Medicine

Mass. Practice Environment Dips Again

Posted in Health Policy, Malpractice, Medicine, Primary Care on May 25th, 2010 by MMS Communications – Comments Off on Mass. Practice Environment Dips Again

MMSIndex_colorMake it 16 down years out of 18.  The MMS Physician Practice Environment, a statistical reading of nine measures affecting the practice climate for physicians in the state, took yet another dip in 2009 and hit a record low.

Four factors led the decline in 2009: professional liability rates, the increasing use of emergency rooms by patients, an aging physician population, and the increasing cost of maintaining a practice.

“A strong physician practice environment is essential to maintain a strong physician workforce,” said MMS President Alice Coombs, M.D., commenting on the analysis in a posting on WBUR’s Commonhealth website.  “And its importance should be self-evident: it has a direct influence on patient care. Yet this latest analysis brings us more sobering news.”

Of the measures leading the decline, Dr. Coombs said professional liability and emergency room use were the most troublesome. Professional liability has been the driving force behind the decline of the index for years, and Dr. Coombs said a “critical step forward to improving the practice environment would be to enact liability reform.”  The rise in emergency room use highlights a new and disturbing dimension of the index, as it points to the delivery of primary care taking place in emergency departments.

A picture of the state’s practice environment from year to year is valuable by itself. But the MMS analysis includes a index for the nation as a whole, providing a reference point to judge changes in the state.  And a comparison reveals stark differences between the state and the rest of the nation as the four factors leading the state’s decline increased at a rate substantially faster than the national rate. The conclusion: when it comes to providing a good practice environment for physicians, Massachusetts and the nation are headed in opposite directions. Since 2006, the Massachusetts Index has declined 1.5 percent, while the U.S. Index has advanced 1.2 percent.

“Reversing the decline in the physician practice environment will lead to a stronger, more viable health care delivery system,” Dr. Coombs wrote. “The current climate should be cause for concern. And action.”

Read Dr. Coomb’s post on WBUR’s Commonhealth

A Snapshot of U.S. Physicians

Posted in Health, Health Policy, Health Reform, Medicine on September 6th, 2009 by MMS – Comments Off on A Snapshot of U.S. Physicians

"Physicians are the linchpins of the U.S. health care system because their clinical decisions affect how up to 90 percent of every health care dollar is spent." So begins Data Bulletin No. 35, the 2008 Health Tracking Study Physician Survey, from The Center for Studying Health System Change, dated September 2009. The survey covers a number of topics on physicians and their practices, including demographics, practice organization, career satisfaction, compensation, and distribution of physicians around the nation. "If policy makers are to guide the health care system toward greater value," HSC writes, "they need timely, credible information about physicians and their practice of medicine."   

Rankings, Ratings and Report Cards

Posted in Medicine on April 15th, 2009 by MMS – Comments Off on Rankings, Ratings and Report Cards

Massachusetts Health Quality Partners (MHQP) has released its annual report on Clinical Quality in Primary Care for 150 medical groups, and it continues to show that the state's physicians consistently exceed the national norm and often lead the country in key clinical areas related to preventive care, managing chronic conditions, and the appropriate use of medications and tests. There is, however, variability in performance among medical groups, and there are still measures where the numbers aren't as high as any of us would like.

At a time when rankings, ratings and report cards seem to be coming at us from all sides, MHQP's reports have gained a good deal of credibility in the physician community, in part because they are developed through a collaborative process that includes physicians, health plans, purchasers and consumers. And, we think MHQP's reports, stack up very well on attributes that are important to physicians.

What's measured is important. MHQP reports are based on national standards for clinical quality that are closely related to patients' health and well-being. And they continue to evolve. For instance, recently added measures focus on outcomes of care and overuse, as well as processes of care.

The methodologies are widely accepted. MHQP uses NCQA's HEDIS data sets, which have been in use for many years and which are also developed through a collaborative, evidence-based process. We're well aware of the limitations of claims-based data and the need to account better for the types of patients a physician treats, the complexity of their conditions, and their willingness and ability to keep appointments and comply with physicians’ recommendations. Used properly, however, the data can help drive the improvements in patient care we all work toward.

The numbers are large. Since MHQP compiles HEDIS data from the state's five major health plans, reports at the physician group level generally include enough patients to make the data credible and meaningful.

The method of reporting is unbiased, not judgmental or punitive. MHQP doesn't have any agenda other than quality improvement, and they work closely with their Physicians Council (which we both sit on) and other stakeholders, including the Massachusetts Medical Society, to make sure their reports are presented in a way that reflects that spirit. 

