June 8, 2012
By C. Elizabeth O'Keeffe*
"Drain Brain" and the Impact of Specialization on the Global Healthcare Physician Supply Curve
The Economist (6/2) this week suggests that global competition for physicians is heating up in unexpected ways. As the "First World" physician development process requires years of advanced education and training, those advanced economic systems that are looking for an easier route to fill their gaps in physician supply look increasingly to "Third World" countries that, in turn, are already in the midst of their own healthcare supply crunch. The Association of American Medical Colleges predicts a shortage in the United States of 45,000 primary-care doctors by 2020, precisely the type of doctor who might manage chronic conditions. Thus, doctors in less developed countries have heavy incentives to advance their training by recruitment offers from overseas. Concerned about such "draining of brains," the World Health Organization in 2010 signed a resolution to limit the recruitment of doctors from less economically developed countries to those more developed. Others, however, question whether restricting movement of the newly forming global supply chain in healthcare may be appropriate.
State Sunshine Acts May Have Small Impact
Reuters Health (6/4) reports that in the instance of at least two states (Maine and West Virginia), laws requiring disclosure of drug company payments to physicians (Sunshine Acts) may not have an actual impact on prescriber patterns. The thought behind disclosure requirements is that doctors may be less likely to accept gifts or payments that might influence their prescribing choices if the information is reported publicly. According to a research study published in the Archives of Internal Medicine, the impact of Sunshine Acts on prescribing habits may be statistically significant but not greatly so.
Watching Healthcare Dollars Go to Defensive Medicine Hurts Innovation and Healthcare System Design
Amednews.com (6/4) reports that dollars for medical innovation are being diverted away for defensive medicine. The costs of practicing medicine defensively to avoid medical lawsuits are estimated at $60 billion annually, according to a June 28, 2010, study in the Archives of Internal Medicine. The cost of carrying liability insurance is another large expenditure for physicians and others. However, Richard Migliori, MD, executive vice president for health services for UnitedHealth Group, recently told the Senate Finance Committee, "With the very visible impact and the efforts around the health system on quality and the pursuit of quality, my anticipation is that quality of care will go up and the whole issue around defensive medicine will become much more mitigated."
Center for Medicare & Medicaid Services: Joint Venturing With Private Sector to Promote Care Quality and Innovation
The Center for Medicare & Medicaid Services (CMS) (6/6) announced this week a multi-payor initiative aimed at fostering collaboration between public and private healthcare payors to strengthen primary care. As part of this initiative, Medicare will work with commercial and state health insurance plans and offer bonus payments to primary care doctors who better coordinate care for their patients. According to CMS' press release, primary care practices must agree to provide enhanced services for their patients, including offering longer and more flexible hours, using electronic health records; delivering preventive care; coordinating care with patients' other health care providers; engaging patients and caregivers in managing their own care, and providing individualized, enhanced care for patients living with multiple chronic diseases and higher needs. CMS says it "will pay primary care practices a care management fee, initially set at an average of $20 per beneficiary per month, to support enhanced, coordinated services." "Simultaneously, participating commercial, State, and other federal insurance plans are also offering an enhanced payment to primary care practices that provide high-quality primary care," CMS says.
The Trouble With Sample Drugs
Amednews.com (6/5) reports on a recent research study that illustrates fraud and abuse concerns are not the only issues related to sample drugs. According to the study, published in the May-June issue of the Journal of the American Board of Family Medicine, "[o]f the 12,581 sample boxes or packages examined, 14% were expired." Concerns include the efficacy of expired drugs, managing any recalls, and diversion. Experts recommend that if sample drugs are accepted in a clinic, a formal inventory process should be established.
Top Healthcare Executives Offer a Checklist to Save Money and Improve Quality
Healthcare Finance News (6/6) reports that a group of top healthcare executives has developed a ten-point checklist critical to improving quality while saving money. The "CEO Checklist for High-Value Health Care," released this week, "includes ten strategies proven effective and essential to improve healthcare quality, reducing waste and lowering costs." This initiative was derived "from an Institute of Medicine (IOM) discussion paper on excess costs in the U.S. healthcare system." The authors of the checklist include chief executive officers "and senior executives from Cincinnati Children's Hospital Medical Center, Cleveland Clinic, Denver Health, Geisinger Health System, Hospital Corporation of America, Intermountain Healthcare, Kaiser Permanente, Partners HealthCare, ThedaCare Center for Healthcare Value, Veterans Health Administration and Virginia Mason Health System."
*We would like to thank C. Elizabeth O'Keeffe, Esquire (Dana-Farber Cancer Institute, Boston, MA), for providing this week's update.
AHLA Teaching Hospital Updates are intended to provide quick summaries of cutting-edge issues of interest to teaching hospitals and their counsel. Additional information and more in-depth coverage on these topics may be available from AHLA Health Lawyers Weekly and appropriate AHLA Practice Groups.
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