest threat. The threat of lung cancer can be reduced almost completely by avoiding tobacco exposure. When patients have a strong history of tobacco exposure, risk of death can be substantially reduced with appropriate screening for lung cancer with low dose CT scanning.

We must try to help all patients — regardless of ethnicity — receive the care and screenings they need. In the words of Benjamin Franklin, "An ounce of prevention is worth a pound of cure."



Share This