The reports are useful to patients and physicians. Patients can use MHQP's reports to gain a better understanding of what constitutes high quality care, the role they play in achieving it, and the relative strengths of different medical groups in areas that are important to them. Physician groups across the state have used the data to target improvement opportunities and to benchmark and disseminate best practices.

No one report can reflect all the important aspects of quality of care, but MHQP has developed a trusted and useful approach to help physicians improve the quality of care we give our patients.

 

Barbara Spivak, MD
President
Mount Auburn Cambridge IPA

Edward Westrick, MD
Vice President, Medical Management
UMass Memorial Health Care

Worcester District Medical Society Forum: Retail Based Health Clinics

Posted in Health Policy, Medicine, Retail Clinics on February 3rd, 2009 by MMS – Comments Off on Worcester District Medical Society Forum: Retail Based Health Clinics

The Worcester District Medical Society's member forum on
retail-based health clinics outlined the clinics' potential impact on physicians and some strategies that physicians can use to respond to their entrance in Massachusetts.

William Ryder, regulatory and legislative counsel for the MMS, summarized the two-year struggle by a coalition of concerned providers to ensure that retail clinics’ scope of practice was strictly limited, that the facilities are safe, and that visit records are efficiently transferred. Those efforts culminated with comprehensive DPH regulations in January 2008. Go to YouTube or watch the video below.

Peter Lindblad, M.D., a primary care physician and medical staff president at St. Vincent’s Hospital, noted that pharmaceutical companies are looking to get involved directly with retail clinics, raising conflict-of-interest concerns to a new level. He also said retail clinics will translate into missed opportunities for routine screenings and preventive care. Go to YouTube, or watch the video below.

Mary Philbin, Ed.M., director of faculty development at UMass Medical School, suggested that physicians respond to retail clinics proactively
by:

  • Adjusting office hours for more convenient patient access
  • Improving communication with patients for better outcomes and
    higher patient satisfaction
  • Coaching patients on the appropriate use of retail clinics

Go to YouTube, or watch the video below.

Podcast: Physician Tiering in Massachusetts

Posted in Health Policy, Medicine on July 31st, 2007 by MMS – Comments Off on Podcast: Physician Tiering in Massachusetts

In July 2006, the Massachusetts Group Insurance Commission,
the agency that buys health insurance for all Massachusetts state employees,
launched the Clinical Performance Improvement Initiative.

This project compiles information on how individual physicians score
against various cost and quality standards, then assigns lower co-pays
to physicians who score well against the standards.

The program has been controversial since the start. The Mass.
Medical Society has have had substantial concerns about the accuracy,
relevance and timeliness of the data, and had real worries about
whether it would create unintended consequences, such as driving a
wedge between patients and their access to care, at precisely the
moment when Massachusetts is trying to improve patients’ access to care.

In this podcast, MMS President Dale Magee, MD, discusses the GIC
program, and what the MMS has been doing to ensure that it supports the
delivery of good health care.

Listen to the podcast (Length 9:42) (This will open your computer’s default media player in a new window)

Download from iTunes

Physician Tiering in Massachusetts

Posted in Health Policy, Medicine on July 31st, 2007 by MMS – Comments Off on Physician Tiering in Massachusetts

In July 2006, the Massachusetts Group Insurance Commission,
the agency that buys health insurance for all Massachusetts state employees,
launched the Clinical Performance Improvement Initiative.

This project compiles information on how individual physicians score against various cost and quality standards, then assigns lower co-pays to physicians who score well against the standards.

The program has been controversial since the start. The Mass. Medical Society has have had substantial concerns about the accuracy, relevance and timeliness of the data, and had real worries about whether it would create unintended consequences, such as driving a wedge between patients and their access to care, at precisely the moment when Massachusetts is trying to improve patients’ access to care.

In this podcast, MMS President Dale Magee, MD, discusses the GIC program, and what the MMS has been doing to ensure that it supports the delivery of good health care.

Listen to the podcast (Length 9:42) (This will open your computer’s default media player in a new window)

Download from iTunes

Physician Focus, April 2007: Arthritis

Posted in Health, Medicine, Physician Focus on June 5th, 2007 by MMS – Comments Off on Physician Focus, April 2007: Arthritis

Forty-three million Americans report that a doctor told them they have arthritis or other rheumatic conditions. According to the Centers for Disease Control, arthritis is the leading cause of disability in the United States, limiting the activities of more than 16 million adults. In Massachusetts, some 1.2 million people have the condition – nearly 26 percent of the population. And the Arthritis Foundation lists more than 100 different types of arthritis.

