A New York Times article citing high rates of physician negligence and suggesting that an apology from doctors who make medical errors can help head off court cases prompted this response from a plaintiffs’ attorney at a prominent law firm: “There is an abundant need for honest penitence and self-reflection on the part of doctors,” said Allan Zelikovic, director of the Medical Malpractice Unit at Weitz & Luxenberg, P.C. “The reality is in cases where a patient is left with hundreds of thousands of dollars in medical expenses and lost earnings—much less years of pain and suffering—it is unlikely that ‘I’m sorry’ will put food on the table.”

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From Medical Economics magazine, more on malpractice ...

The health plan touted by Senator Hillary Clinton would force people to buy something they cannot afford and then impose a heavy fine on them when they don’t buy it, says John G. Goodman, president of the National Center for Policy Analysis, a public policy research organization with offices in Dallas and Washington, DC. It’s Goodman’s view that at the end of the day healthcare consumers will be worse off than they were at the outset. In response, Clinton says that she’ll limit the amount people have to pay in premiums to 5 or 10 percent of their incomes. To read Goodman’s 10-point rejoinder, click here.

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From Medical Economics magazine, more on health insurance ...

Compared to compensation in the specialties and surgery, primary care is generally seen as the poorer step-child. But expect even less in the way of compensation if you’re a female PCP, especially one in family practice, says a new survey by Jackson & Coker, the Georgia-based physician staffing firm. Among other things, that income disparity has prompted some female PCPs to think seriously about leaving the profession down the not-too-distant road. To learn more about the trend and the survey generally, read Jackson & Coker’s press release.

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From Medical Economics magazine, more on primary care ...

Everyone has heard about the looming shortages in primary care, especially in family medicine. At the root of the problem are the lower reimbursements PCPs receive, as compared to their specialist and surgical colleagues. Now, in order to make primary care more attractive, Senate Finance Committee Chair Max Baucus (D-Montana) has proposed boosting Medicare rates for PCPs. But some physicians see this as a robbing-Peter-to-pay-Paul approach. To read why, see this provocative entry from American Medical News.

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From Medical Economics magazine, more on physician shortage ...

Maybe you’ve seen the signs at your local pharmacy saying “E-prescriptions filled here” and “Give your prescription a head start” They’re part of a campaign to encourage patients to convert their doctors to electronic prescribing.

The organization behind the campaign is SureScripts, a company created by the pharmacy industry to promote e-prescribing. That’s technically defined as a prescription that goes directly from the doctor’s computer to the pharmacy’s computer (faxed prescriptions don’t meet the definition). SureScripts estimates that more than 40,000 pharmacies have computer systems capable of receiving e-prescriptions. The bulk of these pharmacies are in national chains such as Walgreens or part of discount retailers such as Wal-Mart. SureScripts operates a nationwide data exchange that connects these pharmacies to doctors who use compatible e-prescribing software.

The e-prescribing signs started appearing in pharmacies on April 29. The one that states “Give your prescription a head start” adds “Ask your doctor for an e-prescription” and invites customers to a SureScripts-sponsored website. Besides explaining the benefits of this technology, the website asks “Does your doctor e-prescribe?” By clicking on the question, a visitor can then enter his ZIP code and find out whether his doctor appears on a list of area e-prescribers. If his name isn’t there, the website invites the visitor to print a flyer about e-prescribing that he can give to his doctor.

Assuming that patients buy into e-prescribing, a lot of flyers could get printed. Only six percent of physicians have the kind of software that can transmit prescriptions electronically to pharmacies, according to SureScripts.

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From Medical Economics magazine, more on e-prescribing ...

Talk about being stuck in the 19th century. Twenty-eight percent of medical practices still don’t accept credit cards, according to a survey by SK&A Information Services.

True, you’d expect a low rate of plastic payment for some specialists. Only 26 percent of pathologists say they swipe credit cards, but then, they’re usually not having direct encounters with patients, unless they’re deceased.

But get this—only 64 percent of general internists take their patient’s credit cards, even though they’re constantly dealing with $15 and $20 co-pays that could easily be swiped. Family physicians are more automated at 81 percent. The most plastic-friendly doctors are urgent-care specialists at 92 percent. That figure is not surprising since their practices, so dependent on walk-in patients, more closely resemble a retail business than others.

Physicians who won’t accept plastic are financially short-sighted, says healthcare IT consultant Rosemarie Nelson in Syracuse, NY. She says some doctors object to paying a credit-card transaction fee that might amount to 3 percent of a $20 charge, or 60 cents. “What they overlook is that if they have to mail a bill to the patient, it’s costing them at least $3 to $5 in labor and supplies,” says Nelson. “It’s more cost-efficient to take the card at the time of service.” She also notes that fewer and fewer people carry cash and checkbooks with them, underlining the need for a credit-card machine at the check-out counter.

Getting set up for credit-card payments is as easy as calling your local bank, which will walk you through the steps, adds Nelson. For more how-to information, read “Ready, set, swipe” in the Oct. 20, 2006, issue of Medical Economics. SK&A Information Services asked more than 200,000 practices representing roughly 500,000 physicians whether they accepted credit cards from MasterCard, Visa, Discover, or American Express. Practices were not asked if they accepted debit cards. It’s possible that some practices that shun credit cards take debit cards since the transaction fee for the latter is usually lower, provided that the patient enters his personal identification number, or PIN. If a debit card from MasterCard or Visa is swiped without a PIN, however, the transaction rate for a credit card kicks in.

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From Medical Economics magazine, more on billing ...

Internist David Brailer used to be the point man for the Bush administration in its push to build a nationwide health information network. He’s now the chairman of a private-equity firm with more money to invest in healthcare IT—$700 million—than he had at his command back in his federal days.