What, exactly, is arthritis? What causes these conditions? Are there preventive steps to take to avoid getting the condition? And what treatments are available?

Bruce Karlin, M.D., program host

Martin J. Kafina, M.D., F.A.C.R., F.A.C.P., clinical instructor in medicine at Harvard Medical School at Beth Israel Deaconess Medical Center and specialist in the private practice of rheumatology at Emerson Hospital in Concord.

Judith Levine. senior vice president for health education, Arthritis Foundation, Massachusetts Chapter

Co-produced with Hopkinton Community Access Television, HCAM-TV, Hopkinton Mass.

Listen to the podcast (Length 8:24) (This will open your computer’s default media player in a new window)

Download from iTunes

Physician Focus, March 2007: Alzheimer’s Disease and Dementias

Posted in Health, Medicine, Physician Focus on June 5th, 2007 by MMS – Comments Off on Physician Focus, March 2007: Alzheimer’s Disease and Dementias

Alzheimer’s disease is a progressive brain disorder that gradually destroys a person’s memory, ability to learn, reason, make judgments, communicate and carry out daily activities. It is the most common form of dementias, a group of conditions that destroys brain cells and leads to diminished mental function. And it’s a disease with enormous impact on the family as well. There is no cure, but research is leading to new treatments.  What may be the causes of Alzheimer’s and dementia? Are there preventive steps to take? What is the latest in research? And what is the role of – and impact on – family members?

Bruce Karlin, M.D., program host

Sanford Auerbach, M.D., Associate Professor, Boston University School of Medicine

James Wessler, M.B.A., President and Chief Executive Officer , Massachusetts Chapter, Alzheimer’s Association

Co-produced with Hopkinton Community Access Television, HCAM-TV, Hopkinton Mass.

Listen to the podcast (Length 11:15) (This will open your computer’s default media player in a new window)

Download from iTunes

Physician Focus, February 2007: Vaccines and Immunizations

Posted in Health, Medicine, Physician Focus on June 5th, 2007 by MMS – Comments Off on Physician Focus, February 2007: Vaccines and Immunizations

Vaccines are some of medicine’s best preventive measures. Some, like the Salk and Sabine vaccines for polio, have eradicated debilitating diseases altogether. Some prevent illness for all ages, like flu vaccines. And many have erased childhood diseases, like mumps, measles, and chickenpox. New ones – like Gardasil for cervical cancer – are added to our protective arsenal. Yet new cases of polio, whooping cough, measles and mumps have appeared, here in the United States as well as overseas. How are vaccines developed and how effective are they? What are the risks of immunizations? Who should be immunized? And how valid is the controversy surrounding some of the vaccines?   

Bruce Karlin, M.S., Program Host

Susan M. Lett, M.D., M.P.H., Medical Director, Immunization Program, Department of Public Health, Commonwealth of Mass.

Sean Palfrey, M.D., Founder and Director of the Immunization Initiative, Mass. Chapter, American Academy of Pediatrics; Clinical Professor of Pediatrics and Public Health, Boston University School of Medicine; Pediatrician, Boston Medical Center.

Co-produced with Hopkinton Community Access Television, HCAM-TV, Hopkinton Mass.

Listen to the podcast (Length: 9:54) (This will open your computer’s default media player in a new window)

Download from iTunes

Physician Focus, January 2007: Obesity

Posted in Health, Medicine, Physician Focus on April 2nd, 2007 by MMS – Comments Off on Physician Focus, January 2007: Obesity

Obesity is now a national medical problem. Data compiled by the National  Center for Health Statistics show that 30 percent of U.S. adults 20 years of age and older—over 60 million people – are obese. Also alarming is the fact that the percentage of young people who are overweight has more than tripled since 1980. Among children and teens aged 6–19 years, 16 percent – 9 million young people – are considered overweight. To many, the causes of this American epidemic are obvious. But what are the consequences of obesity – in personal and psychological health, medical costs, and economic terms?  How far into the future will they be felt?  And what can we do about it?

Bruce Karlin, M.D., Program Host

Stuart R. Chipkin , M.D., Chair, MMS Committee on Nutrition; Physician, Valley Medical Group, Amherst;

Caroline M. Apovian, M.D., F.A.C.N., Vice-Chair, MMS Committee on Nutrition; Director, Nutrition & Weight Management Center , Boston Medical Center

Co-produced with Hopkinton Community Access Television, HCAM-TV, Hopkinton Mass.

Listen to the podcast (Length: 11:15) (This will open your computer’s default media player in a new window)

Download from iTunes