Those big bucks are hitting the marketplace. Brailer’s firm, Health Evolution Partners, announced on April 28 that it was investing an undisclosed amount of money in an electronic prescribing company called Prematics. Various health plans have rolled out Prematics’ e-prescribing service—including wireless hand-held computers—for participating physicians to use free of charge.

As part of the deal, Brailer will join the Prematics board of directors and hobnob with some other Beltway public servants who have migrated to private industry. Two members of the company’s executive council are former Health and Human Services Secretary Tommie Thompson and former Sen. John Breaux (D) from Louisiana.

Health Evolution Partners is channeling money to Prematics through an investment fund called the Health Evolution Partners Innovation Network. Four well-connected physicians serve as HEPIN advisors: Former Surgeon General and general surgeon Richard H. Carmona, preventive medicine specialist David M. Lawrence, former chairman and CEO of Kaiser Permanente; psychiatrist Arnold Milstein, co-founder of The Leapfrog Group; and preventive medicine specialist Molly J. Coye, founder and CEO of The Health Technology Center.

Brailer headed the Office of the National Coordinator for Health Information Technology, a branch of HHS, from May 2004 to April 2006.

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From Medical Economics magazine, more on technology ...

Certified EHRs are supposed to be the best, and the kind the feds want you to buy, but the number of programs attaining this status has tailed off big-time.

EHR certification is part of the federal push for a nationwide health information network. The US Department of Health and Human Services contracts with a private group called the Certification Commission for Healthcare Information Technology to certify EHR programs that can perform basic tasks such as creating and displaying problem lists, checking for drug interactions, and issuing reminders about overdue tests. The feds won’t let a hospital subsidize an EHR for you unless it has this stamp of approval.

Ninety programs were certified under the initial set of standards that CCHIT issued in 2006. However, CCHIT introduces new and tougher standards each year. That may explain why only 24 programs have been certified so far based on 2007 CCHIT criteria. The organization is still processing 27 applications that came in by the March 31 deadline for certification based on last year’s standards. However, even if all of them are approved, the total number of programs certified as meeting the 2007 criteria would only come to 51.

One key reason for the fall-off is the CCHIT requirement introduced in 2007 for electronic prescribing, says Mark Anderson, CEO of AC Group, a healthcare IT consulting firm in Montgomery, TX. “A lot of vendors don’t have this,” says Anderson, who notes that true e-prescribing is not merely faxing an Rx to a pharmacy, but transmitting it on a computer-to-computer basis. Anderson predicts that vendors will have an even harder time meeting the proposed criteria for 2008, which require EHRs, among other things, to be able to swap patient medical summaries with each other.

Adding such features to an EHR can translate into hundreds of thousands of dollars in programming costs for a vendor. In light of this expense, only the biggest and most well-heeled companies will be able to keep up with ever changing CCHIT criteria. “I think only 27 vendors will be able to pass this next set,” says Anderson.

EHR vendors lacking certified products probably won’t survive in the marketplace, says Anderson, who expects the number of EHR vendors to decline from roughly 390 today to less than 50 in 2012. While a smaller field of vendors simplifies shopping for an EHR, it also will raise prices, he notes.

Many doctors consider EHRs already too pricey. The average cost for nine programs certified under the 2007 CCHIT criteria was close to $30,000 per doctor over three years, according to a recent study by AC Group.

CCHIT spokesperson Sue Reber says another reason for the decline in certified programs is that since certification is good for three years, some vendors in the CCHIT class of 2006 may wait until 2009 before they reapply. Nevertheless, CCHIT is pleased with the number of vendors that have sought certification under the 2007 criteria, says Reber. “Vendors see certification as a competitive necessity.”

[Via Medical Economics’ InfoTech Bulletin]

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From Medical Economics magazine, more on EHR ...

The release last month of the Bush administration’s 2008 National Drug Control Strategy was cause for optimism, but only barely.

On the plus side, the use of illicit drugs among young people has declined 24 percent since 2001, when the first such report was released. The steepest drops have occurred in the use of meth, LSD, ecstasy, steroids, marijuana, and other “street” drugs.

But kids, it turns out, are finding drugs closer to home, sometimes in the family medicine chest. According to the report, prescription drug abuse among the young is on the rise, especially the abuse of opioid pain killers. For youngsters 12 or older, in fact, a pain reliever like OxyContin is now vying with marijuana as the “gateway” drug of choice—the one that initiates even more serious drug abuse down the road. The administration has promised to step up its efforts to control the problem, through youth education and random testing but also through aggressive law enforcement efforts, aimed in part at the prescribers themselves. continues…

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From Medical Economics magazine, more on DEA ...

Cyber attacks on U.S. government computers are mushrooming in number, according to the April 10 cover story of BusinessWeek, and that doesn’t bode well for the security of patient data stored in the computers maintained by doctors and hospitals.

The article, titled “The New E-spionage Threat,” describes how the latest techniques to infiltrate computer networks and harvest sensitive information are “rendering traditional defenses—firewalls and updated antivirus software—virtually useless.” BusinessWeek reports that much of this high-tech spying can be traced back to foreign governments, namely China (which has denied the charge).

Computer spying represents a new form of asymmetrical warfare. “You don’t need an Army, a Navy, an Air Force to beat the U.S,” a US Air Force general is quoted as saying. “You can be a peer force for the price of the PC on my desk.”

Hospitals, doctors, and insurers should be just as alarmed about their own computer defenses.

The New E-spionage Threat [Via BusinessWeek]

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From Medical Economics magazine, more on computers ...